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目的探索医院与社区联合,对慢性心力衰竭患者进行院外规范化管理干预的有效途径和方式。方法选择出院的心力衰竭患者1 894例,随机分为3组:医院社区联合组630例,其中男352例,女278例,平均年龄(69.39±12.46)岁;医院对社区全科医师进行心力衰竭诊疗技能及规范化管理知识的培训,医院与社区共同制定心力衰竭患者的干预方案,社区全科医师对心力衰竭患者进行防治管理。医院组631例,其中男359例,女272例,平均年龄(68.51±12.15)岁;由专科医师对心力衰竭患者进行院外随访干预。社区组633例,其中男356例,女277例,平均年龄(68.50±12.51)岁;不开展对社区全科医师的培训,由社区医师对心力衰竭患者进行随访。所有病例平均随访(12.0±1.6)个月。结果医院社区联合组、医院组患者的一级终点事件总病死率、心血管病死率、心力衰竭再住院率、心力衰竭急诊率较社区组分别下降17.53%、15.71%、19.11%、18.15%,差异均有统计学意义(均P<0.05);二级终点事件患者的心功能级别、左心室射血分数(LVEF)、依从性、生活质量均明显高于社区组,心力衰竭恶化率较社区组下降15.59%(均P<0.05);平均住院日较社区组减少4.56d(P<0.05);社区全科医师的心力衰竭诊治及管理水平明显提高。结论通过医院与社区联合对院外心力衰竭患者进行规范化管理干预,提高社区全科医师的心力衰竭诊治及管理水平,可显著降低心力衰竭患者的病死率、再次住院率、心力衰竭急诊率,改善患者的心功能、依从性、生活质量及预后,降低医疗费用。
Objective To explore an effective way and method for hospitals and communities to intervene in standardized management of patients with chronic heart failure. Methods A total of 1 894 discharged patients with heart failure were randomly divided into 3 groups: 630 patients in the hospital community combined group, including 352 males and 278 females, with an average age of 69.39 ± 12.46 years; Failure diagnosis and treatment skills and standardized management knowledge training, hospitals and communities together to develop intervention programs for patients with heart failure, community GPs in patients with heart failure prevention and management. The hospital group of 631 cases, including 359 males and 272 females, the average age (68.51 ± 12.15) years of age; by specialist physicians for heart failure patients were hospitalized for follow-up intervention. Community-based 633 patients, 356 males and 277 females, with an average age of (68.50 ± 12.51) years of age; no community-based general practitioner training, community physicians were followed up for patients with heart failure. All cases were followed up for an average of (12.0 ± 1.6) months. Results The first case fatality rate, cardiovascular mortality rate, heart failure rehospitalization rate and heart failure emergency rate in the hospital community combined group and hospital group were 17.53%, 15.71%, 19.11% and 18.15% lower than those in the community group, respectively. (P <0.05). The level of heart function, left ventricular ejection fraction (LVEF), compliance and quality of life in the secondary end point patients were significantly higher than those in the community group. The worsening rate of heart failure was higher than that in the community (P <0.05). The average length of hospital stay was 4.56 days less than that of the community-based group (P <0.05). The diagnosis and management of community-based physicians in heart failure were significantly improved. Conclusions Through hospital and community joint standardized management intervention for patients with heart failure outside the hospital to improve community GP diagnosis and management of heart failure can significantly reduce the mortality in patients with heart failure, re-hospitalization rate, heart failure emergency rate, improve the patient Heart function, compliance, quality of life and prognosis, lower medical costs.