摘要
目的了解安徽省县/市卫生服务体系内糖尿病和精神分裂症服务提供协作性现状,为推进慢性病分级诊疗试点过程中如何加强服务协作提供建议。方法采用典型抽样方法,对安徽省马鞍山市、肥西县和肥东县卫生体系进行案例分析,在三地调查的机构数量均为11所,以定量和定性研究方法相结合,通过文件分析和专家咨询制定2种疾病诊疗的理论服务包,对医生的问卷调查收集机构提供的数据采用差异分析方法分析服务的差距指数、重叠指数和过度指数。结果 3个卫生体系在糖尿病服务提供中均存在1个断裂点,肥西县和肥东县在精神分裂症服务提供中分别存在2个和3个断裂点;2种疾病的服务协作特点不同,糖尿病服务提供的特点是村级/街道明显过度提供(过度指数≥4.5)和县/市级机构的提供不足(差距指数≥1.5),精神分裂症服务提供呈现基层严重提供不足(差距指数≥6.8)和县/市级机构不足与过度提供并存。结论 3个卫生体系需结合各自的服务协作现状,弥合服务断裂点、机构层面各司其职、体系层面统筹协调,从而推进体系内的服务协作。
Objective To examine the status of care coordination for diabetes and schizophrenia patients in health systems for improving medical service coordination in hierarchical diagnosis and treatment practice. Methods With typical sampling, Ma＇anshan municipality, Feidong and Feixi county in Anhui province were selected as the case study sites and totally 33 medical institutions （ll in each of the three sites）were surveyed. Theoretical service packages for diabetes and schizophrenia diagnosis and treatment were constructed through documents review and experts consultation and the medical service provided actually to the patients with the two diseases were assessed with a questionnaire survey among doctors in the institutions studied. The gaps between theoretical and actual medical service were analyzed using deficit, overlap, and excess indexes. Results There was one discontinuous segment in medical service （ a service item not provided by all the institutions at different levels within the health system） to diabetes patients in each of the three health systems, two and three discontinuous segments in medical service to schizophrenia patients in health system of Feixi and Feidong county. The care coordination of the health systems showed different characteristics for medical service to diabetes and schizophrenia patients ,with the over provision （excess index ≥ 4. 5 ） in institutions at village/commnnity level and defi- cit provision （ deficit index ≥ 1.5 ） in institutions at county/municipality level for service to diabetes patients, and the deficit provision （deficit index ≥ 6. 8 ） in institutions at village/community level and both over and deficit provision in institutions at county/municipality level for service to schizophrenia patients. Conclusion The study results suggest that care coordination in health systems in Anhui province needs to be promoted by bridging discontinuous segment in medical service, advancing cooperation among medical institutions at different level, and making comprehensive arrangement within health systems.
出处
《中国公共卫生》
CAS
CSCD
北大核心
2016年第10期1352-1357,共6页
Chinese Journal of Public Health
关键词
卫生体系
服务协作
差异分析
health care system
care coordination
gap analysis
