城市社区管理与慢性病干预服务包设计研究  

Urban Community Management and Chronic Disease Intervention Service Package Design

作　　者：王演艺 杨梦莹 高继龙 WANG Yan-yi;YANG Meng-ying;GAO Ji-long(College of Rehabilitation Medicine,Jining Medical University,Jining 272067,China)

机构地区：[1]济宁医学院康复医学院,山东济宁272067 [2]济宁医学院生物科学学院,山东日照276826 [3]济宁第一人民医院康复医学科,山东济宁272111

出　　处：《医学与哲学（A）》2018年第7期38-41,63,共5页Medicine & Philosophy:Humanistic & Social Medicine Edition

基　　金：2016年山东省社科联人文社会科学项目(16-ZCSH-01);2016年济宁市医疗卫生类科技计划项目(2016-56-103)

摘　　要：依据"未病先防、既病防变"的现代健康理念,梳理我国当前城市社区治理现状,以全局性视角构架基层社区慢性病干预服务包项目。在已有的区域性服务包实践基础上,充分考虑筹资渠道、关联主体权责、干预手段等问题,形成以保健预防为主体的基本服务包、以干预防控为主体的标准服务包以及以个性化诊治康复为主体的定制服务包,变被动慢性病治疗为主动健康管理。引导人们根据实际需求接受"基层首诊、双向转诊、急慢分治、上下联动"的分级诊疗服务,优化我国慢性病综合防控管理路径。According to the modern health concept of“prevention before disease onset,prevention of disease from exacerbating”,carding the current situation of urban community governance in our country,this article constructs the grass-roots community chronic disease intervention service package project in a holistic view.Based on the practical and regional service packages,fully considered financing channels,power and responsibility of related subjects,intervention measures and so on,this project designs the basic service package with health care prevention,standard service package with intervention control,and customized service package with individualized treatment rehabilitation.This design changes passive chronic disease treatment to active health management.Meanwhile,it will guide people accept the hierarchical medical service of“first diagnosis,two-way referral,separation of urgent and chronic diseases,upper and lower linkage”by their actual needs,and optimize the path of comprehensive chronic disease prevention and control in China.

关 键 词：慢性病干预 服务包 城市社区 项目设计 

分 类 号：R-05[医药卫生]