Zhou Zhuo-Yi, Du Ze, Liao Xia, Shi Xiao-Jun, Wang Hao-Yang, Ning Ning, Zeng Wei-Nan
School of Experimental Art, Sichuan Conservatory of Music, Chengdu 610021, China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 Sep;53(5):916-921. doi: 10.12182/20220960208.
To investigate the effect of whole-process case management based on service process design on patients undergoing total knee arthroplasty (TKA) in areas including pain, function, satisfaction, and complications.
A total of 204 patients who underwent unilateral TKA between April 2021 and March 2022 at the Department of Orthopedics, West China Hospital, Sichuan University were enrolled. By using a random number table, the patients were randomly assigned to two groups, 102 in the general case management group (group G) and 102 in the whole-process case management group (group W). Patients in group G received traditional perioperative case management, while those in the whole-process case management group received integrated case management optimized on the basis of the service process design. The two groups of patients were studied through comparison of their general data, Visual Analogue Scale (VAS) pain score, knee flexion and range of motion, Hospital for Special Surgery (HSS) knee score, the 18-item Patient Satisfaction Questionnaire Short Form (PSQ-18), ability to climb stairs, and complications at 3 days and 3, 8, and 12 weeks after TKA.
There was no significant difference between the two groups in patient general information or baseline data collected at the time of enrollment ( >0.05). There was no significant difference in HSS score, joint range of motion, and VAS pain score between the two groups before the surgery and 3 days after the surgery ( >0.05). However, the HSS score, joint range of motion, and VAS pain scores of group W were significantly superior to those of group G at 3, 8 and 12 weeks after the surgery (all <0.05). In addition, group W demonstrated significantly better ability to climb up and down stairs than that of group G at 12 weeks after the surgery ( < 0.001). In terms of satisfaction, patients in group W were significantly more satisfied than those in group G at 3 days, and 3, 8, and 12 weeks after the surgery ( <0.001).
Whole-process case management based on service process design has a positive effect of relieving pain, increasing range of motion, improving function, increasing satisfaction, and reducing complications in patients undergoing TKA.
探讨基于服务流程设计的全程个案管理对全膝关节置换术（TKA）患者在疼痛、功能、满意度及并发症等方面的影响。
选取2021年4月至2022年3月在四川大学华西医院骨科行单侧TKA的204例患者。采用随机数字表法将患者随机分为两组，一般个案管理组（G组）102例，全程个案管理组（W组）102例。G组患者接受传统围手术期个案管理，而全程个案管理组患者接受基于服务流程设计优化的综合个案管理。通过比较两组患者的一般资料、视觉模拟评分法（VAS）疼痛评分、膝关节屈曲度及活动范围、特殊外科医院（HSS）膝关节评分、18项患者满意度问卷简表（PSQ-18）、爬楼梯能力以及TKA术后3天、3周、8周和12周时的并发症情况对两组患者进行研究。
两组患者的一般信息或入组时收集的基线数据无显著差异（>0.05）。两组患者术前及术后3天的HSS评分、关节活动范围及VAS疼痛评分无显著差异（>0.05）。然而，术后3周、8周和12周时，W组的HSS评分、关节活动范围及VAS疼痛评分均显著优于G组（均<0.05）。此外，术后12周时，W组患者上下楼梯的能力明显优于G组（<0.001）。在满意度方面，术后3天、3周、8周和12周时，W组患者的满意度明显高于G组（<0.001）。
基于服务流程设计的全程个案管理对TKA患者具有缓解疼痛、增加活动范围、改善功能、提高满意度及减少并发症的积极作用。
