上海市市级医院儿内科卫生资源配置及医疗服务供给现况调查

A cross-sectional study of the current pediatric internal medicine health resource allocation and service supply in Shanghai municipal hospitals

目的分析上海市市级医院儿内科卫生资源配置和医疗服务供给现况,为优化儿内科医疗资源配置、提高医疗服务能力提供依据。方法依托上海市市级医院临床能力促进与提升儿内科联盟,采用问卷调查方法,调查上海市4家公立市级儿童专科医院、15家综合性医院儿科及3家妇产科医院新生儿科,收集2020年儿内科医师和护士人数、儿内科床位数、儿内科门急诊人次数、儿内科出院人次数等数据。比较不同类型医院数据,并与本市医护总体人力资源进行比较,描述和分析上海市市级医院儿内科卫生资源配置和医疗服务供给现状,提出儿内科医疗资源配置的对策和建议。结果本次调研的市级医院中,儿内科医师1253人,占全市医师的1.68%,儿内科护士2029人,占全市护士的2.09%;儿内科医护比为1∶1.62。儿内科医师以硕士学历为主(占50.84%),儿内科护士以本科学历为主(占55.89%)。儿内科医师以中级职称为主(占39.43%);儿内科护士以初级职称为主(占54.02%),仅1.28%为高级职称。儿童专科医院在市级医院儿内科设备配置和医疗服务供给中占绝对优势,基本设备配置占81.71%,床位资源配置占75.60%,门急诊人次占74.04%,发热门诊人次数占83.58%,出院人次数占80.42%。结论上海市儿童专科医院资源配置优势明显,但儿童专科医院医师年均负担出院人次负荷高于全市医师的平均水平。通过市级儿童专科医院对儿科联合体的技术支撑和辐射,帮助综合性医院儿内科进一步加强自身建设,将有助于提升本市综合医院儿内科门急诊服务能力,提高区域内儿内科医疗服务同质化水平。

Objective To analyze the current situation of pediatric internal medicine health resource allocation and medical service supply in Shanghai municipal hospitals,so as to provide a perspective on pediatric internal medicine medical resource allocation and improvement.Methods Relying on the pediatric internal medicine alliance of municipal hospitals in Shanghai,we performed a questionnaire survey to collect data on the number of physicians and nurses,hospital beds,outpatient and emergency visits,and discharges in 2020.The enrolled hospitals in the alliance consisted of 4 tertiary pediatric hospitals,pediatrics departments of 15 general hospitals,and neonatal units of 3 obstetrics and gynecology hospitals.Data among different types of hospitals were compared,and they were compared with the overall human resources of healthcare in the city.Also,the current status of pediatric health resources and medical service supply in Shanghai municipal hospitals were presented,and suggestions for pediatric internal medicine medical resource allocation were provided.Results Among the enrolled municipal hospitals,there were 1253 pediatricians,accounting for 1.68%of all the physicians in Shanghai.There were 2029 pediatric nurses,accounting for 2.09%of all the nurses in Shanghai.The ratio of pediatricians to nurses was 1∶1.62.The pediatricians were mainly with master’s degrees(50.84%),pediatric nurses were mainly with bachelor’s degrees(55.89%),and only 1.53%were with master’s or doctor’s degrees.Pediatricians were predominantly of median-grade titles as attending doctors(39.43%),while pediatric nurses were predominantly of junior professional titles(54.02%)and only 1.28%with senior professional titles.Children’s specialized hospitals had an absolute advantage in the equipment resource utilization and medical service supply,with 81.71%of basic equipment allocation,75.60%of bed resources allocation,74.04%of emergency and outpatient visits,83.58%of fever clinic visits and 80.42%of hospital discharges.Conclusion The resource allocation of pediatric medicine in Shanghai municipal hospitals was with priority in children's specialized hospitals,and the average health service utilization in children's specialized hospitals was higher than the average level.With the leadership and technical support from the tertiary children's specialized hospital in the pediatric health service alliance,the pediatric departments in general hospitals may improve their quality of medical care.