基于冰山角分析法的城市社区卫生服务双向转诊问题分析

A Tip Angle Analysis of Two-way Referral in Urban Community Health Service

目的通过对城市社区卫生服务双向转诊工作存在的问题进行分析,参考国外的成功经验,提出改进双向转诊工作的建议,以促进城市社区卫生服务的发展。方法采用问卷调查法,抽取5个规范且工作开展得较好的社区卫生服务中心的辖区居民进行调查,了解社区居民对社区卫生服务工作的满意度,评估社区卫生服务工作的开展情况。采用头脑风暴法、名义群体法找出双向转诊工作落实困难的原因,采用冰山角分析法进行分类分析。结果社区居民对国家社区卫生服务方面的政策、社区卫生服务工作、服务态度、设施设备、技术水平、信任程度的满意度分别为96.61%、96.62%、96.09%、92.19%、91.40%、95.05%;对国家社区卫生服务方面政策的满意度与对社区卫生服务工作、服务态度、设施设备、技术水平、信任程度等的满意度均存在线性关系,且为正相关。采用头脑风暴法、名义群体法找出双向转诊工作落实困难的原因有24个;通过冰山角分析法得出,双向转诊工作落实困难的表面原因有3个,过渡原因有19个,根本原因有2个。结论双向转诊工作落实困难的根本原因是:没有建立起严格的"守门人"制度、机制不明确和政府重视程度不够。解决社区卫生服务双向转诊工作的难题关键是制度的设计和完善,只有这样才能从根本上解决问题。

Objective To analyze the problem in ＂Two-way Referral＂ of urban community health service（CHS）,in combination with successful experience abroad,so as to propose the suggestion for improvement of the ＂Two-way Referral＂ work and thus to promote the development of urban CHS. Methods A questionnaire survey was conducted among residents sampled from five normative CHS centers to know their satisfaction degree on CHS work and to evaluate the situation of CHS work.The brainstorming and nominal group techniques were used to find out the difficulties in performance of ＂Two-way Referral＂,and then classification analysis was conducted by the tip angle analysis. Results The satisfaction degrees of the residents on the State policy of CHS,CHS work,attitude,equipment,skills and accreditation were respectively 96.61%,96.62%,96.09%,92.19%,91.40%,95.05%.And the satisfaction degree on State policy of CHS was positively linearly correlated with the satisfaction degrees on CHS work,attitude,equipment,skills and accreditation.By using the brainstorming and nominal group techniques 24 factors were determined for difficulties in performance of ＂Two-way Referral＂ work,and according to the tip angle analysis there were 3 apparent reasons,19 transition reasons and 2 fundamental reasons. Conclusion The basic reasons for difficulties in performance of ＂Two-way Referral＂ are lack of strict ＂gatekeeper＂ system,non-clear mechanisms and no enough attention from the government.The key to resolve these problems are the design and improvement of the system,which the only way to completely resolve the problems.