我国卒中医疗机构分级水平现况调查

Survey of Stroke Medical Facilities in Hospitals from China Stroke Research Network

目的明确我国接诊卒中患者的医疗机构卒中医疗资源配置情况及水平。方法 2012年对当时的中国卒中研究网络成员单位(China Stroke Research Network,CSRN)的554家单位进行了关于卒中医疗资源分布的调查。对每家单位发放调查问卷以获取该单位医疗资源分布情况,包括人力资源情况、设备资源情况、空间资源情况和组织管理情况。调查问卷的内容设置参考欧洲卒中医疗资源调查(European stroke facilities survey)对高级卒中中心(comprehensive stroke center,CSC)、初级卒中中心(primary stroke center,PSC)和卒中接诊最小机构(any hospital ward,AHW)的定义标准。结果在发放调查问卷的所有医疗机构中,有521家(94.0%)反馈了合格的调查问卷。按照欧洲卒中医疗资源调查标准,在反馈的医疗机构中有20家(3.8%)达到CSC标准,有179家(34.4%)达到PSC标准,有64家(12.3%)达到AHW标准,而有258家(49.5%)未达到上述任何一级可收治卒中医疗机构的标准。上述分别达到CSC、PSC、AHW和未符合标准的各级医疗机构中,在前一年收治卒中患者的数量分别为70 052例(8.8%)、334 834例(42.2%)、88 364例(11.1%)和299 806例(37.8%)。在未达到标准的机构中,有11家(4.3%)机构无法提供24 h头颅计算机断层扫描检查,209家(81.0%)机构既不能提供卒中诊疗成型方案,也无法提供卒中患者接诊的标准化临床路径。结论在被调查的接诊急性卒中患者的医疗机构中,只有不足2/5的单位可提供较为理想的卒中诊疗资源。我国仅有一半的急性卒中患者在CSC和PSC就诊。

Objective To investigate the allocation of stroke medical facilities and the level of medical service in hospitals admitting stroke patients in China.Methods A survey of stroke medical facilities in all 554 hospitals from China Stroke Research Network（CSRN） was conducted in 2012. These hospitals were from 31 provinces or municipalities, covering nearly the entire China's Mainland. The relevant information was obtained by questionnaires, including hardware and software resources and medical service management and etc. The criteria and definitions for comprehensive stroke center（CSC）, primary stroke center（PSC）, and any hospital ward（AHW） of minimum unit admitting stroke patients in questionnaires were used referring to the relevant criteria and definitions of the European stroke facilities survey.Results Of all the hospitals, 521（94.0%） completed the questionnaires. Of the 521 hospitals, 20（3.8%） met CSC criterion, 179（34.4%） met PSC criterion, 64（12.3%） met AHW criterion, and 258（49.5%） didn＇t reach any of the above criteria. Hospitals meeting the criteria for CSC, PSC, AHW and none of all the criteria had admitted 70 052（8.8%）, 334 834（42.2%）, 88 364（11.1%）, and 299 806（37.8%）patients in the last year before the survey, respectively. Of the 258 hospitals at the lowest level of medical service, 11（4.3%） could not provide 24-hour cerebral computed tomography scanning service, 209（81.0%） could provide neither the complete stroke diagnosis and treatment scheme nor standard clinical pathway for acute stroke patients.Conclusions Only less than 2/5 of investigated hospitals admitting acute stroke patients had optimal medical facilities for stroke. Only half of acute stroke patients received treatment in CSC and PSC in this survey.