医联体背景下基层医疗卫生机构服务能力及影响因素研究
Medical Service Capacity and Influencing Factors of Primary Health Care Institutions Under Medical Alliance
张亚琳 1刘力滴 2陈正勇 3刘长明 4杨梓钰 2曹毅 5廖晓阳2
作者信息
- 1. 610300 四川省成都市青白江区妇幼保健院全科;610041 四川省成都市,四川大学华西医院全科医学中心
- 2. 610041 四川省成都市,四川大学华西医院全科医学中心
- 3. 610300 四川省成都市青白江区城厢镇公立中心卫生院内二科
- 4. 610200 四川省成都市双流区西航港社区卫生服务中心全科医疗科
- 5. 610300 四川省成都市青白江区妇幼保健院全科
- 折叠
摘要
背景 医联体建设是我国深化医改的重要举措,旨在促进医疗服务重心下移和资源下沉,提升基层服务能力.有研究显示,医联体建设可以提升基层医疗卫生机构的服务能力,但各整合要素对基层医疗卫生机构服务能力的影响尚不明确.目的 分析基层医疗卫生机构的服务能力,并探究医联体背景下服务能力的影响因素.方法 于2019 年 12 月,采用课题组自行编制的结构化问卷对成都市参与了医联体建设的 381 家基层医疗卫生机构开展调查,调查内容涉及人员配置、门诊和住院服务、医联体建设情况等,由当地卫生行政部门统一发放及回收问卷.以在岗职工数、注册全科医生数、床位数、门急诊人次、入院人次、病床使用率 6 项指标作为基层医疗卫生机构的服务能力评价指标,采用秩和比法将 381 家机构的服务能力分为 3 档,采用有序Logistic回归分析基层医疗卫生机构服务能力的影响因素.结果 381 家基层医疗卫生机构的中位在岗职工数为 54(48)人,中位注册全科医生数为 4(8)人,中位床位数为 50(50)张,中位门急诊人次为 49 460(60 317)人次,中位入院人次为 1 440(2 071)人次,中位病床使用率为68.43%(45.18%).依据秩和比,服务能力被评价为好、中、差的机构分别有61家(16.0%)、260家(68.3%)、60 家(15.7%).有序Logistic回归分析结果显示,机构建筑面积及与医联体内机构合作开展教学查房、远程读片情况是基层医疗卫生机构服务能力的影响因素(P<0.05).结论 四川省成都市基层医疗卫生机构的服务能力较好,机构建筑面积及医联体帮扶方式中的教学查房、远程读片会影响基层医疗卫生机构的服务能力.
Abstract
Background The construction of medical alliance is important measure for deepening medical reform.It aims to move the focus and resource to primary health care institutions,and improve service capabilities.Studies have shown that the medical alliance can improve the service capabilities of primary health care institutions,but the exact reason for this is not clear.Objective To analysis the service capabilities of the of primary health care institutions,and explore the impact of service capabilities in the context of medical alliance.Methods In December 2019,we survey on staffing,outpatient and inpatient service and medical alliance construction of 381 primary health care institutions which participated in medical alliance in Chengdu by structured questionnaire.Local administrative departments of public health gave out and recovered questionnaire.With the number of staff,registered generals,beds,outpatient and emergency visits,admission,and the use rate of the beds as the indicator of the service capabilities,we used rank sum ratio to analyze the comprehensive medical service capabilities and divide them to 3 gear.Using orderly Logistic regression to explore the influencing factors of integrated medical services.Results The median number of staff in 381 primary health care institutions was 54(48),registered generals was 4(8),beds was 50(50),outpatient and emergency visits was 49 460(60 317),admission was 1 440(2 071),the use rate of beds was 68.43%(45.18%).According to the rank and ratio,there were 61(16.0%),260(68.3%),and 60(15.7%)institutions with good,medium and poor comprehensive medical service ability,respectively.The analysis of orderly Logistic regression analysis showed that institutional building area,teaching rounds and remote film reading are the influencing factors of the comprehensive medical service capabilities of primary health care institutions(P<0.05).Conclusion The medical service capacity of primary health care institutions in Chengdu,Sichuan Province are relatively good.Institutional building area,teaching rounds and remote film reading in the medical assistance method significantly affect the comprehensive medical service capabilities.
关键词
医联体/基层医疗卫生机构/医疗服务能力/影响因素分析/成都Key words
Medical alliance/Primary health care institutions/Medical service capacity/Root cause analysis/Chengdu引用本文复制引用
基金项目
四川省卫生健康委项目(TJZ201909)
四川省科技厅软科学研究计划(2022JDR0325)
出版年
2024
国家科技期刊平台
NSTL
万方数据