成都市糖尿病患者社区卫生服务中心和医院两种就诊途径的成本-效果比较  

Cost-effectiveness Comparison Between Community-based Medical Management and Hospital Therapy Among Patients with Diabetes Mellitus in Chengdu

作　　者：王琼[1] 魏咏兰[1] 夏劲节[1] 姚思君[1] 

机构地区：[1]四川省成都市疾病预防控制中心慢病科,四川成都610041

出　　处：《实用预防医学》2013年第5期626-628,共3页Practical Preventive Medicine

摘　　要：目的比较常规医院治疗糖尿病和社区糖尿病患者管理的效果及患者花费,为糖尿病患者找到一条合理就医途径。方法选取成都市1所二级医院和1所社区卫生服务中心的糖尿病患者为研究对象,开展为期1年5次追踪调查,了解患者血糖、糖化血红蛋白控制情况以及年度治疗费用使用情况,总共206例完成了此次追踪调查。结果医院组糖尿病患者年平均直接医疗费用为4 850.66元,社区组为2 439.16元,医院组在1年治疗总费用及其门诊和住院费用上的花费均高于社区组,差异有统计学意义(P<0.05)。基线时医院组患者血糖控制情况比社区组患者差,经1年治疗后,医院组患者血糖控制良好率为27%,控制一般率为52%,糖化血红蛋白控制良好率为16%,控制一般率为84%,社区组患者经1年管理后,血糖控制良好率为45.28%,控制一般率为16.04%,糖化血红蛋白控制良好率为48.11%,控制一般率为35.85%,两组患者终期调查血糖和糖化血红蛋白控制率经统计学检验差异无统计学意义(P>0.05)。社区组成本-效果比均低于医院组,差异有统计学意义(P<0.05)。结论社区卫生服务中心在糖尿病患者管理中相对患者来说比医院有更大的费用优势,但对于血糖或糖化血红蛋白控制不良的患者来说,医院控制效果更好。因此在医院和社区之间建立有效的双向转诊通道对糖尿病防治具有良好的意义。Objective To compare the therapeutic effects and cost-effectiveness between hospital routine therapy and community-based medical management among patients with diabetes mellitus（DM）,and to find out a rational treatment way for DM patients.Methods DM patients selected from a second-class hospital and a community health center（CHC） in Chengdu were served as the research objects.A one-year follow-up investigation was implemented for the patients＇ annual direct cost,fasting blood-glucose（FBG） and glycosylated hemoglobin（HbA1c）.Totally 206 patients were surveyed.Results The average annual direct costs of patients in hospital therapy group and CHC group were $4,850.66 and $2,439.16,respectively.The total cost of one-year treatment,the outpatient cost,and hospitalization expenses were significantly higher in hospital therapy group than those in CHC group,and the difference was statistically significant（P〈0.05）.At baseline survey,the FBG control rate of hospital therapy group was lower than that of CHC group.After the one-year follow-up,the rates of good control and general control for FBG in hospital therapy group were 27% and 52%,respectively;the rates of good control and general control for HbA1c in hospital therapy group were 16% and 84%,respectively.After the one-year follow-up,the rates of good control and general control for FBG in CHC group were 45.28% and 16.04%,respectively;the rates of good control and general control for HbA1c in CHC group were 48.11% and 35.85%,respectively.No statistically significant difference was found in the control rates of BFG and HbA1c between the two groups during the final survey（P〈0.05）.The cost-effectiveness ratio of CHC group was lower than that of hospital therapy group,and the difference was statistically significant（P〈0.05）.Conclusions CHC management of patients with DM shows the benefit of lower treatment expenses as compared with hospital therapy,while hospital therapy exhibits better control effectiveness among DM patients with abnormal

关 键 词：糖尿病 医院 社区卫生服务中心 成本效果分析 

分 类 号：R587.1[医药卫生—内分泌]