内科

目的探讨疾病诊断相关分组（DRG）付费模式下，本土化临床路径管理在输卵管妊娠、胎膜早破及腹股沟斜疝患者中的实施效果。方法选取2023年1月至2024年8月广西壮族自治区妇幼保健院收治的输卵管妊娠（800例）、胎膜早破（540例）及腹股沟斜疝（760例）患者作为研究对象，并将各病种患者随机分为观察组与对照组。观察组接受DRG付费模式下本土化临床路径管理，对照组接受常规诊疗管理。比较两组的诊疗效率指标（住院天数）、经济成本指标（住院总费用、材料费、医疗服务费、检查检验费、药品费）、患者体验指标（患者满意度）及临床安全指标（并发症发生率）。结果在三个病种中，观察组的住院天数、住院总费用及医疗服务费均少/低于对照组，患者满意度均高于对照组（均P<0.05）；两组材料费及并发症发生率差异均无统计学意义（均P>0.05）。在输卵管妊娠及腹股沟斜疝两个病种中，观察组的检查检验费均低于对照组（均P<0.05）。在胎膜早破及腹股沟斜疝两个病种中，观察组的药品费均低于对照组（均P<0.05）。结论在DRG付费模式下，实施本土化临床路径管理可有效缩短住院时间、降低医疗费用、提高患者满意度，且未增加并发症风险，有助于实现医疗质量、效率、成本与患者体验的协同优化。

Objective To explore the implementation effectiveness of localized clinical pathway management under the diagnosis-related groups (DRG) payment model for patients with tubal pregnancy, premature rupture of membranes, and indirect inguinal hernia. Methods Patients with tubal pregnancy (800 cases), premature rupture of membranes (540 cases), and indirect inguinal hernia (760 cases) admitted to Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital from January 2023 to August 2024 were selected as the study subjects, and patients with each disease were randomly divided into an observation group or a control group. The observation group received localized clinical pathway management under the DRG payment model, while the control group received conventional diagnosis and treatment management. Treatment efficiency indicators (length of hospital stay), economic cost indicators (total hospitalization costs, material costs, medical service fees, examination and test fees, medication costs), patient experience indicators (patient satisfaction), and clinical safety indicators (incidence of complications) were compared between the two groups. Results Across all three disease entities, the observation group had less hospitalization days, lower total hospitalization costs, and lower medical service fees compared to the control group, while patient satisfaction was higher in the observation group than in the control group (all P<0.05); there was no statistically significant difference in material costs or the incidence of complications between the two groups (all P>0.05). For two disease entities, tubal pregnancy and indirect inguinal hernia, examination and test fees were lower in the observation group than in the control group (all P<0.05). For two disease entities, premature rupture of membranes and indirect inguinal hernia, medication costs were lower in the observation group than in the control group (all P<0.05). Conclusion Under the DRG payment model, implementing localized clinical pathway management can effectively shorten hospital stays, reduce medical costs, and improve patient satisfaction without increasing the risk of complications. This approach contributes to the synergistic optimization of medical quality, efficiency, cost, and patient experience.