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目的分析住院、门诊、社区卫生服务3种不同的医疗服务模式对慢性病防治的成本鄄效果,寻求一种较为理想的医学防治模式。方法采用等比例、分层、随机抽样方法,抽取2002年11月-2003年11月6所医院212例冠心病、糖尿病、慢性阻塞性肺病3种常见慢性病患者,其中住院病例68例、门诊病例74例、社区卫生服务病例70例。采用患者自填式问卷调查并结合个案访问、查阅病历等方法,运用卫生经济学的成本鄄效果分析方法进行统计分析、评价。结果住院组、门诊组、社区服务组平均每例患者1年所花费用分别为9997元、6939元、7128元;质量评估得分率分别为78.39%,58.23%,83.03%;成本鄄效果比值(C/E差别有统计学意义)分别为127.53,119.17,85.85;增量成本鄄效果比值穴△C/△E雪为131.55,123.14,83.91。社区卫生服务组平均每例患者1年所花费用与住院组比较,差别有统计学意义穴P<0.05雪,与门诊组比较,差别无统计学意义穴P>0.05雪;质量评估得分率与住院组比较,差别无统计学意义穴P>0.05雪,与门诊组比较,差别有统计学意义穴P<0.05雪,C/E和△C/△E比值与住院及门诊组比较,差别有统计学意义穴P<0.05、P<0.01雪,敏感度分析,C/E和△C/△E比值与住院及门诊组比较,差别有统计学意义穴P<0.01雪。结论社区卫生服务在防治慢性病方面具有显著的社会、经济效益,是一种较理想的慢性病防治医疗服务模式。
Objective To analyze the cost-effectiveness of three different medical service models for inpatients, outpatients, and community health services for the prevention and treatment of chronic diseases, and to find a more ideal medical control model. Methods A total of 212 patients with coronary heart disease, diabetes mellitus and chronic obstructive pulmonary disease were selected from six hospitals from November 2002 to November 2003 using equal proportion, stratification, and random sampling methods. Among them, 68 patients were hospitalized and outpatient cases. 74 cases and 70 cases of community health services. Using patient self-administered questionnaire surveys, combined with case visits, medical records, and other methods, the statistical analysis and evaluation were conducted using the cost-effectiveness analysis method of health economics. Results The cost per patient in the hospitalized, outpatient, and community service groups was 1,999 yuan, 6,939 yuan, and 7,128 yuan, respectively. The quality assessment scores were 78.39%, 58.23%, and 83.03%, respectively; the cost-effectiveness ratio ( The C/E difference was statistically significant. They were 127.53, 119.17, and 85.85, respectively; the incremental cost/effectiveness ratios were △C/△E, and the snow was 131.55, 123.14, and 83.91. The average cost per patient in the community health service group was 1 year compared with that of the hospitalized group. The difference was statistically significant (P<0.05 snow). Compared with the outpatient group, the difference was not statistically significant (point P>0.05 snow; quality assessment score was Compared with the hospitalized group, the difference was not statistically significant. Point P>0.05 snow, compared with the outpatient group, the difference was statistically significant. Point P<0.05 snow, C/E and △C/△E ratios were compared with the inpatient and outpatient groups. Statistical significance Point P<0.05, P<0.01 snow, sensitivity analysis, C/E and △C/△E ratios compared with hospital and outpatient groups, the difference was statistically significant with P<0.01 snow. Conclusion The community health service has significant social and economic benefits in the prevention and treatment of chronic diseases. It is an ideal model for the prevention and treatment of chronic diseases.