摘要
目的探讨不同模式下城市医疗体系协作开展情况,提出改进意见,为未来的协作方式提供参考依据。方法本研究确定了3种主要的协作模式,分别是南京市中大医院、鼓楼医院和所辖社区卫生服务中心的松散协作模式(松散模式);武汉市第五医院直管社区卫生服务中心模式(直管模式);镇江市医疗集团模式(集团模式)。选取这3种协作模式下协作医院和社区卫生服务机构的医务人员与管理者为研究对象。于2013年9月对受访者进行实地调查,问卷内容包括基本信息、协作开展的基本情况及主要障碍、对协作的认知评价等。在文献阅读和专家咨询的基础上,结合课题组前期研究,选取13个指标用于评价协作现状。采用因子分析法提取主要成分,并对不同模式、职业类别受访者对协作现状的评价进行综合分析。结果共提取4个公因子,分别为慢性病预防与管理因子、诊疗服务因子、信息连续性因子、业务学习进修因子。松散、直管、集团模式受访者对协作现状评价的综合得分分别为-0.12、0.17、-0.08,医务人员、管理者对协作现状评价的综合得分分别为-0.02、0.05。结论慢性病预防与管理、诊疗服务、信息连续性、业务学习进修4个因子可对协作模式进行综合评价。不同模式在各个因子上的得分存在差异。管理者和医务人员对协作开展情况的评价不一致,需要建立有效的利益调整策略和适当的激励机制。
Objective To evaluate the situation of urban medical collaboration under different modes and come up with suggestions for improvement in order to provide references for further collaboration. Methods The study identified three major collaborative modes ： loose cooperative mode of Nanjing Zhongda Hospital, Gulou Hospital and community health service centers （loose mode） ; the mode of community health service centers under the direct administration of the Fifth Hospital of Wuhan （direct administration mode ）; the medical group mode of Zhenjiang （consortium model ） . The medical workers and administrators of cooperative hospitals and community health service centers under the three collaborative modes were chosen as subjects. In September 2013, we conducted field investigations on the subjects, and the questionnaire content included basic information, the situation and major barriers of collaboration, and the evaluation of collaboration, etc. On the basis of literature reading and expert consultation and according to the preliminary studies, we selected 13 indexes for the evaluation of collaboration status. Main components were extracted using factor analysis, and comprehensive analysis was made on the collaboration status evaluated by subjects under different modes and of different occupations. Results Four common factors were extracted, namely chronic disease prevention and management, diagnosis and treatroent, information continuity, and further education on professional work. The comprehensive scores given on collaboration status by subjects under loose mode, direct management mode and consortium mode were -0. 12, 0. 17 and -0. 08 respectively, and the comprehensive scores given on the collaboration status by medical workers and administrators were -0. 02 and 0. 05 respectively. Conclusion Comprehensive evaluation on the collaborative mode can be performed in terms of four factors which are chronic disease prevention and management, diagnosis and treatment, information continuity, and further education on professional work. Difference exists in the score of each factor under each mode. Inconsistency exists in the collaboration status evaluated by managers and medical workers, thus effective strategies for benefit adjustment and proper incentive mechanism are needed.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第19期2241-2245,共5页
Chinese General Practice
基金
国家自然科学基金面上项目(71173118)--医院和社区协作模式下慢性病医疗服务提供整合评估与改进策略研究
江苏省“青蓝工程”项目资助
关键词
卫生服务
合作行为
城市
因子分析法
Health services
Cooperative behavior
Cities
Factor analysis
