CAJ | 학술논문

目的探讨家庭-社区-医院网络化管理(HCHNM)防治脑卒中的临床效果.方法 2011年6至12月,运用家庭医生、双向转诊、急救中心等结点将家庭、社区和医院连接起来,实行脑卒中患者居家康复、社区首诊和住院救治的网络化管理.按照社区居民健康档案在青岛市实行HCHNM的八大湖和浮山后社区随机选择80例脑卒中患者作为管理组,而在未实行HCHNM的中山路和辽宁路社区随机选择80例作为对照组,进行入户问卷调查.使用x2检验比较两组患者在康复效果方面的差异,使用成组资料两样本t检验比较两组患者在生存质量、日常生活能力、生活满意度及人均医疗费用方面的差异.结果管理组脑卒中患者康复总体有效率为86.25％(69/80),明显高于对照组67.50％(54/80),差异有统计学意义(x2=221.807,P＜0.05).管理组生存质量得分高于对照组(t=4.593,P＜0.05),其中在体能、家庭活动、运动、情绪、自理能力、社会活动、上肢功能、工作能力方面的得分高于对照组(t=7.775、2.244、5.329、3.832、5.463、2.979、5.924、3.555,P＜0.05),而在语言、性格、思维能力和视觉方面差异无统计学意义(t=0.561、1.466、0.831、1.000,P＞0.05).管理组在日常生活活动能力、生活满意度方面的得分明显高于对照组,而人均医疗费用远低于对照组(t=12.998、20.760、-29.777,P＜0.05).结论家庭-社区-医院网络化管理在改善脑卒中患者康复效果、提高自理能力、提高生存质量和生活满意度方面具有明显效果,也减轻了患者的医疗负担,是一种有效、安全且经济的新型康复治疗模式.
목적 탐토가정-사구-의원망락화관리(HCHNM)방치뇌졸중적림상효과.방법 2011년6지12월,운용가정의생、쌍향전진、급구중심등결점장가정、사구화의원련접기래,실행뇌졸중환자거가강복、사구수진화주원구치적망락화관리.안조사구거민건강당안재청도시실행HCHNM적팔대호화부산후사구수궤선택80례뇌졸중환자작위관리조,이재미실행HCHNM적중산로화료녕로사구수궤선택80례작위대조조,진행입호문권조사.사용x2검험비교량조환자재강복효과방면적차이,사용성조자료량양본t검험비교량조환자재생존질량、일상생활능력、생활만의도급인균의료비용방면적차이.결과 관리조뇌졸중환자강복총체유효솔위86.25％(69/80),명현고우대조조67.50％(54/80),차이유통계학의의(x2=221.807,P＜0.05).관리조생존질량득분고우대조조(t=4.593,P＜0.05),기중재체능、가정활동、운동、정서、자리능력、사회활동、상지공능、공작능력방면적득분고우대조조(t=7.775、2.244、5.329、3.832、5.463、2.979、5.924、3.555,P＜0.05),이재어언、성격、사유능력화시각방면차이무통계학의의(t=0.561、1.466、0.831、1.000,P＞0.05).관리조재일상생활활동능력、생활만의도방면적득분명현고우대조조,이인균의료비용원저우대조조(t=12.998、20.760、-29.777,P＜0.05).결론 가정-사구-의원망락화관리재개선뇌졸중환자강복효과、제고자리능력、제고생존질량화생활만의도방면구유명현효과,야감경료환자적의료부담,시일충유효、안전차경제적신형강복치료모식.
Objective To explore the effectiveness of the home-community-hospital network management (HCHNM) on the prevention and treatment of stroke.Methods From June to December 2011,HCHNM was implenented in Qingdao of Shandong Province to prevent and treat stroke patients.According to community residents healthcare records,A total of 80 stroke patients were randomly selected from Badahu and Fushanhou communities (study group) and another 80 patients from Zhongshan Road and Liaoning Road communities (control group).A household questionnaire survey was then conducted among these participants.Chi-square test and t test were used for data analysis.Results The overall effective rate of the study group was 86.25％ (69/80),which was significantly higher than that of the control group (67.5％) (x2=221.807,P＜0.05).The study group also showed largely improved quality of life (total score:t=4.593;physical fitness,family activities,movement,mood,self-care ability,social activities,upper limb function and work ability scores:t values were 7.775,2.244,5.329,3.832,5.463,2.979,5.924 and 3.555,respectively; all P＜0.05),although language,character,thinking and vision abilities had no statistically significant difference from the control group (t values were 0.561,1.466,0.831 and 1.000,respectively; all P＞0.05).The scores of daily activities and life satisfaction of the study group were higher than those of the control group,while per capita medical cost was much lower (t values were 12.998,20.760 and-29.777,respectively; all P＜0.05).Conclusions As an effective,safe and economy therapy model,HCHNM could improve rehabilitation,self-care ability,quality of life,and life satisfaction of community stroke patients.In addition,it greatly mitigates medical burden.