脑性瘫痪儿童医院康复与医院-家庭康复模式的成本-效果分析

Cost-effectiveness Analysis of Hospital Rehabilitation and Hospital-family Rehabilitation in Children with Cerebral Palsy

目的对脑瘫患儿医院康复与医院-家庭康复模式进行成本-效果分析。方法 2016年1月至12月,将本院60例1~3岁的脑瘫患儿分为医院康复组和医院-家庭康复组,每组各30例。医院康复组给予本科规范的中西医结合康复治疗(运动疗法、物理因子疗法和中医综合疗法),医院-家庭康复组由医院提供专业技术培训、指导和对患儿进行专业评估,家长实际操作。分别于治疗前、治疗结束时采用粗大运动功能测试(GMFM)和Peabody精细运动发育量表(PDMS-FM)评价患儿粗大运动功能和精细运动功能。结果治疗结束时,与医院-家庭康复组比较,医院康复组GMFM评分显著改善(t=5.333,P<0.001),总医疗成本显著增高(t=23.614,P<0.001),但GMFM和PDMS-FM视觉-运动整合评分每增加1分所支出的医疗费用降低(t>2.065,P<0.05)。结论医院康复模式对小年龄脑瘫儿童可能是更为经济、有效的治疗方案,医院-家庭康复模式可以作为此年龄段的有效补充康复模式。

Objective To analyze the cost-effectiveness of hospital rehabilitation and hospital-family rehabilitation in children with cerebralpalsy.Methods From January to December,2016,60cases of children aged one to three years with cerebral palsy were divided intohospital rehabilitation group and hospital-family rehabilitation group,with30cases in each group.The hospital rehabilitation group receivedrehabilitation of traditional Chinese and Western medicine treatment,including exercise therapy,physical therapy and Chinese Medical therapy;while the hospital-family rehabilitation group received family rehabilitation.The Gross Motor Function Measure(GMFM)and PeabodyDevelopmental Motor Scale-fine Motor(PDMS-FM)were used to evaluate the motor function and fine motor function before and aftertreatment.Results The GMFM score was higher(t=5.333,P<0.001),and the total medical cost was higher(t=23.614,P<0.001)in thehospital rehabilitation group than in the hospital-family rehabilitation group.However,the cost of medical care was significantly lower forevery1-point increase in GMFM and visual-motion integration of PDMS-FM in the hospital rehabilitation group than in the hospital-familyrehabilitation group(t>2.065,P<0.05).Conclusion The hospital rehabilitation model may be a more economical and effective treatment foryounger age children with cerebral palsy,and the hospital-family rehabilitation model could be used as an effective complementary rehabilitationmodel for this age group.