| 杨伟,王颖,乔艳艳,等.从护理院被照护者疾病分布状况探索医养结合医疗干预模式[J].中国临床保健杂志,2021,24(4):546-550. |
| 从护理院被照护者疾病分布状况探索医养结合医疗干预模式 |
| The study on medical intervention mode in “combining medical care with nursing care” from the distribution of diseases among the patients in nursing homes |
| 投稿时间：2021-05-17 |
| DOI：10.3969/J.issn.1672-6790.2021.04.024 |
| 中文关键词: 老年人公寓 医护疗养所 健康调查 疾病管理 早期医疗干预 |
| 英文关键词: Housing for the elderly Nursing homes Health surveys Disease management Early medical intervention |
| 基金项目:国家社会科学基金项目(18BGL248);陕西省社科界重大理论与现实问题研究项目(2019Z091) |
| 作者 | 单位 | E-mail | | 杨伟 | 西安交通大学第一附属医院,老年内一科,西安 710061 | yang1986007@126.com | | 王颖 | 西安交通大学第一附属医院,涉外病房,西安 710061 | | | 乔艳艳 | 陕西省西安市碑林区康福得护理院 | | | 韩斌 | 陕西省西安市碑林区康福得护理院 | | | 蒋文慧 | 西安交通大学医学部护理系 | | | 张玮 | 西安交通大学第一附属医院,老年内一科,西安 710061 | | | 苏显明 | 西安交通大学第一附属医院,老年内一科,西安 710061 | | | 任延平 | 西安交通大学第一附属医院,老年内一科,西安 710061 | ryp0071@126.com |
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| 中文摘要: |
| 目的 通过分析护理院不同照护阶段被照护者主要疾病分布、营养状态及自理能力,探索医养结合医疗干预模式的实践依据。方法 收集西安某护理院2018年1月至2020年10月,具有完整出院病历及首页信息的被照护者238例,统计疾病种类及住院天数,据被照护者住院天数将患者分为急性期照护组、中期照护组及长期照护组,分析不同组被照护者主要疾病患病率差异；同时对在院127名被照护者使用微型营养评估量表(MNA-SF)及自理能力评估量表(Barthel指数)评估营养状态及自理能力,分析在院被照护者营养及自理能力的差异。结果 被照护女性较男性在痴呆、心脏病患病率高,差异有统计学意义。不同照护阶段,脑卒中、骨折或骨折术后、感染、器官功能不全患病率差异有统计学意义；急性期照护阶段感染性疾病患病率较其他阶段高,中期照护阶段骨折或骨折术后较其他阶段高,而长期照护阶段脑卒中、器官功能不全患病率高,差异有统计学意义。不同性别被照护者营养状态、失能状态差异无统计学意义,失能与营养状态无关联。结论 养老机构应加强营养及自理能力评估与支持,结合被照护者患病特点,划分以“养”或“医”为干预重点的人群进行分类管理,合理有效地分配医疗照护资源；在以护理院为代表的“养中设医”医养结合养老机构,设立“老年专科医师参与的疾病管理模式”可能成为有效提高医疗水平而不增加养老机构运营成本的新医疗干预模式。 |
| 英文摘要: |
| Objective To explore the practical basis of medical intervention mode in “combining medical care and nursing service” by analyzing the distribution of main diseases,nutritional status and self-care ability of the care recipients among different nursing stages in nursing home.Method A total of 238 care recipients with complete discharge medical records and homepage information were enrolled,From January 2018 to October 2020 in a nursing home in the city of Xi′an.Disease diagnosis and length of stay of them were counted.According to the length of stay,the care recipients were divided into acute care group,intermediate care group and long-term care group.The prevalence rate of major diseases among different groups of patients were analyzed.Simultaneously,127 care recipients currently in the nursing home were evaluated by the micro-nutrition assessment scale and the self-care ability assessment scale,in order to evaluate the nutritional status and self-care ability.Result The prevalence rate of dementia and heart diseases in women were higher than that in men in the nursing home.The prevalence rate of stroke,fracture or post-fracture,infection,and organ dysfunction were statistically different among care groups.The prevalence rate of infectious diseases in the acute care stage,fracture or postoperative fracture in the intermediate care stage,stroke and organ dysfunction in the long-term care stage were higher than that in other stages and with statistic significance.Nutritional status and self-care ability between the two genders were no statistic difference.Conclusion The elderly care institutions should strengthen the assessment and support of nutrition and self-care ability,focus on “medical care” or “nursing service” recipients.In the nursing homes represented by “combining medical care with nursing care”,the “disease management mode involving geriatrics specialist training” may become a new medical intervention mode to effectively improve the medical level without increasing the operating cost of the elderly care institutions. |
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