基于协同论的医养结合服务衔接机制研究

Research on the convergence mechanism of the medical-nursing combined care based on synergy theory

目的识别文献中医养结合服务衔接要点,在协同论视角下建立医养结合服务衔接机制,为促进我国医养结合一体化发展提供参考。方法检索2013年9月至2021年9月中国知网数据库中医养结合相关文献,检索式为TI=医养结合AND SU=(衔接+转换+协调+机制),"北大法宝"和百度学术数据库进行补充检索。采用文献内容分析法筛选医养结合衔接要点,以协同论为视角构建医养结合衔接机制。结果共纳入42篇文献,经分析得出8个医养结合衔接要点,包括医疗、养老、康复、护理4个横向衔接要点,居家、机构、社区3个纵向衔接要点,机构型医养1个核心衔接要点。基于协同论和8个衔接要点构建出"431"式医养结合服务衔接机制,即医疗、护理、康复和养老服务的横向联动,居家、机构和社区模式的纵向跳转,并以机构型养老为重心的发展模式。结论医养结合服务衔接不畅是阻碍我国医养结合一体化发展的关键难题,应积极推进"431式"医养结合服务衔接发展,做到横向联动、纵向跳转、资源共享,推进我国养老体系高质量发展。

Objective To identify the key convergence points in the medical-nursing combined care among literature,and establish a mechanism for medical-nursing combined care integration from the perspective of the synergy theory,for the purpose of promoting the integrated development of such care in China.Methods Relevant literature on the medical-nursing combined care were retrieved from the CNKI database from September 2013 to September 2021.The search formula used was TI="the medical-nursing care integration"AND SU=(convergence+transformation+coordination+mechanism),while supplementary searches were made using"pkulaw.com database"and Baidu Scholar database.The method of literature content analysis was used to screen key points of the medical-nursing combined care,and the convergence mechanism was built based on the perspective of the synergy theory.Results A total of 42 literatures were included in this study,8 key convergence points of medica-nursing combined care integration were identified.Namely the 4 key horizontal convergence points of medical care,aging care,rehabilitation and nursing,the 3 key vertical convergence points of home care,institution care and community care,and the one key convergence point of institutional medical care.Based on the synergy theory and the 8 key convergence points,the"431"convergence mechanism of medical-nursing combined care was constructed.This mechanism refered to the horizontal linkage of healthcare,nursing,rehabilitation and aging care,the vertical redirection among home care,institution care and community care modes,and the development mode focusing on institutional aging care.Conclusions At present,the poor convergence between aging care and nursing care in China is a key roadblock hindering the integrated development of aging and nursing care.Medical-nursing combined care should be conducive to the"431"convergence development,achieving horizontal linkage,vertical redirection,and resource sharing,for the purpose of high-quality development of China's aging care system.