北京市社区卫生服务中心上门医疗服务实施中质量问题的定性研究

Quality problems of community home care service in Beijing:a qualitative observatory study

目的了解北京市上门医疗服务开展过程中存在的质量问题。方法2021年3—5月,在北京市的6个主城区(丰台区、海淀区、朝阳区、东城区、西城区和石景山区)中采用目的抽样法抽取10个社区卫生服务中心(丰台区3个,海淀区和朝阳区各2个,东城区、西城区和石景山区各1个),通过实地观察10个社区卫生服务中心提供的17次上门医疗服务、访谈出诊的医护人员和查阅相应的医疗文书,梳理出上门医疗服务实施中的质量问题。结果通过对收集到的资料进行分析和整理,提炼出3类上门医疗服务结构质量问题和6类上门医疗服务过程质量问题。其中,结构质量问题包括:(1)上门医疗出诊排班不明确、人员资质偏低;(2)上门医疗缺少专用的交通工具;(3)部分中心缺少上门医疗服务规范。过程质量问题包括:(1)用物准备不全;(2)医疗操作过程中佩戴首饰;(3)操作前未查体;(4)操作中未严格遵循无菌原则;(5)医疗垃圾未妥善处置;(6)医疗文书的错填、漏填。结论北京市的上门医疗服务实施过程中,存在着人力物力不足、出诊排班不明确、缺少统一的上门医疗服务规范、质量管理不到位等问题。可通过提高供给侧上门医疗服务资源配置、制定上门医疗服务规范、加强针对上门医疗服务的质量控制来提高上门医疗服务的质量。

Objective To investigate the quality issues of community home care service in Beijing.Methods A study on quality of community home care service was conducted from March to May in 2021 in six urban districts of Beijing,and 10 community health service centers were selected as study sites by purpose sampling method.The quality issues of home care service were studied by observing the process of 17 home care services,interviewing medical staff and reviewing relevant medical documents.Results The study extracted 3 structural quality problems and 6 process quality problems of home care service.The structural quality problems included unclear service scheduling and insufficient qualification of the personnel;lacking special transportations;and lacking home health service standards in some centers.The process quality problems included incomplete material preparation,wearing jewelry during medical procedures,no physical check-up before procedures,not strictly following the aseptic principle in the operation,not properly disposing medical wastes,wrong or missing filling of medical documents.Conclusions There are some problems in the implementation of community home care service in Beijing,such as insufficient medical personnel and material resources,unclear service scheduling,lack of unified medical service standards,and insufficient quality management.Therefore,these problems should corrected to ensure the quality of community home care services in Beijing.