紧密型县域医疗卫生共同体监管的影响因素与重点内容研究  

Influencing factors and key contents of the regulation of compact county medical community

作　　者：尚钊 郑怡萍 薛冬羽 刘雨晴 李跃平[1] 张宝泉[2] 戴悦[1] Shang Zhao;Zheng Yiping;Xue Dongyu;Liu Yuqing;Li Yueping;Zhang Baoquan;Dai Yue(School of Health Management,Fujian Medical University,Fuzhou 350122 China;Natology Department,Fujian Provincial Maternal and Child Health Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学卫生管理学院,福州350122 [2]福建医科大学附属福建省妇幼保健院新生儿科,福州350001

出　　处：《中华医院管理杂志》2024年第2期79-85,共7页Chinese Journal of Hospital Administration

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

摘　　要：目的明确紧密型县域医疗卫生共同体(以下简称紧密型医共体)监管的关键影响因素和重点内容, 为完善紧密型医共体监管体系提供参考。方法检索2000—2021年发表的紧密型医共体监管与医疗卫生服务体系监管相关文献及2003—2021年发布的相关政策文本, 采用文献分析和德尔菲法确定紧密型医共体监管影响因素和监管内容;采用决策试验与评价实验法(DEMATEL)分析影响紧密型医共体监管的关键因素, 并通过优序图法确定紧密型医共体监管的重点内容。结果共获得14项紧密型医共体监管影响因素和15项监管内容。根据各影响因素的中心度和原因度结果, 确定激励约束(11.349, 0.936)、卫生法律法规(10.912, 0.653)、绩效考核(10.610, 0.249)、财政投入(10.198, 0.481)为对其他因素有较强影响的关键原因因素;监管成本(12.293, -0.822)、专职监管人员能力(10.471, -0.654)、专职监管人员数量(10.378, -0.388)为较易受到其他因素影响的核心结果因素。根据优序图法结果共确定12项监管重点内容, 按照重要性得分排序依次为服务对象满意度(60.0)、医务人员满意度(59.0)、公共卫生服务(56.5)、绩效考核标准(51.5)、双向转诊情况(51.0)、紧密型医共体运行考核(50.5)、医疗质量管理标准(49.0)、医疗服务质量(47.0)、财政补助经费(47.0)、绩效考核分配(46.5)、医保支付打包(46.5)和基金结余分配(45.0)。结论为完善紧密型医共体监管体系, 有效提升监管成效, 应重点关注关键原因因素和关键结果因素的影响, 聚焦于对满意度、医疗服务、管理标准和利益机制4个方面重点内容的监管。Objective To identify the key influencing factors and regulatory contents of compact county medical community,and to provide references for the improvement of compact county medical community regulatory system.Methods To search the literature related to the regulation of compact county medical community and the regulation of health care service system published from 2000 to 2021 and the related policy texts released from 2003 to 2021,and to identify the influencing factors and regulatory contents of compact county medical community regulation by using literature analysis and the Delphi method.The decision-making experiment and evaluation of experiments(DEMATEL)method was used to analyze the critical influencing factors of the compact county medical community regulation.The preferential order diagram method was used to identify the key contents of the compact county medical community regulation.Results A total of 14 influencing factors of compact county medical community regulation and 15 regulatory contents were obtained.Based on the results of the centrality and causality of each influencing factor,it was determined that incentive constraints(11.349,0.936),health laws and regulations(10.912,0.653),performance appraisal(10.610,0.249),and financial input(10.198,0.481)were the key causative factors that had a stronger influence on the other factors.The cost of regulation(12.293,-0.822),full-time regulator capacity(10.471,-0.654),and number of full-time regulators(10.378,-0.388)were core outcome factors that were more likely to be influenced by other factors.A total of 12 key regulatory contents were identified based on the results of the preferential order diagram method,and in order of importance scores,satisfaction of client satisfaction(60.0),satisfaction of medical staff(59.0),public health services(56.5),performance appraisal standards(51.5),bidirectional referral status(51.0),assessment of the operation of the compact county medical community(50.5),quality management standards of medical care(49.0),medical se

关 键 词：卫生保健联合体 紧密型县域医疗卫生共同体 监管 影响因素 监管内容 

分 类 号：R197.1[医药卫生—卫生事业管理]