双向转诊服务在冠心病患者转诊及救治中的应用效果评价  

Evaluation of application effect of two-way referral service in the referral and treatment of coronary disease

作　　者：宋新涛 李勇[2] 赵倩[3] 杨毅宁[3] 李晓梅[3] 庞亚男 俞婧[4] Song Xintao;Li Yong;Zhao Qian;Yang Yining;Li Xiaomei;Pang Yanan;Yu Jing(School of Public Health,Xinjiang Medical University,Urumqi 830011,China;Remote Medicine Center of Xinjiang Medical University,Urumqi 830011,China;Cardiovascular Disease Center of Xinjiang Medical University,Urumqi 830011,China;Teaching and Scientific Research Department of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐830011 [2]新疆医科大学远程医学中心,乌鲁木齐830011 [3]新疆医科大学心血管病中心,乌鲁木齐830011 [4]新疆医科大学第一附属医院教学科研工作部,乌鲁木齐830011

出　　处：《中华健康管理学杂志》2023年第2期130-135,共6页Chinese Journal of Health Management

基　　金：新疆维吾尔自治区重点研发计划(2020B03002-2)。

摘　　要：目的评价双向转诊服务在冠心病患者转诊及救治中的应用效果。方法采用非随机对照研究,连续入选2021年1月至2022年1月新疆地区通过远程医疗服务模式下的绿色转诊通道(green referral channel,GRC)转诊至新疆医科大学第一附属医院接受救治的80例冠心病患者作为GRC转诊组;并采用倾向性评分匹配同期年龄、性别、所属地区、医保类型等基本情况相近且通过常规就诊渠道转诊至该院的冠心病患者110例作为常规转诊组。采用t检验、χ^(2)检验及非参数检验比较两组患者的疾病严重程度、转诊时间、住院费用等指标的差异,并获得GRC转诊组的满意度情况。结果GRC转诊组心功能Ⅲ级(纽约心脏病协会心功能分级)、合并心力衰竭、合并心房颤动以及介入治疗的比例均显著大于常规转诊组(均P<0.05),转诊总时间、等床时间均显著低于常规转诊组[14.16(9.62,25.61)比34.39(28.51,49.68)h、2.13(0.83,6.64)比24.58(20.27,27.68)h](Z=8.465、9.172,均P<0.001),住院费用、手术治疗费及材料费均显著高于常规转诊组[24755(11559,56521)比14700(9375,29534)元、6013(2096,8256)比2562(2044,6154)元及12093(1267,35689)比1329(826,16125)元](Z=2.814、2.917、3.353,均P<0.05),诊断费显著低于常规转诊组[4878(3628,6847)比5719(4228,7639)元](Z=2.323,P<0.05)。GRC转诊组患者对于转诊流程、就诊时间、就诊体验的满意率均超过90%。结论基于远程医疗的双向转诊服务在冠心病患者的转诊及救治中具有较好的应用效果。Objective To evaluate the effect of two-way referral service in referral and treatment of patients with coronary disease.Methods A non-randomized controlled study was used,80 patients with coronary disease who were referred to the First Affiliated Hospital of Xinjiang Medical University through the fast referral channel,also called green referral channel(GRC)of telemedicine service mode from January 2021 to January 2022 were selected as the GRC referral group.A propensity score was used to match 110 patients from the same period with coronary disease who were referred to this hospital through conventional medical channels and had similar basic conditions such as age,gender,region and medical insurance type as the conventional referral group.The differences in disease severity,referral time,hospitalization cost and other indicators were compared using t-test,χ^(2)test and nonparametric test between the two groups,and the satisfaction of the GRC referral group was investigated.Results The proportion of patients with heart function gradeⅢ(NYHA grading),heart failure,atrial fibrillation and interventional therapy in the GRC referral group was significantly higher than conventional referral group(all P<0.05).The total referral time and bed waiting time of patients in the GRC referral group were significantly shorter than conventional referral group[14.16(9.62,25.61)vs 34.39(28.51,49.68)h,2.13(0.83,6.64)vs 24.58(20.27,27.68)h](Z=8.465,9.172,all P<0.001).The hospitalization cost,surgical treatment cost and material cost in GRC referral group were significantly higher than conventional referral group[24755(11559,56521)vs 14700(9375,29534)CNY,6013(2096,8256)vs 2562(2044,6154)CNY,12093(1267,35689)vs 1329(826,16125)CNY](Z=2.814,2.917,3.353,all P<0.05),and the diagnosis cost was significantly lower than conventional referral group[4878(3628,6847)vs 5719(4228,7639)CNY](Z=2.323,P<0.05).In the GRC referral group,the satisfaction rates with referral process,visit time and patient experience were all above 90%.Conclusion Two-w

关 键 词：冠心病 远程医疗 转诊 效果 

分 类 号：R541.4[医药卫生—心血管疾病]