基于病种分值付费的高龄股骨颈骨折患者临床护理路径的构建研究

doi:10.3761/j.issn.0254-1769.2022.20.001

摘要/Abstract

摘要：

目的构建基于病种分值付费的高龄股骨颈骨折患者的临床护理路径,为该类患者的临床护理工作提供路径表单,为评价其护理质量提供依据。方法基于文献分析法和头脑风暴法构建路径表单,初步构建基于病种分值付费的高龄股骨颈骨折患者的临床护理路径,于2022年1月—3月采用德尔菲法对17名专家进行2轮专家函询,确立该临床护理路径。结果 2轮专家函询的有效问卷回收率均为100%,专家权威系数为0.879、0.918,肯德尔和谐系数为0.476、0.299,最终形成的临床护理路径包含6项一级指标、18项二级指标、107项三级指标。结论该研究构建的基于病种分值付费的高龄股骨颈骨折患者临床护理路径具有较高的科学性、可靠性及实用性,可作为该类患者临床措施实施和护理质量评价的依据。

关键词: 股骨颈骨折, 高龄, 临床护理路径, 骨科, 病种分值付费

Abstract:

Objective To construct the evaluation index of clinical nursing path for elderly patients with femoral neck fracture under Diagnosis-Intervention Packet（DIP） payment,to provide the path form for the clinical nursing work of such patients,and to provide the basis for evaluating their nursing quality. Methods Based on the literature evidence-based and brainstorming methods,the path form was constructed,and the clinical nursing path of elderly patients with femoral neck fracture was initially constructed based on DIP payment. From January to March 2022,17 experts were interviewed by Delphi method for 2 rounds of expert correspondence,and the operation form of their clinical nursing path indicators was established. Results The effective questionnaire recovery rates of the 2 rounds of expert correspondence were 100%;the expert authority coefficients were 0.879,0.918;the Kendall harmony coefficient was 0.476,0.299. The final path indicators included 6 first-class indicators,18 second-class indicators,and 107 third-class indicators. Conclusion The index of clinical nursing pathway for elderly patients with femoral neck fracture based on DIP payment has high scientificity,reliability and practicality,and it can be used as the basis for clinical implementation and evaluation of such patients.

Key words: Femoral Neck Fracture, Advanced Age, Clinical Nursing Pathway, Orthopaedics, Diagnosis-Intervention Packet

潘卫宇, 谢煜, 李佳佳, 杨阳. 基于病种分值付费的高龄股骨颈骨折患者临床护理路径的构建研究[J]. 中华护理杂志, 2022, 57(20): 2437-2444.

PAN Weiyu, XIE Yu, LI Jiajia, YANG Yang. Construction of clinical nursing pathway for femoral neck fracture in the elderly based on Diagnosis Intervention Packet[J]. Chinese Journal of Nursing, 2022, 57(20): 2437-2444.

图/表 1

参考文献 30

[1]	Chen J, Lu K, Chen H, et al. Trunk skeletal muscle mass and phase angle measured by bioelectrical impedance analysis are associated with the chance of femoral neck fracture in very elderly people[J]. Clin Interv Aging, 2020, 15(1):889-895. DOI URL
[2]	吕振邦, 李庭, 吴新宝. 加速康复外科理念下老年髋部骨折围手术期管理的研究进展[J]. 中华创伤骨科杂志, 2018, 20(5):451-455.
	LÜ ZB, Li T, Wu XB, et al. Promoting peri-operative management of senile hip fractures in light of enhanced recovery after surgery[J]. Chin J Orthopaedic Trauma, 2018, 20(5):451-455.
[3]	Bhandari M, Swiontkowski M. Management of acute hip fracture[J]. J New Eng Med, 2017, 377(21):2053-2062. DOI URL
[4]	Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychological consequences in elderly patients after a hip fracture:a review[J]. Clin Inter Aging, 2018, 13:143.
[5]	边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]. 中华骨科杂志, 2020, 40(21):1453-1460.
	Bian YY, Cheng KY, Chang X, et al. Reports and analysis of amount of hip and knee arthroplasty in China from 2011 to 2019[J]. Chin J Orthop, 2020, 40(21):1453-1460.
[6]	杨阳, 张煜琪, 朱豫虹, 等. DIP付费下以业财管信融合模式赋能公立医院精益运营体系构建[J]. 中国卫生经济, 2022, 41(2):88-92.
	Yang Y, Zhang YQ, Zhu YH, et al. Construction of lean operation system of public hospitals energized by the integration mode of practice financial management informationization under DIP payment[J]. Chin Health Economics, 2022, 41(2):88-92.
[7]	杨阳, 张煜琪, 李逸璞, 等. DIP付费下医院绩效与成本联动管理机制的探讨[J]. 会计之友, 2021(24):79-84.
	Yang Y, Zhang YQ, Li YP, et al. Discussion on the linkage management mechanism of hospital performance and cost under DIP paymen[J]. Friends of Accounting, 2021(24):79-84.
[8]	Burgers PT, Van Lieshout EM, Verhelst J, et al. Implementing a clinical pathway for hip fractures;effects on hospital length of stay and complication rates in five hundred and twenty six patients[J]. Int Orthop, 2014, 38(5):1045-1050. DOI PMID
[9]	Flikweert ER, Izaks GJ, Knobben BA, et al. The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture:design and results of a clinical trial[J]. BMC Musculoskelet Disord, 2014, 15:188. DOI URL
[10]	宋宏晖, 张鹏, 徐炜, 等. 加速康复外科管理模式对高龄髋部骨折患者护理效果评价[J]. 中华创伤杂志, 2021, 37(9):825-832.
	Song HH, Zhang P, Xu W, et al. Evaluation of nursing effect of enhanced recovery after surgery model in elderly patients with hip fracture[J]. Chin J Trauma, 2021, 37(9):825-832.
[11]	姜永杰. 临床护理路径在双极人工股骨头置换手术治疗股骨颈骨折中的应用[J]. 国际护理学杂志, 2021, 40(1):148-150.
	Jiang YJ. Application of clinical nursing pathway in bipolar artificial femoral head replacement in the treatment of femoral neck fracture[J]. Int J Nurs, 2021, 40(1):148-150.
[12]	石广卉, 王姣, 杜玲, 等. 临床路径在高龄股骨颈骨折患者人工髋关节置换术围术期护理中的应用[J]. 实用临床医药杂志, 2017, 21(4):216-217.
	Shi GH, Wang J, Du L, et al. Application of clinical pathway in perioperative nursing of elderly patients with femoral neck fracture undergoing artificial hip replacement[J]. J Clin Med Pract, 2017, 21(4):216-217.
[13]	何美凤, 池丽娜, 孙珍. 临床康复护理路径在老年股骨颈骨折术后的应用效果观察[J]. 护理实践与研究, 2017, 14(3):36-38.
	He MF, Chi LN, Sun Z. Application of clinical nursing pathway in bipolar artificial femoral head replacement in the treatment of femoral neck fracture[J]. Nurs Pract Res, 2017, 14(3):36-38.
[14]	蔡宇, 周华军, 程文俊, 等. 加速康复外科联合标准化康复路径在全髋关节置换术治疗老年股骨颈骨折患者中的应用[J]. 中华创伤骨科杂志, 2016, 18(8):673-678.
	Cai Y, Zhou HJ, Cheng WJ, et al. Efficacy of fast-track surgery combined with standard rehabilitation training in elderly patients after total hip arthroplasty[J]. Chin J Orthopaedic Trauma, 2016, 18(8):673-678.
[15]	徐明杰. 基于HIS系统的临床路径在股骨颈骨折中的设计应用[D]. 郑州: 郑州大学, 2015.
	Xu MJ. Design and application of clinical pathway based on HIS system in femoral neck fracture[D]. Zhengzhou: Zhengzhou University, 2015.
[16]	郑海伦, 黄巧萍, 王春, 等. 临床护理路径在股骨颈骨折患者中应用效果的Meta分析[J]. 中国循证医学杂志, 2015, 15(11):1327-1333.
	Zheng HL, Huang QP, Wang C, et al. Effects of clinical nursing pathway in femoral neck fracture patients:a meta-analysis[J]. Chin J Evidence-Based Med, 2015, 15(11):1327-1333.
[17]	宋玉芝. 老年股骨颈骨折患者行人工髋关节置换实施临床护理路径的研究[D]. 济南: 山东大学, 2011.
	Song YZ. Research on clinical nursing path of elderly patients with femoral neck fracture undergoing artificial hip replacement[D]. Jinan: Shandong University, 2011.
[18]	兰喜梅. 应用临床路径对股骨颈骨折患者实施健康教育的效果观察[J]. 护理实践与研究, 2010, 7(10):30-32.
	Lan XM. Observation on the effect of health education on patients with femoral neck fracture by applying clinical pathway[J]. Nurs Pract Res, 2010, 7(10):30-32.
[19]	郑金艳. 临床护理路径在老年股骨颈骨折患者围手术期的应用[J]. 国际护理学杂志, 2009, 28(6):829-831.
	Zheng JY. The application of the clinical nursing pathway in the eldly patients with femoral neck fracture[J]. Int J Nurs, 2009, 28(6):829-831.
[20]	郎子佳, 王立平. ICU病人俯卧位通气护理敏感性指标体系的构建[J]. 护理研究, 2020, 34(15):2650-2654.
	Lang ZJ, Wang LP. Construction of index system for nursing sensitivity of prone position ventilation in ICU patients[J]. Nurs Res, 2020, 34(15):2650-2654
[21]	Chang SC, Lai JI, Lu MC, et al. Reduction in the incidence of pneumonia in elderly patients after hip fracture surgery:an inpatient pulmonary rehabilitation program[J]. Medicine(Baltimore), 2018, 97(33):e11845.
[22]	梁小芹, 鲁雪梅, 刘均娥, 等. 共管照护模式在老年髋部骨折患者中的研究进展[J]. 中华护理杂志, 2020, 55(10):1484-1489. DOI
	Liang XQ, Lu XM, Liu JE, et al. Research progress on geriatric orthopedic co-management care model in geriatric hip fracture patients[J]. Chin J Nurs, 2020, 55(10):1484-1489. DOI
[23]	张燕, 王婷婷, 车路, 等. 高龄髋部骨折患者早期活动管理方案的构建及应用研究[J]. 中华护理杂志, 2019, 54(11):1615-1620. DOI
	Zhang Y, Wang TT, Che L, et al. Construction and application of early activity management scheme for elderly patients with hip fracture[J]. Chin J Nurs, 2019, 54(11):1615-1620. DOI
[24]	Kim BH, Lee S, Yoo B, et al. Risk factors associated with outcomes of hip fracture surgery in elderly patients[J]. Korean J Anesthesiol, 2015, 68(6):561-567. DOI PMID
[25]	张新玉, 安帅, 黄江, 等. 髋部骨折患者术后新发肺部感染的危险因素分析[J]. 北京医学, 2018, 40(1):19-22.
	Zhang XY, An S, Huang J, et al. Analysis of risk factors for new postoperative pulmonary infection in patients with hip fracture[J]. Beijing Med, 2018, 40(1):19-22.
[26]	Bohl DD, Sershon RA, Saltzman BM, et al. Incidence,risk factors,and clinical implications of pneumonia after surgery for geriatric hip fracture[J]. J Arthroplasty, 2018, 33(5):1552-1556. DOI URL
[27]	李信欣, 吕启圆, 李江圳, 等. 髋关节置换术后患者院外功能锻炼依从性与健康信念的纵向研究[J]. 中华护理杂志, 2019, 54(8):1180-1184. DOI
	Li XX, Lü QY, Li JZ, et al. Longitudinal study on compliance of out of hospital functional exercise and health belief of patients after hip replacement[J]. Chin J Nurs, 2019, 54(8):1180-1184.
[28]	王文慧, 张利峰, 李信欣, 等. 髋关节置换术后患者不同时期关节功能变化及其影响因素研究[J]. 中华护理杂志, 2017, 52(6):649-653.
	Wang WH, Zhang LF, Li XX, et al. Study on the changes of joint function and its influencing factors in different periods after hip replacement[J]. Chin J Nurs, 2017, 52(6):649-653.
[29]	李建军. 公立医院现代经济管理体系的理论设计与探索[J]. 会计之友, 2020, 21:2-8.
	Li JJ. Theoretical design and exploration of modern economic management system in public hospitals[J]. Friends of Accounting, 2020, 21:2-8.
[30]	杨阳, 张露丹, 李建军. 基于作业成本法的DRG成本核算探讨[J]. 中国医院管理, 2020, 40(12):60-64.
	Yang Y, Zhang LD, Li JJ. Discussion on DRG cost accounting based on activity-based costing[J]. Hosp Manag China, 2020, 40(12):60-64.