摘要
目的将Markov模型引入社区高血压变化研究中,探讨家庭医生制度的施行对社区高血压人群危险分层状态变化的影响。方法回顾性调查2014年1月1日至2016年12月31日在上海市徐汇区13家社区卫生服务中心建档并进行持续管理的高血压患者共计98966例,根据高血压危险分层标准分为高血压低危、中危、高危、极高危4种状态,按是否与家庭医生签约分成两组(签约组50920例,占51.45%;未签约组48046例,占48.55%),各自建立四状态的Markov模型,验证模型的预测效果,并采用模型预测2017—2020年研究对象的高血压危险分层状态变化。结果(1)高血压各危险分层人群中,以高血压中危和极高危人群为主(>80%)。与2014年相比,2016年低危患者人数减少[签约组9042例(17.76%)比6851例(13.45%);非签约组9971例(20.75%)比7906例(16.46%)],极高危人数增多[签约组15609例(30.65%)比17639例(34.64%);非签约组13847例(28.82%)比15641例(32.55%)]。(2)采用Markov模型计算1年后高血压人群危险分层变化状态转移过程,绝大部分保持维持在原状态;随着高血压危险程度的增加,由其他状态转移到极高危状态的转移概率逐渐增大;极高危状态不向低危状态转移(0%),但低危状态可向极高危状态转移,且未签约组[2.06%(205/9971)]大于签约组[1.85%(167/9042)]。(3)采用Markov模型预测2017—2020年高血压各危险分层人数与构成比,两组人群高血压人数由高到低均为中危、极高危、低危、高危;随着时间的延长,低危患者比例逐渐降低,且签约组降低率低于未签约组;中危、高危、极高危的比例逐渐上升,签约组的升高率低于未签约组。结论Markov模型验证准确性较好,模型稳定性高,可用于高血压预后研究;家庭医生的签约服务对高血压的健康管理有积极作用。
Objective To explore the effect of family doctor system on the risk stratification of community hypertensive population by application of Markov model Methods Retrospective investigation was conducted on hypertensive patients under continuing management from 13 community health service centers in Shanghai Xuhui District from January 2014 to December 2016.Among 98996 subjects,50920(51.45%)were contracted to family doctors(contracted group)and 48046(48.55%)did not contracted to family doctors(non-contracted group).According to the risk stratification of hypertension,the four-state Markov model(low-risk,medium-risk,high-risk,and extremely high-risk)was established.The prediction effect of the model was validated,and the changes in the risk stratification status of hypertension in the study subjects from 2017 to 2020 was predicted by using the Markov model.Results Among all subjects the number of medium-risk and extremely high-risk accounted for the majority(>80%).Compared with 2014,in 2016 the number of low-risk patients with hypertension was decreased from 9042 cases(17.76%)to 6851 cases(13.45%)in contracted group;and from 9971 cases(20.75%)to 7906 cases(16.46%)in non-contracted group;the number of people at extremely high risk of hypertension was increased from 15609 cases(30.65%)to 17639 cases(34.64%)in the contracted group;from 13847 cases(28.82%)to 15641 cases(32.55%)in the non-contracted group.According to the Markov model one year after the risk stratification,the risk status of most subjects remained in the original one.There was not transform from extremely high-risk to low-risk state(0%),but there was transform from low-risk to extremely high-risk state in some extend,and the degree of transform in non-contracted group[2.06%(205/9971)]was higher than the contracted group[1.85%(167/9042)].Predicted by the Markov model,between 2017 and 2020 the number and proportion of the medium-risk>extremely high-risk>low-risk>high-risk in both contracted group and non-contracted group.With the extension of time,low-risk
作者
王婷婷
密一恺
唐利明
玄泽亮
潘志刚
Wang Tingting;Mi Yikai;Tang Liming;Xuan Zeliang;Pan Zhigang(Department of General Practice,Xiamen Hospital of Zhongshan Hospital Affiliatad to Fudan University,Xiamen 361015,China;Laboratory of Health Dynamics and Policy Transformation,Shanghai Jiao Tong University School of Public Health,Shanghai 200025,China;Department of General Practice,Longyan First Hospital,Longyan 364200,China;Shanghai Xuhui District Health and Family Planning Commission,Shanghai 200030,China;Department of General Practice,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华全科医师杂志》
2020年第6期495-501,共7页
Chinese Journal of General Practitioners
基金
上海市卫生和计划生育委员会重要薄弱学科建设(2015ZB0601)。
关键词
高血压
MARKOV模型
危险分层
家庭医生
Hypertension
Markov model
Risk stratification
Family physician system
