健康管理视角下村卫生室健康服务适宜项目集合研究

Appropriate Projects Set of Village Clinics' Health Care Service under the Health Management Perspective

目的在健康管理视角下,从需要层面、供给层面、政策与理论层面整合探讨村卫生室健康服务适宜项目集合,为相关研究及政策的制定提供参考依据,以改进、完善村卫生室健康服务项目内容。方法于2011年9月10—25日,在山东省抽取1个发达县,采用多阶段分层抽样方法,根据经济发展状况把所辖乡镇分为发达、中等、欠发达三层,随机抽取1个中等层次乡镇,在其所属的73所村卫生室中随机抽取143名医护人员进行问卷调查,调查内容包括文化程度、年龄、专业等情况。依据前期调查结果得出27所村卫生室机构设备条件、经济和财政支撑情况。运用文献检索方法,查阅关于村卫生室健康服务项目的相关文献,确立村卫生室健康服务项目的初始集合;采用功能需求分析法,引入IDEF0模型,参照所确立的村卫生室健康服务项目初始集合,按照"功能大类-功能子类-职能域-业务过程-业务活动"的层次结构建立村卫生室健康服务功能的业务模型,得出其在政策与理论层面的适宜项目集合。运用Delphi法制订适宜项目选入标准,整合需要层面、供给层面和政策与理论层面的健康服务项目,确立适宜健康服务项目集合。结果在功能子类层面共确立13项村卫生室健康服务适宜项目。结论村卫生室健康服务适宜项目已稳步拓展,但依然存在不足,需要进一步完善服务功能、提升服务能力。建议在科学界定村卫生室健康服务适宜项目集合的基础上,提高村卫生室人员的总体素质,增加政府对村卫生室的投入,规范村卫生室的管理,提升项目综合服务能力以及逐步拓宽适宜服务项目。

Objective To find out appropriate project set of health service from the aspects of need,supply,policy and theory under the health management perspective so as to provide certain reference for related research and policy formulation. Methods From 10-25 of September,2011,by multistage stratified sampling method,a developed county was selected from Shandong and according to its economic development condition divided into three levels： developed,middle-developed,under-developed. Then a middle-developed county was selected and 143 medical workers from its 73 subsidiary village clinics were investigated questionnaire about their educational background,ages and major,and so on. According to the investigation results in the former period,the equipment condition,economic condition,and financial support of 27 village clinics were obtained. Then we checked the relevant literature about health service project of village clinics,set up the initial collection and by using the function demand analysis method,introducing the model of IDEF0,referring to the collection of health service projects of village clinics,finally established the business model according to the hierarchical structure of functional categories-functional subclass-function area-business process-business activities to obtain the suitable projects set in the policy and theory level. By using Delphi method,the entry standard for suitable projects were set up and the heath care service projects were integrated from the aspects of need,supply,policy and theory to establish the collection of suitable projects. Results 13 suitable projects of health service of village clinics were set up from functional level. Conclusion The suitable projects of health service of village have been steadily expanded,but with shortcomings. In order to further improve the service functions and the service ability,it is suggested that on the basis of scientific definition of health service project of village clinics,the overall quality of medical staff ofvillage clinics be improved,government investment in village clinics be increased,the management of village clinics be standardized,the comprehensive service ability of project be improved and the suitable service projects be gradually expanded.