脑梗死患者分级医疗服务体系建设模式研究

Study on building hierarchical medical service system for cerebral infarction patients

目的:探讨脑梗死患者分级医疗服务体系建设模式,建立三级综合医院与二级综合医院双向转诊新路径,提高双向转诊的有效性、及时性,提高转诊患者满意度。方法:根据诊断、纳入及排筛标准选取60例患者,随机分为研究组和对照组各30例。60例均在北京中医院治疗14天,研究组第15天开始在隆福医院治疗,对照组继续在中医院治疗。隆福医院采用中西医结合康复治疗方法,比较两组治疗效果、费用及转诊中的不良事件。结果:研究组入隆福医院14天与对照组中医院住院28天后NIHSS评分、BI指数比较均无显著差异(P>0.05);研究组转入隆福医院治疗期间总费用及日均费用较对照组于中医院治疗第15天至第28天费用均明显下降(P<0.05);本研究期间,研究组患者转诊过程中均未出现不良事件。结论:脑梗死患者,经过三级医院急性期治疗后转入二级医院安全、可行;二级医院住院费用明显低于三级医院,可以节省患者医疗费用,减轻社会负担;分级诊疗模式有利于促进现有卫生资源的合理配置。

Objectives： To explore hierarchical medical system for cerebral infarction patients and to build a new route of dual referral between tertiary and secondary hospital to increase the effectiveness and timeliness of dual referral and patient satisfaction. Methods： According to diagnosis, inclusion and exclusion criterion, 60 patients were selected and randomly divided into research group and control group each of 30 patients. All 60 patients were treated for 14 days in Beijing Chinese medicine hospital first, then patients of research group began treatment in Beijing Longfu hospital since 15th day. Patients of control group continued to be treated in Chinese medicine hospital, others of research group were given a combination of Chinese and Western medicine treatment in Longfu hospital. Finally comparing the effect, cost and adverse events in referral between two group patients. Results： NIHSS scores ,BI index of research group patients on 14th day in Longfu hospital compared to those of control group on 28th days in Beijing Chinese medicine hospital had no significant difference,（p〉0.05）. During treatment in Longfu hospital of research group the total and daily expense compared to control group on the same period had an obviously decreased （p〈0.05）, which was a significant difference. During the research, there was no adverse events of research group patients in the course of referral. Conclusions： Cerebral infarction patients refer to secondary hospital after treatment in acute phase by tertiary hospital are safe and practical. Expense of secondary hospital is noticeable lower than tertiary hospital, which may save patients＇ cost and lighten social burden. Classified medical care mode will benefit the reasonable deploy of health resources.