非政府举办社区卫生服务机构的全科门诊实践研究

Practice of GP Clinic in a Non- government CHS Institution

目的了解非政府举办社区卫生服务机构的全科门诊实践情况。方法对北医三院第二门诊部(育新花园社区卫生服务站,简称育新社区站)进行个案研究,通过机构资料查阅、现场观察、患者问卷调查的方法收集机构的组织框架、健康档案、成本核算、医患关系深度等相关数据。结果育新社区站的全科门诊实践历程大致可分为三个阶段:社区建档团队→慢性病管理门诊→全科门诊,2013年仍处于亏损状态。全科门诊的医患关系深度得分为(28.7±6.3)分,高于其他门诊类型,差异有统计学意义(P<0.05)。60岁以上老年人的签约率和活档率分别高达78.0%和100.0%,慢性病患者的活档率排序依次为:脑卒中100.0%、冠心病100.0%、糖尿病40.8%、高血压36.4%、其他慢性病26.9%。结论对于非政府举办的社区卫生服务机构来说,如何在高质量社区医疗服务和成本效益之间找寻良好平衡点是一个至关重要的核心性问题,建议政府进一步细化社区卫生服务机构的绩效考核和付费补偿机制。

Objective To understand the practice situation of GP clinic in a non - government CHS institution. Methods To carry out a case study on the Second Outpatient Department of Peking University Third Hospital （ Yuxin garden community health service station, Yuxin CHS for short） , the framework data of the institution, health records, cost accounting and data of patient - doctor relationship depth were collected by reviewing administrative documents, field observation and patient questionnaire survey. Results There were three stages of GP clinic practice in Yuxin CHS ： health records filing team → chronic disease management clinic→ GP clinic, which had negative profit until 2013. The score of patient -doctor relationship depth in GP clinic was （ 28.7 ±6. 3 ）, higher than those scores of other clinics with significant difference （ P 〈 0. 05 ） . The rates of signed contract and utilization of health records of community elderly residents more than 60 were 78. 0% and 100.0%. The utilization rates of patients with chronic diseases were： stroke 100.0%, CHD 100.0%, diabetes 40. 8%, hypertension 36.4%, other chronic diseases 26. 9%. Conclusion For non - government CHSs, a key issue is how to balance high quality service and cost efficiency. It is suggested that the government should further refine CHS performance assessment andpay compensation mechanism.