社区嵌入式中医药特色医养结合服务绩效评价及障碍因子诊断研究

Performance Evaluation and Obstacle Factor Diagnosis of Community Embedded Integrated Medical and Nursing Care with Characteristics of Traditional Chinese Medicine

背景在“全面推进健康中国建设”和“积极应对人口老龄化国家战略”背景下,科学评价社区嵌入式中医药特色医养结合服务绩效是提升医养结合服务质量的关键。目的评价社区嵌入式中医药特色医养结合服务绩效并分析其主要障碍因子,为政府部门制定相关政策及开展社区嵌入式中医药特色医养结合服务绩效评价提供现实依据。方法于2022年11月,将构建的社区嵌入式中医药特色医养结合服务绩效评价指标体系转化为机构基本情况、工作人员满意度和老年人满意度三份调查问卷;于2022年11月—2023年1月,采用问卷调查法,深入10家样本机构收集机构基本数据、工作人员和老年人满意度数据;于2023年2—3月,使用TOPSIS法对社区嵌入式中医药特色医养结合服务绩效进行评价,并利用障碍度模型分析服务绩效的主要障碍因子。结果10家机构的嵌入性总体、结构嵌入、关系嵌入Cn值和嵌入绩效Cn值的排序一致,7家机构的认知嵌入Cn值和嵌入绩效Cn值排序一致,并且与各机构服务绩效的Cn值排序保持一致。社区嵌入式中医药特色医养结合服务绩效的主要障碍因子分别是C33(中医养生保健指导服务人次)、C44(老年人满意度)、C8(机构与合作伙伴坚持合作共赢)、C37(中医非药物疗法康复护理人次占比)、C39(服务的老年人数量)。结论社区嵌入式中医药特色医养结合的嵌入性、结构嵌入、关系嵌入对其嵌入绩效均有正向影响,认知嵌入对嵌入绩效基本有正向影响。政府部门应明确职能定位,强化政策支持,健全评价体系,注重动态评价,引导和促进社区嵌入式中医药特色医养结合高质量发展;机构应通过加强与合作伙伴的结构嵌入、关系嵌入和认知嵌入,从而不断提升其服务绩效,满足居家社区老年人多样化、多层次的健康养老服务需求,同时要把握好嵌入的度,以免产生嵌入性的负效应。

Background In the context of"comprehensively promoting the construction of a healthy China"and"actively responding to the national strategy of aging population",scientific evaluation of the performance of community embedded integrated medical and nursing care with characteristics of TCM is the key to improving the quality of integrated medical and nursing care.Objective Evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM and analyze main obstacles,providing practical basis for government departments to formulate relevant policies and carry out performance evaluation of it.Methods In November 2022,the performance evaluation index system for community embedded integrated medical and nursing care with characteristics of TCM was transformed into three questionnaires:basic information of the institution,satisfaction of staff and the elderly.From November 2022 to January 2023,a questionnaire survey method was used to collect basic data from 10 sample institutions,as well as satisfaction data from staff and the elderly.From February to March 2023,the TOPSIS method was used to evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM,and the obstacle degree model was used to analyze the main obstacle factors of service performance.Results The overall embeddedness,structural embeddedness,relationship embeddedness,and embedded performance Cn of the 10 institutions are ranked consistently,7 institutions have the same ranking of cognitive embedding and embedding performance Cn,and the ranking is consistent with the service performance Cn of each institution.The main obstacles to the performance of community embedded integrated medical and nursing care with characteristics of TCM are C33(number of TCM health care guidance services),C44(elderly satisfaction),C8(institutions and partners adhere to win-win cooperation),C37(the proportion of TCM non pharmacological therapy rehabilitation nursing personnel),C39(number of elderly people served).Conclusion The embeddedness,structural embeddedness,and relational embeddedness of community embedded integrated medical and nursing care with characteristics of TCM have a positive impact on its embedding performance.Cognitive embedding has a basic positive impact on embedding performance.Government departments should clarify their functional positioning,strengthen policy support,improve the evaluation system,pay attention to dynamic evaluation,and guide and promote the high-quality development of community embedded integrated medical and nursing care with characteristics of TCM.Institutions with characteristics of TCM should strengthen their structural embedding,relationship embedding,and cognitive embedding with partners,in order to continuously improve their service performance,to meet the diversified and multi-level health care service needs of the elderly in home communities.At the same time,should grasp the degree of embedding,so as not to produce the negative effect of embedding.