分级诊疗视角下公立医院改革探索

Exploration of Medical Reform in Public Hospitals with Hierarchic Diagnosis and Treatment

分级诊疗对三级医院具有机遇与挑战,厦门市三级医院通过专科医师、基层医疗机构全科医师和健康管理师的"三师共管",实施一系列"慢病先行"分级诊疗的具体措施,并对措施产生效果进行分析。分级诊疗后,三级医院慢性病门诊量下降,基层医疗机构门诊量增加;学科建设优化;糖尿病患者血糖、糖化血红蛋白的达标率增加;高血压患者血压达标率逐渐上升;慢性病患者医药费用开支有所降低、居民满意度提升。针对厦门市分级诊疗探讨公立医院改革,以期为中国公立医院改革提供可借鉴的经验。

Hierarchic diagnosis and treatment means opportunity and challenge for hospitals of class three. Hospitals of class three in Xiamen practiced a series of concrete measures of ＂chronic diseases first＂ with co-management of doctors of special physi- cians, general practitioners at grassroots medical institutions and health managers,and analyzed the results. With hierarchic diagnosis and treatment, outpatient number in hospitals of class three lowered while it increased in grassroots medical institutions. Discipline construction was optimized, the rates of reaching the standards for blood glucose and glycosylated hemoglobin for diabetes patient in- creased. Blood pressure success rose gradually. Medical expenses of patients with chronic diseases lowered considerably, and the sat- isfaction degree of residents increased. The exploration of medical reform in public hospitals undergoing hierarchic diagnosis and treatment means to be a reference for reform in China public hospitals.