北京市朝阳区分级诊疗实施效果研究

Implementation Status of Hierarchical Medical System in Chaoyang District,Beijing

目的探讨北京市朝阳区分级诊疗实施效果,分析存在的问题,为分级诊疗制度的进一步完善提供政策建议。方法收集2015年8月—2016年9月北京市朝阳区26家医联体成员单位的调查数据和朝阳区42家社区卫生服务中心的绩效考核数据。采用医疗服务量、双向转诊量、医务人员交流情况及基本医疗服务指标得分评价朝阳区的分级诊疗实施效果。结果与2015年相比,2016年朝阳区医联体内上级医院的门诊人次、急诊人次及住院人次分别增长了3.45%、14.55%、13.78%,基层医疗卫生服务机构的门诊人次、急诊人次及住院人次分别增长了8.52%、5.63%、28.27%。与2015年相比,2016年北京市朝阳区医联体下转就诊人次增长了67.34%,上级医院向基层医疗卫生服务机构下派专家数增长了544.33%。2016年42家社区卫生服务中心的居民健康档案管理、老年人健康管理、医疗质量得分与2015年比较,差异无统计学意义(P>0.05);高血压患者健康管理、2型糖尿病患者健康管理得分高于2015年,合理用药得分低于2015年(P<0.05)。结论朝阳区开展医联体框架下的分级诊疗工作取得了一定成效,上级医院和基层医疗卫生服务机构的医疗服务量均有所增长,下转就诊人次增多,基层医疗卫生服务机构的慢性病管理能力得到提高,但合理用药方面仍有待加强。

Objective To explore the implementation status of hierarchical medical system in Chaoyang District,Beijing,and analyze the existing challenges during the implementation process,in order to provide recommendations for further development of this system. Methods We collected the survey data for the period of August 2015 to September 2016 of the members of 26 regional medical consortiums（ RMCs）,and the performance appraisal data for the same period of 42 community health service centers（ CHSCs） in Chaoyang District,Beijing. We assessed the implementation status of the hierarchical medical system in this district from the aspects of medical service workload,number of dual referrals,medical talents exchange and scores of 6 quality indicators for basic medical services. Results Compared with 2015, the average number of outpatient visits,emergency visits,inpatient visits and downward referrals increased 3. 45%,14. 55%,13. 78%,67. 34%,respectively in the upper-level hospitals in the 26 RMCs in 2016. The average number of outpatient visits,emergency visits,inpatient visits and experts from the upper-level hospitals increased 8. 52%,5. 63%,28. 27%,544. 33%,respectively in the Community helath service organlzations（ CHSOs） in the 26 RMCs in 2016 compared with 2015. The average scores of residents＇ health records management,health management for the elderly and quality of medical services for 42 CHSCs in 2016 were not significantly different from those in 2015（ P 0. 05）. The 42 CHSCs obtained higher scores for health management for hypertension and health management for type 2 diabetes but lower scores for rational use of medicines in 2016 compared with 2015（ P 0. 05）.Conclusion The implementation of the hierarchical medical system has achieved certain positive effects in Chaoyang District,specifically,the medical service workload in both the upper-level hospitals and CHSOs in the 26 RMCs have increased,and the number of downward referrals have increased as well; the capabilities of chronic disease management for CHSCs in this district have demonstrated enhancement,but the rational use of drugs in these institutions needs to be improved.