上海市老年医疗护理机构脑卒中康复现状调查

目的了解目前上海市老年医疗护理机构脑卒中康复资源现状,以期为脑卒中单病种护理质量控制提供指导。方法 2016年3月,整群抽取上海市老年护理管理质量控制中心督查范畴的老年护理院、社区卫生服务中心以及设置老年护理床位的区县综合医院等68所医疗机构为研究对象。采用问卷调查法调查其2015年收治脑卒中及卒中后遗症患者人数、平均住院天数、平均床日费用、医疗保险报销比例、各年龄段老年患者比例、康复开展状况等。结果上海市老年医疗护理机构康复护理设施配置完善程度不一,72.1%的机构单独设置康复科;康复护理人力以初级职称人员为主,占70.37%,各机构人员配置差异较大。脑卒中/卒中后遗症患者呈高龄化趋势,80岁以上患者占55.39%,且女性多于男性;医疗保险可报销比例为18%~100%;各机构平均床日费用及平均住院天数差别较大。结论目前上海市老年医疗护理机构康复资源较为薄弱,分布不均;需强化康复医护人员队伍建设,探索脑卒中单病种医疗付费和医疗保险模式;发展脑卒中家庭康复,提供延续性医疗护理服务。

Investigation of the Recurrent Status of Rehabilitation Resources of Geriatric Care Institutions in Shanghai

Objective To investigate the recurrent status of rehabilitation resources of geriatric care insti-tutions in Shanghai,in order to provide guidance for stroke nursing quality control.Methods By using questionnaire to investigate 68 institutions including nursing homes,community health centers and com-prehensive hospitals that had geriatric care beds.All these institutions were in the supervision of Shanghai Elderly Control Management Quality Control Center.The content of the questionnaire including stroke patients'quantity in 2015,average hospitalization days,average bad day fee,medical insurance coverage, age stratification,rehabilitation status,et al.Results Rehabilitation facilities differ from each institution, with 72.1% institutions had independent rehabilitation department.Rehabilitation medical staff were mainly primarytitle,which took a proportion of 70.37%.There were more female patients than male patients,and the stroke patients showed a trend of aging with 55.39% patients over 80 years old.The coverage of medical insurance differ from 18% to 100%.The average hospitalization days and average bad day fee were also very different.Conclusions The rehabilitation resources in Shanghai geriatric care institutions is insuffi-cient,we need to strengthen rehabilitation medical staff's training,and explore payment model and medi-cal insurance of stroke single disease.We also can develop stroke home care to provide continuing care for geriatric stroke patients.