基于医疗联合体架构的全专联合诊疗模式探索研究

Research of the general practice and specialist combined diagnosis and treatment mode based on the medical consortium structure

目的:分析全专联合诊疗模式的实施效果,为优化区域“1+1+1”签约服务,探索分级诊疗的发展提供依据。方法:以正式运行徐汇区全专云医联平台的时间作为划分依据,收集比较2017年6月1日—2018年5月31日和2018年6月1日—2019年5月31日的以下数据:(1)徐汇区“1+1+1”签约居民的签约组合内医疗机构就诊情况;(2)徐汇区65岁以上“1+1+1”签约居民健康管理情况;(3)上海市级预约转诊平台与徐汇区全专云医联平台的双向转诊情况。结果:徐汇区全专云医联平台运行前一年,徐汇区“1+1+1”签约居民的签约组合内医疗机构就诊人次数为4859064,运行后第一年为4829679,未见明显变化。徐汇区全专云医联平台运行前一年,徐汇区65岁以上居民的健康管理率为73.28%,运行后第一年为75.01%,同比上升1.73%。徐汇区全专云医联平台运行后第二年,徐汇区“1+1+1”签约居民的上转、下转人次较第一年有所增加;运行后第一年的双向转诊率为52.32%,第二年为46.46%,同比下降5.86%,但其双向转诊率均显著高于上海市级预约转诊平台的同年相关数据。结论:全专联合诊疗模式对区域分级诊疗的实施发挥了积极作用,但与实现全面转变传统就医观念、合理有序就医仍有一定差距,通过进一步推进上海市医疗行业的数字化转型,全专联合诊疗服务未来可期。

Objective:To analyze the implementation effect of the general practice and specialist combined diagnosis and treatment mode,and to provide a basis for optimizing regional 1+1+1“contract service and exploring the development of graded diagnosis and treatment.Methods:The following data were collected and compared from June 1,2017 to May 31,2018 and from June 1,2018 to May 31,2019 based on the official operation time of Xuhui District general practice and specialist cloud medical union platform:(1)The medical institution visits of the“1+1+1”contracted combination portfolio of contracted residents in Xuhui District;(2)health management of“1+1+1”contracted residents over 65 years old in Xuhui District;(3)two-way referral between Shanghai municipal appointment referral platform and Xuhui District general practice and specialist cloud medical union platform.Results:In Xuhui District,the number of visits to medical institutions in“1+1+1”contracted combination portfolio of contracted residents was 4859064 one year before the operation of Xuhui District general practice and specialist cloud medical union platform,and 4829679 in the first year after operation,which showed no significant changes.The health management rate of residents over 65 years old in Xuhui District was 73.28% one year before the operation of Xuhui District general practice and specialist cloud medical union platform,and 75.01% in the first year after operation,which increased of 1.73% year-on-year.In the second year after the operation,the number of up-referral and down-referral of“1+1+1”contracted residents increased compared with the first year;the two-way referral rate was 52.32% in the first year after operation,and 46.46% in the second year,which decreased by 5.86% year-on-year,but the two-way referral rate was significantly higher than the relevant data of Shanghai municipal appointment referral platform in the same year.Conclusion:The mode of general practice and specialist combined diagnosis and treatment has played a positive role in the implementation of regional graded diagnosis and treatment,but there is still a certain gap between the realization of a comprehensive transformation of traditional medical concepts and a reasonable and orderly medical treatment,and by further promoting the digital transformation of the medical industry in Shanghai,general practice and specialist combined diagnosis and treatment services can be expected in the future.