【摘要】 目的对北京市社区糖尿病研究项目中三级甲等医院—社区糖尿病患者管理效果指标开展分析研究,以期探讨其管理方式是否有效可行,为社区病种管理提供借鉴。方法选择样本社区2 269例2型糖尿病患者,根据2011—2017年的干预效果指标记录,以血糖、血脂和血压的达标情况为效果指标标准,将研究对象分为完全达标组、一般达标组和不达标组3组。对3组患者各年度的效果指标、并发症发生率以及因并发症产生的住院费用进行测算分析。结果随着干预时间的延长,完全达标组和一般达标组的3类检测指标达标比例从2008年的21.34%和15.29%分别提高至2017年的73.44%和24.26%,3类指标均合格的情况从2008年的12.83%增长至2017年的28.27%。伴随干预时间的延长,糖尿病患者各年度心脑肾并发症发生率在增加,但增速有所控制。各年度并发症花费的总医疗费用呈增长趋势,但相对于不达标组,完全达标组和一般达标组各年份因并发症产生的住院费用相对较少。结论三级甲等医院—社区糖尿病患者管理模式有利于减缓糖尿病患者相关并发症的发生,并可节省因并发症产生的住院费用。更多还原

【Abstract】 Objective To analyze the outcome indicators of a class A tertiary hospital-community hospital management model for diabetic patients involved in the Beijing Community Diabetes Research Project, in order to explore its effectiveness and feasibility and to provide reference for the community-based disease management. Methods A total of 2269 patients with type 2 diabetes from the sample community were selected. According to the intervention effect records in terms of blood glucose, blood lipid and blood pressure from 2011 to 2017, the study subjects were divided into three groups: fully-compliant group, generally-compliant group and incompliant group. The outcome indicators, complication rate, and hospitalization expenses due to complications in the three groups were calculated and analyzed annually. Results With the extension of the intervention time, the proportions of the patients with three normal outcome indicators in the fully-compliant group and the generally-compliant group increased from 21.34% and 15.29% in 2008 to 73.44% and 24.26% in 2017, respectively. The proportions of patients whose three indicators were all normal rose from 12.83% in 2008 to 28.27% in 2017. The annual incidence of newly-onset heart, brain and kidney complications in diabetic patients increased, but the increasing rate had been controlled. The total medical expenses for treating complications in each year showed an increasing trend. However, compared with the incompliant group, the hospitalization expenses incurred by complications in the fully-compliant group and the generally-compliant group were lower. Conclusion The class A tertiary hospital-community hospital management model for diabetic patients decreases the occurrence of complications and hospitalization expenses due to complications.更多还原