慢性病服务跨机构协作模式探索及效果评价——基于医务人员的调查  

Evaluation and analysis of cross-institutional collaboration models for chronic diseases services:A survey of medical personnel

作　　者：殷璇[1] 钱东福 谷小丽[1] 汪润清[2] YIN Xuan;QIAN Dong-fu;GU Xiao-li;WANG Run-qing(School of Health Policy and Management,Nanjing Medical University,Nanjing Jiangsu 211166,China;Office of Asset and Industry Management,Nanjing Medical University,Nanjing Jiangsu 211166,China)

机构地区：[1]南京医科大学医政学院,江苏南京211166 [2]南京医科大学资产与产业管理处,江苏南京211166

出　　处：《中国卫生政策研究》2018年第6期47-51,共5页Chinese Journal of Health Policy

基　　金：国家自然科学基金项目(71473130)

摘　　要：目的:对比医务人员对干预前后在跨机构协作效果上的评价变化,为促进医务人员的跨机构沟通和协调、完善慢性病服务跨机构协作模式提供实证依据。方法:采用典型抽样和多阶段随机抽样相结合,对县、乡、村医务人员进行问卷调查,运用倾向得分匹配干预前后样本,并对结果进行统计学分析。结果:干预方案实施一年后,县级医院参与度提高,但工作认同感降低;乡级医疗卫生机构以患者为中心提供慢性病服务水平提升,但从培训中得到的帮助效果有限;慢性病服务跨机构协作对改善村医诊疗水平帮助大。建议:在跨机构协作模式政策制定层面,重视县级医院医务人员工作需求,改善利益激励方式,明确晋升渠道及标准;建立健全跨机构培训机制,注重理论与实际相结合,发挥对个人发展的激励作用;从慢性病提供连续性角度,探索县、乡、村在跨机构协作中的角色和任务。Objectives： To compare the changes in effectiveness of cross-institutional collaboration before and after intervention and non-intervention from medical personnel in order to empirically support promoting cross-institutional communication,coordination and cooperation modes for chronic diseases services. Methods： The typical sampling and multistage random sampling were used to conduct a questionnaire survey among medical personnel at villages,townships and county levels. The Propensity（ Tendency） Scores were used to match the samples of the baseline and the following year of intervention,and the results were statistically analyzed. Results： After one-year of intervention,the county-level hospital doctors manifested higher participation while the sense of identity in work decreased;township medical personnel offered patient-centered provision of chronic disease services at higher level,but they received limited benefits from training attendance; and village medical institutions benefited a lot from the improved health care services and improved the clinic capability from cross-institutional collaboration on chronic diseases services. Suggestions： At the level of cross-institutional collaboration model policy development,attention should be paid on the work needs of county-level hospital doctors. It is also necessary to improve incentive mechanism and to work out definite and clear procedures and standards of promotion,establish a sound cross-institutional training mechanism and put knowledge into practice thereby encouraging individual development. For ultimate stand-straight,the roles and responsibilities of multi-level institutions in cross-institutional cooperation should be explored from the perspective of continuous chronic disease services.

关 键 词：慢性病 跨机构协作 干预实验 

分 类 号：R197[医药卫生—卫生事业管理]