Abstract: Background　Clinical pathway（CP）is a modern management model widely used in large-scale general hospitals，which helps to improve the quality of healthcare.However，there are few studies concerning on its use in inpatient care for single diseases in primary healthcare facilities.Objective　To evaluate the effect of CP use on cost control of inpatient care for single diseases in primary healthcare facilities.Methods　This retrospective study was conducted in Qinhong Community Health Center after the single disease（respiratory disease）was determined and the corresponding CP management regimen was developed.Participants were composed of control group〔CAP inpatients（subgroup A1）and AECOPD inpatients（subgroup B1）treated without CP management（control group）during March to December 2016〕，and CP group〔CAP inpatients（subgroup A2）and AECOPD inpatients（subgroup B2）treated with CP management during January 2017 to March 2018〕.The average length of stay，total hospitalization expense，percentage of pharmaceutical cost，and percentage of antibiotics cost were compared between subgroups A1 and A2，and between subgroups B1 and B2.Results　There were no significant differences in average age，sex ratio，and disease severity between subgroups A1 and A2，and between subgroups B1 and B2（P>0.05）.Shorter average length of stay，less total hospitalization expense，lower percentage of pharmaceutical cost，and lower percentage of antibiotics cost were found in subgroup A2 instead of subgroup A1（P<0.05），and in subgroup B2 instead of subgroup B1（P<0.05）.Conclusion　Single disease management with CP can reduce the total hospitalization costs，shorten hospital days and standardize antibiotic use in primary healthcare facilities．

Key words: Clinical pathway, Respiratory system, Community health servicrs, Disease management, Hospital costs

摘要： 背景　临床路径管理作为现代化的管理模式在大型综合医院已广泛应用，有助于医疗质量提升。但目前关于基层医院病房进行单病种临床路径的研究较少。目的　探讨在基层医院专科病房实施临床路径对成本控制的影响。方法　制定基层医院临床路径管理方案，确定入路径病种。采用回顾性调查方法，将2016年3—12月收治的未入临床路径社区获得性肺炎〔CAP（A1组）〕、慢性阻塞性肺疾病急性加重〔AECOPD（B1组）〕患者作为对照组。2017年1月—2018年3月进入并完成临床路径的CAP（A2组）、AECOPD（B2组）患者作为临床路径组。比较对照组和临床路径组平均住院日、住院总费用、药占比、抗占比。结果　A1组和A2组、B1组和B2组年龄、性别、疾病严重程度比较，差异无统计学意义（P>0.05）。A2组平均住院日、住院总费用、药占比、抗占比低于A1组，B2组平均住院日、住院总费用、药占比、抗菌药物费用占比（抗占比）低于B1组，差异有统计学意义（P<0.05）。结论　基层医院按照临床路径进行单病种管理能有效降低医疗费用，减少住院日，规范抗生素使用。

关键词: 临床路径, 呼吸系统, 社区卫生服务, 疾病管理, 医院费用