上海市某区分级诊疗制度实施现状分析  

Analysis of current status of implementing a tertiary referral medical care system in a district of Shanghai

作　　者：计光跃[1] 胡立安[1] 史明秀 朱永松[2] 

机构地区：[1]上海市第十人民医院后勤保障处,上海200072 [2]上海市第十人民医院院长办公室,上海200072

出　　处：《中国卫生资源》2016年第4期315-317,322,共4页Chinese Health Resources

摘　　要：目的 :通过对上海市闸北区社区居民的问卷调查,了解上海市闸北区分级诊疗制度实施现状,为推动分级诊疗制度的建立提供政策建议。方法 :在2015年9—10月,采取偶遇抽样的方法,在上海市闸北区各级医院和社区卫生服务中心门诊进行为期2个月的现场调查,调查对象为社区居民,发放调查问卷900份,回收有效问卷855份,有效回收率为95.0%。结果 :调查的社区居民社区卫生服务中心首诊率仅为40.4%;影响居民由社区转诊到医院主要影响因素为"有绿色通道"、"增加流程,转诊手续繁琐";影响社区居民由医院转诊到社区的主要原因为"病情稳定,后续康复不需要在大医院"、"对社区硬件环境设备不满意";调查对象中接受过社区转诊服务的居民仅仅占14.4%,由社区转诊到综合医院的重复检查率为78.9%。结论 :上海市居民社区首诊意愿率和实际转诊率较低,转诊后重复检查率较高。建议进一步提高社区基本医疗服务的供给能力,构建医疗联合体,建立信息共享云平台,协同制定统一转诊标准。Objective： To understand current status of a tertiary referral medical care system in Zhabei, Shanghai through residents questionnaire survey; to provide policy recommendations for establishing a tertiary referral medical care system. Methods： A self-designed questionnaire survey was conducted among 900 community residents through accidental sampling, 855 were returned and the valid returned rate was 95.0%. Results： First diagnosis rate in community health service centers was only 40.4%; the major potential factors hindered residents from being referred from community health service centers to hospitals were ＂green channel＂ and ＂referral procedure is complicated＂. The major potential factors of residents referred from hospitals to community health service centers were ＂stable condition＂ and ＂poor community environment and equipment＂. The result showed 14.4% of surveyed residents had received community referral service and 78.9% of survey residents repeated the same inspection in hospitals. Conclusion： First diagnosis rate in community health service centers and referral rate among Shanghai residents were low; the repetitive examination rate was high. Some recommendations were put forward, such as improving basic community health services supply capacity, constructing medical association, establishing an information sharing platform, and developing unified criteria for referral.

关 键 词：分级诊疗 社区 医院 转诊 

分 类 号：R197[医药卫生—卫生事业管理]