基于服务流程设计的全程管理对全膝关节置换术患者功能及满意度影响的初步研究

Preliminary Study on the Effect of Whole-Process Case Management Based on Service Process Design on the Function and Satisfaction of Patients Undergoing Total Knee Arthroplasty

目的研究基于服务流程设计的全程管理对全膝关节置换术患者疼痛、功能、满意度及并发症发生等的影响。方法选取2021年4月–2022年3月在四川大学华西医院骨科接受单侧全膝关节置换术的患者204例,使用随机数字表法分为普通组和全程管理组各102例。普通组患者接受传统围手术期管理,全程管理组患者接受基于服务流程设计优化后的全程管理。比较两组患者一般资料,术后3 d及术后3、8、12周的视觉模拟疼痛评分(VAS)、膝关节伸屈活动度、特种外科医院膝关节评分(HSS)、患者满意度调查问卷简表(PSQ-18)评分、术后12周上下楼梯能力以及并发症发生情况等。结果两组患者一般资料及入组时的基线数据比较差异无统计学意义(P>0.05)。两组患者术前及术后3 d HSS评分、关节活动度及VAS疼痛评分差异无统计意义(P>0.05),但在术后3、8、12周时全程管理组评分均优于普通组,差异有统计学意义(P<0.05)。同时,在术后12周时全程管理组患者较普通组具有更好的上下楼梯能力,差异有统计学意义(P<0.001)。在满意度方面,全程管理组患者在术后3 d,术后3、8、12周时满意度均优于普通组(P<0.001)。结论基于服务流程设计的全程管理对减轻膝关节置换术患者疼痛、增加活动度、改善功能、提高满意度和减少并发症等具有积极作用。

Objective To investigate the effect of whole-process case management based on service process design on patients undergoing total knee arthroplasty(TKA)in areas including pain,function,satisfaction,and complications.Methods A total of 204 patients who underwent unilateral TKA between April 2021 and March 2022 at the Department of Orthopedics,West China Hospital,Sichuan University were enrolled.By using a random number table,the patients were randomly assigned to two groups,102 in the general case management group(group G)and 102 in the whole-process case management group(group W).Patients in group G received traditional perioperative case management,while those in the whole-process case management group received integrated case management optimized on the basis of the service process design.The two groups of patients were studied through comparison of their general data,Visual Analogue Scale(VAS)pain score,knee flexion and range of motion,Hospital for Special Surgery(HSS)knee score,the 18-item Patient Satisfaction Questionnaire Short Form(PSQ-18),ability to climb stairs,and complications at 3 days and 3,8,and 12 weeks after TKA.Results There was no significant difference between the two groups in patient general information or baseline data collected at the time of enrollment(P>0.05).There was no significant difference in HSS score,joint range of motion,and VAS pain score between the two groups before the surgery and 3 days after the surgery(P>0.05).However,the HSS score,joint range of motion,and VAS pain scores of group W were significantly superior to those of group G at 3,8 and 12 weeks after the surgery(all P<0.05).In addition,group W demonstrated significantly better ability to climb up and down stairs than that of group G at 12 weeks after the surgery(P<0.001).In terms of satisfaction,patients in group W were significantly more satisfied than those in group G at 3 days,and 3,8,and 12 weeks after the surgery(P<0.001).Conclusion Whole-process case management based on service process design has a positive effect of relieving pain,increasing range of motion,improving function,increasing satisfaction,and reducing complications in patients undergoing TKA.