慢性病规范化管理对社区居民糖尿病就诊行为与医保费用影响分析.docVIP

慢性病规范化管理对社区居民糖尿病就诊行为与医保费用影响分析 　　摘 要 目的：了解马陆镇社区糖尿病患者的专病管理规范化执行情况。方法：选取2012至2015年纳入马陆镇社区卫生服务中心进行糖尿病健康管理的患者，采集其2012至2015年期间在上海市各级医疗机构的所有费用交易明细，筛选出就诊于马陆镇社区卫生服务中心的糖尿病专病患者2 574人，分析其就诊行为和医保费用的变化。结果：2012至2015年，在马陆镇社区卫生服务中心签约进行规范化糖尿病管理，并在中心进行就诊的患者人数整体呈现缓慢上升趋势，但每年就诊的患者流失率和新增率均超过10.00%；糖尿病专病患者就诊次数以5次及以下为主（占比超过30.00%）；患者报销的次均费用在65～69元之间波动。结论：马陆镇社区糖尿病患者的专病管理不规范，就诊人群波动很大；但在医保费用控制方面做的较好。 　　关键词 糖尿病；就诊行为；医保费用 　　中图分类号：R587.1 文献标志码：A 文章编号：1006-1533（2017）22-0013-03 　　Analysis of influence of standardized management of chronic diseases on the medical behaviors and medical insurance expenses of patients with diabetes mellitus in a community 　　GE Yuanyuan1， YAN Haifeng1， LU Ping1， ZHU Jie1， GAO Bo1， SU Yongqiang2， WANG Jue2（1.Malu Community Health Service Center of Jiading District， Shanghai 201801， China； 2.Jiading District Medical Insurance Affairs Center， 　　Shanghai 201801， China） 　　ABSTRACT Objective： To understand the standardized implementation of specific disease management in patients with 　　diabetes mellitus in Malu Community. Methods： The patients with diabetes included in the diabetes health management were selected from 2012 to 2015 in Malu Community Health Service Center， and all transaction details of their fees at all levels of medical institutions in Shanghai were collected. Then 2 574 patients with diabetes mellitus who were treated in Malu Community Health Service Center were selected to analyze their changes in treatment behaviors and medical insurance expenses. Results： From 2012 to 2015， the numbers of the patients who contracted to undergo standardized diabetes management and received the treatment at the center generally showed a slow upward trend in Malu Community Health Service Center. However， both loss rate and new rate of the annual treatment of special diabetic patients were more than 10.00%， and the number of visits of the patients with diabetes mellitus were mainly 5 times and below（accounting for more than 30.00%）， and the average cost distribution