CAJ | 학술논문

目的探讨医院、社区协同健康管理对出院后老年慢性心力衰竭(CHF)患者的影响,为建立社区老年CHF患者综合管理模式提供依据.方法纳入228例老年CHF患者为研究对象,以社区为单位将患者随机分为社区管理组(106例)与协同管理组(122例).社区管理组出院后转社区卫生服务机构管理,医院不再提供后续健康干预治疗;协同管理组由医院、社区协同管理.1年后比较两组患者用药依从性、因心力衰竭再住院率、病死率、平均再住院天数、医疗费用及明尼苏达心力衰竭生活质量(LiHFe)评分.结果两组一般临床资料无明显差异,具有可比性.经过1年的健康管理,与社区管理组相比,协同管理组用药依从性明显提高(x2=8.97,P＜0.05).协同管理组再住院率、人均住院天数、住院费用与社区管理组相比均明显降低,差异有统计学意义(x2=9.91,t=3.78、3.61,P＜0.05).在进行健康管理前,两组患者的LiHFe评分差异无统计学意义(t=0.42、0.81、0.66、0.44、0.41,P＞0.05),出院1年后,协同管理组的各项评分均优于社区管理组,差异有统计学意义(t=6.37、11.81、6.16、9.64、9.13,P＜0.05).但两组患者的病死率差异无统计学意义( x2=0.247,P＞0.05).结论医院、社区协同健康管理是老年CHF患者降低再住院率、减轻医疗负担、提高生活质量切实有效的管理措施.
목적 탐토의원、사구협동건강관리대출원후노년만성심력쇠갈(CHF)환자적영향,위건립사구노년CHF환자종합관리모식제공의거.방법 납입228례노년CHF환자위연구대상,이사구위단위장환자수궤분위사구관리조(106례)여협동관리조(122례).사구관리조출원후전사구위생복무궤구관리,의원불재제공후속건강간예치료;협동관리조유의원、사구협동관리.1년후비교량조환자용약의종성、인심력쇠갈재주원솔、병사솔、평균재주원천수、의료비용급명니소체심력쇠갈생활질량(LiHFe)평분.결과 량조일반림상자료무명현차이,구유가비성.경과1년적건강관리,여사구관리조상비,협동관리조용약의종성명현제고(x2=8.97,P＜0.05).협동관리조재주원솔、인균주원천수、주원비용여사구관리조상비균명현강저,차이유통계학의의(x2=9.91,t=3.78、3.61,P＜0.05).재진행건강관리전,량조환자적LiHFe평분차이무통계학의의(t=0.42、0.81、0.66、0.44、0.41,P＞0.05),출원1년후,협동관리조적각항평분균우우사구관리조,차이유통계학의의(t=6.37、11.81、6.16、9.64、9.13,P＜0.05).단량조환자적병사솔차이무통계학의의( x2=0.247,P＞0.05).결론 의원、사구협동건강관리시노년CHF환자강저재주원솔、감경의료부담、제고생활질량절실유효적관리조시.
Objective To explore the effect of hospital-community-based collaborative management on elderly out-patients with chronic heart failure (CHF).Methods A total of 228 out-patients with CHF were randomly assigned to the community-based health management group (n =106 ) and the hospitalcommunity-based collaborative health management group (n =122).In community-based health management group,the patients only received community-based health management,while in hospital-community-based collaborative health management group the patients accepted comprehensive health management.One year later,medication compliance,readmission rate,mortality,average length of hospitalization,medical costs and Minnesota living with heart failure questionnaire (LiHFe) were compared between the two groups.Results No statistically significant differences in clinical data were found between the two groups at baseline.After one year,medication compliance was significantly improved in hospital-community-based collaborative health management group when compared to community-based health management group ( x2 =8.97,P ＜ 0.05 ).Readmission rate,average length of hospitalization and medical costs of hospital-community-based collaborative health management group were lower than community-based health management group (x2 =9.91 ; t =3.78,3.61 ; all P ＜ 0.05 ).One year ago,the items of LiHFe including physical dimension,emotion,symptom and social dimension and total score showed no significant between the two group (t =0.42,0.81,0.66,0.44,0.41 ; all P ＞ 0.05 ).While one year later,all the scores of hospital-communitybased collaborative health management group were significantly declined( t =6.37,11.81,6.16,9.64,9.13;P ＜ 0.05 ).Mortality showed no significant difference between the two groups ( x2 =0.247,P ＞ 0.05 ).Conclusion Hospital-community-based collaborative management for health care may be a practical and valuable strategy for decreasing readmission rate and medical burden and improving quality of life of elderly patients with CHF.