基于主题框架分析法的福建省紧密型县域医疗卫生共同体监管现状分析  

Analysis of the supervision status of intensive countywide medical community in Fujian province based on thematic frame analysis

作　　者：尚钊 薛冬羽 郑怡萍 李跃平[2] 戴悦[2] Shang Zhao;Xue Dongyu;Zheng Yiping;Li Yueping;Dai Yue(School of Health Management,Fujian Medical University,Fuzhou 350122,China;Institute of Health Research,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学卫生管理学院,福州350122 [2]福建医科大学卫生健康研究院,福州350122

出　　处：《中华医院管理杂志》2023年第6期411-416,共6页Chinese Journal of Hospital Administration

基　　金：福建省科技厅创新战略研究项目(2021R0054);福建省县域医共体建设现状调研(2022B011)。

摘　　要：目的分析紧密型县域医疗卫生共同体(以下简称紧密型医共体)的监管现状与存在问题,为完善紧密型医共体监管体系提供借鉴。方法2022年3—5月,采用分层随机抽样方法,选取福建省的紧密型医共体作为研究现场,对其所属的卫生健康行政部门及医保部门的工作人员、总医院院长、乡镇卫生院院长和职能科室负责人进行关键人物访谈,访谈内容主要包括紧密医共体监管主体、监管措施与内容、监管效果、监管薄弱环节以及如何完善内部与外部监管机制等;利用主题框架分析法分析访谈资料,对数据进行描述性分析。结果共选取5家紧密型医共体的23人进行关键人物访谈。最终形成的紧密型医共体监管主题框架包括监管主体、监管内容、监管措施、监管实效和现存问题5个总主题,涵盖14个一级指标和52个二级指标,监管主体以政府部门为主(15次),监管内容聚焦于医疗资源(10次),监管措施围绕具体制度(4次)、具体活动(4次)与考核评价(4次)展开,监管实效表现为当前的监管力度较强(5次),现存问题主要是政府监管存在不足(12次)、社会力量监督困难(11次)和内部治理遇到阻碍(5次)。结论应通过完善政府监管机制、重视社会力量监督与实现内部有效治理,优化紧密型医共体监管体系。Objective To analyze the supervision mode and problems of intensive countywide medical communities and explore the methods and strategies to improve their supervision system.Methods From March 2022 to May 2022,a stratified random sampling method was used and the intensive countywide medical communities in the province were selected for field study.In-depth interviews were made with the staff of the healthcare administration departments and health insurance agencies affiliated with intensive countywide medical communities,directors of general hospitals,directors of township hospitals,and heads of functional departments.These interviews mainly covered the principal entities of countywide medical community supervision,supervision measures and contents,supervision effects,supervision weaknesses,and how to improve internal and external supervision mechanisms.The interviews results were analyzed using thematic framework analysis and the data were subject to a descriptive analysis.Results 23 persons of five intensive countywide medical communities were selected for key person interview.The finalized framework of regulatory elements of intensive countywide medical communities consists of such five general themes as regulatory subjects,regulatory content,regulatory measures,regulatory effectiveness and existing problems,comprising 14 level-1 indicators and 52 level-2 indicators.The main regulatory bodies were mainly government departments(15 times),the regulatory content was focused on medical resources(10 times),the regulatory measures cover specific regulations(4 times),specific activities(4 times)and assessment and evaluation(4 times).And the regulatory effectiveness demonstrated a currently strong regulation strength of medical communities(5 times),and the existing problems were insufficient government supervision(12 times),difficulties encountered by social forces in their supervision(11 times)and internal governance(5 times).Conclusions The supervision system of intensive countywide medical communities should be opt

关 键 词：卫生保健提供 联合 紧密型县域医疗卫生共同体 主题框架分析法 监管现状 问题研究 福建省 

分 类 号：R197[医药卫生—卫生事业管理]