2021年度国家康复医学专业医疗服务与质量安全报告

doi:10.3969/j.issn.1006-9771.2022.12.001

摘要/Abstract

摘要：

目的从医疗机构康复医疗服务结构、环节、结局质量等方面，对2020年全国综合医院康复医学科、康复医院的医疗服务与质量安全进行分析。

方法数据来源于国家医疗质量管理与控制信息系统，2021年度调查全国全部二级以上综合医院、康复医院，包含中医、中西医结合综合医院共9 138家2020年相关数据，其中2 676家抽样调查医院配置了康复医学病房，数据清洗后实际共纳入2 268家医院数据，进行康复医疗服务统计分析。并选取2017年至2020年均参与康复医学科调查表填报共6 336家医院进行康复医学科病房设置以及医疗服务质量分析。

结果在2021年度报送数据9 138家综合医院中，仅2 676家设置有康复医学病房，其中委管委属综合医院中3家尚未设置病房。综合医院中，57.92%医院的平均每床配置医师数、80.44%医院的平均每床配置康复治疗师数、53.92%医院的平均每床配置护士数未达到国家要求，且各地区康复医学科每床平均配置康复医务人员数量差距较大。综合医院骨科、神经内科病房、重症医学科病房早期康复介入率分别为13.20%、18.90%、29.25%。综合医院康复医学科出院患者平均日常生活活动能力(ADL)改善率为76.35%，康复专科医院出院患者ADL改善率为64.30%。

结论我国康复医学专业医疗服务与质量安全整体稳中有升，同质化程度进一步加强。目前存在的突出问题：2020年全国多数综合医院未配置康复医学科病房，且全国康复医务人员总量不满足要求、分布不均；康复早期介入不足，康复治疗效果尚有提升空间。

关键词: 康复医学, 医疗服务, 质量安全, 质量控制

Abstract:

Objective To describe the medical services, quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2020 from the aspects of structure, link and outcome quality.

Methods Through the National Clinical Improvement System of the National Health Commission, all secondary and above general hospitals and rehabilitation hospitals were investigated in 2021, the relevant data from 9 138 hospitals, including traditional Chinese Medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2020. A total of 2 676 sampling hospitals were equipped with rehabilitation medicine wards. After cleaning, a total of 2 268 samples of hospitals were included for analysis. Then, the setting of wards of rehabilitation medicine departments in 6 336 hospitals that participated in the questionnaire of rehabilitation medicine departments from 2017 to 2020 was analyzed.

Results Among the 9 138 general hospitals surveyed this year, only 2 676 had rehabilitation wards, and three general hospitals administrated to National Health Commision had not yet set up wards. In general hospitals, the average number of physicians per bed in 57.92% hospitals, the average number of rehabilitation therapists per bed in 80.44% hospitals, and the average number of nurses per bed in 53.92% 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 13.20%, 18.90% and 29.25% respectively in the department of orthopedics, department of neurology and department of intensive care in general hospitals. The average activity of daily living improvement rate of discharged patients from rehabilitation department of general hospital was 76.35%, and that of discharged patients from rehabilitation specialized hospital was 64.30%.

Conclusion Professional medical services and quality safety of rehabilitation medicine in China improve steadily, and the degree of homogenization is further strengthened. However, from the perspective of the current prominent problems, in 2020, most general hospitals in China have not configured the wards of rehabilitation medicine, and there are problems such as the total number of rehabilitation medical personnel in the country does not meet the requirements, uneven distribution, insufficient early intervention in rehabilitation, and room for improvement of rehabilitation treatment effect, which need continuous improvement.

Key words: rehabilitation medicine, medical services, quality and safety, quality control

中图分类号:

R493

张元鸣飞,杨延砚,张娜,刘京宇,刘小燮,张之良,周谋望. 2021年度国家康复医学专业医疗服务与质量安全报告[J]. 《中国康复理论与实践》, 2022, 28(12): 1365-1379.

ZHANG Yuanmingfei,YANG Yanyan,ZHANG Na,LIU Jingyu,LIU Xiaoxie,ZHANG Zhiliang,ZHOU Mouwang. 2021 National Report on Rehabilitation Medicine Services, Quality and Safety in Medical Care System[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1365-1379.

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表1

各医院住院患者重点康复评定或操作实施人数及占比情况"

重点操作项目		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		417.67	313.81	184.1	199.87	1574.41
	进行NIHSS评定/n(%)	174.24(41.72)	162.51(51.79)	102.58(55.72)	90.14(45.10)	229.00(14.55)
	进行Brunnstrom评定/n(%)	410.45(98.27)	288.62(91.67)	158.71(86.21)	169.32(84.72)	1064.67(67.62)
科年均脑外伤人数/n		48.81	31.68	15.75	27.29	85.81
	进行Glasgow评定/n(%)	37.21(76.23)	21.97(69.35)	11.34(72.00)	22.90(83.91)	57.89(67.46)
科年均脊髓损伤人数/n		88.86	27.61	8.55	15.89	300.08
	进行脊髓损伤神经学分类国际标准评定/n(%)	87.61(98.59)	26.94(97.57)	6.40(74.85)	15.44(97.17)	296.04(98.65)
	进行脊髓独立性评估/n	38.47(43.29)	12.71(46.03)	3.35(39.18)	7.18(45.19)	128.00(42.67)
科年均失语症人数/n		114.70	64.68	30.34	42.36	212.77
	进行失语症筛查简易试验/n(%)	114.32(99.67)	61.67(95.35)	27.58(90.90)	38.86(91.74)	201.31(94.61)
	进行语言康复训练/n(%)	111.42(97.14)	55.34(85.56)	26.08(85.96)	31.80(75.07)	169.54(79.68)
科年均构音障碍人数/n		95.10	53.45	28.7	37.12	210.77
	进行Frenchay评定/n(%)	91.59(96.31)	38.66(72.33)	20.16(70.24)	25.24(68.00)	187.46(88.94)
	进行言语康复训练/n(%)	89.58(94.20)	45.85(85.78)	25.69(89.51)	25.78(69.45)	191.77(90.99)
科年均吞咽障碍人数/n		172.85	97.83	48.88	64.98	319.62
	进行洼田饮水试验/n(%)	172.5(99.80)	95.09(97.20)	43.70(89.40)	61.21(94.20)	284.69(89.07)
	进行吞咽造影检查/n(%)	53.17(30.82)	15.16(15.94)	3.37(7.71)	6.26(10.23)	82.85(29.10)
	进行吞咽训练/n(%)	170.74(98.98)	88.95(93.54)	41.96(96.02)	42.52(69.47)	247.00(86.76)
科年均神经源性膀胱人数/n		84.9	34.22	12.31	18.65	332.77
	进行排尿日记/n(%)	82.89(97.63)	23.96(70.02)	7.01(56.95)	8.42(45.15)	194.92(58.57)
	进行尿流动力学检查/n(%)	54.76(64.50)	11.97(34.98)	2.12(17.22)	3.67(19.68)	105.38(31.67)
	进行间歇导尿/n(%)	72.94(85.91)	18.99(55.49)	5.04(40.94)	7.42(39.79)	139.62(41.96)
科年均痉挛人数		226.33	100.40	59.26	68.10	461.92
	进行改良Ashworth评定/n(%)	226.22(99.59)	100.03(99.63)	59.19(99.88)	61.13(89.77)	459.92(99.57)
	进行神经阻滞治疗/n(%)	20.33(8.98)	9.32(9.28)	6.14(10.36)	9.97(14.64)	23.77(5.15)
科年均挛缩人数/n		107.88	50.3	30.31	27.91	259.15
	进行关节活动度评定/n(%)	106.25(98.49)	49.76(98.93)	29.85(98.48)	26.93(96.49)	218.08(84.15)
	进行关节松动术/n(%)	105.93(98.19)	48.67(96.76)	30.19(99.60)	26.84(96.17)	217.38(83.88)
	进行牵伸治疗/n(%)	106.81(99.01)	45.86(91.17)	28.87(95.25)	27.14(97.24)	256.54(98.99)
科年均深静脉血栓形成(DVT)人数/n		70.52	21.43	6.78	13.30	145.85
	所有出院患者中，进行DVT临床特征评分/Wells评分/n(%)	481.79(52.48)	117.41(16.19)	38.35(6.55)	36.80(6.88)	215.00(4.83)
	所有出院患者中，进行DVT预防措施/n(%)	340.72(37.11)	108.65(14.98)	35.74(6.11)	37.45(7.00)	278.69(6.26)
疼痛人数/n		258.85	220.39	230.17	172.10	704.00
	进行视觉模拟评分/n(%)	252.23(97.44)	194.33(88.18)	162.77(70.72)	126.11(73.28)	513.31(72.91)
	进行物理因子治疗/n(%)	252.78(97.66)	207.94(94.35)	222.82(96.81)	164.58(95.63)	700.15(99.45)
	进行注射治疗/n(%)	47.39(18.31)	58.25(26.43)	85.03(36.94)	63.22(36.73)	59.38(8.43)
科年均认知功能障碍人数/n		140.71	71.54	31.94	55.48	570.69
	所有出院患者中，进行认知功能筛查(MMSE/MoCA)/n(%)^a	159.16(17.34)	91.55(12.62)	34.43(5.88)	52.06(9.72)	202.62(4.55)
	进行计算机辅助认知康复训练/n(%)	87.89(62.46)	42.92(59.99)	12.51(39.17)	27.53(49.62)	319.38(55.96)
	所有脑卒中出院患者中，进行认知功能筛查(MMSE/MoCA)/n(%)	95.16(67.63)	27.48(38.41)	6.29(19.69)	21.40(38.57)	303.00(53.09)

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参考文献 20

[1]	国家卫生和计划生育委员会. 2016年国家医疗服务与质量安全报告[M]. 北京: 人民卫生出版社, 2017: 346-356.
	National Health and Family Planning Commission. National Health Service and Quality Safety Report 2016[M]. Beijing: People's Medical Publishing House, 2017: 346-356.
[2]	国家卫生和计划生育委员会. 2017年国家医疗服务与质量安全报告[M]. 北京: 科学技术文献出版社, 2018: 380-391.
	National Health and Family Planning Commission. National Health Service and Quality Safety Report 2017[M]. Beijing: Science and Technology Academic Press, 2018: 380-391.
[3]	国家卫生和计划生育委员会. 2018年国家医疗服务与质量安全报告[M]. 北京: 科学技术文献出版社, 2019: 276-284.
	National Health and Family Planning Commission. National Health Service and Quality Safety Report 2018[M]. Beijing: Science and Technology Academic Press, 2019: 276-284.
[4]	张娜, 张元鸣飞, 刘京宇, 等. 国家康复医学专业医疗服务与质量安全报告(2019年)[J]. 中华物理医学与康复杂志, 2020, 42(12): 1146-1152.
	ZHANG N, ZHANG Y M F, LIU J Y, et al. National Rehabilitation Medicine Professional Medical Service and Quality Safety Report (2019)[J]. Chin J Phys Med Rehabil, 2020, 42(12): 1146-1152.
[5]	国家卫生健康委员会. 2020年国家医疗服务与质量安全报告[M]. 北京: 科学技术文献出版社, 2021.
	National Health Commission. National Health Service and Quality and Safety Report 2020[M]. Beijing: Science and Technology Academic Press, 2021.
[6]	国家卫生健康委员会. 2021年国家医疗服务与质量安全报告[M]. 北京: 科学技术文献出版社, 2022.
	National Health Commission. National Health Service and Quality and Safety Report 2021[M]. Beijing: Science and Technology Academic Press, 2022.
[7]	周谋望. «国家医疗服务与质量安全报告»康复医学专业指标解读[J]. 康复学报, 2022, 32(1): 1-5.
	ZHOU M W. Interpretation of professional indexes of Rehabilitation Medicine in National Medical Service and Quality Safety Report[J]. J Rehabil, 2022, 32(1): 1-5.
[8]	国家卫生部医政司. 卫生部关于印发«综合医院康复医学科基本标准(试行)»的通知[EB/OL]. (2011-05-24)[2022-10-30]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=51787.
[9]	国家卫生部医政司. 卫生部关于印发«康复医院基本标准(2012年版)»的通知[EB/OL]. (2012-04-25) [2022-10-30]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=54557.
[10]	张元鸣飞, 樊静, 周谋望, 等. 2013-2018年国家三级医院康复医学科住院患者医疗服务与质量安全报告:基于医院质量监测系统病案首页数据[J]. 中国康复医学杂志, 2020, 35(7): 771-774.
	ZHANG Y M F, FAN J, ZHOU M W, et al. Medical Service and quality safety Report of inpatients in Rehabilitation Medicine Department of national tertiary hospitals from 2013 to 2018: based on the data from the first page of medical records of hospital quality monitoring system[J]. Chin J Rehabil Med, 2020, 35(7): 771-774.
[11]	CIEZA A, CAUSEY K, KAMENOV K, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2021, 396(10267): 2006-2017. doi: 10.1016/S0140-6736(20)32340-0 pmid: 33275908
[12]	邱卓英, 郭键勋, 杨剑, 等. 康复2030:促进实现«联合国2030年可持续发展议程»相关目标[J]. 中国康复理论与实践, 2017, 23(4): 373-378.
	QIU Z Y, KWOK J K F, YANG J, et al. Rehabilitation 2030: Realization of United Nation Sustainable Development Goals 2030[J]. Chin J Rehabil Theory Pract, 2017, 23(4): 373-378.
[13]	中国政府网. 中共中央国务院印发«"健康中国2030"规划纲要»[EB/OL]. (2016-10-25)[2022-10-30]. http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[14]	中国政府网. 中共中央国务院印发«关于制定国民经济和社会发展第十四个五年规划和二〇三五年远景目标的建议»[EB/OL]. (2020-11-03)[2022-10-30]. http://www.gov.cn/zhengce/2020-11/03/content_5556991.htm.
[15]	国家卫生健康委医政管理局. 关于印发加快推进康复医疗工作发展意见的通知[EB/OL]. (2021-06-16)[2022-10-30]. http://www.nhc.gov.cn/yzygj/s7653pd/202106/c1053bb207f94415aeb8f393b8716b8e.shtml.
[16]	国家卫生健康委医政管理局. 关于开展康复医疗服务试点工作的通知[EB/OL]. (2021-10-27) [2022-10-30]. http://www.nhc.gov.cn/yzygj/s7653pd/202110/9af02fe668e74aa3a0271e425ef0ea58.shtml.
[17]	世界卫生组织. 康复胜任力架构[J]. 邱卓英,郭键勋,孙宏伟,等,译. 中国康复理论与实践, 2022, 28(3): 249-264.
	World Health Orgnization. Rehabilitation Competency Framework[J]. QIU Z Y, KWOK J K F, SUN H W, et al., trans. Chin J Rehabil Theory Pract, 2022, 28(3): 249-264.
[18]	周谋望, 李涛. 积极开展加速康复外科工作,促进我国骨科围手术期康复的发展[J]. 中国康复医学杂志, 2020, 35(7): 769-770.
	ZHOU M W, LI T. To accelerate rehabilitation surgery and promote the development of orthopaedic rehabilitation in perioperative period[J]. Chin J Rehabil Med, 2020, 35(7): 769-770.
[19]	周谋望. 以康复医学专业质量管理与控制为抓手,促进学科同质化发展[J]. 中国康复医学杂志, 2021, 36(11): 1337-1338.
	ZHOU M W. Taking quality management and control of rehabilitation medicine as the starting point to promote the development of discipline homogeneity[J]. Chin J Rehabil Med, 2021, 36(11): 1337-1338.
[20]	陈向励. 中国康复信息服务业的现状与未来发展思考[J]. 康复学报, 2015, 25(3): 53-57, 61.
	CHEN X L. Construction status and future development of rehabilitation information service industry in China[J]. Rehabil Med, 2015, 25(3): 53-57, 61.

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
脊髓损伤患者接受间歇性导尿健康教育人数/n		82.70	20.09	5.58	13.46	254.31
	神经源性膀胱人数/n	94.90	34.22	12.31	18.65	332.77
	间歇性导尿宣教率/%	87.14	58.71	45.33	72.17	76.42
人工髋关节置换术后患者接受体位指导人数/n		19.80	11.04	5.37	5.75	32.31
	人工关节置换术后人数/n	29.29	13.91	6.36	7.33	53.91
	人工关节置换术后体位指导宣教率/%	67.60	79.37	84.43	78.44	59.93
脑卒中后肩痛患者接受预防健康教育人数/n		227.80	129.30	75.99	67.90	234.54
	脑卒中人数/n	436.14	316.41	191.59	209.31	1606.33
	脑卒中后肩痛预防宣教率/%	52.23	40.86	39.66	32.44	14.60
脑卒中后吞咽障碍患者接受营养筛查人数/n		167.89	88.08	35.74	35.29	139.46
	脑卒中后吞咽障碍患者人数/n	172.85	97.83	48.88	64.98	319.62
	吞咽障碍营养筛查率/%	97.13	90.03	73.12	54.31	43.63
脑卒中后吞咽障碍患者接受进食指导人数/n		163.16	92.16	45.13	51.07	167.00
	吞咽障碍进食指导率/%	94.39	94.20	92.33	78.59	52.25