国内分级诊疗现状的系统评价

Systematic Review on the Current Situation of Hierarchical Diagnosis and Treatment in China

目的:系统评价国内分级诊疗现状和面临的问题,为国家卫生决策提供参考。方法:以"分级诊疗"为关键词检索自各数据库建库起至2016年6月发表于中国知网、维普、万方数据库中的相关文献,全面收集国内分级诊疗现状的研究,从结局评价指标和面临的问题两方面进行系统评价。结果:共纳入23项研究,其中18项为调查研究,3项为回顾性/调查研究,1项为回顾性研究,1项为随机对照研究。结局评价指标中,9项研究以对分级诊疗的认知度、知晓度为评价指标,结果表明群众认知度、知晓度不高,而医护人员较高;7项研究以实施现状为评价指标,结果表明实施现状总体不理想;3项研究以人力资源为评价指标,结果表明基础医疗机构卫生人力资源水平不理想;3项研究以满意度为评价指标,结果表明群众满意度较高;2项研究以实施模式为评价指标,结果表明目前的模式较好地促进了分级诊疗的施行;2项研究以费用为评价指标,结果表明个人支付费用较高。面临的问题中,19项研究提出分级诊疗相关制度不完善,16项研究提出基层医疗机构水平不足,7项研究提出患者缺乏基层就医习惯,7项研究提出宣传不足。结论:目前国内分级诊疗的现状还不理想,还面临很多问题。通过提高基层医疗水平、完善分级诊疗制度、提高患者基层就医意愿、加大分级诊疗的宣传,可深入推进分级诊疗的实施,为卫生决策提供客观和有价值的参考。

OBJECTIVE：To systematically review the current situation and facing problems of hierarchical diagnosis and treatment in China,and provide basis for nation health-related decisions. METHODS：Using＂hierarchical diagnosis and treatment＂askeyword,relevant literatures in CNKI,VIP database,and Wanfang database from building to Jun. 2016 were retrieved. Study for current situation of hierarchical diagnosis and treatment in China was comprehensively collected,and systematical review was conducted from aspects of outcome evaluation indicators and facing problems. RESULTS：Totally 23 studies were included,in which,18 were investigative studies,3 were retrospective/investigative studies,1 was retrospective study,and 1 was randomized controlled study. In the outcome evaluation indicators,9 took awareness of hierarchical diagnosis and treatment as review indicators,showing that the public had poor awareness;7 took the current situation as review indicator,showing that the overall current situation was unsatisfactory;3 took human resources as review indicator,showing that human resources in primary medical institutions were not ideal;3 took satisfactory degree as review indicator,showing that the public were generally satisfied with hierarchical diagnosis;2 took the implementation model as review indicator,showing that the current model had been able to promote hierarchical diagnosis and treatment;2 took medical cost as review indicator,showing that individuals paid higher. In the facing problems,19 studies suggested the imperfect systems for hierarchical diagnosis and treatment,16 suggested that primary medical treatment was limited in capability,7 suggested that patients still preferred big hospitals to primary medical institutions,and 7 suggested that it lacked publicity. CONCLUSIONS：The current situation of hierarchical diagnosis and treatment is certainly not ideal but still facing many problems in China. Improving the levels in primary institutions,hierarchical diagnosis and treatment system and patients＇ willingness to primary medical institutions,and increasing its publicity can deeply promote the implementation of hierarchical diagnosis and treatment and provide objective and valuable reference for health decision-making.