基于Delphi法构建医保版龙氏量表的研究

关键词：龙氏量表  康复医保  功能康复  价值医疗

Keywords:Long's scale  rehabilitation health insurance  functional rehabilitation  value-based care

摘要：

      摘要 目的：通过赋分，将分类型《龙氏日常生活能力评定量表》（简称龙氏量表）转化为医保版龙氏量表（连续性评分），使量表评分能够直观地反映失能者在康复治疗过程中的功能变化。 方法：研究小组通过深入讨论和综合文献研究，修订了龙氏量表分值及其评定方法（0分、1分、2分），并拟定两种改良龙氏量表赋分方案（+7分，+9分），运用Delphi法进行专家函询，确定医保版龙氏量表。采用回顾性分析法，验证该量表的信度和效度。 结果：本次研究共有24名专家受邀参与咨询，专家函询信回收率为87.5%（21/24），专家平均权威系数为0.836，66.7%（14/21）的专家支持+7分改良龙氏量表赋分方案。医保版龙氏量表的内部一致性及与改良巴氏指数（BI）的相关性均与初始龙氏量表一致，具有良好的信度和效度。 结论：本研究+7分的赋分方案将龙氏量表转变为连续性计分量表，其分数变化可以衡量功能改善程度，为以价值医疗为导向的康复医保支付提供新的依据。

Abstract:

      Abstract Objective： To transform the categorical Long's Activities of Daily Living Assessment Scale （referred to as the Long's Scale） into a medical insurance version （continuous scoring） by assigning scores， enabling a more intuitive reflection of functional changes in individuals with disabilities during the rehabilitation process. Method： The research team， through in-depth discussions and comprehensive literature review， revised the scoring and assessment methods of the Long's Scale （0 points， 1 point， 2 points）， and proposed two improved scoring schemes for the Long's Scale （+7 points， +9 points）. The Delphi expert consultation method was employed to consult experts and determine the Medical Insurance Long's Scale. Retrospective analysis was used to validate the reliability and validity of this scale. Result： A total of 24 experts were invited to participate in the consultation， with an expert consultation response rate of 87.5% （21/24）. The average authority coefficient of the experts was 0.836, with 66.7% （14/21） of experts supporting the +7 points improved scoring scheme for the Long's scale. The Medical Insurance Long's Scale demonstrated good internal consistency and correlation with the modified Barthel index（MBI）， consistent with the initial Long's Scale， demonstrating showing excellent reliability and validity. Conclusion： The +7 points scoring scheme in this study transformed the Long's Scale into a continuous scoring scale， enabling the measurement of functional improvement， thereby providing a new basis for value-based medical insurance payments in rehabilitation.