基于分级诊疗的急性脑卒中规范化三级康复治疗效果及卫生经济学评价

Evaluation on Effect and Health Economics of Standardized Three-stage Rehabilitation Program on Acute Stroke Patients Based on Hierarchical Diagnosis and Treatment

目的探讨基于分级诊疗的急性脑卒中规范化三级康复治疗效果和卫生经济学价值。方法选取2014年7月—2015年6月在重庆市江津区中心医院住院治疗的急性脑卒中非手术患者128例,根据患者是否接受规范化三级康复治疗分为对照组(n=63)和康复组(n=65)。对照组进行常规治疗,自由选择康复训练项目,无专门的康复治疗计划;康复组在常规治疗的基础上采用基于分级诊疗的急性脑卒中规范化三级康复治疗。两组患者在入组时和治疗30、90、180 d时采用改良Rankin量表(MRS)和Barthel指数(BI)评价两组患者的治疗效果。比较两组患者的费用并进行成本-效果分析。结果时间与治疗方案在MRS评分上有交互作用(P<0.05),治疗方案在MRS评分上主效应显著(P<0.05),时间在MRS评分上主效应显著(P<0.05)。康复组患者治疗90、180 d时MRS评分低于对照组(P<0.05);两组患者治疗30、90、180 d时MRS评分低于入组时(P<0.05)。时间与治疗方案在BI评分上有交互作用(P<0.05),治疗方案在BI评分上主效应显著(P<0.05),时间在BI评分上主效应显著(P<0.05)。康复组患者治疗90、180 d时BI评分高于对照组(P<0.05);两组患者治疗30、90、180 d时BI评分高于入组时(P<0.05)。康复组直接医疗费用高于对照组,直接非医疗费用和间接费用均少于对照组(P<0.05)。康复组患者MRS评分每减少1分、BI评分每增加1分所需平均成本均少于对照组(P<0.05)。结论基于分级诊疗的急性脑卒中规范化三级康复治疗,不仅可以有效促进患者神经功能恢复,而且可以减轻患者的经济负担。

Objective To evaluate the effect and health economic value of standardized three - stage rehabilitation program on acute stroke patients based on hierarchical diagnosis and treatment. Methods A total of 128 acute stroke patients without operation were selected in Jiangjin Central Hospital of Chongqing from July 2014 to June 2015. Based on whether the patient to accept the standardized three - stage rehabilitation program,128 patients were non - randomly assigned to rehabilitation group （n = 65）and control group （n = 63）. Patients in the control group received routine treatment and were allowed to rehabilitation training without special rehabilitation plan;on the basis of routine treatment,patients in the rehabilitation group were intervened by standardized three - stage rehabilitation program based on hierarchical diagnosis and treatment mode. The modified Rankin scale （MRS）and Barthel index （BI）were performed at the recruitment and 30,90 and 180 days after treatment. The total costs were compared between the two groups for the cost - effectiveness analysis. Results There was significant difference in interaction between time and treatment method in MRS score （P 〈 0. 05）,and the main effect of treatment method and time on MRS score was significant （P 〈 0. 05）. The MRS score of the patients in the rehabilitation group was lower than that of the control group at 90 and 180 days after treatment （P 〈 0. 05）;and both of the 2 groups had significantly lower outcomes of MRS score at 30,90 and 180 days after treatment than that at the recruitment （P 〈 0. 05）. There was significant difference in interaction between time and treatment method in BI score （P 〈 0. 05）,and the main effect of treatment method and time on BI score was significant （P 〈 0. 05）. The BI score of the patients in the rehabilitation group was higher than that of the control group at 90 and 180 days after treatment （P 〈 0. 05）;and both of the 2 groups had significantly higher outcomes of BI score at 30,90 and 180 days after treatment than that at the recruitment （P 〈 0. 05）. The direct medical cost of the rehabilitation group was higher than that of the control group,and the direct non - medical cost and indirect cost were less than those of the control group （P 〈 0. 05）. Decreasing 1 point in MRS scores,the rehabilitation group spenting were less than the control group （P 〈 0. 05）;while elevating 1 point in BI scores,the rehabilitation group spenting were less than the control group （P 〈 0. 05）. Conclusion Standardized three - stage rehabilitation program on acute stroke patients based on hierarchical diagnosis and treatment can significantly improve neural function and reduce the medical expense.