居家社区医养结合服务能力及提升路径研究:基于39个案例的模糊集定性比较分析

Research on the capacity and improvement path of home-and community-based integrated health and social care:A fuzzy-set qualitative comparative analysis based on 39 cases

目的:实证分析我国居家社区医养结合服务能力的多元驱动路径,为促进医养结合服务体系完善提供有益参考。方法:基于世界卫生组织老年人综合照护(ICOPE)实施框架构建分析框架,选取我国无锡市、焦作市、长沙市、成都市、重庆市的39个区(县)作为样本案例,采用模糊集定性比较分析(fsQCA)方法剖析高或非高水平居家社区医养结合服务能力的组态路径。结果:居家社区医养结合服务能力的提升是各要素组合作用的结果。研究发现4条路径组合将有助于居家社区医养结合服务能力发展,另有3条路径组合或将阻碍居家社区医养结合服务能力发展;制度环境支持、筹资保障水平与区域老年人口需求程度是其中的关键因素。结论:我国居家社区医养结合服务能力受到多重因素间的相互作用与影响,应从多方面出发共同施策以提升服务能力。

Objective:Empirical analysis of the multiple driving paths of service capabilities of home-and community-based integrated health and social care in China,for providing useful reference for promoting the system improvement.Methods:Based on the World Health Organization s Integrated Care for Older People(ICOPE)implementation framework,an analysis framework for service capabilities of home-and community-based integrated health and social care was constructed.39 districts(counties)in Wuxi,Jiaozuo,Changsha,Chengdu,and Chongqing were included.The fuzzy-set qualitative comparative analysis(fsQCA)method was used to analyze the configuration paths of high or non-high-level service capabilities of home-and community-based integrated health and social care.Results:The service capabilities of home-and community-based integrated health and social care is improved by the configuration of various factors.Four path configurations might contribute to the development of service capabilities of home-and community-based integrated health and social care,and three path configurations might hinder the development.Institutional support,financing mechanism and the demand level of regional aging population are the key factors.Conclusions:Service capabilities of home-and community-based integrated health and social care are affected by the interaction and interrelation between multiple factors.Strategies should be jointly implemented from different aspects to improve service capabilities.