Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation.
Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation.
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团队方法的价值与糖尿病足问题的临床途径相结合：临床评估。
DOI：
10.3402/dfa.v1i0.5731
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发表时间：
2010
影响因子：
--
通讯作者：
Nambiar A
中科院分区：
文献类型：
--
作者：
Nather A;Siok Bee C;Keng Lin W;Xin-Bei Valerie C;Liang S;Tambyah PA;Jorgensen A;Nambiar A
评价国立大学医院（NUH）多学科糖尿病足团队结合临床路径管理糖尿病足问题（DFP）的有效性，包括平均住院时间（ALOS）、再入院率、每例患者的住院费用、重大再截肢率和并发症发生率。 从2002年（团队组建前）到2007年（团队组建后），939名患者因DFP入住NUH骨科。它包括6个患者队列-2002年61例，2003年70例，2004年148例，2005年180例，2006年262例，2007年218例。所有患者均由NUH多学科糖尿病足团队结合临床路径进行管理。对5个参数（ALOS、每例患者的住院费用、大截肢率、再入院率和并发症发生率）进行统计分析。从2002年到2007年，平均寿命从20.36天显著减少到12.20天（p = 0.0005）。大截肢率从31.15%下降到11.01%（P <0.0005）。并发症发生率也从19.67%显著降低至7.34%（p = 0.005）。多学科团队成立后，每位患者的住院费用和再入院率有所降低，但无统计学意义。 我们的评估表明，多学科团队方法结合NUH临床路径的实施，可有效降低ALOS、大截肢率和DFP并发症发生率。
To evaluate the effectiveness of management of diabetic foot problems (DFP) by the National University Hospital (NUH) Multidisciplinary Diabetic Foot Team combined with a clinical pathway in terms of average length of stay (ALOS), readmission rates, hospitalisation cost per patient, major reamputation rate, and complication rate. 939 patients admitted to the Department of Orthopaedic Surgery, NUH, for DFP from 2002 (before team formation) to 2007 (after team formation). It consisted of six cohorts of patients – 61 for 2002, 70 for 2003, 148 for 2004, 180 for 2005, 262 for 2006, and 218 for 2007. All patients were managed by the NUH Multidisciplinary Diabetic Foot Team combined with a clinical pathway. Statistical analyses were carried out for five parameters (ALOS, hospitalisation cost per patient, major amputation rate, readmission rate, and complication rate). From 2002 to 2007, the ALOS was significantly reduced from 20.36 days to 12.20 days (p=0.0005). Major amputation rate was significantly reduced from 31.15 to 11.01% (p<0.0005). There was also a significant reduction in complication rate from 19.67 to 7.34% (p=0.005). There were reductions in the hospitalisation cost per patient and readmission rate after formation of the multidisciplinary team but they were not statistically significant. Our evaluation showed that a multidisciplinary team approach combined with the implementation of a clinical pathway in NUH was effective in reducing the ALOS, major amputation rate, and complication rate of DFP.