成都市新津县公益性医疗卫生服务体系改革绩效评估系列之八:新津县2009～2011年基本公共卫生服务绩效评估  

Performance Evaluation of Primary Healthcare System Reform in Xinjin County, Chengdu City. Ⅷ: Evaluation of the Essential Public Health Services from 2009 to 2011

作　　者：王莉[1] 沈建通[1] 李幼平[1] 师成虎[1] 李筱[1] 王应强[1] 李萃萃[1] 杨宗霞[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2014年第4期385-393,共9页Chinese Journal of Evidence-based Medicine

基　　金：成都市卫生局资助项目"新津县公益性医疗卫生服务体系改革绩效评估"(编号:H1106077)

摘　　要：目的 综合评估2009～2011年4月成都市新津县基本公共卫生服务绩效，为完善和推行成都市公益性医疗卫生服务体系提供证据。方法 根据成都市新津县区域卫生信息平台数据，定量描述和比较新津县健康档案、慢病管理、分娩管理和精神卫生情况。结果 ① 新津县2010年体检88 772人，检出健康问题14 497例（检出率16%），每检出1例成本为122.5元。② 截至2011年4月，新津县健康档案建档率达98.2%，但不同机构建档率差异较大（68.08%～109.02%），部分档案内容不完整。③ 高血压患者共7 318例，建档率90.1%；糖尿病患者共2 187例，建档率95.1%。④ 2009～2011年死胎、死产和新生儿产后死亡率均低于4‰，连续8年产妇零死亡，剖宫产率达61%。⑤ 2010年精神病患者管理率97.3%，比2009年减少2.7%。结论 ① 新津县全民免费体检率不高，疾病检出率低。② 健康档案建档率较高，覆盖人群较广，接近全民覆盖。③ 慢病建档率较高，但慢病发现率较低。④ 对精神病患者的管理率接近100%。⑤ 新津县实施产科上收至县级医疗机构，有效控制和降低了产妇与新生儿死亡风险，但剖宫产比例过高。⑥ 新津县基于区域卫生信息系统的公共卫生服务与管理具有一定示范意义，但数据收集、使用和挖掘需进一步改进。ObjectiveTo comprehensively evaluate the essential public health service in Xinjin county of Chengdu from 2009 to April 2011, so as to provide evidence for improving primary healthcare system reform in Chengdu city. MethodsThe data was collected from the Xinjin county-wide health information system. The electronic health records, chronic disease management, childbirth management and mental health were quantitatively described and compared. Resultsa） In 2010, 88 772 residents had the physical examination and health assessment, among which, 14 497 （16%） were detected with some health problems. The average cost per positive detection was RMB 122.5 yuan. b） Up to April 2011, 98.2% of people in Xinjin county have their health records but the proportions were ranged from 68.08% to 109.02% in different primary healthcare providers. The details of the most health records were incomplete. c） 7 318 patients with hypertension and 2 187 diabetes mellitus were detected, and among them, 90.1% of patients with hypertension and 95.1% of patients with diabetes had their health records for chronic diseases management. d） The rate of stillbirth or neonatal mortality was lower than 4‰. There was no maternal death in the 8 years. But the cesarean section rate was about 61%. e） 97.3% of the patients with mental disorders were supervised in 2010, which was reduced by 2.7% compared to 2009. Conclusionsa） There is low proportion of all the residents in Xinjin having physical examination and health assessment and the rate of diseases detection is low as well. b） There is very wide coverage of health records for residents in Xinjin county, nearly universal coverage. c） The health records for the chronic disease patients were well-established, but the early detection rate of the chronic diseases is low. d） High proportion of the patients with mental disorders is supervised. e） The strategy that only county-level hospitals could provide obstetrical service instead of township hospitals is successful to reduce the ne

关 键 词：基层医疗卫生服务 卫生改革 基本公共卫生服务 绩效评估 新津县 

分 类 号：R197.1[医药卫生—卫生事业管理]