基于儿科常见疾病的分级诊疗策略初探:上海东部模式

The strategy of hierarchical treatment based on common pediatric disease: the eastern model in Shanghai

目的聚焦儿科常见疾病,通过建立儿科医疗联合体,制定不同医疗卫生机构分级诊疗和管理的策略,探索有效的儿科服务模式。方法在联合体内成立基于不同病种的联合管理团队,统一诊疗规范、人员培训、药物和场地设置、转诊路径、信息平台等。以儿童哮喘为样本疾病,分专科组和分级诊疗组进行管理,6个月后评价两组患儿的哮喘控制率、医疗费用。结果专科组的哮喘完全控制率由61.9%上升到78.6%,分级诊疗组由65.8%上升到76.1%。专科组和分级诊疗组与哮喘控制有关的平均治疗费用分别为350元和258元。参与分级诊疗的社区卫生服务中心,其儿科普通门诊量同比增长20.3%。结论基于儿科常见疾病的分级诊疗策略达到了同质化的诊疗效果,且医疗费用更低,有效吸引了患儿在基层诊治。新的诊疗服务模式为落实医药卫生体制改革导向,推动分级诊疗发挥了积极作用。

Objective Focusing on common pediatric disease,this paper aims to develop management strategy of hierarchical treatment,and to explore an effective pediatric service model for different grades of health institutions by building medical alliance.Methods Integrated management teams were established in medical alliance based on different diseases to unify the treatment standards,staff training,drug and site allocation,referral pathways and information platform.As a sample,childhood asthma patients were divided into specialist group and integrated group.The control rate and medical expenses were evaluated after 6 months.Results The complete asthma control rate of specialist group increased from 61.9%to 78.6%,and that of integrated group increased from 65.8%to 76.1%.Average treatment expense related to asthma control was 350 yuan for specialist group and 258 yuan for integrated group.Meanwhile,community healthcare centers within medical alliance increased year-on-year outpatient service by 20.3%.Conclusion The strategy of hierarchical treatment for common pediatric disease achieves homogeneous treatment quality and less medical expense,and effectively attracts patients to community healthcare centers.This hierarchical treatment model plays a positive role in promoting the health reform practice and hierarchical treatment.