康复医院临床医师与康复医师共管患者探索

Exploration on an integrated care mode of rehabilitation by both clinicians and physiatrists at a rehabilitation hospital

三级康复医院不仅要为稳定期患者提供系统化、专业化的康复服务,还应具备一定的疾病诊疗、处置能力和急诊、急救能力。作者介绍了康复医院分阶段推进临床与康复逐步深度融合的实践,第一阶段(2015年3月至2016年3月)为临床-康复双路径管理方式,第二阶段(2016年4月至2017年9月)为临床与康复共管患者方式。结果发现,随着康复医师与临床医师共管患者方式的实施,2016年相比2015年同期、2017年相比2016年同期,全院患者平均住院日分别缩短0.5天、3.6天;药占比分别下降4.63、8.47个百分点;康复治疗有效率由95.2%上升至98.0%,原发病治愈好转率维持在97%以上。康复医院实施临床医师与康复医师共管患者方式,有利于缩短平均住院日、降低药占比,提高诊疗效率,促进医疗费用构成比更加合理。

Tertiary rehabilitation hospitals should not only serve patients with systemic and specialized rehabilitations but also have capabilities in diagnosis/treatment,and even emergency responses. This paper introduced an integrated care mode at a rehabilitation hospital,in practicing in-depth and phased integration of clinical service and rehabilitation. Phase 1 (March 2015-March 2016) witnessed the " two-way" model,with coexisting rehabilitation pathway and clinical pathway. The second phase,from April 2016 to September 2017,witnessed the integrated care mode in which clinicians and physiatrists jointly took care of patients. A comparison between the same period of 2016 with data of 2015,and that of 2017 with data of 2016,found average length of stay was shortened by 0.5 day and 3.6 days respectively,the drug ratio fell by 4.63% and 8.47% respectively; the rehabilitation effective percentage was increased from 95.2% to 98.0%. The percentage of cure or improvement for primary diseases was over 97%. The integrated care mode by both clinicians and physiatrists can shorten the length of stay,lower the drug ratio,raise medical efficiency,and encourage a more reasonable ratio of medical expenses.