医联体内知识共享的互动形式及保障机制研究

Interactive Forms and Support Mechanisms for Knowledge Sharing in a Medical Consortium

目的探讨医联体内知识共享的互动形式及保障机制,为医联体内知识共享的有效运行奠定基础。方法于2017-02-28在"周康航新"医联体内4家社区卫生服务中心中各选取管理人员1名、全科医生1名,在上海市浦东新区周浦医院(周浦医院)选取管理人员2名、专科医生1名、医学拓展部人员1名。对12名受访者进行焦点访谈,主要内容为医联体内机构间进行知识共享的互动形式及保障措施。结果医联体内机构间进行知识互动的形式可分为直接互动(全科医生/专科医生线下到周浦医院/社区卫生服务中心交流、线上信息平台的知识存储和共享)和间接互动(诊疗咨询、转诊)两种。医联体内知识共享的保障措施,除保持现有的对全科医生的临床技能考核、荣誉和物质奖励外;还需增加对专科医生的考核和激励,同时通过联谊等措施以加强全科医生团队与专科医生间的情感联系。结论教学查房有助于提升全科医生和专科医生的临床诊疗能力、带教能力,是医联体内各级医疗机构均认可的知识共享形式。需增加对专科医生的考核和激励,并加强专科医生与全科医生团队的感情交流,以保障知识共享的实施。

Objective To explore the interactive forms and support mechanisms for knowledge sharing in a medical consortium,offering a reference for effectively sharing knowledge in the medical consortium.Methods On February 28,2017,we carried out focus group interviews with 12 persons from Zhoukanghangxin Medical Consortium[including 4 managers and 4 general practitioners（GPs） from 4 community health centers（each manager and each general practitioner from each community health center） and 2 managers,1 specialty physician,and 1 worker（from Medical Development Department） from Shanghai Pudong New District Zhoupu Hospital] for exploring the interactive forms and support mechanisms for knowledge sharing in this medical consortium.Results The interactive forms for knowledge sharing in Zhoukanghangxin Medical Consortium could be divided into two categories,one was directly sharing form,mainly through face-to-face communication between GPs and specialty physicians in each of the two settings（community health centers or Shanghai Pudong New District Zhoupu Hospital）,and online knowledge storage and sharing;the other was indirectly sharing form,mainly through consultations and referrals.In terms of the support mechanisms for knowledge sharing in Zhoukanghangxin Medical Consortium,in addition to maintaining the existing clinical techniques assessment mechanism,honor-based and material incentive mechanisms for GPs,assessment and incentive mechanisms for specialty physicians need to be developed,and measures such as activities for improving the friendships between GPs and specialty physicians should be carried out.Conclusion Teaching rounds is an acknowledged form for knowledge sharing in Zhoukanghangxin Medical Consortium,which is contributive to the improvement of clinical diagnosis and treatment abilities and teaching abilities of both GPs and specialty physicians.In order to ensure the development of knowledge sharing,professional technique assessments and incentives for specialty physicians should be enhanced,and the friendships between GPs and specialty physicians should be improved.