北京市医疗联合体分级诊疗效果及影响因素研究

Evaluation of Hierarchical Diagnosis and Treatment Effect and Influencing Factors of Beijing Medical Alliance

目的了解北京市医疗联合体分级诊疗效果现状并探究影响因素。方法采用方便抽样选取26家医疗联合体,基于研究前期构建的指标体系,运用加权TOPSIS法评价分级诊疗效果,通过知情人访谈总结影响医疗联合体分级诊疗效果的因素,采用秩和检验探究医疗联合体分级诊疗效果的影响因素。结果医疗联合体B、A2、A3排名靠前,在“基层首诊、双向转诊、急慢分治、上下联动”4个维度中实施效果都比较好;医疗联合体C2、A8、F2排名靠后,在“双向转诊”“急慢分治”和“上下联动”维度中实施效果明显低于其他医疗联合体。研究结果显示,不同的医疗联合体在核心医院帮扶力度、核心医院级别的差异有统计学意义(P<0.05),影响医疗联合体分级诊疗效果。结论在加强信息化建设、提高基层主动性和家庭医生签约率的同时,需要提高核心医院帮扶力度促进资源下沉,核心医院需因地制宜优化资源配置促进分级诊疗。

Objective To understand the status quo of hierarchical diagnosis and treatment effect of medical alliance in Beijing and explore the influencing factors.Methods The convenience sampling method was used to select 26 vertical medical alliances,and the weighted TOPSIS method was used in combination with the index system established in the previous study to evaluate the effect of hierarchical diagnosis and treatment.The factors influencing the effect of hierarchical diagnosis and treatment in medical alliances were summarized through interviews with insiders,and the rank sum test was used to explore the factors influencing the effect of hierarchical diagnosis and treatment in medical alliances.Results The medical alliance B,A2 and A3 ranked high,and the implementation effect was relatively good in the four dimensions of“primary care first consultation,dual-way referral,acute and slow treatment,and vertical linkage”;The C2,A8 and F2 medical alliances ranked low,and the implementation effect in the dimensions of“dual-way referral”,“acute and slow treatment”and“vertical linkage”was significantly lower than that of other medical alliances.The analysis results showed that the differences in the support intensity and core hospital level of different medical alliances were statistically significant(P<0.05),which affected the hierarchical diagnosis and treatment effect of medical alliances.Conclusion While strengthening the information construction and improving the initiative of grassroots and the signing rate of family doctors,it is necessary to improve the support of core hospitals to promote the sinking of resources.Core hospitals should optimize resource allocation according to local conditions and promote hierarchical diagnosis and treatment.