家庭-社区-医院网络化管理防治脑卒中的效果分析

Effectiveness of home-community-hospital network management on prevention and treatment of stroke

目的 探讨家庭-社区-医院网络化管理（HCHNM）防治脑卒中的临床效果.方法 2011年6至12月,运用家庭医生、双向转诊、急救中心等结点将家庭、社区和医院连接起来,实行脑卒中患者居家康复、社区首诊和住院救治的网络化管理.按照社区居民健康档案在青岛市实行HCHNM的八大湖和浮山后社区随机选择80例脑卒中患者作为管理组,而在未实行HCHNM的中山路和辽宁路社区随机选择80例作为对照组,进行入户问卷调查.使用Х^2检验比较两组患者在康复效果方面的差异,使用成组资料两样本t检验比较两组患者在生存质量、日常生活能力、生活满意度及人均医疗费用方面的差异.结果 管理组脑卒中患者康复总体有效率为86.25％（69/80）,明显高于对照组67.50％（54/80）,差异有统计学意义（Х^2=221.807,P＜0.05）.管理组生存质量得分高于对照组（t=4.593,P＜0.05）,其中在体能、家庭活动、运动、情绪、自理能力、社会活动、上肢功能、工作能力方面的得分高于对照组（t=7.775、2.244、5.329、3.832、5.463、2.979、5.924、3.555,P＜0.05）,而在语言、性格、思维能力和视觉方面差异无统计学意义（t=0.561、1.466、0.831、1.000,P＞0.05）.管理组在日常生活活动能力、生活满意度方面的得分明显高于对照组,而人均医疗费用远低于对照组（t=12.998、20.760、-29.777,P＜0.05）.结论 家庭-社区-医院网络化管理在改善脑卒中患者康复效果、提高自理能力、提高生存质量和生活满意度方面具有明显效果,也减轻了患者的医疗负担,是一种有效、安全且经济的新型康复治疗模式.

Objective To explore the effectiveness of the home-community-hospital network management （HCHNM） on the prevention and treatment of stroke.Methods From June to December 2011,HCHNM was implenented in Qingdao of Shandong Province to prevent and treat stroke patients.According to community residents healthcare records,A total of 80 stroke patients were randomly selected from Badahu and Fushanhou communities （study group） and another 80 patients from Zhongshan Road and Liaoning Road communities （control group）.A household questionnaire survey was then conducted among these participants.Chi-square test and t test were used for data analysis.Results The overall effective rate of the study group was 86.25% （69/80）,which was significantly higher than that of the control group （67.5%） （Х^2=221.807,P〈0.05）.The study group also showed largely improved quality of life （total score：t=4.593;physical fitness,family activities,movement,mood,self-care ability,social activities,upper limb function and work ability scores：t values were 7.775,2.244,5.329,3.832,5.463,2.979,5.924 and 3.555,respectively; all P〈0.05）,although language,character,thinking and vision abilities had no statistically significant difference from the control group （t values were 0.561,1.466,0.831 and 1.000,respectively; all P〉0.05）.The scores of daily activities and life satisfaction of the study group were higher than those of the control group,while per capita medical cost was much lower （t values were 12.998,20.760 and-29.777,respectively; all P〈0.05）.Conclusions As an effective,safe and economy therapy model,HCHNM could improve rehabilitation,self-care ability,quality of life,and life satisfaction of community stroke patients.In addition,it greatly mitigates medical burden.