上海市金山区张堰镇“四定”诊疗模式实施效果分析

Analysis of the implementation effect of“four fixed”diagnosis and treatment mode in Zhangyan Town of Jinshan District,Shanghai

目的:通过实施“四定”诊疗模式改变签约居民的就诊模式,为其提供有效诊疗和精准转介服务。方法:以上海市金山区张堰镇社区卫生服务中心2018年12月31日以前和2020年12月31日以前签约的所有“1+1+1”签约居民为研究对象,分析比较2018年与2020年中心“1+1+1”签约居民的慢性病管理、各类人群签约、签约居民就诊和二三级医疗机构住院查房等相关数据。结果:2020年与2018年相比,签约居民中的慢性病控制良好人数和进行糖化血红蛋白检测的糖尿病患者人数、占比均有所增加。2020年与2018年相比,各类签约人群的签约率均有不同幅度提升,其中孕产妇人群、结核病患者的签约率有较大幅度提升。2020年签约居民人均门诊就诊次数、二三级医疗机构转诊人次数较2018年有所下降,签约居民开具延伸处方数、开具延伸处方人次数和人均开具延伸处方数较2018年均有所上升。结论:推广“四定”诊疗模式有利于做实家庭医生签约服务,增强签约居民的就医获得感,让签约居民逐步流向基层,为实现基层首诊、分级诊疗奠定基础,从根本上缓解居民看病难的问题。

Objective:Through the implementation of the“four fixed”diagnosis and treatment mode,to change the treatment mode of contracted residents,and to provide effective diagnosis and treatment and accurate referral services.Methods:All the“1+1+1”residents who signed the contracts with Zhangyan Community Health Service Center of Jinshan District,Shanghai before December 31,2018 and December 31,2020 were selected as the research objects,and the related data of chronic disease management,signing of various groups,visiting of contracted residents and inpatient ward rounds of secondary and tertiary medical institutions between 2018 and 2020 were analyzed and compared.Results:In 2020,compared with 2018,the number of contracted residents with good control of chronic diseases and the number and proportion of diabetic patients who underwent glycated hemoglobin testing increased.In 2020,compared with 2018,the signing rates of various groups increased by different degrees,among which the signing rates of pregnant women and tuberculosis patients significantly increased.The number of outpatient visits per capita of contracted residents and the number of referrals from secondary and tertiary medical institutions decreased in 2020 compared with 2018,while the number of extended prescriptions issued for contracted residents,the number of extended prescriptions and the number of extended prescriptions issued per capita increased compared with 2018.Conclusion:The promotion of the“four fixed”diagnosis and treatment mode is conducive to realization of contracted services by the family doctors,the enhancement of the sense of access to medical treatment of contracted residents,and the gradual flow of contracted residents to the grass-roots level,which lays a foundation for realization of the first diagnosis and graded diagnosis at the grass-roots level,and fundamentally alleviates the problem of difficult medical treatment for residents.