万州区3~36个月发育预警征阳性儿童“医家结合”早期干预模式的构建与实践效果评价——基于随机对照试验的区县级实践研究

Construction and Practical Effect Evaluation of “Medical-Family” Combined Early Intervention Model for Children Aged 3~36 Months with Positive Developmental Warning Signs in Wanzhou District—A County-Level Practice Study Based on Randomized Controlled Trial

摘要: 目的：构建适用于区县级地区的“医家结合”早期干预模式，并验证其对3~36个月发育预警征阳性儿童的发展促进效果。方法：基于《国际功能、残疾和健康分类(儿童青少年版)》(ICF-CY)理论框架，构建“机构端–家庭端–协同平台”三模块模式，并在万州区开展实践。共纳入178例儿童，随机分为家庭干预组(33例)、医疗机构干预组(80例)、医家结合干预组(65例)，干预时长12个月，每3个月采用盖塞尔发育量表(GESELL)复评。结果：医家结合组儿童发育商(DQ)提升最显著(P < 0.001)，DQ增长值(15.2 ± 3.1)显著高于医疗机构组(10.1 ± 2.8)及家庭组(6.3 ± 2.5)；医家结合组家长依从率达85%，90%的家长能正确演示3种以上家庭训练方法。结论：“医家结合”模式在区县级地区有效、可行，具备推广潜力，为基层儿童保健系统整合早期干预提供了实践范本。

Abstract: Objective: To construct a “medical-family” combined early intervention model suitable for county-level regions and verify its effectiveness in promoting the development of children aged 3~36 months with positive developmental warning signs. Methods: Based on the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework, we constructed a three-module model (institution-end, family-end, collaborative platform) and implemented it in Wanzhou District. A total of 178 children were enrolled and randomly divided into three groups: family intervention (33 cases), medical institution intervention (80 cases), and medical-family combined intervention (65 cases). The intervention lasted 12 months, with follow-up assessments every 3 months using the Gesell Developmental Schedules (GESELL). Results: The medical-family combined group showed the most significant improvement in developmental quotient (DQ) (P < 0.001), with the DQ increase (15.2 ± 3.1) significantly higher than the medical institution group (10.1 ± 2.8) and family group (6.3 ± 2.5). Parental compliance rate in the combined group reached 85%, and 90% of parents could correctly demonstrate 3 or more home training methods. Conclusion: The “medical-family” combined model is effective, feasible, and has promotion potential in county-level regions, providing a practical paradigm for integrating early intervention into primary child health care systems.