糖尿病下肢动脉病变团队管理模式及其效果评价

Model of Team Management of Diabetic Lower Extremity Arterial Disease and Its Effect Evaluation

目的探讨糖尿病下肢动脉病变的团队管理模式,并评价其实施效果。方法选取2013年1—12月(实施团队管理前)在上海市同仁医院内分泌代谢科和血管外科就诊的2型糖尿病患者2 850例,及2014年1—12月(实施团队管理后)在上海市同仁医院内分泌代谢科和血管外科就诊的2型糖尿病患者3 182例。建立糖尿病下肢动脉病变团队管理工作组和流程。比较实施团队管理前后糖尿病性下肢动脉粥样硬化性疾病(LEAD)的筛查率,糖尿病性LEAD住院患者平均住院天数和平均住院费用,糖尿病性LEAD患者血糖、血脂、血压达标率及医疗费用支出、门诊便利性、住院便利性满意度和下肢动脉病变知晓评分。结果实施团队管理后糖尿病性LEAD筛查率高于实施前〔6.88%(212/3 182)比4.49%(128/2 850)〕,差异有统计学意义(P<0.05)。实施团队管理前后糖尿病性LEAD住院患者分别为182、206例,实施团队管理后患者平均住院天数〔(10.8±1.2)d比(13.8±1.5)d〕、平均住院费用〔(21 434±2 245)元比(26 878±3 212)元〕均低于实施前,差异有统计学意义(P<0.05)。实施团队管理前后糖尿病性LEAD患者分别为362、446例,实施团队管理后患者血糖〔46.0%(205/446)比33.1%(120/362)〕、血脂〔43.9%(196/446)比31.8%(115/362)〕达标率均高于实施前,差异有统计学意义(P<0.05);医疗费用支出〔(67.3±13.3)分比(28.2±3.1)分〕、门诊便利性〔(84.6±9.2)分比(67.1±7.4)分〕、住院便利性〔(71.3±8.8)分比(49.2±5.4)分〕满意度和下肢病变知晓〔(79.2±9.7)分比(54.1±9.5)分〕评分均高于实施前,差异有统计学意义(P<0.05)。结论实施团队管理有助于LEAD早期筛查,共同管理糖尿病下肢动脉病变患者;有助于提高患者自我管理能力和血糖、血脂控制;有助于降低医疗费用支出,提高患者满意度。

Objective To investigate the model of team management of diabetic lower extremity arterial disease and evaluate its implementation effect. Methods We enrolled 2 850 type 2 diabetic patients who received treatment in the department of endocrinology and metabolism and the department of vascular surgery in Shanghai Tongren Hospital From January to December 2013 （ before the implementation of team management） , and enrolled 3 182 type 2 diabetic patients who received treatment in the same departments from January to December 2014 （after the implementation of team management） . The working group and process of the team management of diabetic lower extremity arterial disease were established. Comparison was made in the screening rate of diabetic lower extremity atherosclerosis disease （ LEAD ） , the average length of hospital stay and average hospitalization expenses of diabetic LEAD inpatients, the standard reaching rates of blood glucose, blood lipid and blood pressure of diabetic LEAD patients, and the scores of medical expenses, the convenience of outpatient service, the satisfaction with the convenience of hospitalization and the awareness of lower extremity arterial diseases between before and after team management.Results The screening rate of diabetic LEAD after the implementation of team management was higher than that before implementation [6. 88% （212/3 182） vs. 4.49% （128/2 850） ] （P 〈0. 05） . The number of diabetic LEAD inpatients was 182 before the implementation of team management and 206 after the implementation of team management, and the average length of hospital stay [ （ 10. 8 ± 1.2） d vs. （ 13.8 ± 1.5 ） d] and average hospitalization expenses [ （21 434 ± 2 245） yuan vs. （26 878± 3 212 ） yuan ] were lower after the implementation of team management than those before implementation （P 〈 0. 05 ）. The number of diabetic LEAD patients was 362 before the implementation of team management and 446 after the implementation of team management; the standard reaching rates of blood glucose [46.0% （205/446） vs. 33.1% （120 /362） ] and blood lipid [43.9% （196/446） vs. 31.8% （115/362） ] after the implementation of team management were higher those before implementation （P 〈 0. 05 ） ; the scores of medical expenses [ （ 67.3 ± 13.3 ） vs. （ 28.2 ± 3.1 ） ], the convenience of outpatient service [ （84. 6 -9. 2） vs. （67. 1 ±7.4） ] , the satisfaction with the convenience of hospitalization [ （71.3 ±8.8） vs. （49.2 ±5.4） ] and the awareness of LEAD [ （79. 2 ±9.7） vs. （54. 1 ±9.5） ] were higher after the implementation of team management than those before implementation （ P 〈 0.05 ） . Conclusion The implementation of team management contributes to the early finding of LEAD and the joint management of. diabetic LEAD patients, improves the self - management ability of patients, helps them better control blood glucose and blood lipid, lowers medical expenses, and improves their satisfaction.