论著

基于区域专科联盟的联盟医院淋巴水肿专科干预小组建立与实践

Establishment and practice of a lymphoedema specialty nursing team in alliance hospitals based on a regional specialty alliance

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探讨基于区域专科联盟模式,在联盟医院内建立淋巴水肿专科干预小组的有效策略及其对患者干预效果的影响。方法 对区域医联体内7家联盟医院(包括德阳市人民医院、广汉市人民医院、罗江区人民医院、广汉妇幼保健院、德阳肿瘤医院、中江妇幼保健院、什邡市妇幼保健院)20名医护人员进行淋巴水肿知识及干预技能培训,建立区域性淋巴水肿专科干预小组,制定小组工作职责、实施专科质量控制。选取2024年5—8月淋巴水肿专科干预小组干预模式开展期间作为观察组, 选取2024年1—4月淋巴水肿专科干预小组干预模式开展前作为对照组。对比两组医护人员淋巴水肿相关知识掌握合格率、住院患者淋巴水肿风险筛查率、淋巴水肿高风险患者措施落实率、出院随访患者上肢功能评定评分及患者就医满意度。结果 干预后,护理人员淋巴水肿知识各维度得分[基础知识(17.36±2.54)、诊断与评估(25.66±4.34)、治疗与管理(25.08±4.73)、预防与康复(15.36±2.53)、总分(85.36±8.52)]均高于干预前[基础知识(11.35±2.29)、诊断与评估(17.87±3.18)、治疗与管理(18.28±3.85)、预防与康复(10.39±2.24)、总分(55.35±7.56)](t=7.859, P<0.001; t=6.475, P<0.001; t=4.986, P<0.001; t=6.578, P<0.001; t=11.782, P<0.001); 观察组住院患者淋巴水肿风险筛查率高于对照组(80.72% vs 61.24%), 对比差异有统计学意义(χ2=31.454, P<0.001); 观察组患者出院时及出院后1月上肢功能评定(DASH)量表评分[(23.36±8.63)(20.16±7.34)分]低于对照组[(25.32±9.16)(22.25±7.67)分], 对比差异有统计学意义(t=2.884, P=0.004; t=3.646, P=0.001); 观察组患者出院时患者就医满意度评分(83.36±8.63)高于对照组(71.37±10.33), 对比差异有统计学意义(t=16.460, P<0.001)。结论 基于区域专科联盟体的联盟医院淋巴水肿专科干预小组能够有效地实现三级医院优质干预资源下沉, 在联盟内可实现淋巴水肿防治同质化、专科人才培训基地建设,整体提升区域内淋巴水肿防控效果,提高患者就医满意度。
Objective To explore effective strategies for establishing a lymphoedema specialty nursing team within alliance hospitals based on a regional specialty alliance and assess its impact on patient care outcomes.Methods A regional lymphedema specialty nursing team was established by training 20 healthcare professionals from 7 hospitals(Deyang City People’s Hospital,Guanghan People’s Hospital, Luojiang People’s Hospital, Guanghan Maternal and Child Health Hospital, Deyang Tumor Hospital, Zhongjiang Maternal and Child Health Hospital, and Shifang Maternal and Child Health Hospital)in a regional medical consortium, focusing on lymphedema knowledge and intervention skills.The team’s responsibilities and nursing quality control protocols were standardized.The observation group included data from May to August in 2024(post-intervention period), while the control group comprised data from January to April in 2024(pre-intervention period).Comparisons were made between the two groups regarding healthcare professionals’qualification rate in lymphedema knowledge,inpatients’ lymphedema risk screening rate, implementation rate of preventive measures for high-risk patients, upper extremity function assessment scores(using the Disabilities of the Arm,Shoulder and Hand [DASH] scale)at discharge and 1-month post-discharge, and patient satisfaction.Results After the intervention, healthcare professionals’ lymphedema knowledge scores significantly improved across all domains:basic knowledge(17.36±2.54 vs 11.35±2.29), diagnosis/assessment(25.66±4.34 vs 17.87±3.18), treatment/management(25.08±4.73 vs 18.28±3.85),prevention/rehabilitation(15.36±2.53 vs 10.39±2.24),and total score(85.36±8.52 vs 55.35±7.56)(t=7.859, P<0.001; t=6.475, P<0.001; t=4.986, P<0.001; t=6.578, P<0.001; t=11.782, P<0.001).The observation group demonstrated a higher lymphedema risk screening rate(80.72% vs 61.24%,χ2=31.454,P<0.001).DASH scores in the observation group were significantly lower than the control group at discharge(23.36±8.63 vs 25.32±9.16)and 1-month post-discharge(20.16±7.34 vs 22.25±7.67)(t=2.884, P=0.004; t=3.646, P=0.001).Patient satisfaction scores at discharge were higher in the observation group(83.36±8.63 vs 71.37±10.33, t=16.460, P<0.001).Conclusions The lymphoedema specialty nursing team in alliance hospitals based on a regional specialty alliance effectively facilitates the high-quality nursing resources homogenization in primary hospitals.Within the alliance, it achieves homogenization of lymphoedema prevention and treatment, establishes a training base for specialty talents, and overall enhances lymphoedema prevention and control within the region, thereby improving patient satisfaction with healthcare.
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