ABSTRACT
Objective:To explore the effect of swallowing function training on dysphagia patients after anterior cervical decompression and interbody fusion.Methods:From January 2014 to January 2018, 119 patients with anterior cervical decompression and interbody fusion and difficulty in swallowing were divided into intervention group (59 cases) and control group (60 cases) by random digits table method. Patients in the control group were given routine hospital nursing and health education, while patients in the intervention group were given swallowing function training for 6 months, and swallowing function and quality of life were evaluated by Water Swallow Test and M.D.Anderson Dysphagia Inventory(MDADI) and compared between the two groups.Results:There was no significant difference in swallowing function and quality of life between the two groups( P> 0.05). After intervention, Water Swallow Test score was 2.00 (1.00, 3.00) in the intervention group, and 3.00 (2.00, 4.00) in the control group, the difference was statistically significant ( Z value was 3.205, P < 0.01). After intervention, the total score of MDADI and general, emotional, social and physiological functions dimensions was (69.91 ± 10.59), (3.37 ± 0.63), (21.37 ± 2.97), (17.91 ± 2.14), (27.26 ± 4.19) in the intervention group, and (64.61 ± 9.78), (2.96 ± 0.66), (19.69 ± 3.03), (16.48 ± 4.41) in the control group, the difference was statistically significant ( t value was 2.257-3.714, all P < 0.05). Conclusions:Swallowing function training can improve the range and strength of patients' oral, tongue, cheek, mandible and pharynx and larynx muscles, and help improve patients' dysphagia and quality of life.
ABSTRACT
Objective: To explore the effects of the bi-directional referral system from the perspective of the medical service consumer.Methods: A balanced panel data which was adjusted by Propensity Score Matching was employed to evaluate the effects of two-way referral system using difference-in-difference (DID) for the 2013 and 2015 data.The evaluation indicators including actual cost sharing ration, out-of-pocket cost per unit, the possibility of high cost, annual inpatient visits and length of hospital stay per unit were used.Results: Compared with the control group, the two-way referral system resulted in an 11.3% (P<0.001) increase in actual cost sharing ratio and an increase of 0.710 (P<0.001) annual inpatient visits in the intervention group.However, the policy did not significantly reduce the possibility of high-cost medical expenses and reduce the length of hospitalization and the annual cost hospitalization.Conclusion: Based on the key findings of the analysis of this study, the two-way referral system has beneficial effects on reducing inpatient financial burden and optimizing resource allocation.