社区规范化管理对慢性阻塞性肺疾病患者质量调整生命年的影响研究  

The Effect of Community Standardized Management on Quality Adjusted Life Year of Patients with Chronic Obstructive Pulmonary Disease

作　　者：徐迅[1] 李凡[1] 朱云霞[1] 傅欢娟 沈朝英 陆元英 庄棋军 徐刚[4] 蔡映云[5] 张颖 柳胜生 朱美英 

机构地区：[1]上海交通大学附属第一人民医院松江分院,上海市201600 [2]上海市松江区小昆山社区卫生服务中心 [3]上海市松江区新浜社区卫生服务中心 [4]上海交通大学公共卫生学院 [5]复旦大学附属中山医院呼吸病研究所 [6]上海市松江区卫生局 [7]上海市松江区疾控中心

出　　处：《中国全科医学》2013年第7期798-801,共4页Chinese General Practice

基　　金：上海市卫生局课题(2007169);上海市松江区科委课题(2007医学)

摘　　要：目的探讨慢性阻塞性肺疾病患者规范化管理后质量调整生命年(QALY)的差异。方法采用以社区为单位的整群随机化分组的现场试验设计,采用St George呼吸问卷评估生命质量。将两个社区随机分为干预组(规范化管理)和对照组(常规管理),分析两组慢性阻塞性肺疾病患者管理后QALY的差异。结果根据抽样结果小昆山社区为干预组,新浜社区为对照组,132例患者参加了本次研究,102例患者完成一年随访,其中小昆山47例慢性阻塞性肺疾病患者,新浜55例慢性阻塞性肺疾病患者。干预后小昆山患者平均每人每年获得1.42 QALY,而新浜却失去0.95 QALY。成本效用分析显示,小昆山社区每投入529.70元可获得1年的QALY收益,而新浜社区每投入992.79元反而导致1年的QALY损失。增量成本效用比分析显示干预组比对照组每节约137.60元的投入,反而能多获得一年的QALY收益。结论社区慢性阻塞性肺疾病患者的规范化管理不仅可以提高生命质量,而且可以有效减少医疗费用支出,减轻经济社会负担,获得最佳成本效用。Objective To evaluate the effect of standardized management on quality adjusted life year （QSLY） of patients with chronic obstructive pulmonary disease （COPD） in the community. Methods Two communities were randomly assigned as an intervention group （standardized management） and a control group （routine management）. The St George＇s respiratory questionnaire was used to assess the quality of life. Post - management QALY difference was compared between the two groups. Results Xiao Kunshan Community was assigned as the intervention group and Xinbang Community as the control group. Among the 132 COPD patients enrolled into the study, 102 patients completed the one- year follow- up, 47 from Xiao Kunshan Community and 55 from Xinbang Community. After the intervention, patients from Xiao Kunshan Community gained 1.42 QALY per person/year, and patients from Xinbang community lost 0. 95 QALY per person/year. Cost - effectiveness analysis showed that one QALY was gained for 529.70 RMB＇s input by Xiao Kunshan community, while one QALY was lost for 992. 79 RMB＇s input by Xinbang community. The incremental cost effectiveness ratio （ICER） showed that the intervention group gained one more QALY for 137.60 RMB less input than the control group. Conclusion Community standardized management of COPD patients not only improves patients＇ quality of life, but also reduces medical cost.

关 键 词：肺疾病 慢性阻塞性 生命质量 质量调整生命年 

分 类 号：R563[医药卫生—呼吸系统]