医共体模式对急性脑梗死重组组织型纤溶酶原激活剂静脉溶栓品质的影响

Effect of medical community model on intravenous thrombolysis quality of recombinant tissue-type plasminogen activator(rt-Pa)in patients with acute cerebral infarction

目的探讨医共体模式对急性脑梗死(ACI)重组组织型纤溶酶原激活剂(rt-Pa)静脉溶栓品质的影响。方法收集2017年1—12月医共体模式前所收治的ACI患者为对照组(2775例),其中静脉溶栓167例;收集2018年1—12月医共体模式后的ACI患者为试验组(2775例),其中静脉溶栓249例。组建医共体卒中团队,优化流程,持续质量改进。比较两组间ACI患者静脉溶栓率、溶栓患者入院至溶栓时间DNT、DNT≤60 min的比例、溶栓患者的住院西药费、总费用,并对发病至就诊时间OCT与DNT相关性分析。结果5550例ACI患者,对照组静脉溶栓率6.0%,低于试验组的9.0%,差异有统计学意义(P<0.001),使溶栓患者DNT由59 min缩短为54 min(Z=2.492,P=0.013),DNT≤60 min患者比例从59.3%提高至72.3%(P<0.01),降低了溶栓患者住院西药费(Z=2.507,P=0.012)、住院总费用(Z=2.602,P=0.009),试验组中OCT与DNT负相关性减弱。结论应用医共体管理能提升急性脑梗死的静脉溶栓品质,即有效提高整体静脉溶栓率、缩短DNT、提高DNT≤60 min的比例、降低住院西药费、总费用,实现临床医疗与公共卫生管理的双赢。

Objective To investigate the effect of medical community model on intravenous thrombolysis quality of recombinant tissue-type plasminogen activator(rt-Pa)in patients with acute cerebral infarction(ACI).Methods The patients with ACI treated before the medical community model from January to December 2017 were selected as the control group(n=2775),of which there were 167 cases of thrombolysis.The patients with ACI after the medical community model from January to December 2018 were selected as the study group(n=2775),including 249 cases of thrombolysis.The stroke team of medical community was set up to optimize the process and the quality.The intravenous thrombolysis rate of ACI patients,the door to needle time(DNT)and the proportion of DNT≤60 min,the cost of western medicine and hospitalization cost were compared between the two groups,while the correlation between OCT and DNT was analyzed.Results In 5550 patients with ACI,the thrombolytic rate of the control group was 6.0%,which was lower than that of the experimental group(9.0%),the difference was statistically significant(P<0.001).The DNT of patients with thrombus was shortened from 59 min to 54 min(Z=2.492,P=0.013),and the proportion of DNT≤60 min was increased from 59.3%to 72.3%(P<0.01).The cost of western medicine(Z=2.507,P=0.012)and total cost of hospitalization(Z=2.602,P=0.009)were reduced.The negative correlation between OCT and DNT was weakened in the experimental group.Conclusion The application of medical community management can improve the quality of intravenous thrombolysis in ACI patients,which can effectively increase the rate of intravenous thrombolysis,shorten DNT,increase the proportion of DNT≤60 min,and reduce the cost of western medicine and total cost of hospitalization,thus realizing the win-win situation of clinical medical treatment and public health management.