Morse跌倒量表评估在住院患者防跌倒护理中的成本效果

Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients

目的:利用临床大数据分析护士使用Morse跌倒量表评估住院患者防跌倒护理的成本效果。方法:以中南大学湘雅三医院对护士开展Morse跌倒量表培训前1年的59 358例住院患者为对照组,其中男26 862例,女32 496例;以对护士实施Morse跌倒量表评估培训后1年的66 203例住院患者为观察组,其中男29 881例,女36 322例。记录两组临床护士在跌倒风险评估中花费的时间及住院患者跌倒的发生情况,分析Morse跌倒量表评估与临床结局及护理人力成本之间的关系,并进行成本效果分析。另外,对观察组中被评估为跌倒高风险患者与非高风险患者的跌倒发生率进行比较。结果:Morse跌倒量表评估的结果显示:观察组和对照组的跌倒发生率分别为3.39/10万和3.82/10万,差异无统计学意义(U=0.807,P>0.05),二级及以上跌倒伤害率分别为27.30%和20.00%,差异亦无统计学意义(χ^(2)=0.345,P>0.05),但使用量表评估的人力成本增加130 641.82元,增量成本效果比为43 547.27。然而,使用Morse跌倒量表被评估为跌倒高风险患者的跌倒发生率明显高于非高风险患者(U=2.941,P<0.05)。结论:Morse跌倒量表评估对成人住院患者预防跌倒有一定的效果,但效果有限,且成本效果分析欠佳。建议在评估之后进一步落实对跌倒高风险患者的干预措施,以便提升预防跌倒的管理水平和效益。

Objective:To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients.Methods:A total of 59358 hospitalized patients,who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale,served as a control,including 26862 males and 32496 females.While the 66203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale,including 29881 males and 36322 females.The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups,and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing.The cost-effectiveness was analyzed.In addition,the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients.Results:The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100000 and 3.82/100000,respectively,there was no significant difference between the 2 groups(U=0.807,P>0.05);the injury rates of falls of Grade 2 and above in the observation group and the control group were 27.30%and20.00%,respectively,with no significant difference(χ^(2)=0.345,P>0.05);but the labor cost was increased by 130641.82 Chinses Yuan,and the incremental cost-effectiveness ratio was 43547.27.However,the incidence of fall was significant higher in the falling high-risk patients by the assessment of the Morse Fall Scale than that in the non-high-risk patients(U=2.941,P<0.05).Conclusion:The evaluation of the Morse Fall Scale has a certain effect,but it is limited in the prevention of falls in adult hospitalized patients,and the cost-effectiveness analysis is not good.It is recommended to implement the intervention measures for high-risk patients after the assessment,which may improve the management level and efficiency of fall prevention.