民营医院托管基层医疗机构服务质量研究

Quality assessment of primary healthcare institutions entrusted to private hospitals

目的 基于需方角度对民营医院托管模式下基层医疗机构服务质量进行评价。方法 以北京市仁和医院和礼贤中心卫生院组成的纵向整合模式为典型案例。利用初级卫生保健质量评价工具（Primary Care Assessment Tool，PCAT）中文版问卷，收集2016年11月、2017年9月两次需方调查数据（n＝376）。利用Stata 14.0和Excel 2013进行描述性统计和多元线性回归分析。结果 2017年基层医疗机构在连续性、综合性、协调性等核心维度和延伸维度质量得分均高于2016年，且在除连续性和协调性（转诊）之外的其他维度差异显著。2017年PCAT总得分为21.28分，显著高于2016年的19.83分，差异有统计学意义（P〈0.01）。结论 在仁和医院托管礼贤中心卫生院这一纵向整合模式下，从需方角度看，基层医疗机构服务质量逐步提升；需进一步加强基层医疗机构的首诊（可及）、综合性（实际提供服务）和面向社区属性。

Objective To evaluate the quality of primary healthcare institutions entrusted to private hospitals as seen by the consumers.Methods The vertical integrated model between Renhe Hospital and Lixian township health center was selected as the case study. Consumer survey data of both November 2016 and September 2017 were collected by using Primary Care Assessment Tool （PCAT） （n=376）. Stata 14.0 and Excel 2013 were used for descriptive statistics and multiple linear regression.Results Scoring in such key domains as continuity, comprehensiveness and coordination, and the derivative domains was higher in 2017 than those of 2016. And the differences were significant except for the domain of continuity and coordination （referral）. PACT total score in 2017 was 21.28, higher than 19.83 in 2016 and the difference was significant（P〈0.01）.Conclusions Under the vertical integrated model between Renhe and Lixian, the quality of primary healthcare institutions was improving from 2016 to 2017 from the perspective of consumers. First contact （accessibility）, comprehensiveness （services availability） and community orientation of primary healthcare institutions need to be strengthened in the future.