分级诊疗背景下医院人力资源配置的合理性研究

Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment

目的通过成都市医疗人力资源的配置均衡性研究,探讨人力资源配置结构对医院医疗服务能力的影响,为医院优化人才队伍结构提供理论依据。方法采用莫兰指数和基尼系数分别评价医疗人力资源配置的空间聚集性和等级分布不均衡性,采用疾病复杂指数、住院天数及手术难度作为结局变量,建立多元回归分析模型探索人力资源指标对医院医疗服务能力的影响。结果成都市医生人才呈现较为明显的空间聚集性,且为空间正相关关系(莫兰指数为0.290),而护士人才的分布并无明显的空间聚集性(莫兰指数为0.102)。在不同医疗服务能力分段下,医生和护士的基尼系数分别为0.518和0.576,均超过0.5,表明医疗人力资源等级分布差距悬殊。回归分析结果显示,高级职称医师人数增加和医护比例扩大均能够提升医院的疾病复杂指数。高级职称医师人数增加对于提升医院的手术能力也有一定影响。而医护比例扩大将略微增加患者的住院天数。结论优化医疗人力资源在不同地区和不同级别医院中的配置是分级诊疗制度建设中的一项重要任务,要更进一步整合全市范围内的医疗人力资源,加强基层卫生机构的人才培养和队伍建设。各级医院应根据自身发展定位进一步优化自身的人力资源配置结构,三级医院应当更加注重高级职称医师人才的培养,优化医护比例,提升医院的医疗服务能力。而基层医院应当注重医护人才的全面建设,加强全科医师的人才队伍发展,实现成都市医疗服务能力的全面提升。

Objectives To analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure. Methods The Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index(CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities. Results The distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation(Moran’s Idoctor=0.290);the distribution of nurses had no obvious spatial aggregation(Moran’s Inurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients’ hospital stay. Conclusions Optimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.