慢性病医防融合国内外实践进展与经验总结  

Progress and experience of the medical-prevention integration of chronic diseases:China and international practices

作　　者：薛梅启旸 陈鸣声[1,2] XUE Meiqiyang;CHEN Mingsheng(School of Health Policy and Management,Nanjing Medical University,Nanjing,Jiangsu 211166,China;不详)

机构地区：[1]南京医科大学医政学院,江苏南京211166 [2]江苏卫生健康职业学院公共卫生管理学院

出　　处：《中国农村卫生事业管理》2025年第3期153-161,共9页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目(72474109,72174093)。

摘　　要：随着慢性非传染性疾病成为我国公共卫生与全民健康的重大挑战,其预防与控制亟需加强。医防融合作为一种新兴的健康管理模式,通过整合医疗与公共卫生资源,逐步成为应对慢性病挑战的重要策略。文章旨在借鉴国内外经验,为剖析我国现有医防融合实践中的不足与挑战,推动我国医防融合机制的创新与实践提供理论支持与实践参考。通过梳理国内外医防融合的特色实践模式与发展现状,结合我国医防融合政策支持状况与国家试点工作开展情况,分析和探讨了慢性病照护模式(CCM)、慢性病照护扩展模式(ECCM)、创新型慢性病管理框架(ICCC)、界首模式、介休样板等不同医防融合模式的内涵与应用。从现有实践来看,国内慢性病医防融合模式取得了初步成效,在政策导向、服务模式、实践探索等方面积累了宝贵经验。然而,现有医防融合模式的构建策略及作用机制在科学性和有效性方面仍面临挑战。As chronic non-communicable diseases become a major public health and national health challenge in China,their prevention and control urgently need to be strengthened.As a new health management model,the medical-prevention integration is gradually becoming an important strategy to address the challenge of chronic diseases by integrating medical and public health resources.This paper aims to draw lessons from domestic and international experiences,and to provide theoretical support and practical references for analyzing the weaknesses and challenges of the current practices of medical-prevention integration in China,and advancing the innovation and practice of its mechanism.Combining China’s policy support for medical-prevention integration and the progress of national pilot projects in China,this paper sorts out the distinctive practical models and development status of medical-prevention integration both domestically and internationally.It provides an analysis and discussion to the concepts and applications of various models,including the Chronic Care Model(CCM),Expanded Chronic Care Model(ECCM),Innovative Care for the Chronic Conditions Framework(ICCC),Jieshou Model,and Jiexiu Model.Based on current practices,the medical-prevention integration model for chronic diseases in China has achieved initial success,accumulating valuable experience in policy guidance,service models,and practical exploration.However,the strategies for constructing the current models and the mechanisms still face challenges in terms of scientific rigor and effectiveness.

关 键 词：慢性病 医防融合 整合模式 照护模式 慢性病管理 综述 

分 类 号：R19[医药卫生—卫生事业管理]