基于区域医联体心衰专科联盟临床同质化管理的回顾性分析

Retrospective Analysis of Clinical Homogeneity Management Based on Regional Medical Association of Heart Failure Specialist Alliance

摘要: 目的：评估区域医联体内心衰专科联盟临床同质化管理运行两年来的成效。方法：回顾性分析专科联盟成立前后(2020年 vs 2022年)各成员单位的总体业务量，以某家下层单位为例，对比分析该单位总体业务水平，然后根据心衰住院患者人数(n = 312 vs n = 437)分析其远程会诊人次、上转人次、次均住院天数、次均住院费用、药占比和患者满意度。结果：与2020年相比，2022年各级医院的门诊人次、住院人次、双向转诊量明显增加；下沉单位的总体门诊人次、住院人次分别增长21.98%和34.04%、双向转诊增长约40%。比较两年的心衰住院患者数据，与2020年相比，2022年该单位心衰住院患者的远程会诊增长率达66.67%，上转人次占比下降11.85%。此外，专科联盟成立后，心衰患者次均住院天数和药占比显著下降(均P < 0.05)，次均住院费用明显减少(P < 0.05)；患者就医满意度明显增加(P < 0.05)。结论：区域医联体心衰专科联盟临床同质化管理取得初步成效，继续加强优势资源下沉，吸收更多医疗单位致力于为患者提供更多医疗保障。

Abstract: Objective: To evaluate the effect of clinical homogenization management in the heart failure spe-cialist alliance in the regional medical union in the past two years. Methods: The overall business volume of each member unit before and after the establishment of the specialist alliance (2020 vs 2022) was retrospectively analyzed. Taking a lower-level unit as an example, the overall business level of the unit was compared and analyzed. Then, according to the number of patients with heart failure (n = 312 vs n = 437), the number of remote consultations, the number of referrals, the aver-age length of hospitalization, the average hospitalization cost, the proportion of drugs and the satis-faction of patients were analyzed. Results: Compared with 2020, the number of outpatient visits, inpatient visits and two-way referrals of hospitals at all levels increased significantly in 2022. The total outpatient and inpatient visits of sinking units increased by 21.98% and 34.04% respectively, and two-way referral increased by about 40%. Comparing the data of inpatients with heart failure in two years, compared with 2020, the remote consultation of inpatients with heart failure in the unit in 2022 was increased by 66.67%, and the proportion of up-transfer patients decreased by 11.85%. In addition, after the establishment of the specialized alliance, the average hospitalization days and drug proportion of patients with heart failure decreased significantly (both P < 0.05), and the average hospitalization cost decreased significantly (P < 0.05). The satisfaction of patients with medical treatment was significantly increased (P < 0.05). Conclusion: The clinical homogenization management of the heart failure specialist alliance has achieved initial results, continued to strengthen the sinking of superior resources, and absorbed more medical units to provide more medical security for patients.