脑卒中三级康复患者的功能综合评定与费用和时间的关系

The relationship between the initial stage FCA score and costs and hospital day in stroke patients received standard tertiary rehabilitation

目的:探讨脑卒中三级康复患者的费用特点、发病初期FCA评分与三级康复期间各项费用、住院时间的关系。方法:82例脑卒中患者随机分成康复组和对照组,康复组给予规范的三级康复治疗,对照组仅一般的常规内科治疗,每例患者在入选时(V0)采用功能综合评定(FCA)量表进行功能评价,分别采集两组患者自发病到发病后6个月的直接医疗费用、直接非医疗费用和间接费用。结果:两组患者住院时间及总费用均无显著性差异(P均>0.05)。两组患者入组时(V0)FCA总分与住院时间、直接医疗费用、总费用间呈负相关(P<0.01—0.05)。康复组入组时(V0)FCA运动部分评分与直接医疗费用、总费用及住院时间间呈负相关(P<0.01—0.05);对照组入组时(V0)FCA认知部分评分与直接医疗费用、总费用及住院时间间呈负相关(P<0.01—0.05)。两组患者住院时间与直接医疗费用、直接非医疗费、总费用间存在着较好的正相关(P<0.01),与非住院用药治疗费用之间呈较好的负相关(P<0.01)。结论:脑卒中患者的直接医疗费用、总费用与发病初期综合功能水平有关;发病初期FCA总分能较好的预测脑卒中患者直接医疗费用、总费用以及住院时间;发病初期FCA运动部分评分能较好的预测接受三级康复治疗的脑卒中患者住院时间、直接医疗费用、总费用;而发病初期FCA认知部分评分能较好的预测没有得到三级康复治疗的脑卒中患者住院时间、直接医疗费用、总费用。

Objective： To investigate the characteristics of the costs in stroke patients received standard tertiary rehabilitation, the relationship of the initial stage functional comprehensive assessment（FCA） scores with the costs of major items and length of stay （LOS）. Method： Eighty two patients of primary cerebral infarction and primary cerebral hemorrhage were divided into treated group and controlled group randomly. Patients in the treated group were given standardized tertiary rehabilitation, while those in the controlled group received normal internal medicine treatments but without standardized tertiary rehabilitation. All patients were assessed with the scale of FCA at the time at admission after stroke. Result： The differences of LOS and total costs hadn＇t statistical significant between the two groups （P〉0.05）. The FCA scores at the admission were negatively correlated to LOS, direct medical costs and total costs in two groups （P〈0.01-0.05）. The FCA motor subscale scores at admission were negatively correlated to direct medical costs, total costs and LOS in the treated group （P〈0.01-0.05）. The FCA cognition subscale scores at admission negatively correlated to direct medical costs, total costs and LOS in the controlled group （P〈0.01-0.05）.LOS was significantly positive correlated to direct medical costs, direct non-medial costs and total costs in two groups of patients （P〈0.01）. Conclusion： There is marked positive relationship between LOS and direct medical costs, direct non-medial costs, total costs in stroke patients. Direct medical costs and total costs are related to the severity of comprehensive function at the initial stage of stroke. The initial stage FCA score may be able to predict the direct medical costs, total costs and LOS in stroke patients.