医联体医院专科与社区全科合作对糖尿病管理的效果与费用研究

目的：评估医联体中的医院专科和社区全科合作开展糖尿病管理的临床效果以及费用情况，为建立更为有效的社区慢性疾病管理模式提供科学依据。方法：糖尿病患者415名，随机分成联合管理组和对照组。研究空腹血糖、餐后2h血糖、糖化血红蛋白、血压等指标在管理1年前后的变化。采用成本效果分析中的倍差法（difference-in-difference），以糖化血红蛋白为评估的关键指标，计算成本效果。结果：观察12个月时，联合管理组的空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压和舒张压较干预前明显下降（P〈0．05）。联合管理组和对照组社区每年每例糖尿病患者的管理成本分别是412．14元和491．34元。结论：在医联体工作框架下，医院专科与社区全科联合管理糖尿病的做法具有较好的成本效果，可为其它慢性病管理所借鉴。

Clinical effect and cost of diabetes control through hospital and community cooperation in hospital group service model

Objective： To evaluate clinical effect and cost of patients with diabetes, who were served by GPs- SPs cooperation model in a hospital group and to find right evidences for community-level chronic disease management in China. Methods： A total of 415 diabetes patients were divided into joint management and control groups. Fasting glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, blood pressure and other indicators of diabetes management were collected before and after the one-year intervention. The difference-in-difference model was used to evaluate the cost-effectiveness of the intervention. Results： Average fasting glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, systolic and diastolic blood pressure decreased significantly in the joint management group over the twelve-month intervention period （ P〈0.05 ）. The costs of management of diabetes patients were 412.14 yuan and 491.34 yuan respectively for the joint management and control groups. Conclusion： Under the service system of hospital group, the model of GPs-SPs cooperation has good cost-effectiveness in diabetes control, and it is a good sample for other chronic diseases.