基于ICF的脑卒中康复质控:真实世界证据初探

Rehabilitation Quality Control of Stroke Based on the International Classification of Function ing,Disability,and Health:A Preliminary Study of Real-world Evidence

目的:以脑卒中综合康复干预为例,为基于“国际功能,残疾和健康分类”(ICF)的康复质控体系提供真实世界证据。方法:选取125例脑卒中患者组成便利样本,构建项目反应理论(IRT)模型。进一步估算患者功能水平和类目难度,并计算出入院的功能水平变化,以及功能水平与巴氏指数(BI)的相关关系,并测算功能改善所需支付的经济成本。结果:出入院功能水平与BI显著正相关,且出院功能水平显著高于入院。21 d的住院周期内,约25%的患者可获得功能提升17%,治疗费约为520元/天,住院费约为800元/天。结论:项目反应理论模型为ICF康复质控体系下的功能水平测算、治疗靶点选择和经济成本核算提供分析策略和应用工具。

Objective:To provide real-world evidence for the rehabilitation quality control system based on the International Classification of Functioning,Disability and Health(ICF),taking a comprehensive rehabilitation intervention after stroke as an example.Methods:An item response theory(IRT)model was constructed using a convenience sample of 125 patients with stroke.Patients’functioning levels and difficulties with items were further estimated.Changes in functioning levels between discharge and admission,correlations between functioning levels and the Barthel index(BI),and the economic costs of functioning improvements were calculated.Results:Functioning levels at admission and discharge were significantly positively correlated with BI.Patients’functioning was significantly higher at discharge compared with that at admission.During a 21-day hospitalization period,approximately 25%of the patients achieved a 17%improvement in functioning.Rehabilitation treatment and hospitalization expenses were approximately 520 and 800 yuan per day,respectively.Conclusion:The IRT model provides analytical strategies and application methods for functioning measurement,therapeutic target selection,and economic cost accounting based on the ICF rehabilitation quality control system.