分级诊疗体系运行影响因素的解释结构模型构建  

Influencing factors for hierarchical medical system： interpretative structural modeling

作　　者：孟德昕[1] 张淑娥[2] 樊超[2] 茹义福 李海燕[2] 时宇[2] 谢奉哲 杨立斌[2] 迟沫涵[2] 毛大川 孙涛[2] 

机构地区：[1]哈尔滨医科大学附属第二医院,150081 [2]哈尔滨医科大学卫生管理学院

出　　处：《中华医院管理杂志》2016年第7期481-484,共4页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金（71403071）;黑龙江省自然科学基金（G201411）;黑龙江省哲学社会科学研究规划项目（13D053）

摘　　要：目的构建分级诊疗体系运行影响因素的多级递阶结构模型，并识别各影响因素间的作用关系与传导环路，为我国分级诊疗体系的健康运行提供合理化建议。方法结合既往文献筛选30类影响因素，经3位卫生政策管理专家核检，总结并归纳出当前分级诊疗体系运行的16类影响因素。采用解释结构模型方法分析各影响因素间的层级关系及传导环路，得到分级诊疗体系运行影响因素的直观层次结构模型。结果我国分级诊疗体系的16类影响因素存在一个三级递阶结构和两条传导环路。制约分级诊疗体系运行成效的直接因素是“双向转诊”，最深层的内核因素是“人力建设”和“治理机制”，二者主要通过“自我成长”与“外部约束”2条传导环路共同影响分级诊疗体系的健康运行。结论各影响因素存在着交互递阶效应，并聚积成“功能角色”“主体间关系”“患者参与度”3个节点要素。Objective To build a multi-level hierarchical structure model of the influencing factors for hierarchical medical system, to identify the role relationship between all the factors and transmission pathways, and to recommend on developing Chind s hierarchical medical system. Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system. On such basis, 16 influencing factors were identified by three health policy experts, which affect operations of the current system. Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops. Results There exist among the 16 factors a ＂3-level hierarchical structure＂ and two conduction loops. The factor directly limiting the hierarchical medical system is ＂two-way referral＂, and most internal core drivers are ＂human resources development＂ and ＂governance mechanism＂. By means of self-growth and external constraints, they exert their influence on the operation of hierarchical medical system. Conclusions There are interactive hierarchical effects among the factors, merging into three node elements of ＂functional role＂, ＂inter-entity relationship＂ and ＂patient participation＂.

关 键 词：分级诊疗 影响因素 解释结构模型法 

分 类 号：R197.1[医药卫生—卫生事业管理]