县域内紧密型医共体分级诊疗模式对中-重度COPD患者救治的影响

Effect of hierarchical diagnosis and treatment model of compact county medical community on the treatment for patients with moderate to severe COPD

目的探讨县域内紧密型医共体分级诊疗模式对中-重度慢性阻塞性肺疾病(COPD)患者救治的影响。方法选取2022年5月至2023年4月本县域内医共体的基层中心分院和牵头医院(连州市人民医院)接诊的中-重度COPD患者150例设为研究组,同时选取2021年5月至2022年4月接诊的150例中-重度COPD患者设为对照组。对照组男120例,女30例,年龄(67.25±7.63)岁,严重程度C级60例、D级90例;研究组男123例,女27例,年龄(66.83±7.55)岁,严重程度C级56例、D级94例。研究组予以县域内紧密型医共体分级诊疗模式管理,对照组予以常规诊疗模式管理。随访1年后比较两组患者依从性,病死率,第1秒用力呼气容积(FEV1%),COPD患者自我评估测试(CAT)评分,6 min步行距离,1年急性加重次数及生活质量等。采用t检验、χ^(2)检验。结果研究组病死率为3.33%(5/150),低于对照组的病死率9.33%(14/150),差异有统计学意义(χ^(2)=7.545,P=0.006);研究组失访25例(16.67%),对照组失访16例(10.67%);对照组和研究组实际成功随访各120例。研究组COPD患者的复诊率、戒烟率、吸入剂使用率分别为81.67%(98/120)、79.17%(95/120)、92.50%(111/120),高于对照组的30.00%(36/120)、28.33%(34/120)、59.17%(71/120),差异均有统计学意义(均P<0.05)。随访1年后,与对照组相比,研究组FEV1%较高[(44.97±6.16)%比(37.16±5.24)%],1年急性加重次数较少且CAT评分较低[(1.20±0.45)次比(1.90±0.55)次,(17.75±5.35)分比(22.10±5.05)分],6 min步行距离较长[(263.28±93.06)m比(177.65±95.12)m],1年医疗费用较低[(12071.25±390.63)元比(13519.94±386.75)元],差异均有统计学意义(均P<0.05);研究组生活质量各维度评分均较对照组高(均P<0.001)。结论县域内紧密型医共体分级诊疗模式有助于减缓中-重度COPD患者肺功能的进一步恶化,减少每年急性发作的频率,降低患者的住院费用及病死率,提高患者的生活耐受能力,改善预后,值得临床进一步研究应用。

Objective To explore the impact of hierarchical diagnosis and treatment model of compact county medical community on the treatment for patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods A total of 150 patients with moderate to severe COPD who were admitted to the grassroots central branch of the medical community and the leading hospital of our country(Lianzhou People's Hospital)from May 2022 to April 2023 were selected as a study group,and 150 patients with moderate to severe COPD from May 2021 to April 2022 were selected as a control group.In the control group,there were 120 males and 30 females,aged(67.25±7.63)years,with 60 cases of grade C and 90 cases of grade D.In the study group,there were 123 males and 27 females,aged(66.83±7.55)years,with 56 cases of grade C and 94 cases of grade D.The study group was managed by the hierarchical diagnosis and treatment model of compact county medical community,while the control group was managed by the routine diagnosis and treatment model.After 1 year of follow-up,the compliance,mortality,forced expiratory volume in the first second(FEV1%),COPD Assessment Test(CAT)score,6-min walking distance,annual acute exacerbation times,and quality of life were compared between the two groups.t test andχ^(2)test were used.Results The mortality rate of the study group was 3.33%(5/150),which was lower than that of the control group[9.33%(14/150)],with a statistically significant difference(χ^(2)=7.545,P=0.006).There were 25 cases(16.67%)lost to follow-up in the study group and 16 cases(10.67%)in the control group.The control group and the study group were followed up successfully with 120 cases each.The follow-up rate,smoking cessation rate,and inhaler usage rate in the study group were 81.67%(98/120),79.17%(95/120),and 92.50%(111/120),which were higher than those in the control group[30.00%(36/120),28.33%(34/120),and 59.17%(71/120)],with statistically significant differences(all P<0.05).After 1 year of follow-up,compared with the control group,the FEV1%of the study group was higher[(44.97±6.16)%vs.(37.16±5.24)%],the number of acute exacerbations and CAT score were lower[(1.20±0.45)vs.(1.90±0.55),(17.75±5.35)points vs.(22.10±5.05)points],the 6-min walking distance was longer[(263.28±93.06)m vs.(177.65±95.12)m],and the annual medical expenses were lower[(12071.25±390.63)yuan vs.(13519.94±386.75)yuan],with statistically significant differences(all P<0.05);the quality of life scores of the study group were higher than those of the control group(all P<0.001).Conclusion The hierarchical diagnosis and treatment model of compact county medical community is helpful to slow down the further deterioration of lung function in patients with moderate to severe COPD,reduce the number of acute exacerbations,reduce the annual medical expenses and mortality rate,and improve the patients'living tolerance and prognosis,which is worthy of promotion and application.