目的 探讨神经内科专科护理敏感指标体系的建立意义及在护理质量控制方面的应用效果.方法 2018年8月成立神经内科专科敏感指标研究小组,通过文献法、小组头脑风暴法、3轮德尔菲专家咨询确立神经内科专科护理敏感指标体系,并将其应用于临床,观察2019年神经内科1330例患者专科敏感指标的达标率和对质量控制的影响.结果 通过对比2019年神经内科专科护理敏感指标四个季度的结果,组间比较可见吞咽功能评估正确率和良肢位摆放正确率第一季度与第三季度有统计学差异(P<0.05,P<0.05),第一季度与第四季度统计学差异明显(P<0.01,P<0.01);吞咽功能障碍患者误吸发生率第一季度与第三季度,第一季与第四季均有统计学差异(P<0.05,P<0.05);非计划拔管发生率第一季度与第四季度有统计学差异(P<0.05);跌倒/坠床发生率之间没有统计学差异.结论 护理敏感指标体系为护理质量管理效果评价提供了科学依据,对神经内科专科护理质量管理有积极的促进作用.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

Population Health ManagementVol. 21, No. 3 Letter to the EditorCost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, ChinaZhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie SuZhongqin WanSearch for more papers by this author, Chaoyun LiSearch for more papers by this author, Faqing LongSearch for more papers by this author, Yuhui ZhangSearch for more papers by this author, Bufei WangSearch for more papers by this author, Yingman WuSearch for more papers by this author, Mingming DaiSearch for more papers by this author, Desheng WangSearch for more papers by this author, Bin ChenSearch for more papers by this author, Yangyang DuanSearch for more papers by this author, and Qingjie SuSearch for more papers by this authorPublished Online:1 Jun 2018https://doi.org/10.1089/pop.2017.0205AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China." Population Health Management, 21(3), pp. 253–254FiguresReferencesRelatedDetailsCited byReview of cost-effectiveness of antithrombotic alternatives in patients with atrial fibrillation1 July 2021 | Revista da Associação Médica Brasileira, Vol. 67, No. 7 Volume 21Issue 3Jun 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Zhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie Su.Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China.Population Health Management.Jun 2018.253-254.http://doi.org/10.1089/pop.2017.0205Published in Volume: 21 Issue 3: June 1, 2018Online Ahead of Print:March 12, 2018PDF download

Objective To explore the effect of mobile phone-based health education on independent living ability of postoperative patients with hypertensive intracerebral hemorrhage. Methods Sixty patients with postoperative hypertensive intracerebral hemorrhage who underwent craniotomy in our hospital during March 2016 and December 2017 were divided into experimental and control groups, 30 cases in each group, according to the random number table method. Functional training conducted during hospitalization in both groups. After discharge, the control group used a telephone for follow-ups every 2 weeks and took part in a face-to-face training in the first month to implement continuous nursing intervention for a total of 3 months. After discharge, in the experimental group, various information forms of rehabilitation training for hypertensive intracerebral hemorrhage were comprehensively integrated, and mobile phone education was used for a total of 3 months in addition to the training as in the control group. The two groups were compared in terms of independent living ability between the two groups. Result The scores of independent living ability and self-care ability, action ability, metastatic ability, social cognitive ability and communication ability of the experimental group were significantly higher than those of the control group (P＜0.05). Conclusion The mobile phone-based education can promote the effect of rehabilitation exercise in patients with hypertensive intracerebral hemorrhage, so as to promote the independent living ability of patients.

Objective To investigate the improvement of antiplatelet therapy for secondary prevention of ischemic stroke (IS) in Hainan Province.Methods Application of antiplatelet therapy was investigated in 1300 IS patients readmitted to 10 class B or A hospitals of Hainan Province from January 2011 to March 2012.Physicians involved in scientific project of 10 hospitals were trained.Application of antiplatelet therapy in 1279 patients was investigated once more in 2015.The improvement of antiplatelet therapy was analyzed.Results The awareness rate and curative rate of antiplatelet therapy for second prevention of IS were significantly increased in IS patients,accounting for 60.4％ and 49.2％ in 2011,86.5％ and 76.9％ in 2015 (P＜0.01).The low dose/drug withdrawal ratio was significantly decreased,accounting for 20.1 ％ and 5.3 ％ in 2011,2.7 ％and 3.5％ in 2015 (P＜0.05,P＜0.01).The knowledge test score of antiplatelet drugs was significantly increased in neurologists of 10 hospitals,which was 55.6 in 2011 and 78.2 in 2015 (P＜0.01).The difference in antiplatelet therapy for second prevention of IS was disappeared in class B and A hospitals (r=0.092,P=0.405).Conclusion Involvement in scientific project and guideline training can improve antiplatelet therapy for secondary prevention of IS and reduce the gap between hospitals at different levels.

Survivors of ischemic stroke are still at a significant risk for recurrence. Antiplatelet agents are the treatment of first choice for long-term secondary prevention of vascular events. This study aims to assess a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan province, China. In five hospitals from the intervention group, four highly experienced physicians trained 62 neurologists, who in turn trained 613 stroke patients to improve their awareness and adherence to antiplatelet therapy. Physicians and patients of the control group received usual stroke management programs. After one-year follow-up, the proportion of patients who took the antiplatelet therapy increased significantly in the intervention group, reaching 73.2%, with a pre–post difference between two arms of 22.9% ( P < 0.01). There was also a significant net increase in the proportion of patients with awareness of antiplatelet therapy (24.4%, P < 0.01). Multivariate analysis illustrated health promotion program, higher education, annual household income, insurance, and medical status affected antiplatelet drug use in stroke patients. In conclusion, the health promotion program, based on a train-the-trainer approach, showed positive effects on awareness of and adherence to antiplatelet therapy, which has the potential to be scaled up to other resource-limited areas.

Survivors of ischemic stroke are still at a significant risk for recurrence. Numerous effective strategies for the secondary prevention of ischemic stroke have now been established; however, these guidelines are not widely known. In this retrospective, a multicenter study was conducted from January 2011 to February 2012 in 10 general hospitals, which included 1300 elderly patients who had previously been diagnosed with ischemic stroke and re-admitted to hospitals. Logistic regression models were fitted to determine the relationship between compliance with secondary prevention therapy and each variable of interest. The treatment rates of antihypertensive, antiplatelet and lipid-lowering therapy were only 56.3%, 48.9% and 19.6%, respectively. Multivariate analysis presented that cardiovascular risk factors would motivate patients with hypertension and hyperlipidemia to receive corresponding treatments. However, it is worth noting that they did not influence the use of antiplatelet therapy. In addition, high education, health education and insurance promote the use of secondary prevention in patients. In conclusion, the importance of antiplatelet therapy should not be ignored any more. Besides, health education will raise patients' attention to ischemic stroke.

Objective To investigate the antiplatelet drug therapy for secondary prevention of cerebral ischemic stroke and its influence factors.Methods A total of 1300cerebral ischemic stroke patients readmitted to 10general hospitals in Hainan Province were included in this study.Drugs used in their antiplatelet therapy were investigated and analyzed by univariate and multivariate logistic regression analysis.Results The aware rate and curative rate of antiplatelet therapy were 60.4%and 49.2%,respectively,in the patients.Multivariate logistic regression analysis showed that education level,medical insurance and health education were the independent factors for antiplatelet therapy for the secondary prevention of cerebral ischemic stroke.Conclusion Antiplatelet therapy for the secondary prevention of cerebral ischemic stroke is not optimistic.Clinicians need to improve their understanding of cerebral ischemic stroke and strengthen their health education in order to improve their aware and curative rate of antiplatelet therapy.