失能高危老年人躯体功能干预效果及成本效果评价

Evaluation of the effectiveness and cost of physical function intervention in elderly at high risk of disability

目的评价慢性非传染性疾病(简称慢性病)自我管理技能及跌倒预防技能科普讲座和八段锦练习对失能高危老年人躯体功能干预效果及成本效果,为开展失能高危老年人干预提供科学依据。方法于2021年3—4月采用多阶段随机抽样方法抽取深圳市170名失能高危老年人作为管理对象,根据行政区分为干预组(85名)和对照组(85名),对干预组管理对象定期给予慢性病自我管理技能及跌倒预防技能科普讲座和八段锦练习,对照组管理对象接受所在社区原有医疗卫生服务。干预1年后进行终期评估,将166名基线调查和终期评估均参与者作为研究对象,两组各83名,以躯体功能简易体能测试(SPPB)得分作为结局指标。项目开展期间收集基线调查、随访干预和终期评估的社区成本投入,并计算成本效果比和增量成本效果比。采用SPSS 17.0统计软件进行t检验和χ^(2)检验,采用倍差法评价SPPB得分的干预效果。结果基线调查时,干预组和对照组人口社会学特征,临床检测指标、中心性肥胖率、多病共存患病率和SPPB得分差异均无统计学意义(P>0.05)。干预前,干预组和对照组研究对象SPPB得分分别为(8.01±0.77)和(8.15±0.74)分,干预后分别为(9.48±1.07)和(8.28±1.06)分。倍差法分析结果显示,调整混杂因素后,干预使干预组研究对象SPPB得分净提高1.337分,干预组干预前后差异有统计学意义(β_(E)=1.337,P<0.05)。社区开展项目干预组和对照组研究对象总成本分别为704.81和488.19元/人,成本效果比为479.46元/分,增量成本效果比为162.02元/分。结论采取慢性病自我管理及跌倒预防技能科普讲座结合八段锦练习能够改善失能高危老年人躯体功能且符合卫生经济学原则。

Objective To evaluate the effect and cost of intervention on physical function in elderly at high risk of disability through popular science lectures on self-management skills and fall prevention skills of chronic non-communicable diseases(chronic diseases)and eight paragraphs of exercises,and provide the scientific basis for intervention in elderly at high risk of disability.Methods From March to April 2021,the multi-stage random sampling method was used to select 170 elderly with high risk of disability in Shenzhen as the management subjects.According to administrative districts,the subjects were divided into intervention group(85 cases)and control group(85 cases).Subjects in the intervention group were regularly given with popular science lectures on chronic disease self-management skills and fall prevention skills and eight-paragraph exercises.Subjects in the control group were given with health service in the district.After one year,the final assessment was performed;166 subjects involving baseline survey and final assessment served as the study subjects(83 cases in each group).Simple Physical Function Test(SPPB)scores were used as outcome indicator.Community cost inputs for baseline surveys,follow-up interventions,and final assessments were collected during the project,and cost-effectiveness ratios and incremental cost-effectiveness ratios were calculated.The t test and χ^(2) test were used to analyze the data.The fold-difference method was used to evaluate the intervention effect of SPPB scores.The used sofware was SPSS 17.0.Results At the baseline survey,there were no significant differences in the characteristics of demographic sociology,the clinical testing indicators,the rate of central obesity,prevalence of coexisting multimorbidity and SPPB score(P>0.05).Before intervention,the SPPB scores in the intervention group and control group were(8.01±0.77)and(8.15±0.74)points;after intervention,the SPPB scores in the intervention group and control group were(9.48±1.07)and(8.28±1.06)points.The results of the fold-difference method analysis showed that after adjusting confounding factors,the SPPB score of the control group was net increased by 1.337 points by intervention(βE=1.337,P<0.05).The per capita cost of subjects in the intervention group and the control group was 704.81 yuan/person and 488.19 yuan/person,and cost effectiveness ratio(CER)and incremental cost-effectiveness ratio(ICER)were 479.46 yuan/point and 162.02 yuan/point,respectively.Conclusion The combination of the lecture on chronic disease self-management and fall prevention skills with the eight-paragraph exercise can improve the physical function of the elderly at high risk of disability and conform to the principles of health economics.