医联体背景下基层医疗卫生机构服务能力及影响因素研究  

Medical Service Capacity and Influencing Factors of Primary Health Care Institutions Under Medical Alliance

作　　者：张亚琳 刘力滴[2] 陈正勇 刘长明 杨梓钰 曹毅[1] 廖晓阳 ZHANG Yalin;LIU Lidi;CHEN Zhengyong;LIU Changming;YANG Ziyu;CAO Yi;LIAO Xiaoyang(Department of General Practice,Chengdu Qingbaijiang Maternal and Child Health Care Hospital,Chengdu 610300,China;General Practice Medical Center,West China Hospital,Sichuan University,Chengdu 610041,China;Second Department of Internal Medicine,Chengxiang Town Center Hospital Qingbaijiang District,Chengdu 610300,China;Department of General Practice,Xihanggang Community Health Center,Chengdu 610200,China)

机构地区：[1]四川省成都市青白江区妇幼保健院全科,610300 [2]四川大学华西医院全科医学中心,四川省成都市610041 [3]四川省成都市青白江区城厢镇公立中心卫生院内二科,610300 [4]四川省成都市双流区西航港社区卫生服务中心全科医疗科,610200

出　　处：《中国全科医学》2024年第34期4302-4307,共6页Chinese General Practice

基　　金：四川省卫生健康委员会项目(TJZ201909);四川省科技厅软科学项目(2022JDR0325)。

摘　　要：背景医联体建设是我国深化医改的重要举措,旨在促进医疗服务重心下移和资源下沉,提升基层服务能力。有研究显示,医联体建设可以提升基层医疗卫生机构的服务能力,但各整合要素对基层医疗卫生机构服务能力的影响尚不明确。目的分析基层医疗卫生机构的服务能力,并探究医联体背景下服务能力的影响因素。方法于2019年12月,采用课题组自行编制的结构化问卷对成都市参与了医联体建设的381家基层医疗卫生机构开展调查,调查内容涉及人员配置、门诊和住院服务、医联体建设情况等,由当地卫生行政部门统一发放及回收问卷。以在岗职工数、注册全科医生数、床位数、门急诊人次、入院人次、病床使用率6项指标作为基层医疗卫生机构的服务能力评价指标,采用秩和比法将381家机构的服务能力分为3档,采用有序Logistic回归分析基层医疗卫生机构服务能力的影响因素。结果381家基层医疗卫生机构的中位在岗职工数为54(48)人,中位注册全科医生数为4(8)人,中位床位数为50(50)张,中位门急诊人次为49460(60317)人次,中位入院人次为1440(2071)人次,中位病床使用率为68.43%(45.18%)。依据秩和比,服务能力被评价为好、中、差的机构分别有61家(16.0%)、260家(68.3%)、60家(15.7%)。有序Logistic回归分析结果显示,机构建筑面积及与医联体内机构合作开展教学查房、远程读片情况是基层医疗卫生机构服务能力的影响因素(P<0.05)。结论四川省成都市基层医疗卫生机构的服务能力较好,机构建筑面积及医联体帮扶方式中的教学查房、远程读片会影响基层医疗卫生机构的服务能力。Background The construction of medical alliance is important measure for deepening medical reform.It aims to move the focus and resource to primary health care institutions,and improve service capabilities.Studies have shown that the medical alliance can improve the service capabilities of primary health care institutions,but the exact reason for this is not clear.Objective To analysis the service capabilities of the of primary health care institutions,and explore the impact of service capabilities in the context of medical alliance.Methods In December 2019,we survey on staffing,outpatient and inpatient service and medical alliance construction of 381 primary health care institutions which participated in medical alliance in Chengdu by structured questionnaire.Local administrative departments of public health gave out and recovered questionnaire.With the number of staff,registered generals,beds,outpatient and emergency visits,admission,and the use rate of the beds as the indicator of the service capabilities,we used rank sum ratio to analyze the comprehensive medical service capabilities and divide them to 3 gear.Using orderly Logistic regression to explore the influencing factors of integrated medical services.Results The median number of staff in 381 primary health care institutions was 54(48),registered generals was 4(8),beds was 50(50),outpatient and emergency visits was 49460(60317),admission was 1440(2071),the use rate of beds was 68.43%(45.18%).According to the rank and ratio,there were 61(16.0%),260(68.3%),and 60(15.7%)institutions with good,medium and poor comprehensive medical service ability,respectively.The analysis of orderly Logistic regression analysis showed that institutional building area,teaching rounds and remote film reading are the influencing factors of the comprehensive medical service capabilities of primary health care institutions(P<0.05).Conclusion The medical service capacity of primary health care institutions in Chengdu,Sichuan Province are relatively good.Institutional building are

关 键 词：医联体 基层医疗卫生机构 医疗服务能力 影响因素分析 成都 

分 类 号：R197[医药卫生—卫生事业管理]