以分级诊疗为导向的三级医院门诊糖尿病患者分类研究

Diabetes outpatient patient classification analysis in tertiary hospital based on hierarchical healthcare system

目的:根据分级诊疗的两种首诊模式对糖尿病患者进行分类,了解可下沉到基层就诊的患者人数,找出医院分级诊疗实行过程中存在的问题,寻求从根本上改善医疗资源配置的途径。方法:运用德尔菲专家咨询法得到的门诊慢性病患者分级诊疗分类指标,根据糖尿病及其并发症的严重程度和控制情况、化验和检查指标异常情况、是否接受注射治疗或者住院治疗、患者每次用药情况等进行分类。结果:经筛选,分类的全年糖尿病患者共10 362人,全年糖尿病患者就诊量为57 780人次。强制性基层首诊模式与经济引导型首诊模式下,可下沉至基层卫生服务中心的患者分别达到75.19%和68.67%。结论:无论采用哪种首诊模式,约70%的现有三级医院医疗资源可以释放用于对病情较严重的患者进行更加仔细地诊治,以及培养人才和科研技术指导。

Objectives:To classify diabetes patient according to two kinds of first visiting modes,learn which kinds of diabetes patients can first visiting in primary healthcare institute,find out problems in hierarchical healthcare system implementation and how to improve health resources allocation.Methods:Delphi was used to get outpatient chronic disease patient classification index system.With the index of diabetes severity and its complications,the test result,injection or not,hospitalization or not and drug,patients have been classified.Results:10362 of 57780 diabetes patients have involves in classification system.Under the mode of authoritative primary healthcare first visiting or economic motivation,75.19%or 68.67%patient can first visited in primary healthcare institute respectively.Conclusions:There is 70%of diabetes patients can first visit in primary healthcare institute and release top tertiary hospital resource,which is more benefit on severity disease treatment,human resources training and research.