多学科合作诊疗创新家庭医生服务模式实践探索  

Multi-Disciplinary Treatment Innovative Family Doctor Service Model Practice Exploration

作　　者：花晓莉[1] 钱海芹 季祥霞 董彩红 王国乙 HUA Xiaoli;QIAN Haiqin;JI Xiangxia;DONG Caihong;WANG Guoyi(Department of Medical Group Office,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an Jiangsu 223300,China;Department of Hospital Office,the Second Branch of the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an Jiangsu 223300,China;Department of Medical Service,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院医疗集团办公室,江苏淮安223300 [2]南京医科大学附属淮安第一医院第二分院办公室,江苏淮安223300 [3]南京医科大学附属淮安第一医院医务处,江苏淮安223300

出　　处：《中国卫生标准管理》2024年第4期101-104,共4页China Health Standard Management

基　　金：国家卫生健康委医院管理研究所医疗质量循证管理持续改进研究项目(YLZLXZ22G012)。

摘　　要：随着医改的深入和《“健康中国2030”规划纲要》的提出,社区基层医院需要创新医疗卫生服务供给模式,提供优质高效的医疗服务,强化体系创新、技术创新、模式创新实现医院高质量发展。社区基层医院亟须完善和探索家庭医生签约服务模式,从而推进慢性病防、治、管整体融合发展。南京医科大学附属淮安第一医院第二分院在家庭医生签约服务管理方面做了一些有益的探索。文章阐述了“全科医生、专科专家、家庭药师”多学科合作诊疗(multi-disciplinary treatment,MDT)新型家庭医生服务模式的意义,落实MDT家庭医生服务模式的具体做法、实施成效及未来展望,为社区基层医院提升慢性病健康管理提供借鉴。With the deepening of medical reform and the proposal of "Healthy China 2030 Plan Outline",community primary hospitals need to innovate the supply mode of medical and health services to provide high-quality and efficient medical services,strengthen system innovation,technological innovation and model innovation to achieve high-quality development of hospitals.Community basic hospitals need to improve and explore the contract service model of family doctors,so as to promote the integrated development of chronic disease prevention,treatment and management.The Second Branch of the Affiliated Huai'an No.1People's Hospital of Nanjing Medical University has done some useful exploration in the management of family doctor contract service.This paper expounds the significance of the new family doctor service model of multi-disciplinary treatment(MDT)and treatment of general practitioners,specialist experts and family pharmacists,and the specific practices,implementation results and future prospects of the implementation of the MDT and treatment of family doctor service model,so as to provide reference for community primary hospitals to improve the health management of chronic diseases.

关 键 词：家庭医生 多学科合作诊疗 慢性病管理 糖尿病 创新模式 社区 

分 类 号：R197[医药卫生—卫生事业管理]