医院-社区脑出血患者双向转诊标准及干预方法的探讨

Studies on the criteria of two-way referral between hospital and community health-care service center for patients with cerebral hemorrhage： an analysis of 91 cases

探讨三级医院与社区卫生服务中心之间脑出血患者的双向转诊的标准和干预方案。2007年10月至2010年9月我们采用医院与社区协商制定脑出血术后患者的双向转诊标准进行双向转诊。共91例患者，失访13例。其中干预组42例，采用双向转诊标准，对照组36例，患者、家属自行选择转诊，随访3年。干预组患者遵医服药（95％，40例）、生活自理能力Barthel指数提高（50％，21例）、身体功能障碍Fugl—Meyer运动功能量表评分提高（79％，33例）、自我监测（81％，34例）及定期复查（76％，32例）的比例均高于对照组，对照组依次为64％（23例）、31％（11例）、28％（10例）、25％（9例）、25％（9例）（均P〈0．01），且对照组平均每人费用为2246元／月，干预组为575元／月。三级医院向社区转诊的标准及干预方法有利于脑出血术后患者康复及降低医疗费用。

This study aimed to study the criteria of two-way referral between tertiary-care hospital and community health-care service center for patients with cerebral hemorrhage and a protocol of implementation to promote its treatment and rehabilitation. The criteria of two-way referral between tertiarycare hospital and community health-care service center for patients with cerebral hemorrhage after surgical operation were formulated on a trial basis with mutual consultation by the department of neurosurgery, Shenzhou hospital affiliated to Shenyang Medical College and Hunhewan Community Health-Care Service Center, Heping district, Shenyang. Totally, 91 patients of cerebral hemorrhage admitted to the hospital during October 2007 to September 2010 were recruited for the study, 46 in the intervention group with twoway referral and 45 in the control group by self-referral determined by their family members. All the patients of the two groups were followed-up for three years. During the follow-up in the intervention group, 40 of 46 （95%） patients could comply with taking medication ordered by physicians, ability of daily living remarkably improved by Barthel index in 21 （50%）, physical function recovered well in 33 （79%）, 34 （81%） could insist in self-monitoring and 32 （76%） could visit physicians for regular consultation, all these being significantly better than those in the control group （64%, 31%, 28%, 25% and 25%, respectively） （P 〈 0. 01 ）. Medical and rehabilitative cost for patients with cerebral hemorrhage accounted for 575 RMB yuan per month in intervention group, as compared to 2246 RMB yuan for those in control group. Two-way referral for patients with cerebral hemorrhage can reduce their medical cost and promote their better rehabilitation.