DPC(diagnosis-procedure combination)からみた腹腔鏡下胆嚢摘出術のクリニカルパスの効果

概要

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With the introduction of the diagnosis procedure combination (DPC), medical institutions are required, with the aim of more effective cost management, to pursue optimal duration of hospital stay and improved efficiency in medical care. Clinical pathway is an important tool for that purpose, and the present study was performed to determine whether the clinical pathway is compatible with the DPC system, using pertinent data from 116 patients with cholelithiasis. Patients were screened for those receiving piece-work outpatient medical care, based on predictive factors, and thereby 19 (82.6%) of 23 patients were noted to have concurrent common bile duct stones (CBDs). The duration of hospitalization was 9.2 days for laparoscopic cholecystectomy (LC), 14.1 days for open cholecystectomy, and 14.5 days for cholecysto-choledocholithotomy; all these durations were within the range of hospital stay duration II defined by the DPC system. The clinical pathway for LC currently used at this department has thus proven to provide optimization of the duration of hospital stay and improvement of efficiency in medical care while maintaining consistency with the piece-work outpatient medical care scheme, and therefore, is evaluated to be an appropriate clinical pathway compatible with the DPC system.
東京女子医科大学の論文