许秀,江潭耀,燕铁斌,等.基于国家标准的ICF-RS评估神经内科和康复科脑卒中住院患者康复结局和医疗支出[J].中华物理医学与康复杂志,2025,47(9):847-852
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| 基于国家标准的ICF-RS评估神经内科和康复科脑卒中住院患者康复结局和医疗支出 |
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| DOI：10.3760/cma.j.cn421666-20240929-00804 |
| 中文关键词: 功能、残疾、健康分类的康复组合评定 脑卒中 神经内科 康复科 医疗构成 |
| 英文关键词: International Classification of Functioning, Disability and Health, Rehabilitation Set Stroke Neurology departments Rehabilitation departments Medical composition |
| 基金项目:国家自然科学基金面上项目（82272614）；广州市科技计划项目市校（院）联合资助项目（202201020079） |
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| 中文摘要: |
| 目的 采用国家标准的功能、残疾、健康分类的康复组合评定（ICF-RS）评估神经内科和康复科脑卒中患者康复治疗前、后的疗效及其医疗构成占比。 方法 采用ICF-RS（30条）分别对神经内科和康复科脑卒中住院患者康复治疗前、后的功能状态进行评估，然后分别以评估者的临床经验（评估者评价）和ICF-RS APP中的智能评估模型（APP智能评价）对每例患者的功能等级（正常、轻度、中度、重度功能障碍）进行评估，并从医院病例系统中导出其住院期间的医疗支出数据。采用秩和检验比较患者康复治疗前、后的功能变化，并采用Kappa系数评价APP智能评价与评估者评价患者功能等级的一致性。 结果 康复治疗前，神经内科和康复科患者ICF-RS的30条类目均存在异常，康复治疗后，神经内科患者25条有显著改善，康复科患者8条有显著改善(P＜0.05)。康复治疗后，神经内科和康复科脑卒中患者人均功能改善分别为25%和13%，功能每改善1%的支出分别为977元和1481元，其中日均康复治疗支出分别为143元和862元，康复治疗支出占总支出分别为14%和58%。采用APP智能评价与评估者评价患者功能等级的Kappa一致性系数，在整体功能上均>0.8。 结论 国标ICF-RS可作为神经内科早期和康复科恢复期脑卒中患者的功能变化、康复疗效和医疗支出构成比的评估工具；在功能等级评价上，APP模型与评估者之间的一致性良好。 |
| 英文摘要: |
| Objective To evaluate the outcomes of stroke treatment in neurology and rehabilitation departments using the International Classification of Functioning, Disability and Health′s Rehabilitation Set (ICF-RS). Method The functional status of stroke survivors before and after treatment in the neurology and rehabilitation departments was evaluated using the ICF-RS (30 items). Each patient′s functioning was graded (normal, mild, moderate or severe dysfunction) by an experienced clinical evaluator and also by the intelligent evaluation model in the ICF-RS app. Medical expenditure data during hospitalization were extracted from the hospital′s case records. Rank sum tests compared the functional changes in a patient before and after their rehabilitation. Kappa coefficients were computed to evaluate the consistency of the functional grades assigned by the evaluators and the app. Results Before the rehabilitation treatment, all 30 items of the ICF-RS were abnormal for all of the patients from the neurology and rehabilitation departments. After their rehabilitation treatment, 25 items had improved significantly for the neurology patients and 8 had improved significantly for those from the rehabilitation department. After their rehabilitation treatment, the average functional improvement among the neurology patients was 25%. For the rehabilitation patients it was 13%. The total expenditure for every 1% improvement in function was Y977 for the neurology patients (including Y143 for rehabilitation) and Y1,481 for the rehabilitation patients (including Y862 of actual rehabilitation). The proportions of rehabilitation expenditure were thus 14% and 58% respectively. The kappa coefficients quantifying overall consistency were both greater than 0.8. Conclusion The national standard ICF-RS can be used to evaluate functional changes, rehabilitation efficacy and the composition of stroke patients′ medical expenditures in the early stage of neurology and the recovery period in the rehabilitation department. The consistency of the functional level evaluations between the app and human evaluators is good. |
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