薛军等

[摘要] 目的 探讨以临床路径管理为基础评价医疗服务质量的绩效指标及权重，构建绩效评价体系。 方法 通过文献检索初步确定以临床路径管理为基础的绩效评价指标，制订问卷咨询专家，通过三轮咨询和修改，完善评价指标及权重。对河北北方学院附属第一医院（以下简称“我院”）胆囊结石腹腔镜胆囊切除术、慢性鼻-鼻窦炎、2型糖尿病的临床路径医疗服务管理绩效进行评价。 结果 绩效评价量表最终由7个一级指标和30个二级指标构成。通过该绩效评价系统进行测试，发现我院2型糖尿病临床路径的各项指标缺陷率均最低，其次是胆囊结石腹腔镜胆囊切除术，慢性鼻-鼻窦炎各项绩效评价最差。 结论 以临床路径管理为基础的医疗服务管理绩效评价系统应能正确评价临床路径的效果，并对其管理工作发挥导向作用。

[关键词] 临床路径管理；医疗服务；绩效评价

[中图分类号] R197.323 [文献标识码] B [文章编号] 1673-7210（2015）02（b）-0153-04

[Abstract] Objective To investigate the performance index and weight of the clinical pathway implementation based on function evaluating medical quality of service， establish the performance evaluation system. Methods Through literature search identified performance evaluation index based on clinical pathway management， developed questionnaire consulting experts， through 3 times of consultation and modify， improvesd the evaluation index and weight. The medical service management performance on clinical patyway of gallstone undergoing laparoscopic cholecystectomy， chronic rhinosinusitis， type 2 diabetes in the First Affiliated Hospital of Hebei North University （"our hospital" for short） were evaluated. Results The performance evaluation table was constituted of 7 first level indexes and 30 two levels indexes. By testing the system performance evaluation， it showed that the defects rate of indicators in clinical pathway of type 2 diabetes in our hospital was the lowest， followed was laparoscopic cholecystectomy for gallbladder stones， the performance evaluation of chronic sinusitis was the worst. Conclusion The medical service management performance evaluation system based on clinical pathway should be able to correctly evaluate the effect of clinical pathway， and play the guiding role of the management work.

[Key words] Clinical pathway management； Medical service； Performance evaluation

临床路径是临床医护管理的重要工具之一，有指导医护人员主动、预见性工作的作用，使患者也能够自觉参与到医护过程中，提高抢救效果和医疗质量，降低医疗费用[1]。目前，国家卫生计生委组织的相关专家已经研究并制订了22个专业，共计331个病种的临床路径[2]，胆囊结石腹腔镜胆囊切除术、慢性鼻-鼻窦炎及2型糖尿病均有其临床路径。临床路径管理优劣需要一套考核标准对其进行评价，从而优化临床路径管理。绩效评价对临床路径管理工作具有重要导向促进作用，可引导医院服务管理和技术要素向临床路径工作需要的方向流动[3]。……