医联体共管COPD分级诊疗模式的效果分析

目的 探讨区域医疗联合体(简称医联体)共管COPD分级诊疗模式对COPD患者的影响.方法 以2015年1月1日至2015年12月31日在北京市东城区新中街辖区内收集的COPD患者34例为对照组;以2016年1月1日至2016年12月31日在该辖区收集的COPD患者53例为试验组,对试验组实行医联体共管分级诊疗.对比分析两组的(COPD assessment test,CAT)评分、FEV1%pred、年急性发作次数、年度医疗费用.结果 研究前2组患者CAT评分、FEV1%pred及气流受限程度分布差异均无统计学意义(P>0.05).随访1年后试验组CAT评分低于对照组(P<0.05);试验组FEV1%pred明显高于对照组(P<0.05).试验组年急性发作次数、年医疗费用均明显低于对照组(P<0.05).分层分析显示试验组门诊维持治疗费用低于对照组(P<0.05),住院治疗费用2组差异无统计学意义(P>0.05).年急性加重门诊、急诊就诊率2组差异无统计学意义(P>0.05).亚组分析显示两组住院患者血气分析PO2、PCO2及FEV1%pred比较差异无统计学意义(P>0.05).结论 医联体共管分级诊疗能明显提高COPD患者的生活质量,改善气流受限程度,减低疾病风险及医疗费用.

Effect analysis of hierarchical diagnosis model of chronic obstructive pulmonary disease by co-management of health alliance

Objective To discuss the effect of hierarchical diagnosis model of chronic obstructive pulmonary disease(COPD) by co-management of health alliance on COPD patient.Methods From January 1,2015 to December 31,2015,34 patients with COPD in new pages of dongcheng district of Beijing were as control group;53 patients with COPD were as experiment group,which was given hierarchical diagnosis by co-management of health alliance.Comparative analysis of two groups of COPD assessment test (CAT) score,the percentage of pulmonary function FEV1 accounting for expected value (FEV1%pred),annual acute episodes and annual medical costs were conducted.Results Before the study the CAT scores,degree of FEV1%pred and limited airflow distribution in two groups of patients show no obvious difference (P>0.05).After 1 year follow-up the CAT score of experiment group is lower than that of control group(P<0.05);the FEV1%pred for the experimental group is significantly higher than the control group (P<0.05).For the experiment group the number of acute attack and annual medical costs are significantly lower than that of the control group (P<0.05).Hierarchical analysis shows that the outpatient expense of maintenance treatment of the experiment group is lower than that of the control group (P<0.05);the hospitalization expenses between the two groups show no difference (P>0.05).The annual acute exacerbation and emergency-department visits are similar between the two groups (P>0.05).Subgroup analysis showes that the blood gas analysis of PO2,PCO2 and FEV1%pred for two groups of hospitalized patients exhibit no difference (P>0.05).Conclusions hierarchical diagnosis by co-management of health alliance can significantly improve the quality of life in patients with chronic obstructive pulmonary disease,improve airflow limited degree,and reduce the risk of diseases and medical cost.