Wammack L, Mabrey J D
University Hospital, San Antonio, USA.
Clin Nurse Spec. 1998 May;12(3):122-9; quiz 130-1. doi: 10.1097/00002800-199805000-00012.
Using critical pathways, with variance analysis and continuous quality improvement techniques to refine the pathways, the efficiency of total hip and total knee surgeries in one academic health center was maximized. Using a retrospective cohort study design, complications, readmissions, morbidity/mortality, and function scores were examined in two groups of patients attended by the same surgeon for the year before and the year after the implementation of an outcomes management program. The length of stay was reduced by 57% for knee patients and by 46% for hip patients. Hospital costs were reduced 11% for all knees and 38% for hips. Complications were also significantly reduced. There was no statistically significant difference between pre- or postoperative knee or hip outcome scores. The program resulted in significant savings without adversely affecting overall outcome.
通过使用关键路径，采用差异分析和持续质量改进技术来完善路径，一所学术医疗中心的全髋关节和全膝关节手术效率得以最大化。采用回顾性队列研究设计，对同一位外科医生在实施结果管理项目前一年和后一年诊治的两组患者的并发症、再入院情况、发病率/死亡率及功能评分进行了检查。膝关节患者的住院时间缩短了57%，髋关节患者缩短了46%。所有膝关节手术的医院成本降低了11%，髋关节手术降低了38%。并发症也显著减少。术前或术后膝关节或髋关节的结果评分之间无统计学显著差异。该项目在未对总体结果产生不利影响的情况下实现了显著的成本节约。
