基于以人为本整合型医疗健康服务导向的医联体三联模式的价值医疗实践

Value-based medical practice of the integrated medical consortium triad model guided by person-centered integrated care

目的基于以人为本的整合型医疗健康服务(PCIC)导向的医联体三联模式,探索实现价值医疗的具体方法。方法建立以联合家庭医师工作室、专家工作室和联合病房为主体的医联体三联模式,并以问题为导向实施医联体内互联网医院云医疗功能,以消化科数据为例,分析医联体内专科医疗和健康服务结果。数据来源于医院年度专科诊疗数据报表和信息系统的慢病管理数据。结果2020年3月—2022年2月,消化内科2年下派专家门诊分别96和87人次,专家查房102和89人次,开展新技术新项目7和12项,签约消化疾病预防与诊疗服务8644和13421户家庭,签约服务居民28436和42558人次,联合专家门诊服务9387和17555例次,联合病房住院患者354和689例次;2年分别新增消化疾病住院病种4和3种,完成胃(肠)镜检查677和936例次,发现消化系统恶性肿瘤21例和35例。结论PCIC导向的医联体三联模式可提升基层医疗机构诊疗能力,提高慢病签约率和肿瘤早筛率,促进分级诊疗,实现价值医疗。

Objective To explore specific methods for achieving value-based healthcare through the integrated medical consortium triad model guided by person-centered integrated care(PCIC).Methods The integrated medical consortium triad model was established with collaborative family physician studios,expert studios,and joint wards as its core components.Guided by a problem-oriented approach,the implementation incorporates cloud medical functionalities of an internet hospital within the integrated medical consortium.Using digestive health data as an example,the outcomes of specialized medical care and health services within the consortium were analyzed.Data was sourced from annual specialty diagnosis and treatment reports from the hospital,as well as chronic disease management data from the information system.Results From March 2020 to February 2022,the department of digestive internal medicine conducted 96 and 87 expert outpatient consultations,102 and 89 expert ward rounds,and implemented 7 and 12 new technologies and projects,respectively.They signed contracts for preventive and diagnostic services for digestive diseases with 8,644 and 13,421 households,providing services to 28,436 and 42,558 residents.Joint expert outpatient services totaled 9,387 and 17,555 instances,with 354 and 689 inpatient cases in joint wards.Over the two years,they added 4 and 3 new hospitalization categories for digestive diseases,completed 677 and 936 gastroscopies,and identified 21 and 35 cases of malignant tumors in the digestive system.Conclusions The PCIC-guided integrated medical consortium triad model enhances the diagnostic and treatment capabilities of primary healthcare institutions,increases the signing rate for chronic diseases and early screening for tumors,promotes tiered diagnosis and treatment,and achieves value-based healthcare.