上海市社区舒缓疗护(临终关怀)项目试点机构临终关怀服务现状调查  

The Service Status of Hospice Care Pilot Settings in Shanghai

作　　者：王华萍 施永兴 周佳秋 

机构地区：[1]上海市浦东新区老年医院,201314 [2]中国生命关怀协会调研部 [3]上海市宝山区杨行镇社区卫生服务中心

出　　处：《中国全科医学》2015年第34期4244-4247,共4页Chinese General Practice

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养计划资助项目(PWRq2013-03)

摘　　要：目的了解上海市政府实事舒缓疗护(临终关怀)项目试点机构的临终关怀服务现状,为临终关怀服务的开展提供依据。方法以上海市政府实事临终关怀项目试点机构18家社区卫生服务中心为调查对象。于2014年3—6月,采用自行设计的结构式调查问卷进行调查。调查内容包括:试点机构的基本情况,床位使用情况,医疗业务情况,机构收支运行情况及2014-03-13试点机构患者住院和居家情况。结果 2013年18家试点机构收治临终患者数为1 301人,其中中心城区817人(占62.8%),郊区438人(占33.7%),崇明县46人(占3.5%),临终患者总住院天数为37 729 d,人均住院天数为29.0 d;共有临终关怀病床234张,病床使用率为43.8%(32 082/73 189),临终关怀病床周转次数为5.6(1 301/234)。2013年试点机构临终关怀出院患者日均住院费用为189.7元,人均住院费用为5 500.5元。2013年试点机构临终关怀科总收入为2 039.8万元,总支出为2 277.5万元,收支结余为-237.7万元,平均每家机构为-13.2万元。2014-03-13,18家试点机构共有住院患者152人,于当日入院临终患者36人;共有居家患者35人。结论上海市临终关怀服务网络初步形成,降低了患者的医疗费用,节约了医疗卫生资源,但目前存在临终关怀病床使用率和周转次数低、资源利用率不高及运营资金紧张等问题。应进一步建立合理的临终关怀服务筹资与补偿机制,落实临终关怀科功能定位,完善医保配套政策,整合社区卫生资源,推进临终关怀服务发展。Objective To investigate the status of hospice care service in the pilot settings of Shanghai municipal hospice care program,in order to provide references for carrying out hospice care service. Methods We took 18 community health service centers that were pilot settings of Shanghai municipal hospice care program as research objects. From March to June in 2014,we employed a self-designed structural questionnaire to conduct survey in these settings. The survey content concluded the general information about the settings,the usage of sick beds,the condition of health service,the income and expenses of the settings and the status of hospitalization and home living of patients on March 13,2014. Results In 2013,the number of patients admitted into the 18 settings were 1 301,among which 817（62. 8%）were from central urban area,438（33. 7%） were from suburb areas and 46（3. 5%）were from Chongming County. The total number of hospitalization days was 37 729 d, and the average number of hospitalization days per person was 29. 0 d;there were all together 234 sick beds, with a bed occupancy rate of 43. 8%（32 082/73 189）,and sick bed turnover times was 5. 6（1 301/234）. In 2013,the hospitalization cost per day of discharged patients was 189. 7,and the hospitalization cost per person was 5 500. 5. In 2013,the total income of the department of hospice care in the 18 settings was 20. 398 million yuan;the total expense was 22. 775 million yuan;the balance of payments was -2. 377 million yuan,averagely -132 000 for each setting. On March 13,2014,the number of＆nbsp;inpatients of the 18 settings was 152,and the number of patients who were admitted on that day was 36;there were also 35 patients who received care at home. Conclusion The network of Shanghai hospice care service has been initially formed,which has reduced the medical cost of patients and saved health care resources. However, problems exist, such as low sick bed occupancy rate and turnover times, low utilization rate of resources and tight operation cap

关 键 词：临终关怀医疗 临终病人 服务现状 

分 类 号：R197[医药卫生—卫生事业管理]