CAJ | 학술논문

目的：定量测量经重症监护病房（ ICU）治疗出院后的肝移植患者连续性医疗服务利用现状，并探索影响连续性医疗服务利用的相关因素，为提高肝移植患者连续性医疗服务利用提供依据。方法连续性收集2008年1月—2014年12月于四川省人民医院经ICU治疗出院后的肝移植患者200例为调查对象。收集患者的一般资料（包括性别、年龄、文化程度、居住地、就业状况、职业类型、医疗保险类型、医疗保险报销比例、肝移植术后出院时间、家庭年人均收入、住所到随访医院距离）。通过系统文献复习、Delphi专家咨询法构建连续性医疗服务利用调查问卷，患者出院2个月后，进行门诊随访，由患者本人填写连续性医疗服务利用调查问卷。结果本研究共调查200例经ICU治疗出院后的肝移植患者，患者本人不能或不愿意配合调查者4例，共有196例完成了问卷调查，其中回收有效问卷192份，有效回收率为98.0%。连续性医疗服务利用问卷总得分为（58.0±8.4）分，其中医患间人际连续性维度得分为（30.1±4.4）分，信息连续性维度得分为（11.2±4.0）分，机构连续性维度得分为（10.8±5.0）分，多学科连续性维度得分为（5.9±3.9）分。不同医疗保险报销比例、家庭年人均收入、住所到随访医院距离患者连续性医疗服务利用得分比较，差异有统计学意义（ P<0.05）。结论经ICU治疗出院后的肝移植患者连续性医疗服务利用率不高，还存在信息不连接、资源重复浪费等问题；医疗保险报销比例、家庭年人均收入、住所到随访医院距离是影响经ICU治疗出院后的肝移植患者连续性医疗服务利用的相关因素。
목적：정량측량경중증감호병방（ ICU）치료출원후적간이식환자련속성의료복무이용현상，병탐색영향련속성의료복무이용적상관인소，위제고간이식환자련속성의료복무이용제공의거。방법련속성수집2008년1월—2014년12월우사천성인민의원경ICU치료출원후적간이식환자200례위조사대상。수집환자적일반자료（포괄성별、년령、문화정도、거주지、취업상황、직업류형、의료보험류형、의료보험보소비례、간이식술후출원시간、가정년인균수입、주소도수방의원거리）。통과계통문헌복습、Delphi전가자순법구건련속성의료복무이용조사문권，환자출원2개월후，진행문진수방，유환자본인전사련속성의료복무이용조사문권。결과본연구공조사200례경ICU치료출원후적간이식환자，환자본인불능혹불원의배합조사자4례，공유196례완성료문권조사，기중회수유효문권192빈，유효회수솔위98.0%。련속성의료복무이용문권총득분위（58.0±8.4）분，기중의환간인제련속성유도득분위（30.1±4.4）분，신식련속성유도득분위（11.2±4.0）분，궤구련속성유도득분위（10.8±5.0）분，다학과련속성유도득분위（5.9±3.9）분。불동의료보험보소비례、가정년인균수입、주소도수방의원거리환자련속성의료복무이용득분비교，차이유통계학의의（ P<0.05）。결론경ICU치료출원후적간이식환자련속성의료복무이용솔불고，환존재신식불련접、자원중복낭비등문제；의료보험보소비례、가정년인균수입、주소도수방의원거리시영향경ICU치료출원후적간이식환자련속성의료복무이용적상관인소。
Objective To make quantitative measurement of the current utilization of continuous medical service for liver transplant discharged patients after undergoing ICU treatment in hospital, in order to explore relevant factors for the utilization and provide basis for the improvement of the utilization. Methods Consecutively enrolled 200 liver transplant patients who underwent ICU treatment in and discharged from Sichuan People's Hospital from January 2008 to December 2014. The general data of the enrolled patients were collected,including gender,age,education level,place of residence,employment status, occupation type,medical insurance type,the proportion of reimbursement in medical insurance,the discharge time after liver transplant,family per capita income and the distance from place of residence to follow-up hospitals. By a systematic review of literatures and Delphi expert consultation method, made a questionnaire about continuous medical services. Two months after discharge,outpatient follow-up was undertaken,during which the patients were asked to finish the questionnaire. Results Among the 200 patients, 4 patients weren't able or willing to participate the survey, thus 196 patients completed the questionnaire survey, and 192 effective questionnaires were collected with an effective rate of 98. 0% . The total score of continuous medical service utilization was ( 58. 0 ± 8. 4 ), and the scores for the continuity of doctor - patient relation, information continuity,setting continuity and the continuity of multiple disciplines were(30. 1 ± 4. 4),(11. 2 ± 4. 0),(10. 8 ± 5. 0 ) and ( 5. 9 ± 3. 9 ) . The score of continuous medical service utilization varied significantly with the proportion of reimbursement in medical insurance,domestic per capita income and the distance from place of residency to follow-up hospitals ( P < 0. 05 ) . Conclusion The utilization rate of continuous medical service for liver transplant discharged patients after undergoing ICU treatment in hospital is not high,and some problems still exist,such as the discontinuity and repeated waste of resources. The proportion of reimbursement in medical insurance, family per capita income and the distance from place of residency to follow - up hospitals are influencing factors for the utilization of continuous medical service for liver transplant discharged patients after undergoing ICU treatment in hospital.