| Purpose:Cerebral apoplexy(Stroke)is an acute cerebrovascular disease,which is caused by brain tissue damage or dysfunction caused by the sudden rupture or blockage of blood vessels in the brain that prevents blood from flowing to the brain.It has the characteristics of high morbidity,high disability,high mortality and high recurrence rate.Since 2007,stroke has successively surpassed cardiovascular disease and malignant tumor to become the leading cause of death in China.According to the statistics of Chinese epidemiological studies,about 70-80%of patients after stroke cannot live independently because of disability.If they fail to receive effective continuous treatment and rehabilitation care,the risk of disability and dementia is very high.Once the level of paralysis or dementia is reached,the effects of interventions are very limited,care and treatment are expensive and place a huge financial burden on patients,families and society.At present,there are many researches on the aspects of stroke treatment,rehabilitation and nursing in China,but most of them focus on the independent stages(such as treatment in the acute stage and nursing in the recovery stage).The whole process integrated intervention service system for patients’medical rehabilitation and nursing has not been established.In this study,through the construction of an integrated service model of medical care and maintenance of stroke patients,empirical research on the supply and demand sides of integrated services,to provide relevant suggestions for the development and operation of the service model,and to achieve integrated services of stroke medical care and maintenance Mode exploration feasible ideas.Method:(1)Questionnaire survey.Using the self-designed "Questionnaire for the Research on the Key Factors of Integrated Services of Stroke Patients’Medical,Health and Nursing",the Guangdong Provincial Hospital of Traditional Chinese Medicine,Southern Medical University Southern Hospital,the First Affiliated Hospital of Jinan University,and Guangzhou Old People’s Hospital The integrated service provider is the subject of the survey.Through a convenient questionnaire survey,an exploratory study of the key driving factors of the service model supply is carried out,hoping to promote the development of the integrated medical service model of stroke patients from the perspective of the service provider.Use the "Survey Form of Personalized Chronic Disease Management Service Demand for Stroke(Stroke)Patients" designed by the research group to understand the service demand side,that is,the practical dilemma faced by stroke patients and their families and the demand for chronic disease management services,in order to deepen the chronic disease Management work provides clues and directions.(2)Semi-structured interview.By visiting the Guangdong Provincial Hospital of Traditional Chinese Medicine,the First Affiliated Hospital of Jinan University,and the Guangzhou Old People’s Hospital,etc.,to understand the current status of stroke treatment and rehabilitation,patients’ discharge flow,stroke patient management,etc.,and to integrate stroke medical care and nursing care.Conduct interviews on the subject of service and conduct research on the construction of service models.(3)functional analysis.By defining the relevant stakeholders in the integrated system of stroke medical care and nursing,the functional analysis was carried out,and the basic connotation,components,structural levels and functional requirements of the integrated service system were expounded and analyzed.Result:(1)In this paper,the participants of the integrated service mode of health care for stroke patients are classified into six categories:Level 3 hospital,level 2 hospital and rehabilitation institution,basic medical institution,elderly care institution,stroke health manager,stroke patients and their families,and their respective concept categories and functional orientation in the integrated service are analyzed.On this basis,the government is responsible for the overall planning and patient-centered service Through the link of stroke health managers,coordinate the resources of tertiary hospitals,primary medical institutions,elderly care institutions,etc.,to provide stroke patients with the whole process and continuous integrated service mode of medical health care from admission to rehabilitation,and even return to community rehabilitation.(2)In the study of key driving factors of service providers,through semi-structured interviews and literature review,the driving factors of the integrated service system of health care and nursing of brain apoplexy are sorted out,including three-level hospital factors,twolevel and grass-roots medical institutions factors,interest factors,resource factors,concept factors,market factors and government factors.According to these seven factors,305 valid data were collected.According to the results of the investigation,four key driving factors of the integrated health care service system of brain apoplexy were obtained by using the principal component analysis method,which were the driving factors of three-level hospital,the driving factors of government and two-level and grass-roots medical institutions,the driving factors of market interests and the driving factors of resources and ideas.(3)In the service demand side of stroke patients personalized chronic disease management service demand survey,500 questionnaires were issued,and finally 456 effective questionnaires were recovered.The factors of service acceptance of stroke chronic disease management were tested by χ2 test.The results showed that age and family per capita disposable income had significant influence on service demand(P<0.05).Single factor analysis of variance showed that the three factors of mRS grade,occupation and the time before the first stroke diagnosis had significant influence on the total cost of stroke(P<0.05).One way ANOVA of patients’ willingness to pay showed that the respondents(patients or family members)had significant influence on patients’ willingness to pay(P<0.05).Conclusion:For service providers:(1)Through the guidance of the government,we will promote the construction of the integrated health care service system for stroke patients with the link of "stroke health managers".First of all,the government should take the responsibility of overall planning in the construction of integrated health care service system for stroke patients,including guiding and encouraging grass-roots medical staff to learn and master appropriate technologies related to stroke prevention and control,and encouraging doctors in tertiary hospitals to support grass-roots;second,accelerate the role of"stroke health manager",including personnel training,platform construction,etc.At the same time,we should improve the supporting system construction of endowment insurance and medical insurance system in the integration of medical care and maintenance.(2)Strengthen the ability of stroke treatment in tertiary hospitals with stroke center as the focus.We will continue to optimize the emergency green channel process and shorten the time from admission to intravenous thrombolysis for stroke patients.To improve the level of stroke related appropriate technology,actively carry out clinical research,and improve the treatment of stroke.Further improve the regional stroke treatment network,promote the "three one hour golden stroke treatment circle",and carry out academic exchanges,technical guidance,quality control management with the regional senior stroke center,so as to reduce the morbidity and mortality of stroke.(3)Encourage the market participation of multiple subjects.Government,public institutions,non-profit organizations,private institutions,volunteer organizations,charities and other organizations participate in the integrated service of health care.The government should adhere to the principle of simplifying administration and delegating power,encourage the access of social capital,introduce competition mechanism and socialize public service in promoting the integrated service of health care.(4)Information platform construction and concept change.It is considered that the "stroke health manager" will establish the health management files of stroke patients,and medical institutions,rehabilitation institutions,pension institutions and "stroke health manager"will share and exchange the medical rehabilitation resources and pension resources on this platform,so that the medical staff can pay attention to both medical treatment and follow-up management.For service demanders:(5)Improve the pertinence of integrated medical,health and nursing services for stroke patients.In the face of the travel difficulties that patients generally respond to,the integrated service mode of health care for stroke patients should be coordinated by "stroke health manager",and help stroke patients choose targeted service paths according to multiple factors such as the degree of disability,rehabilitation expectations,economic conditions,etc.(6)Strengthen health education and change the concept of patients and their families.Actively carry out health education and other ways to enhance residents’ awareness of stroke,establish the concept of"preventable and controllable",improve residents’ health literacy,enhance residents’awareness of chronic disease management,and promote their use of chronic disease management services.At the same time,we should cultivate a scientific concept of medical consumption,establish the concept of hierarchical diagnosis and treatment,cultivate the public’s trust in the grass-roots medical staff and "stroke health managers",promote the integrated service of health care with stroke patients as the core,and promote the change of the public’s concept from disease treatment to health care. |
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