基于行动者网络理论的卒中整合型医疗服务体系实例研究——以某大型三甲医院医疗服务体系为例  

Case research on stroke integrated medical service system based on actor network theory:taking the medical service system of a large-scale tertiary hospital as an example

作　　者：付敏 欧阳俊婷 王艺东[1] 叶艳芳 FU Min;OUYANG Junting;WANG Yidong;YE Yanfang(Sun Yat sen Memorial Hospital,Sun Yat sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院,广东广州510120

出　　处：《现代医院》2024年第12期1921-1925,1929,共6页Modern Hospitals

基　　金：广东省医学科研基金(A2022495)。

摘　　要：目的 为应对当前卒中防控的严峻形势,为我国解决群众对疾病早防早治意识匮乏、就医难、医联体结构松散、医疗资源利用效率低下等问题,充分调动各方资源,共同实现体系建设目标。方法 以某大型三甲医院主导建立卒中医疗服务体系为例,通过构建卒中防控医联体建设行动者网络理论分析模型,利用转译原理对卒中防控医联体网络中异质行动者、强制通行点、招募、利益共享和动员进行深入分析,平衡各方利益诉求,排除运行体系中存在的障碍。结果 应用行动者网络理论方法,通过凝聚院内多学科力量,加强质控,加强区域协同救治、开展筛查、宣教与培训促进早筛早诊早治,该卒中中心规范救治患者例数呈现增长趋势,年均增长率达到10.93%,卒中中心救治时间显著缩短,过去四年间,患者进入医院到开始静脉溶栓治疗的时间中位数缩短15 min,患者入院到股动脉穿刺成功的时间中位数缩短67 min。结论 可从多部门、多机构、多学科协作,加强患者宣教,开展筛查,加强信息化建设与质控等方面入手,调动体系中各利益相关者,力图妥善解决卒中防控难题。Objective To cope with the severe situation of stroke prevention and control,and to solve the problems of lack of awareness of early prevention and treatment of diseases,difficulty in seeking medical treatment,loose structure of medical consortia,and low efficiency of medical resource utilization among the masses in China,fully mobilize resources from all parties,and jointly achieve the goal of system construction.Methods Taking the establishment of a stroke medical service system led by a large tertiary hospital as an example,a theoretical analysis model of the actor network of stroke prevention and control medical consortia was constructed.The translation principle was used to conduct in-depth analysis of heterogeneous actors,mandatory access points,recruitment,benefit sharing,and mobilization in the stroke prevention and control medical consortium network,balance the interests and demands of all parties,and eliminate obstacles in the operation system.Results By applying the actor network theory method,consolidating multidisciplinary forces within the hospital,strengthening quality control,enhancing regional collaborative treatment,conducting screening,education,and training to promote early screening,diagnosis,and treatment,the number of patients treated in the stroke center showed an increasing trend,with an average annual growth rate of 10.93%.The treatment time of the stroke center was significantly shortened.In the past four years,the median DNT time was shortened by 15 minutes,and the median DPT time was shortened by 67 minutes.Conclusion Multiple departments,institutions,and disciplines can collaborate to strengthen patient education,conduct screening,enhance information technology construction and quality control,mobilize various stakeholders in the system,and strive to properly solve the problem of stroke prevention and control.

关 键 词：行动者网络理论 转译 卒中 医疗服务体系 利益相关者分析 

分 类 号：R197.1[医药卫生—卫生事业管理]