汪鑫,王东,徐珑,等.基于国际功能、残疾和健康分类康复组合综合体系评价长沙市医保功能相关分类模式在脑梗死恢复期患者中的应用效果[J].中华物理医学与康复杂志,2025,47(11):1022-1028
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| 基于国际功能、残疾和健康分类康复组合综合体系评价长沙市医保功能相关分类模式在脑梗死恢复期患者中的应用效果 |
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| DOI：10.3760/cma.j.cn421666-20250324-00256 |
| 中文关键词: 国际功能、残疾和健康分类 康复组合 医保支付模式 功能相关分类 脑梗死 恢复期 |
| 英文关键词: International Classification of Functioning, Disability and Health Medical insurance payment models Function-related groups Brain infarction Convalescence |
| 基金项目:湖南省自然科学基金资助项目（2024JJ9123,2025JJ90310） |
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| 中文摘要: |
| 目的 基于国际功能、残疾和健康分类康复组合（ICF-RS）综合体系评价长沙市医保功能相关分类（FRG）模式在脑梗死恢复期患者中的应用效果。 方法 选取2022年6月至2023年5月于湘雅博爱康复医院就诊的脑梗死恢复期患者90例。根据患者的功能情况给予相应干预，包括临床治疗、康复治疗、中医治疗、康复护理。入院3 d内和出院时，对患者进行基于ICF-RS的综合体系（脑梗死综合评估量表）评估，内容包括ICF-RS、改良Ashworth量表（MAS）、Fugl-Meyer量表（FMA）、简易精神状态量表（MMSE）、波士顿诊断性失语症检查（BDAE）。 结果 ICF-RS综合体系评估结果显示，脑梗死患者治疗后除b280（痛觉）及x005（MAS）外，其余19项ICF专项评分、3项量表（FMA、MMSE、BDAE）评分、ICF-RS专项总分及脑梗死综合评估量表总分均较治疗前显著改善（P＜0.05），功能严重程度分级亦较治疗前明显改善（P＜0.05）。频数法评估结果显示，脑梗死患者治疗后共有13个ICF-RS类目的治疗效果优于治疗前，FMA上肢评分、FMA下肢评分、FMA总分及MMSE评分较治疗前改善（P＜0.05），治疗前、后的MAS评分及BDAE分级比较，差异无统计学意义（P＞0.05）。 结论 在长沙市医保FRG模式下，利用基于ICF-RS的综合评估体系可以较好地评价脑梗死恢复期患者的康复疗效。 |
| 英文摘要: |
| Objective To evaluate the effect of applying function-related grouping model of Changsha medical insurance for patients convalescing from a cerebral infarction using the International Classification of Functioning, Disability and Health′s rehabilitation set (ICF-RS). Methods Ninety cerebral infarction patients in convalescence were treated according to their functional status, including clinical treatment, rehabilitation, traditional Chinese medicine treatment, and rehabilitation nursing. Within 3 days after admission and at the time of discharge, they were evaluated using a comprehensive assessment system for cerebral infarction based on the ICF-RS. The modified Ashworth scale (MAS), Fugl-Meyer assessment (FMA), the mini-mental state examination (MMSE) and the Boston diagnostic aphasia examination (BDAE) were also employed. Results With the exception of ICF-RS item b280 (pain perception) and item x005 of the MAS, all of the remaining assessments indicated significant enhancements compared to the pre-treatment levels. Functional severity grading also improved significantly after the treatment. Thirteen of the ICF-RS categories indicated more favorable therapeutic outcomes after the treatment. That was accompanied by improvements in the FMA upper limb, lower limb and total scores, and in the MMSE scores. However, no significant disparity was detected in the MAS scores or the BDAE grades before and after treatment. Conclusions The comprehensive evaluation system based on the ICF-RS effectively evaluates the effectiveness of rehabilitation after cerebral infarction in a way suitable for medical insurance purposes. |
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