脑卒中后社区三级康复治疗的卫生经济学评价  

The cost-effect evaluation on community-based tertiary rehabilitation in stroke patients

作　　者：崔立军[1] 胡永善[1,2] 沈国光[3] 张安蒙[3] 章亚萍 陈惠芳 沈炜珍 郑钢 于健君[1] 徐一鸣[1] 陈颖[1] 吴毅[1] 

机构地区：[1]复旦大学附属华山医院康复医学科,复旦大学上海医学院康复医学系,上海200040 [2]复旦大学医学神经生物学国家重点实验室 [3]复旦大学附属华山医院永和分院 [4]闸北区临汾社区卫生服务中心 [5]闸北区彭浦镇社区卫生服务中心 [6]闸北区彭浦社区卫生服务中心 [7]闸北区残疾人联合会

出　　处：《中国康复医学杂志》2009年第12期1087-1091,共5页Chinese Journal of Rehabilitation Medicine

基　　金：上海市卫生局科研基金资助项目(2008局级85);上海市闸北区卫生科研基金资助项目(2007重点16)

摘　　要：目的:对脑卒中后社区三级康复治疗服务模式进行成本-效果分析。方法:将49例脑卒中患者按社区随机分为康复组和对照组.康复组存常规内科治疗的基础上给予规范的社区三级康复治疗,对照组给予常规内科治疗,没有进行规范的社区康复治疗。分别存入组时、2个月末和5个月末应用临床神经功能缺损程度最表(clinical neuralimpairment measures scale,NIM)进行神经功能评定,并进行费用调查。结果:规范的社区三级康复治疗2个月末和5个月末,康复组患者的NIM评分分别平均降低了3.26分和4.74分,对照组平均降低了1.08分和1.84分,康复组患者改善程度均显著优于埘照组(P<0.01)。在2个月末和5个月末,康复组NIM每降低1分需要的总费用、直接医疗成本、康复治疗费、西药费用分别为$752.82,$447.75,$199.89,$241.99和$1176.76,$647.01,$255.52,$382.22;对照组每提高1分需要相关费用分别为$2760.36,$1443.69,$358.30,$1072.06和$3899.72.$1988.45,$503.91,$1475.41。对照组约是康复组各项相关费用的2-3倍。结论:社区三级康复治疗服务模式是经济有效的脑卒中社区康复治疗方案。Objective：To evaluate the expense of community-based tertiary rehabilitation in stroke patients through the cost-effect analysis. Method：Forty-nine subjects were randomly divided into two groups according to their community： the rehabilitation group was administered community-based tertiary rehabilitation in addition to routine interventions of internal medicine; the control group was only given the routine ones without standard community- based rehabilitation. All the patients were assessed with clinical neural impairment measure scale （NIM） at the enrolling time, the end of the 2nd month and the 5th month. At the same time, the cost was investigated. Result： There were no significant difference between the two groups in NIM scores at the entering point. However, 2 months and 5 months later, NIM scores decreased 3.26 and 4.74 in the rehabilitation group respertively,while 1.08 and 1.84 in the control group respectively, both differences were significant between the two groups （P〈0.01）.At the end of the 2nd month and the 5th month decreased one point of NtM score. The total costs, direct medical costs, total rehabilitation costs and medicine costs of the rehabilitation group were ￥752.82,￥447.75,￥199.89,￥241.99 and ￥1176.76,￥647.01,￥255.52,￥382.22 respectively, while the costs of the control group were ￥2760.36,￥1443.69, ￥358.30, ￥1072.06 and ￥3899.72, ￥1988.45, ￥503.91 and ￥1475.41. Conclusion： Community -based tertiary rehabilitation is an economical and effective medical strategy for stroke patients in community.

关 键 词：社区三级康复治疗 随机对照 脑卒中 成本-效果分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]