2023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.1006-9771.2025.01.001

摘要/Abstract

摘要：

目的从医疗机构康复医疗服务结构、环节、结果指标等方面，分析2022年全国综合医院康复医学科及康复医院的医疗服务质量与安全现状。

方法本报告数据源自国家医疗质量管理与控制信息系统。2023年度调查共纳入全国7 250家医疗机构的康复医疗质量相关数据，覆盖全部二级以上综合医院、康复医院，以及中医、中西医结合综合医院。经过数据清洗，最终纳入3 153家配置康复医学科病房的医院数据进行深入分析。

结果在2023年度纳入调查的7 250家综合医院中，仅3 277家设置康复医学病房。综合医院中，56.46%医院的平均每床配置医师数、77.67%医院的平均每床配置康复治疗师数、51.18%医院的平均每床配置护士数未达到国家要求。尽管较2021年有所改善，但人才缺口依然显著。此外，综合医院骨科、神经内科病房、重症医学科病房的早期康复介入率分别为13.98%、20.82%和21.36%。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77.69%，康复医院出院患者ADL改善率为66.78%。

结论康复医学科病房配置及设施规模不足，康复服务人力资源短缺，康复服务与临床服务的融入欠缺，康复服务的效果与效率尚有提升空间等。建议扩大康复服务规模、完善学科建设；提高康复人力资源的数量和质量；将康复服务融入健康服务体系；建立健全临床康复指南和技术规范；构建康复医学信息平台等。

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 2022 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 2022, the relevant data from 7 250 hospitals, including traditional Chinese medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2022. A total of 3 153 sampling hospitals that equipped with rehabilitation medicine wards were included for analysis.

Results Among the 7 250 general hospitals surveyed this year, only 3 277 equipped with rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.46% hospitals, the average number of rehabilitation therapists per bed in 77.67% hospitals, and the average number of nurses per bed in 51.18% hospitals did not meet the national requirements. The rates of early rehabilitation intervention were 13.98%, 20.82% and 21.36% 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 departments of general hospitals was 77.69%, and that of discharged patients from rehabilitation specialized hospitals was 66.78%.

Conclusion There are insufficient allocation of wards and facility scales in the department of rehabilitation medicine, a shortage of human resources for rehabilitation services, inadequate integration of rehabilitation services with clinical services, and there is still scope for enhancing the effect and efficiency of rehabilitation services. It is recommended to expand the scale of rehabilitation services and improve discipline construction; increase the quantity and quality of rehabilitation human resources; incorporate rehabilitation services into the health service system; establish and modify clinical rehabilitation guidelines and technical specifications; and construct a rehabilitation medical information platform.

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

中图分类号:

R197.3

刘京宇, 杨延砚, 张元鸣飞, 刘小燮, 张娜, 张之良, 周谋望. 2023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》, 2025, 31(1): 1-20.

LIU Jingyu, YANG Yanyan, ZHANG Yuanmingfei, LIU Xiaoxie, ZHANG Na, ZHANG Zhiliang, . 2023 National Report on Rehabilitation Medicine Services, Quality and Safety in Medical Care System[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(1): 1-20.

图/表 25

图1

图2

图3

图4

图5

图6

图7

图8

图9

图10

图11

表1

住院患者重点康复评定及操作项目实施人数及占比情况"

重点操作项目		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		309.82	170.88	210.35	1132.68
	NIHSS评定/n(%)	162.17(52.30)	94.37(55.20)	96.60(45.90)	23.50(2.10)
	Brunnstrom评定/n(%)	285.17(92.00)	146.43(85.70)	189.37(90.00)	875.13(77.30)
科年均脑外伤人数/n		30.20	12.44	23.61	89.76
	Glasgow Coma Scale评定/n(%)	22.49(74.50)	9.10(73.20)	17.49(74.10)	44.30(49.40)
科年均脊髓损伤人数/n		27.75	7.57	13.65	127.44
	脊髓损伤神经学分类国际标准评定/n(%)	26.58(95.80)	6.61(87.30)	13.15(96.30)	93.57(73.40)
	脊髓独立性评估/n(%)	13.48(48.60)	3.70(48.90)	5.92(43.40)	89.21(70.00)
科年均失语症人数/n		74.34	30.97	42.27	185.43
	失语症筛查简易试验/n(%)	68.61(92.30)	26.81(86.60)	35.63(84.30)	167.75(90.50)
	语言康复训练/n(%)	63.44(85.30)	26.65(86.10)	37.06(87.70)	156.57(84.40)
科年均构音障碍人数/n		58.81	30.53	37.73	171.78
	Frenchay构音障碍评定/n(%)	46.71(79.40)	22.50(73.70)	26.74(70.90)	141.94(82.60)
	言语康复训练/n(%)	51.49(87.60)	26.09(85.50)	32.61(86.40)	138.57(80.70)
科年均吞咽障碍人数/n		109.39	47.38	62.22	360.29
	洼田饮水试验/n(%)	102.28(93.50)	45.52(96.10)	57.80(92.90)	317.55(88.10)
	吞咽造影检查/n(%)	19.65(18.00)	4.97(10.50)	8.99(14.40)	104.94(29.10)
	吞咽训练/n(%)	100.05(91.50)	42.06(88.80)	54.71(87.09)	312.23(86.70)
科年均神经源性膀胱人数/n		34.01	11.94	14.93	101.88
	排尿日记/n(%)	24.93(73.30)	7.76(65.00)	7.70(51.06)	72.56(71.20)
	尿流动力学检查/n(%)	12.51(36.80)	2.64(22.10)	3.02(20.20)	29.68(29.10)
	间歇导尿/n(%)	18.68(54.90)	5.74(48.10)	6.92(46.30)	43.83(43.00)
科年均痉挛人数/n		100.35	52.60	64.95	233.00
	改良Ashworth评定/n(%)	97.82(97.50)	50.13(95.30)	62.81(96.70)	225.81(96.90)
	神经阻滞治疗/n(%)	10.66(10.60)	6.19(11.80)	6.24(9.60)	34.69(14.90)
科年均挛缩人数/n		47.28	34.60	41.98	138.33
	关节活动度评定/n(%)	45.09(95.40)	32.57(94.10)	37.65(89.70)	128.78(93.10)
	关节松动术/n(%)	43.54(92.10)	31.04(89.70)	35.67(85.00)	117.94(85.30)
	牵伸治疗/n(%)	41.22(87.20)	27.33(79.00)	32.21(76.70)	119.44(86.30)
科年均深静脉血栓形成人数/n		26.09	9.30	21.10	68.75
	临床特征评分/Wells评分/n	235.12	84.19	123.05	431.74
	预防措施/n	188.24	62.75	114.99	334.40
科年均疼痛人数/n		226.26	235.62	202.04	228.70
	疼痛视觉模拟评分/n(%)	203.37(89.90)	194.29(82.50)	166.61(82.50)	225.00(98.40)
	物理因子治疗/n(%)	211.58(93.50)	219.29(93.10)	189.70(93.90)	218.43(95.50)
	注射治疗/n(%)	64.29(28.40)	83.82(35.60)	65.31(32.30)	35.25(15.40)
科年均认知功能障碍人数/n		87.32	38.02	65.46	392.74
	计算机辅助认知康复训练/n(%)	58.37(66.80)	17.38(45.70)	37.1(56.70)	95.94(24.40)
	神经调控技术(重复经颅磁刺激/经颅直流电刺激)治疗/n(%)	41.13(47.10)	7.67(20.20)	19.12(29.20)	211.59(53.90)
	出院脑卒中患者认知功能筛查(简易精神状态检查表/蒙特利尔认知评估量表)/n(%)	110.03(35.50)	43.75(25.60)	80.99(38.50)	316.58(27.90)
科年均髋膝关节置换术后人数/n		13.96	6.06	9.04	60.92
	关节功能评定/n(%)	13.01(93.20)	5.69(93.90)	7.96(88.10)	28.76(47.20)

表1

表2

图12

图13

图14

图15

图16

图17

图18

图19

图20

图21

图22

图23

参考文献 16

[1]	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.
[2]	刘京宇, 杨延砚, 周谋望, 等. 国家康复医学专业医疗服务与质量安全报告(2020年)[J]. 中华物理医学与康复杂志, 2022, 44(10): 950-960.
	LIU J Y, YANG Y Y, ZHOU M W, et al. National Rehabilitation Medicine Professional Medical Service and Quality Safety Report (2019)[J]. Chin J Phys Med Rehabil, 2022, 44(10): 950-960.
[3]	张元鸣飞, 杨延砚, 张娜, 等. 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. doi: 10.3969/j.issn.1006-9771.2022.12.001
	ZHANG Y M F, YANG Y Y, ZHANG N, et al. 2021 National Report on Rehabilitation Medicine Services, Quality and Safety in Medical Care System[J]. Chin J Rehabil Theory Pract, 2022, 28(12): 1365-1379.
[4]	刘京宇, 杨延砚, 张元鸣飞, 等. 2022年度国家康复医疗服务与质量安全报告[J]. 中国康复理论与实践, 2024, 30(2): 125-140. doi: 10.3969/j.issn.1006-9771.2024.02.001
	LIU J Y, YANG Y Y, ZHANG Y M F, et al. 2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System[J]. Chin J Rehabil Theory Pract, 2024, 30(2): 125-140.
[5]	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 Rehabilitation Medicine Specialty Indicators in National Report on the Services, Quality and Safety in Medical Care System[J]. Rehabil Med, 2022, 32(1): 1-5.
[6]	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.
[7]	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[A/OL]. (2012-04-25)[2022-10-30]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=54557.
[8]	汤修齐, 邱服冰, 邱卓英, 等. 国际康复政策架构与核心内容研究:基于世界卫生组织康复政策文件的内容分析[J]. 中国康复理论与实践, 2021, 27(9): 996-1005. doi: 10.3969/j.issn.1006-9771.2021.09.002
	TANG X Q, QIU F B, QIU Z Y, et al. Theoretical framework and key elements of international rehabilitation policy: contents analysis of WHO rehabilitation policy documents[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 996-1005.
[9]	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[A/OL]. (2021-06-16)[2022-10-30]. http://www.nhc.gov.cn/yzygj/s7653pd/202106/c1053bb207f94415aeb8f393b8716b8e.shtml.
[10]	World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies[M]. Geneva: World Health Organization, 2010.
[11]	World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action[R]. Geneva: World Health Organization, 2007.
[12]	邱卓英, 郭键勋, 李伦, 等. 世界卫生组织康复指南«健康服务体系中的康复»:背景、理论架构与方法、主要内容和实施[J]. 中国康复理论与实践, 2020, 26(1): 16-20. doi: 10.3969/j.issn.1006-9771.2020.01.003
	QIU Z Y, KWOK J K F, LI L, et al. World Health Organization Rehabilitation Guide Rehabilitation in Health Service System: background, theoretical framework and methods, main contentsand implementation[J]. Chin J Rehabil Theory Pract, 2020, 26(1): 16-20.
[13]	世界卫生组织. 康复指标清单:康复监测和评估架构配套的工具[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2020.
	World Health Organization. Rehabilitation indicator menu: a tool accompanying the Framework for Rehabilitation Monitoring and Evaluation (FRAME)[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2020.
[14]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135. doi: 10.3969/j.issn.1006-9771.2020.02.001
	QIU Z Y, LI L, CHEN D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
[15]	李沁燚, 邱卓英, 陈迪, 等. 基于ICF 构建国家功能、残疾和健康的信息架构和数据体系[J]. 中国康复理论与实践, 2017, 23 (4): 385-389. doi: 10.3969/j.issn.1006-9771.2017.04.004
	LI Q Y, QIU Z Y, CHEN D, et al. Construction of national framework and data systems of functioning, disability, and health of information using ICF[J]. Chin J Rehabil Theory Pract, 2017, 23(4): 385-389.
[16]	世界卫生组织. 国际功能、残疾和健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
	World Health Organization. International Classification of Functioning, Disability and Health (International Chinese Supplement)[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2015.

康复护理指标		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		34.01	11.94	14.93	101.88
	接受间歇性导尿健康教育/n(%)	19.21(56.48%)	4.72(39.53%)	8.92(59.75%)	93.72(91.99%)
人工关节置换术后/n		13.96	6.06	9.04	60.92
	接受体位指导/n(%)	8.91(63.83%)	4.39(72.44%)	6.20(68.58%)	33.95(55.73%)
脑卒中/n		309.82	170.88	210.35	1132.68
	接受肩痛预防健康教育/n(%)	144.01(46.48%)	79.211(46.35%)	113.851(54.12%)	630.391(55.65%)
脑卒中后吞咽障碍/n		109.39	47.38	62.22	360.29
	接受营养筛查/n(%)	108.23(98.94%)	44.43(93.77%)	60.11(96.61%)	243.5(67.58%)
	接受进食指导/n(%)	107.7(98.46%)	46.33(97.78%)	58.2(93.54%)	309.5(85.90%)