基于结构-过程-结果模型的“华西-成华城市区域医疗服务联盟”实施效果评估

Evaluation of“West China-Chenghua Urban Area Medical Service Alliance”based on structure-process-outcome model

该文采用结构-过程-结果模型对"华西-成华城市区域医疗服务联盟"(以下简称"联盟")2016年-2019年的实施效果进行了评估。联盟结构包含领导小组、华西科室、基层机构、支持系统、居民及志愿团队在内的五大组织板块,旨在提供以居民健康为中心的整合、同质、可及的医疗服务。联盟过程主要包括"府院结合"主导的改革合力和"政-人-医-网"的四通机制。联盟结果:基层服务方面,诊疗量增长,接诊病种增加,同质化检验初步实现;基层培训方面,培养出数名高质量社区医生,引进人才数量增加;基层科研工作方面,陆续承担了3项大型科研课题,产出4篇国家级刊物文章;基层获奖方面,先后荣获国家级、省级、市级共5项荣誉称号,并实现了在全国性技能比赛、学术会议上获奖的"零"突破;联盟满意度方面,基层医疗机构员工、四川大学华西医院职工和成华区居民三方均有较高的满意度。联盟在管理和服务上实现了创新,职工及居民满意度均较高,有利于促进区域医疗服务能力同质化的实现,但未来还应对基层医务人员的薪酬体系及能力提升等方面作进一步探索。

This article conducts a mid-term evaluation of the implementation effect of the“West ChinaChenghua Urban Area Medical Service Alliance”from 2016 to 2019 based on structure-process-outcome model.The structure of the alliance included five organizational sections,including the leadership group,West China departments,grassroots organizations,information platforms,and residents and health fan teams,aiming to provide integrated,homogeneous,and accessible medical services centered on residents’health.The process of the alliance mainly included the joint reforms led by the“combination of government and hospital”and the management mechanism of“politics-people-medicine-network”four links.Alliance performance:in terms of grassroots services,the number of diagnoses and treatments increased,the number of diseases received increased,and the homogenization of test was initially achieved;in terms of grassroots training,several high-quality community doctors were trained,and the number of talents introduced increased;in terms of grassroots scientific research,3 large-scale scientific research projects were undertaken and 4 articles were published in national-level publications;in terms of grass-roots awards,5 honorary titles at national,provincial,and municipal levels were gained,and award-winning“zero”breakthrough in national skill competitions and academic conferences was achieved;in terms of alliance satisfaction,the employees in primary medical institutions and West China Hospital of Sichuan University and the residents in Chenghua District were all had high degree of satisfaction.The alliance has achieved innovation in management and services,and the employees and residents are highly satisfied,which is conducive to promoting the realization of the homogeneity of regional medical service capabilities.However,the salary system and capacity improvement of grassroots medical staff should be further explored.