双向转诊医疗风险控制量表模型在社区卫生服务临床工作中的应用

Application of Two-way Referral Medical Risk Control Scale Model in Community Health Services

目的探索双向转诊医疗风险控制量表模型(以下简称:模型)对社区卫生服务临床工作中医疗风险控制的预测效果。方法将来我中心就诊的需要住院治疗的患者按简单随机法随机分为两组,使用模型软件进行评估预测后,决定转诊或住院者为观察组,使用传统临床经验法判定其转诊或住院者为对照组,对两组患者进行全程前瞻性临床观察,并对其转诊率、同病种平均住院天数等指标进行综合分析,判定其医疗卫生服务效果情况。结果模型观察组转诊率、同病种平均住院天数、平均住院费用等均低于传统对照组,患者满意率在对向上转诊工作流程、对社区医生服务态度、对社区护士服务态度、对社区卫生诊治水平等方面高于传统对照组。结论本模型能实时计算预警值,提醒临床医生及时发现问题,对暴露或反映医疗风险的问题快速做出回应,并使医生工作流程变得直观、简便、务实、安全及高效,促使医生规范操作流程,提高医疗技术。进一步完善双向转诊"大病重病到医院,小病康复入社区"的目标,有望达到双向转诊医疗机构与社保部门的统一。

Objective To explore how the two-way referral medical risk control scale model（＂model＂ for short） works in predicting the control of medical risk in community based health service. Methods Patients at our center were randomly divided into two groups,with the observation group transferred or hospitalized according to evaluation results of the model software and the control group transferred or hospitalized according to evaluation results of conventional clinical method.Both groups underwent prospective clinical observation with the referral rates and average hospital stay lengths of identical situation analyzed comprehensively in order to evaluate the effects of the medical services. Results The referral rate,average inpatient stay and cost of the observation group were lower than those of the control group,whereas patient satisfaction on referral procedure,service of community doctors,sevice of community nurses,diagnosis and treatment levels of community health centers was higher in the observation group than in the control group. Conclusion The model is capable of detecting early warnings and recognizing problems in time,which reveals the medical risk and enables health workers to respond quickly.It is also capable of making the workflow for doctors simple,practical,safe and efficient,which helps doctors to regulate their operational processes and to improve their practice.Further improvement of the model targets at the goal that ＂serious disease treated in class A hospitals and mild illness treated by community hospitals＂.