新生儿住院临床路径应用情况分析
黄洁1，赖宝添1，陈婉君2，李丽1，陈敏3
1.东莞东华医院，广东 东莞 523110
2.深圳市罗湖区中医院，广东 深圳 518000
3.北京大学深圳医院，广东 深圳 518000
第一作者：黄洁（1991— ），女，本科，中级统计师，主要研究方向为流行病与卫生统计。联系电话：13450047526，E-mail：2679782031@qq.com
通讯作者：陈婉君（1991— ），女，本科，中级统计师，主要研究方向为流行病与卫生统计。联系电话：13790379928，E-mail：2275567372@qq.com
摘要：目的 本文收集了2022年东莞市两家大型三甲医院新生儿科出院患者的病案首页信息，总结并分析其入院情况、疾病治疗和转归情况等，进行单因素和多因素分析新生儿科患儿临床路径应用情况，为新生儿科患儿治疗途径选择提供可靠依据。结果 单因素分析得出新生儿科患儿临床路径的选择在性别、抢救次数、是否抢救病人、病例轻重、离院方式、是否有出院31天内再住院计划、住院天数上均无统计学差异；而在住院医生、血型（可能是由于溶血性黄疸所致，以下病种分析有提及）、是否月内再住院（再住院的临床路径治疗占比较大）、是否手术（手术患者的临床路径治疗占比较大）、入院途径（门诊入院患者的临床路径占比较大）、住院次数、年龄（临床路径住院的患儿平均年龄是2天）、新生儿出生体重、新生儿入院体重上存在统计学差异。Logistics回归分析得出年龄、住院天数、抢救次数、住院医生、是否抢救病人、是否月内再住院、是否手术、入院途径、是否有出院31天内再住院计划、主要诊断疾病等数据。结论 临床路径治疗在新生儿科大部分病种上均有所应用，且利用率达48.1%；新生儿ABO溶血性黄疸、新生儿肺炎、新生儿病理性黄疸三大病种临床路径治疗占比较大；临床路径实施后能够有效降低患者平均住院天数，门诊途径入院、病情稳定、常见病种的患者更适合进行临床路径治疗；临床路径的实施在病人转归情况的指标上均无统计学差异，而且其能有效减少住院天数，减轻患儿及家属的负担，说明在条件允许的情况下选择临床路径治疗更好。(https://www.daowen.com)
关键词：临床路径；单因素分析；二元logistic回归分析
Analysis of Clinical Pathway Application in Neonatal Hospitalization
Huang Jie1, Lai Baotian1, Chen Wanjun2, Li Li1, Chen Min3
Dongguan Donghua Hospital, Dongguan 523110, China
Abstract:Objective This paper collected the first page information of medical records of discharged patients from the neonatal department of two large Class A hospitals in Dongguan City in 2022, summarized and analyzed their admission status, disease treatment and outcome, and conducted univariate and multivariate analysis of clinical pathway application of children in the neonatal department, so as to provide reliable basis for the selection of treatment pathways for children in the neonatal department.Results Univariate analysis showed that there were no statistical differences in the selection of clinical pathways of neonatology children in terms of gender, rescue times, whether to rescue patients, the severity of cases, the way of discharge, whether there was a re-hospitalization plan within 31 days of discharge, and the length of stay.And in the case of the resident, the blood type (possibly due to hemolytic jaundice, which was mentioned in the analysis of the following diseases), whether to be re-hospitalized within months (clinical route treatment accounted for a large proportion of re-hospitalization), whether to have surgery (clinical route treatment accounted for a large proportion of surgery patients), admission route (clinical route treatment accounted for a large proportion of outpatient patients), hospitalization frequency, age (average age of clinically hospitalized children was 2 days), birth weight of newborns, admission weight of newborns, there was a statistical difference.Age, hospitalization days, rescue times, resident doctors, whether to rescue the patient, whether to be hospitalized again within months, whether to be admitted to hospital, whether to have a re-hospitalization plan within 31 days of discharge, and main diagnosed diseases can be obtained from Logistics regression analysis.Conclusion Clinical route therapy can be used in most diseases of neonatology department, and the utilization rate is 48.1%.ABO hemolytic jaundice in neonates, neonatal pneumonia and neonatal pathological jaundice accounted for a large proportion of the three diseases.After the implementation of clinical pathway, the average length of hospital stay can be effectively reduced.Patients admitted through outpatient pathway, stable condition and common diseases are more suitable for clinical pathway treatment.The implementation of clinical pathway showed no statistical difference in the indicators of patients’ outcomes, and it could effectively reduce the length of hospital stay and reduce the burden of children and their families, indicating that it is better to choose clinical pathway treatment when conditions permit.
Keywords:Clinical pathway;Single factor analysis;Binary logistic regression analysis