医社协同与社区智慧健康小屋:分级诊疗路径再建构  

Medical and Social Cooperation and Community Smart Health Huts:Reconstruction of Hierarchical Diagnosis and Treatment Path

作　　者：吴玉霞 马洪波[2] 米红 WU Yuxia;MA Hongbo;MI Hong(College of Humanities and Arts,Institute for Elder and Children,Ningbo University of Technology,Ningbo 315211,China;Ningbo Zhijiang Social Work Service Evaluation and Research Center,Institute for Elder and Children,Ningbo University of Technology,Ningbo 315200,China)

机构地区：[1]宁波工程学院人文与艺术学院宁波工程学院“一老一小”发展研究院,浙江省宁波市315211 [2]浙江省宁波市之江社会工作服务评估与研究中心宁波工程学院“一老一小”发展研究院,315200

出　　处：《中国全科医学》2024年第13期1638-1644,共7页Chinese General Practice

基　　金：国家社科基金重大项目课题(21ZDA101)。

摘　　要：背景分级诊疗自实施以来进展缓慢,其中对多元主体和利益相关者分析的全面性不足是重要原因之一。目的通过分析分级诊疗中多元主体的利益关系,探讨能结合自上而下和自下而上双重路径的机制创新方案,通过政策创新和路径创新,助力多元主体协同治理,优化分级分流的就医秩序。方法于2022-10-10—2023-03-20选取2个国内先进城市的先进城区(X市S区和N市H区)为典型调研区,通过滚雪球抽样和目的抽样法,选取典型调研区内36位不同利益相关者(涉及市级卫生行政部门、三级医院管理者、三级医院专科医生、社区卫生服务中心管理者、全科医生、健康社工师、患者等7类主体)为研究对象开展深度访谈,运用利益相关者的理论分析方法,分析7大利益主体之间的利益纠葛和掣肘及其对分级诊疗就医秩序健康发展的制约,以探索分级诊疗的机制困境;并对X市S区和N市H区实施健康社工和社区智慧健康小屋试点地区和非试点地区的典型利益相关者的访谈记录进行文本分析,以对比实施前后的效果。结果深度访谈结果显示,“利益相关程度、实施意愿程度、受实施影响程度和对实施影响力”4大维度是影响7类主体实施分级诊疗的主要方面,7大主体有各自利益立场,对分级诊疗起到不同程度的助力和阻力作用,多元主体之间难以形成协同机制是问题的关键。试点地区通过推行社区智慧健康小屋、健康社会工作及其形成的医社协同新机制,有助于增强7大主体的利益相关性,实现更好的分级诊疗秩序。结论社区智慧健康小屋是医社协同新机制的物化空间,健康社工师是新机制的链接点和赋能者。借助于社区智慧健康小屋的新载体和健康社工师的新力量,建构以健康社会工作为中心的医社协同新路径,能实现就医人口的基层前置,对形成分级诊疗的就医秩序起到“增能导流”的�Background One of the important reasons for the slow progress of hierarchical diagnosis and treatment since its implementation is the lack of comprehensiveness in the analysis of multiple subjects and stakeholders.Objective To explore mechanism innovation solutions that combine both top-down and bottom-up paths by analyzing the interest relationships among diverse stakeholders in the hierarchical medical diagnosis and treatment system,and facilitate collaborative governance among diverse stakeholders through policy innovation and path innovation,to optimize the order of hierarchical patient flow.Methods From October 10,2022,to March 20,2023,two advanced urban districts in China(S district in X city and H district in N city)were selected as typical research areas.A total of 36 different stakeholders(involving municipal health administrative departments,tertiary hospital administrators,tertiary hospital specialists,community health service center administrators,general practitioners,health social workers,and patients)were selected as the study subjects for the in-depth interviews through snowball and purposive sampling methods.The stakeholder theory analysis method was employed to analyze the interests and constraints among the seven major stakeholder groups and their constraints on the healthy development of the order of hierarchical medical diagnosis and treatment,and explore the dilemma of the mechanism of hierarchical diagnosis and treatment.Furthermore,textual analysis of interview records of typical stakeholders in the pilot and non-pilot areas of the implementation of health social workers and community smart health huts in S district in X city and H district in N city was conducted to compare the effects before and after the implementation.Results The results of the in-depth interviews showed that four main dimensions,including the degree of interest,willingness to implement,the extent of impact by implementation,and the influence on implementation,are the major factors affecting the implementation of hiera

关 键 词：健康治理 分级诊疗 医社协同 社区智慧健康小屋 健康社会工作 

分 类 号：R-05[医药卫生]