区域医疗中心与基层医疗卫生机构联合管理模式对急性脑梗死患者诊治时间的影响
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摘要
目的研究区域医疗中心与基层医疗卫生机构联合管理模式是否能明显缩短农村及乡镇地区急性脑梗死患者的诊治时间。方法区域医疗中心与基层医疗卫生机构设立专门管理小组,建立联合管理模式,小组中的专门人员针对农村及乡镇地区急性脑梗死患者(观察组,n=200)的就诊、转诊、检查及治疗等全部诊治过程进行管理和指导,记录转诊时间、候诊时间、从发病到神经内科专科就诊时间、检查时间、就医时间,并与同期未进行联合管理的急性脑梗死患者(对照组,n=200)所用时间进行比较。结果联合管理的观察组患者转诊时间[(0.47±0.11)小时]、候诊时间[(2.69±0.87)分钟]、就诊时间[(17.07±1.41)小时]、就医时间[(17.31±1.41)小时]和检查时间[(17.01±4.24)分钟]明显低于对照组[分别为(28.12±3.17)小时、(15.37±0.62)分钟、(41.99±3.43)小时、(53.14±3.78)小时和(90.60±4.80)分钟],差异均有显著性(P<0.05)。结论区域医疗中心与基层医疗卫生机构联合管理模式能明显减少农村及乡镇地区脑梗死患者的院前及院内延误时间,是适用于农村及乡镇地区患者可行的急性脑梗死临床管理模式。
Objective To study whether the regional medical center and basic medical institutions combined management model can obviously shorten diagnosis and treatment time of acute cerebral infarction patients in the rural and township areas. Method Regional medical center and basic medical institutions set up a special management team and personnel management mode. Specialized personnel of management team managed and guided acute cerebral infarction patients(n=200) in rural and township areas all diagnosis and treatment process of seeing a doctor, referral, examination and treatment process. The time of referral, waiting to see a doctor,from the onset to the neurology department clinic, inspection and from the onset to arrival at the neurology department to accept the treatment was recorded. The time was compared with no personnel management patients with acute cerebral infarction(n=200) during the same period. Result The time of referral[(0.47±0.11)h], waiting to see a doctor[(2.69±0.87)min], from the onset to the neurology department clinic[(17.07±1.41)h] and from the onset to arrival at the neurology department to accept the treatment [(17.31±1.41)h]in personnel management patients with acute cerebral infarction was significantly lower than the time in no personnel management patients[(28.12±3.17)h,(15.37±0.62)min,(41.99±3.43)h,(53.14±3.78)h)]. The inspection time[(17.01±4.24)min] in personnel management patients with acute cerebral infarction was significantly lower than the time in no personnel management patients[(90.60±4.80)min]. There was significant difference between the two groups of all(P<0.05). Conclusion The regional medical center and basic medical institutions combined management model could obviously shorten pre-hospital and hospital delaying time of acute cerebral infarction patients in the rural and township areas. The clinical management model of acute cerebral infarction is suitable and feasible for the patients in the rural and township areas.
Objective To study whether the regional medical center and basic medical institutions combined management model can obviously shorten diagnosis and treatment time of acute cerebral infarction patients in the rural and township areas. Method Regional medical center and basic medical institutions set up a special management team and personnel management mode. Specialized personnel of management team managed and guided acute cerebral infarction patients(n=200) in rural and township areas all diagnosis and treatment process of seeing a doctor, referral, examination and treatment process. The time of referral, waiting to see a doctor,from the onset to the neurology department clinic, inspection and from the onset to arrival at the neurology department to accept the treatment was recorded. The time was compared with no personnel management patients with acute cerebral infarction(n=200) during the same period. Result The time of referral[(0.47±0.11)h], waiting to see a doctor[(2.69±0.87)min], from the onset to the neurology department clinic[(17.07±1.41)h] and from the onset to arrival at the neurology department to accept the treatment [(17.31±1.41)h]in personnel management patients with acute cerebral infarction was significantly lower than the time in no personnel management patients[(28.12±3.17)h,(15.37±0.62)min,(41.99±3.43)h,(53.14±3.78)h)]. The inspection time[(17.01±4.24)min] in personnel management patients with acute cerebral infarction was significantly lower than the time in no personnel management patients[(90.60±4.80)min]. There was significant difference between the two groups of all(P<0.05). Conclusion The regional medical center and basic medical institutions combined management model could obviously shorten pre-hospital and hospital delaying time of acute cerebral infarction patients in the rural and township areas. The clinical management model of acute cerebral infarction is suitable and feasible for the patients in the rural and township areas.
引文
[1]徐安定,丁燕,李牧.中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略[J].中国卒中杂志,2014,9(6):522-528.
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[7]魏巍,张乐辉,罗艳侠,等.脑卒中医疗资源综合评价方法及其配置研究现状[J].临床荟萃,2012,27(1):88-91.
[8]王振海,谢柳青,赵春梅,等.急性缺血性脑卒中患者院前及院内延迟因素调查研究[J].中国全科医学,2012,8(15):2605-2608.
[9]龙发青,蔡毅,苏庆杰,等.急性缺血性脑卒中就诊时间及其影响因素分析[J].昆明医科大学学报,2013,34(4):94-97.
[10]张雪海,龙发青,周少珑,等.急性缺血性脑卒中就诊时间及其影响因素分析[J].中国实用神经疾病杂志,2014,17(10):80-81.
[11]张万里,王贞,冯靓,等.影响浙江西南部地区静脉溶栓院内延迟时间的相关因素分析[J].中华神经科杂志,2013,46(11):730-734.
[12]胡晓,李玫,翟浩.完善绿色通道及溶栓流程对提高急性缺血性脑卒中静脉溶栓率的临床观察[J].贵州医药,2016,40(7):754-756.
[13]肖春月.急性脑梗死后出血性转化45例临床分析[J].中国临床医生杂志,2015,43(4):50-52.
[14]张广平,刘楠,李慎茂,等.急性脑梗死动脉溶栓治疗的临床观察[J].中国临床医生,2013,41(2):24-25.
[2]宋彦丽,刘改芬,王艳云,等.中国急性脑梗死院前延误影响因素分析[J].中国卒中杂志,2014,9(9):736-742.
[3]曾儒欣,贺湘蛟,张健.某院农村地区延误急性脑梗死溶栓治疗的影响因素分析[J].中国农村卫生事业管理,2016,36(3):394-397.
[4]曲民强.分析农村地区延误急性脑梗死溶栓治疗的相关因素[J].临床医药文献杂志,2016,3(35):6947-6950.
[5]陈荣波,许伟雄,詹俊青,等.脑梗死患者就诊延迟的影响因素分析[J].中国实用神经疾病杂志,2013,16(9):1-3.
[6]曹海燕,卢俏丽,魏常娟,等.急性脑卒中就诊时间及其影响因素分析[J].中华老年心脑血管病杂志,2012,14(8):834-837.
[7]魏巍,张乐辉,罗艳侠,等.脑卒中医疗资源综合评价方法及其配置研究现状[J].临床荟萃,2012,27(1):88-91.
[8]王振海,谢柳青,赵春梅,等.急性缺血性脑卒中患者院前及院内延迟因素调查研究[J].中国全科医学,2012,8(15):2605-2608.
[9]龙发青,蔡毅,苏庆杰,等.急性缺血性脑卒中就诊时间及其影响因素分析[J].昆明医科大学学报,2013,34(4):94-97.
[10]张雪海,龙发青,周少珑,等.急性缺血性脑卒中就诊时间及其影响因素分析[J].中国实用神经疾病杂志,2014,17(10):80-81.
[11]张万里,王贞,冯靓,等.影响浙江西南部地区静脉溶栓院内延迟时间的相关因素分析[J].中华神经科杂志,2013,46(11):730-734.
[12]胡晓,李玫,翟浩.完善绿色通道及溶栓流程对提高急性缺血性脑卒中静脉溶栓率的临床观察[J].贵州医药,2016,40(7):754-756.
[13]肖春月.急性脑梗死后出血性转化45例临床分析[J].中国临床医生杂志,2015,43(4):50-52.
[14]张广平,刘楠,李慎茂,等.急性脑梗死动脉溶栓治疗的临床观察[J].中国临床医生,2013,41(2):24-25.