社区卫生机构快速研判单病种社区防治服务开展可行性的工具开发研究

Development of a Tool for Community Health Institutions to Rapidly Evaluate the Feasibility of Single Disease Prevention and Control Services

背景在社区大力发展特色业务、建设特色专科过程中,面对社区卫生机构有限的资源和政府、市场、居民及学科多样化的需求之间的矛盾,社区卫生机构亟须在最短的时间内做出最适合本机构业务发展方向的选择和判定。目的开发用于研判"社区开立单病种社区防治服务时某病种是否适合"的决策工具,为社区建设单病种诊疗单元提供参考依据。方法本研究于2017-12-19至2019-10-28,分别采用半结构化访谈法和专家咨询法,半结构化访谈邀请社区的全科医生、全科护士、公共卫生医生、康复师和社区管理层6名专家,围绕建设单病种社区防治服务的定位、目标、要求、原则等进行多对多半结构化访谈;专家咨询选取社区、综合医院、中医医院、高校等专家共20人,通过问卷咨询,对第一轮访谈分析后提取的社区单病种临床路径建设的病种筛选原则及测量方法进行评分,并对评分结果采用界值法进行筛选,最后由项目组成员汇总各阶段研究成果,绘制成"建设社区单病种临床路径的病种遴选流程图"。结果经过访谈和专家咨询,采用界值法最终确定了25项病种筛选原则,其中准入原则21项、排除原则4项。准入原则的测量办法分为历史数据采集(10项)和主观评分(11项)。历史数据采集项目由社区信息科调取相关数据后进行排序,主观评分项目采用Likert 7级评分法对每个病种的表现进行评分并排序,选取总分排名前3位的病种作为社区建设单病种诊疗单元的首选病种。结论本研究所开发的"单病种社区防治服务开展病种筛选工具"包含25条病种筛选原则、测量办法和实施流程,实践上具备可行性,理论上具备科学性和代表性,具有推广价值。

Background During the development of featured services and specialties,it is necessary for community health institutions to choose or determine an appropriate option in the light of their own limited resources,and contradictions between diversified demand and requirements for healthcare of government,market,residents and healthcare disciplines.Objective To develop an auxiliary tool for community health institutions to rapidly evaluate the feasibility of prevention and treatment services for a single disease,providing a reference for the establishment of single disease care unit in community hospitals.Methods This study was conducted between December 19,2017 and October 28,2019 using semi-structured interviews with a group of 6 experts from fields of general care,public health,rehabilitation and community management on topics such as the principles,requirements and targets for establishing a single disease prevention and treatment unit in the community hospital and the designed roles of this unit,and using a questionnaire survey with 20 experts from community,general and TCM hospitals and a college on discussing the values of single disease screening principles and methods for evaluating the feasibility of single disease clinical pathway construction in a community hospital summarized from the results of above-mentioned semi-structured interviews and screened the eligible ones using boundary value analysis.In accordance with the investigation results,the Single Disease Screening Flow Chart for Constructing a Pathway to Community-based Care was developed.ResultsTwenty-five single disease screening principles were determined finally,including four exclusion principles,and 21 admission principles.The admission principles cover historical data analysis(10 items,with weights sorted by the value of item-related information collected by community information department),and subjective scoring(11 items,each using a 7-Point Likert Scale to score the manifestations of a single disease).The three diseases with the highest scores in total were determined as the first choice for a community hospital to build a clinical care unit for the diseases.Conclusion Our tool includes 25 single disease screening principles with detailed measurements and implementation procedure,which is worthy of promotion owing to its theoretical scientificity and representativeness and practical feasibility.