脑卒中偏瘫患者6个月三级康复整体护理期间的成本效果分析

Cost-effectiveness Analysis in Stroke Patients with Hemiplegia Receiving Three-stage Holistic Rehabilitation Care Scheme for 6 Months

目的:对脑卒中偏瘫患者三级康复整体护理方案作成本-效果的经济学统计和分析,为能更有效恢复患者功能的同时节省治疗费等开支提供依据。方法:129例脑卒中患者随机分为A、B、C 3组各43例,均按内科常规治疗,同时A组执行脑血管病三级康复治疗方案:早期Bobath法,中期移乘、站立、重心转移及步行训练,出院后社区康复训练,并配合三级康复整体护理,包括协调康复团队工作,指导康复器具使用,将训练内容融合ADL中及每周访视等。B组仅接受三级康复治疗方案。C组完成常规治疗。治疗6个月末时采用美国国立卫生研究院脑卒中量表(NIHSS)、Fugl-Meyer运动功能评定量表(FMA)、改良Barthel指数(MBI)评定各组间的差值,并对治疗期间的各项费用作成本-效果的经济学统计。结果:3组所花费的总住院费,直接医疗费用比较差异无统计学意义,但间接费用、直接非医疗费用和总费用C组明显高于A组。B组的直接非医疗费用高于A组。A组FMA、MBI评分每提高1分、NIHSS评分降低1分,需要消耗的住院相关费用、直接医疗费和总的成本费用均明显低于B、C组,B组低于C组。结论:实施三级康复治疗及整体护理方案能明显减少医疗费用,是一种经济、有效的护理方案。

Objective： To analyze cost-effectiveness in stroke patients with hemiplegia receiving three-stage holistic rehabilitation care scheme for 6 months.Methods： A total of 129 stroke patients were randomly recruited into care,rehabilitation and control groups.Patients in the care group were given three-stage holistic rehabilitation care and rehabilitation treatment,those in the rehabilitation group were given rehabilitation treatment,and those in the control group were only given routine internal medicine treatments.The National Institutes of Health Stroke Scale（NIHSS）,Simplified Fugl-Meyer Assessment and Modified Barthel Index（MBI） were used at the beginning of recruitment,the end of the 6th month separately after stroke.The costs in each patient during the stage of 6-month rehabilitation were collected,and cost-effectiveness was analyzed.Results： The hospital-stay costs and direct medical costs had no significant difference among the three groups,but direct non-medical costs,indirect costs and total costs in control group were significantly higher than those in care group,and indirect costs in rehabilitative group were significantly higher than those in care group.In the care group,every one point was improved in FMA and MBI score,reduced in NIHSS score.The hospital-stay costs,direct medical costs,and total costs in the care group were significantly lower than those in rehabilitation and control groups.Conclusion：The three-stage holistic rehabilitation care scheme can reduce the costs,and is an economical and effective medical method in stroke patients with hemiplegia.