Porter H B
School of Nursing, Faculty of Health Sciences, University of Western Ontario, London.
Can J Cardiovasc Nurs. 1998;9(1):10-5.
Coronary artery bypass graft surgery (CABG), undertaken because of a decline in quality of life (QOL), is known to decrease morbidity and mortality, but it is expensive. At University Campus, London Health Science Centre, (UC-LHSC), a clinical path for CABG patients categorized as low-risk by UC-LHSC was developed to decrease the costs of CABG surgery through a shortened hospital stay while maintaining quality of patient care. The purpose of this research was to compare traditional care of the CABG patient with the care of those on the Clinical Path for Coronary Artery Bypass Graft Patients on health resource utilization (HRU) and QOL outcomes 6 to 12 months post surgical discharge. The results of this study showed that while the experimental group made significantly more emergency department visits than did the control group, the groups did not differ on the health resource utilization categories of extra office visits, home care, or hospital admission. It was also found that within the experimental (Clinical Path) group there were significantly fewer extra office or clinic visits required by the subjects who received the Preadmission Program than by the participants who did not receive this program. No differences were found in quality of life 6 months after CABG surgery between low-risk patients receiving traditional care and those patients on the CABG Clinical Path. Results of this study have increased understanding of the impact of a shorter hospital stay upon CABG patients and on the health care system.
冠状动脉旁路移植手术(CABG),因生活质量(QOL)下降而实施,已知可降低发病率和死亡率,但费用高昂。在伦敦健康科学中心大学校区(UC-LHSC),针对被UC-LHSC归类为低风险的CABG患者制定了一条临床路径,旨在通过缩短住院时间来降低CABG手术成本,同时维持患者护理质量。本研究的目的是比较CABG患者的传统护理与冠状动脉旁路移植手术患者临床路径上的患者护理在术后6至12个月的健康资源利用(HRU)和生活质量结果方面的差异。本研究结果表明,虽然实验组的急诊就诊次数显著多于对照组,但两组在额外门诊就诊、家庭护理或住院等健康资源利用类别上并无差异。还发现,在实验组(临床路径组)中,接受入院前计划的受试者所需的额外门诊或诊所就诊次数明显少于未接受该计划的参与者。在接受传统护理的低风险患者与CABG临床路径上的患者之间,CABG手术后6个月的生活质量没有差异。本研究结果增进了对缩短住院时间对CABG患者及医疗保健系统影响的理解。