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评估颈椎病手术患者随访护理中多学科随访模式的效率和成本:一项非随机对照研究。

Assessing multidisciplinary follow-up pattern efficiency and cost in follow-up care for patients in cervical spondylosis surgery: a non-randomized controlled study.

作者信息

Fu Zhongmin, Xie Yan, Li Peifang, Gao Menghui, Chen Jiali, Ning Ning

机构信息

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Front Med (Lausanne). 2024 Apr 3;11:1354483. doi: 10.3389/fmed.2024.1354483. eCollection 2024.

Abstract

BACKGROUND

The use of multidisciplinary treatment programs in out-of-hospital healthcare is a new area of research. Little is known about the benefits of this method in the management of discharged patients undergoing cervical spondylosis surgery.

OBJECTIVE

This study aimed to explore the effect of a contracted-based, multidisciplinary follow-up plan in patients after cervical spondylosis surgery.

METHODS

This non-blinded non-randomized controlled study was conducted with 88 patients (44 in the intervention group, 44 in the control group). The clinical outcomes, including Neck Disability Index (NDI), pain score (VAS), Self-Efficacy for Managing Chronic Disease 6-item Scale (SECD-6), and 12-Item Short-Form Health Survey (SF-12) score were assessed at the time of discharge, 24-72 h, 1 month, and 3 months post-discharge. The complications, patient satisfaction, and economic indicators were assessed at the final follow-up (3 months).

RESULTS

Patients who received contracted follow-up showed greater improvement in neck dysfunction at 24-72 h, 1 month, and 3 months after discharge compared to those who received routine follow-up ( < 0.001). At 1 month after discharge, the intervention group exhibited better self-efficacy ( = 0.001) and quality of life ( < 0.001) than the control group, and these improvements lasted for 3 months. The intervention group reported lower pain scores at 24-72 h and 1 month ( = 0.008;  = 0.026) compared to the control group. The incidence of complications was significantly lower in the intervention group (11.4%) compared to the control group (40.9%). The total satisfaction score was significant difference between the two groups ( < 0.001). Additionally, the intervention group had lower direct medical costs ( < 0.001), direct non-medical costs ( = 0.035), and total costs ( = 0.04) compared to the control group. However, there was no statistically significant difference in indirect costs between the two groups ( = 0.59).

CONCLUSION

A multidisciplinary contract follow-up plan has significant advantages regarding neck disability, self-efficacy, quality of life, postoperative complications, patient satisfaction, and direct costs compared with routine follow-up.

摘要

背景

在院外医疗保健中使用多学科治疗方案是一个新的研究领域。对于这种方法在颈椎病手术后出院患者管理中的益处知之甚少。

目的

本研究旨在探讨基于合同制的多学科随访计划对颈椎病手术后患者的影响。

方法

本非盲非随机对照研究纳入了88例患者(干预组44例,对照组44例)。在出院时、出院后24 - 72小时、1个月和3个月时评估临床结局,包括颈部功能障碍指数(NDI)、疼痛评分(VAS)、慢性病管理自我效能量表6项版(SECD - 6)和12项简短健康调查问卷(SF - 12)评分。在最终随访(3个月)时评估并发症、患者满意度和经济指标。

结果

与接受常规随访的患者相比,接受合同制随访的患者在出院后24 - 72小时、1个月和3个月时颈部功能障碍的改善更为明显(<0.001)。出院后1个月,干预组的自我效能(=0.001)和生活质量(<0.001)均优于对照组,且这些改善持续了3个月。与对照组相比,干预组在出院后24 - 72小时和1个月时的疼痛评分更低(=0.008;=0.026)。干预组的并发症发生率(11.4%)显著低于对照组(40.9%)。两组的总满意度评分存在显著差异(<0.001)。此外,与对照组相比,干预组的直接医疗费用(<0.001)、直接非医疗费用(=0.035)和总费用(=0.04)更低。然而,两组的间接费用在统计学上无显著差异(=0.59)。

结论

与常规随访相比,多学科合同制随访计划在颈部功能障碍、自我效能、生活质量、术后并发症、患者满意度和直接费用方面具有显著优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bbf/11022215/29874acc82a0/fmed-11-1354483-g001.jpg

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