浙江省县乡卫生一体化改革运行效果的调查研究

Research on Operation Effect of Integrated Management of County and Township Health System in Zhejiang Province

目的:通过对浙江省县乡卫生一体化改革效果的调查分析,提出进一步推广的建议。方法:采用自制调查表对市和县乡(镇)两级医疗卫生机构进行了问卷调查,并同当地卫生行政、发改部门和基层医疗机构负责人进行了小组座谈。结果:试点地区县级医院和乡镇卫生院的门急诊人次数较试点前均有所增长,乡镇卫生院增长幅度更为明显;绍兴县乡镇卫生院手术并发症发生率从0.68%下降到0.34%,院内感染发生次数从4.56次下降到2.22次,影像诊断阳性率也从49.45%提高到53.19%。结论 :县乡卫生一体化改革使县级医院的龙头作用得到充分发挥,基层医疗服务能力得到有效提升,双向转诊的机制初步建立,提高了县域医疗服务能力。但在推广这种改革模式时,要充分考虑县、乡两级医疗机构的实际情况和需求。

Objective： To put forward a reasonable proposal from the research on operation effect of integrated management of county and township health system in Zhejiang Province. Methods： A survey was conducted in county and township hospital of pilot areas, and diseussion with relevant personnel was doue. Results： The number of outpatient and emergency patients had a certain increase than prepilot in eounty and township hospitals, especially in the latter. Surgical complication rate in Shaoxing county township heahh center decreased from 0.68% to 0.34%, the number of nosocomial infection decreased from 4.56 times to 2.22 times, and the positive rate of imaging diagnnsis increased from 49.45% to 53.19%. Conclusion： The integrated management of county and township health system enhanced the leading role of eonnty hospitals, the capacity of primary health care services was effectively enhanced, and the two-way referral mechanism was initially established to improve the ability of county heahh sen＇ices. But to promote this reform model, full account of actual situation and needs of hospitals should be taken.