质量与结果框架对我国慢性病医防融合服务的借鉴与启示

Study on the Enlightenment of Quality and Outcomes Framework on Medical and Preventive Integration in Chronic Diseases

为破除慢性病“医”“防”分离,我国开展了慢性病医防融合服务工作,但仍存在服务碎片化、信息系统不完善、工作流程不系统,以及缺少科学合理的评价指标体系等问题。质量与结果框架是国际上公认的卫生领域内以结果为导向的质量控制系统和以报酬为导向的激励工具,在慢性病管理方面卓有成效。本研究梳理我国慢性病医防融合现状与问题,分析质量与结果框架应用于我国慢性病医防融合服务的需求与可行性。结果发现,质量与结果框架在我国慢性病医防融合领域有良好的应用前景,借鉴质量与结果框架的管理理念与经验,对基层医疗卫生机构进行按质量支付,通过慢性病公共卫生服务与家庭医生签约服务与绩效报酬相挂钩,引导和规范慢性病医防有机融合。

China has taken measures to strengthen the integration between prevention and treatment in chronic disease,but there were still some problems such as fragmented services,imperfect information system,unsystematic workflow,and lack of sci⁃entific and reasonable evaluation index systems.Quality and Outcomes Framework(QOF)is internationally recognized as a result-oriented quality control system and a reward-oriented incentive mechanism for better management of chronic disease.The problems existed in the current medical and preventive integration were obtained,and the needs and feasibility of QOF in the prac⁃tice of integration between prevention and treatment in chronic disease were analyzed.It can be concluded that QOF has a good ap⁃plication prospect in the field of medical integration of chronic diseases in China,and paying for quality can be applied in primary medical institutions.By link the public health service and contracted family doctor services of chronic disease with the reward,the integration of medical and preventive in chronic diseases can be improved.