2022年度国家康复医疗服务与质量安全报告

doi:10.3969/j.issn.1006-9771.2024.02.001

Abstract

Abstract:

Objective To analyze the medical services, quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2021 in perspectives of structure, segment and outcome quality.
Methods We analyzed the data from National Clinical Improvement System of the National Health Commission, involving 9 328 hospitals, including all secondary and above general hospitals and rehabilitation hospitals, as well as traditional Chinese Medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2021. A total of 2 513 sampling hospitals that equipped with rehabilitation wards were included.
Results Among the 9 328 general hospitals surveyed this year, only 2 713 had rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.77% hospitals, the average number of rehabilitation therapists per bed in 80.36% hospitals, and the average number of nurses per bed in 53.53% hospitals did not meet the national requirements, and the average number of rehabilitation medical personnel per bed in rehabilitation medicine departments in different regions was significantly different. The rates of early rehabilitation intervention were 13.45%, 20.67% and 29.74% respectively in department of orthopedics, department of neurology and intensive care units in general hospitals. The average improvement rate of activities of daily living of discharged patients was 77.87% in rehabilitation department of general hospitals, and 69.01% in rehabilitation hospitals.
Conclusion In 2021, professional medical services, quality and safety of rehabilitation medicine in China have improved steadily. However, most general hospitals in China still have not configured the rehabilitation wards, and there are problems such as the total number of rehabilitation medical personnel in the country does not meet the requirements, early rehabilitation intervention is significantly insufficient, and the implementation of important evaluation and therapies is deficient. The effect of rehabilitation still needs to improve. It is necessary to continuously promote capacity building of the medical rehabilitation to improve the quality of medical rehabilitation services.

Key words: rehabilitation medicine, medical service, quality, safety, quality control

CLC Number:

R493

LIU Jingyu, YANG Yanyan, ZHANG Yuanmingfei, LIU Xiaoxie, ZHANG Na, ZHANG Zhiliang, ZHOU Mouwang. 2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 125-140.

Figures/Tables 20

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Table 1

Number and proportion of rehabilitation assessment and operation items for inpatients"

重点治疗项目	委属委管医院	三级综合医院	二级综合医院	民营医院	康复医院
科年均脑卒中人数/n	602.72	318.57	171.59	218.21	1122.72
NIHSS评定/n(%)	471.17(78.17)	170.78(53.61)	102.90(59.97)	85.10(39.00)	155.18(13.82)
Brunnstrom评定/n(%)	583.18(96.76)	290.15(91.08)	152.81(89.06)	190.03(87.09)	851.07(75.80)
科年均脑外伤人数/n	91.94	32.29	13.59	23.34	98.44
Glasgow Coma Scale评定/n(%)	89.81(97.68)	26.15(80.98)	9.85(72.48)	16.97(72.71)	47.43(48.18)
科年均脊髓损伤人数/n	187.94	29.75	8.25	17.09	200.28
脊髓损伤神经学分类国际标准评定/n(%)	168.29(89.54)	28.35(95.29)	7.64(92.61)	15.38(89.99)	169.06(84.41)
脊髓独立性评估/n(%)	75.53(40.19)	13.75(46.22)	3.73(45.21)	7.25(42.42)	124.44(62.13)
科年均失语症人数/n	229.41	78.54	32.45	58.71	167.81
失语症筛查简易试验/n(%)	222.76(97.10)	75.27(95.84)	28.97(89.28)	52.74(89.83)	164.71(98.15)
语言康复训练/n(%)	196.53(85.67)	69.27(88.20)	27.55(84.90)	51.04(86.94)	165.35(98.53)
科年均构音障碍人数/n	171.94	65.04	34.08	55.40	142.61
Frenchay构音障碍评定/n(%)	145.69(84.73)	53.82(82.75)	24.78(72.71)	42.15(76.08)	121.56(85.24)
言语康复训练/n(%)	149.12(86.73)	57.95(89.10)	28.68(84.15)	45.98(83.00)	135.38(94.93)
科年均吞咽障碍人数/n	249.00	112.41	50.89	96.99	312.35
洼田饮水试验/n(%)	249.00(100.00)	108.62(96.63)	47.51(93.36)	90.35(93.15)	288.53(92.37)
吞咽造影检查人数/n(%)	114.57(46.01)	19.92(17.72)	5.49(10.79)	5.68(5.86)	53.75(17.21)
吞咽训练/n(%)	236.59(95.02)	105.36(93.73)	45.60(89.61)	91.53(94.37)	302.4(96.81)
科年均神经源性膀胱人数/n	166.89	37.40	15.10	23.07	107.71
排尿日记/n(%)	152.41(91.32)	28.31(75.70)	9.33(61.79)	14.59(63.24)	76.18(70.73)
尿流动力学检查/n(%)	95.88(57.45)	14.58(38.98)	2.62(17.35)	3.29(14.26)	63.67(59.11)
间歇导尿/n(%)	121.47(72.78)	20.32(54.33)	6.58(43.58)	9.09(39.40)	64.08(59.49)
科年均痉挛人数/n	250.50	110.02	54.31	72.98	366.2
改良Ashworth评定/n(%)	245.69(98.08)	108.57(98.68)	52.47(96.61)	67.27(92.18)	360(98.31)
神经阻滞治疗/n(%)	25.86(10.32)	12.12(11.02)	4.99(9.19)	5.10(6.99)	16.18(4.42)
科年均挛缩/n	210.88	51.36	32.21	46.20	342.86
关节活动度评定/n(%)	207.38(98.34)	49.70(96.77)	29.64(92.02)	41(88.74)	330.54(96.41)
关节松动术/n(%)	207.88(98.58)	47.48(92.45)	29.62(91.96)	39.67(85.87)	317.69(92.66)
牵伸治疗/n(%)	210.88(100.00)	46.69(90.91)	26.26(81.53)	33.93(73.44)	235.31(68.63)
科年均深静脉血栓形成/n	152.39	27.08	7.63	21.34	124.63
临床特征评分/Wells评分/n(%)	606.81(43.51)	193.30(25.74)	75.38(15.16)	116.10(22.35)	394.08(17.45)
预防措施/n(%)	436.75(31.32)	162.50(21.64)	59.85(12.03)	127.06(24.46)	360.62(15.96)
科年均疼痛人数/n	347.41	234.20	254.56	174.39	482.12
VAS评分/n(%)	345.19(99.36)	217.70(92.95)	210.89(82.84)	150.40(86.24)	456.88(94.76)
物理因子治疗人数/n(%)	333.47(95.99)	225.25(96.18)	239.95(94.26)	165.20(94.73)	453.00(93.96)
注射治疗/n(%)	35.88(10.33)	67.28(28.73)	94.71(37.21)	52.69(30.21)	131.00(27.17)
科年均认知功能障碍人数/n	261.72	94.23	39.00	74.91	464.88
计算机辅助认知康复训练/n(%)	187.06(71.47)	58.20(61.76)	20.88(53.54)	32.12(42.88)	239.00(51.41)
神经调控技术(rTMS/tDCS)治疗/n(%)	218.94(83.65)	41.74(44.30)	8.27(21.21)	25.04(33.43)	196.00(42.16)
出院脑卒中患者认知功能筛查(MMSE/MoCA)/n(%)	299.47(49.69)	116.95(36.71)	45.17(26.32)	75.81(34.74)	578.83(51.56)

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References 15

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康复护理指标	委属委管医院	三级综合医院	二级综合医院	民营医院	康复医院
脊髓损伤后神经源性膀胱/n	166.89	37.40	15.10	23.07	171.23
接受间歇性导尿健康教育/n(%)	159.71(95.70)	21.19(56.66)	4.80(31.79)	11.59(50.24)	71.09(41.52)
人工关节置换术后/n	64.83	12.82	6.22	17.86	56.41
接受体位指导/n(%)	62.06(95.73)	10.43(81.36)	3.84(61.74)	10.65(59.63)	20.15(35.72)
脑卒中/n	602.72	318.57	171.59	218.21	1122.72
接受脑卒中后肩痛预防健康教育/n(%)	255.56(42.40)	130.01(40.81)	77.79(45.33)	112.54(51.57)	480.08(42.76)
脑卒中后吞咽障碍/n	249.00	112.41	50.89	96.99	312.35
接受营养筛查/n(%)	168.77(67.78)	107.35(95.50)	46.29(90.96)	77.81(80.22)	301.83(96.63)
接受进食指导/n(%)	233.06(93.60)	108.57(96.58)	49.26(96.80)	72.90(75.16)	249.91(80.01)

2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System

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