【摘要】目的探讨北京医院肾脏专科医联体工作模式对下级医联体单位(北京东城区第一人民医院)血液净化中心医疗质量及费用的影响。方法选取东城区第一人民医院血液净化中心2016 年1 月1日～2016 年10 月31 日前在透199 例维持性血液透析(maintenance hemodialysis,MHD)患者作为医联体前组，选取2016 年11 月1 日～2017 年8 月31 日在透181 例MHD 患者作为医联体后组。分析肾脏专科医联体工作模式运行前后10 个月下级医联体单位MHD 患者透析相关管理指标，不良事件发生率及同期住院医疗费用的变化。结果肾脏专科医联体成立后东城区第一人民医院MHD 患者血红蛋白达标率明显提高(51.3%比70.2%, χ²＝3, P＜0.001)、血清铁蛋白达标率明显提高(25.1%比43.1%，χ²＝14.153，P＜0.001)、血钾达标率明显提高(79.4% 比87.3%，χ2＝4.219，P＝0.040)、全段甲状旁腺素达标率明显提高(25.6%比43.6%，χ²＝13.673，P＜0.001)；不良事件发生率明显下降(37.2%比26.5%，χ2＝4.948，P＝0.026)；不良事件导致总住院费用明显下降(2 000 357 元比958 053 元)。结论肾脏专科医联体工作模式能够明显提高下级医联体单位MHD 患者血液透析医疗质量控制指标，明显降低MHD 患者不良事件发生率，明显减少不良事件住院费用，全面节省医疗保险费用，充分证明肾脏专科医联体工作模式的可行性和有效性。

【Abstract】Objective To investigate the effect of a professional medical cluster for kidney diseases on medical quality in the hemodialysis center in Beijing East District First People's Hospital. Methods A total of 199 maintenance hemodialysis (MHD) patients treated in the Hemodialysis Center of Beijing East District First People's Hospital from Jan. 1, 2016 to Oct. 31, 2016 were assigned into a group before establishment of the professional medical cluster (pre-medical cluster group). A total of 181 MHD patients treated in the period between Nov. 1, 2016 and Aug. 31, 2017 were enrolled into a group after establishment of the professional medical cluster (post-medical cluster group). Hemodialysis management indicators, adverse events and medical expenses in a period of 10 months were compared between the two groups. Results In the MHD patients treated in the Hemodialysis Center of Beijing East District First People’s Hospital, the rates of satisfaction of target levels were significantly higher in post-medical cluster group than in pre-medical cluster group, which included hemoglobin, serum ferritin, serum potassium and intact parathyroid hormone (70.2% vs. 51.3%, χ²＝14.153, P＜0.001 for hemoglobin; 43.1% vs. 25.1%, χ²＝13.700, P＜0.001 for ferritin; 87.3% vs. 79.4%, χ²＝4.219, P＝0.040 for potassium; 43.6% vs. 25.6%, χ²＝13.673, P＜0.001 for iPTH). Rate of adverse event was significantly lower in post- medical cluster group than in pre- medical cluster group (26.5% vs. 37.2%, χ²＝4.948, P＝0.026). Hospitalization expenses due to adverse events were significantly less in post-medical cluster group than in pre-medical cluster group. Conclusion The professional medical cluster for kidney diseases can improve hemodialysis management indicators, reduce adverse events and hospitalization expenses due to adverse events, and save medical insurance expenses, confirming that this medical cluster is feasible and useful.