医务人员对三级公立医院绩效考核推进分级诊疗制度的态度研究

The Attitude of Medical Staff on Implementing the Hierarchical Medical System in Performance Evaluation in Tertiary Public Hospitals

目的探讨医务人员对三级公立医院绩效考核推进分级诊疗制度落实的态度现状。方法采用多阶段随机抽样调查法。从我国东部、中部、西部3个地区各随机抽取一个省级行政区,再从每个省级行政区按绩效考核等级各选取一家三级公立医院进行医务人员政策评价调查。采用Stata 15.0软件对医务人员态度相关数据进行统计学描述、非参数检验、二元Logistic回归分析等。结果共收集调查问卷12835份。有95.20%的医务人员认为三级公立医院绩效考核对推进分级诊疗制度具有一定促进作用。高年龄段、硕博士研究生、高级专业技术职称以及从事临床医疗的医务人员认为三级公立医院绩效考核对推进分级诊疗制度无促进作用的比例更高。医务人员在三级公立医院绩效考核推进分级诊疗制度的促进程度方面,年龄、最高学历、从事专业类别、地区变量上差异具有统计学意义(P<0.05)。结论三级公立医院绩效考核工作在推进分级诊疗制度落实以及优化监测指标层面有一定的提升空间。还需关注政策与医务人员的利益相关性,打破各级医疗机构间壁垒,促进形成整合协调的医疗服务体系。

Objective To explore the attitude of medical staff on implementing the hierarchical medical system in performance evaluation in tertiary public hospitals.Methods Multi-stage sampling survey was adopted to randomly select one provincial administrative region from each of the eastern,western and central regions,and then one tertiary public hospital was selected from each provincial administrative region according to the performance appraisal level to conduct the policy evaluation survey of medical staff.Stata 15.0 software was used for statistical description,non-parametric test,binary logistic regression analysis,etc.Results A total of 12835 questionnaires were collected.95.20%of medical staff believed that the performance appraisal of tertiary public hospitals played a certain role in promoting the hierarchical diagnosis and treatment system.The proportion of senior age group,postgraduates and doctors,medical personnel with senior professional titles and clinicians who thought that the performance appraisal of tertiary public hospitals had no promotion effect on the hierarchical medical system was higher.There were statistically significant differences in age,highest education level,post type and regional variables of medical staff in promoting the hierarchical medical system in performance appraisal of tertiary public hospitals(P<0.05).Conclusion Performance appraisal has certain optimization space in promoting the implementation of hierarchical medical system and monitoring indicators.It is also necessary to pay attention to the correlation between policies and the interests of medical staff,break down the barriers between medical institutions at all levels,and promote the formation of an integrated and coordinated medical service system.