医务人员对医联体促进分级诊疗的认知与态度调查
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摘要
目的:了解医联体内医务人员对分级诊疗、医联体的认知现状,对医联体促进分级诊疗的态度及其影响因素。方法:随机抽取国内紧密与半紧密型两个医疗集团,对集团内17个成员单位内的1 069名医务人员进行问卷调查,回收有效问卷1 012份。结果:医联体内医务人员对分级诊疗的认知水平较低,只有10.3%的医务人员能够正确判断分级诊疗的就医模式;紧密型医务人员对医联体的认知情况优于半紧密型;不同级别医务人员对医联体促进分级诊疗的态度差异具有统计学意义;医务人员所在医疗机构等级、分级诊疗认知情况和医联体认知情况是影响医务人员对医联体促进分级诊疗态度的重要因素。结论:进一步重视医务人员在推进分级诊疗及医联体建设上的重要作用,完善绩效考核与激励机制,调动医务人员工作积极性,积极探索建立医联体内各级医疗机构风险共担与利益同享机制,实现"上下联动、双向转诊"的理想就医格局。
Objectives:To understand the cognitive status and the attitudes of medical staff on hierarchical health system and medical alliances,analyze the influence factors of the medical alliances on promoting hierarchical health system.Methods:Randomly selected a close medical alliance and a semi-closed medical alliance in China,Questionnaire survey of 1,069 medical staff in 17 medical institutions in the medical alliances,1012 valid questionnaires were collected.Results:The medical staff has a low level of understanding of hierarchical health system,and only 10.3% of medical staff can correctly judge the mode of hierarchical health system.The medical staff in close medical alliances had a better cognitive status of hierarchical health system.The difference in attitudes between different levels of medical staff on medical alliances promoting hierarchical health system is statistically significant.The level of medical institutions where medical staff are located,the cognitive status of hierarchical health system,and the cognitive status of medical alliances are important factors that affect the attitude of medical staff on medical alliances promoting hierarchical health system.Conclusions:Paying more attention to the important role of medical staff in promoting hierarchical health system and medical alliances construction,improving performance appraisal and incentive mechanism,strengthening the enthusiasm of medical staff,actively exploring the establishment of risk sharing and benefit sharing mechanisms for medical institutions at all levels within the medical alliances can help the rational healthcare provision mode of up down linkage,dual referral.
Objectives:To understand the cognitive status and the attitudes of medical staff on hierarchical health system and medical alliances,analyze the influence factors of the medical alliances on promoting hierarchical health system.Methods:Randomly selected a close medical alliance and a semi-closed medical alliance in China,Questionnaire survey of 1,069 medical staff in 17 medical institutions in the medical alliances,1012 valid questionnaires were collected.Results:The medical staff has a low level of understanding of hierarchical health system,and only 10.3% of medical staff can correctly judge the mode of hierarchical health system.The medical staff in close medical alliances had a better cognitive status of hierarchical health system.The difference in attitudes between different levels of medical staff on medical alliances promoting hierarchical health system is statistically significant.The level of medical institutions where medical staff are located,the cognitive status of hierarchical health system,and the cognitive status of medical alliances are important factors that affect the attitude of medical staff on medical alliances promoting hierarchical health system.Conclusions:Paying more attention to the important role of medical staff in promoting hierarchical health system and medical alliances construction,improving performance appraisal and incentive mechanism,strengthening the enthusiasm of medical staff,actively exploring the establishment of risk sharing and benefit sharing mechanisms for medical institutions at all levels within the medical alliances can help the rational healthcare provision mode of up down linkage,dual referral.
引文
[1]国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意见[EB/OL].(2015-09-11)[2018-07-20].http://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.
[2]国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意[EB/OL].(2017-04-26)[2018-07-20].http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.
[3]国家卫生健康委员会.专家解读:打破政策壁垒,以医联体为引领构建分级诊疗新格局[EB/OL].(2017-5-11)[2018-7-20].http://www.nhfpc.gov.cn/zwgk/jdjd/201705/a813ffd1b1a64f65b5cf3cde792a25c8.shtml.
[4]李茜,李凤如,史培娜,等.北京市某医联体医务人员工作积极性现况分析[J].医学与社会,2016,29(1):43-46.
[5]曹凯.激辩医联体[J].中国医院院长,2013(11):34-36.
[6]潘达颜,蓝春勇,李丽,等.跨区域医联体医务人员对医联体建设的认知和需求情况[J].广西医学,2017(12):1900-1904.
[7]汉业旭,姚峥,赵国光,等.分级诊疗背景下医联体发展的探讨与建议[J].中国医院,2018,22(1):47-48.
[8]卢国强.分级诊疗须防陷入利益博弈僵局[N].经济参考报,2016-11-15(005).
[9]陈玲丽,余昌胤,魏来,等.博弈论视角下的医疗联合体运行模式探讨[J].中国医药导报,2016,13(21):131-133.
[10]程苏华,杨照,孙玮.北京某医联体医患双方对分级诊疗模式认知的调查研究[J].医院管理论坛,2017,34(3):19-22.
[11]王海旭,贾慧萍,陈在余.我国医疗联合体发展的问题及对策分析--基于分工协作的角度[J].卫生经济研究,2017(12):22-24.
[12]杨立成,鲍琳辉,田义娟,等.医联体模式下构建双向转诊机制的探讨[J].中国医院,2015,19(7):33-35.
[13]王玲,赵琨,赵锐,等.分级诊疗实施后对医务人员的影响及其认知状况调查[J].中国卫生政策研究,2018,11(1):53-57.
[14]鲁超,姬芳勤,汪卓谟,等.安徽省医务人员对医联体建设及认知情况研究[J].中国医院管理,2016,36(11):42-45.
[15]胡安霞,闰娟娟.山西省医务人员对分级诊疗认知、态度及影响因素分析[J].卫生软科学,2017(11):6-9.
[16]曾微,李跃平,叶晶晶,等.我国医疗联合体模式的对比与研究[J].中国全科医学,2016,19(25):3003-3007.
[17]黄培,易利华.博弈论视角下双向转诊路径选择研究[J].中国初级卫生保健,2013,27(11):3-5.
[18]杨妍玮.基于博弈论的“医联体”合作对策研究[J].医院管理论坛,2015,32(12):6-8.
[19]黄丞.医疗联合体建设“要”在强基层[J].中国医院,2018,22(1):6-8.
[20]方鹏骞,蒋帅,杨兴怡,等.我国分级诊疗制度实施的关键问题与对策探讨[J].中国医院管理,2016,36(11):1-3.
[2]国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意[EB/OL].(2017-04-26)[2018-07-20].http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.
[3]国家卫生健康委员会.专家解读:打破政策壁垒,以医联体为引领构建分级诊疗新格局[EB/OL].(2017-5-11)[2018-7-20].http://www.nhfpc.gov.cn/zwgk/jdjd/201705/a813ffd1b1a64f65b5cf3cde792a25c8.shtml.
[4]李茜,李凤如,史培娜,等.北京市某医联体医务人员工作积极性现况分析[J].医学与社会,2016,29(1):43-46.
[5]曹凯.激辩医联体[J].中国医院院长,2013(11):34-36.
[6]潘达颜,蓝春勇,李丽,等.跨区域医联体医务人员对医联体建设的认知和需求情况[J].广西医学,2017(12):1900-1904.
[7]汉业旭,姚峥,赵国光,等.分级诊疗背景下医联体发展的探讨与建议[J].中国医院,2018,22(1):47-48.
[8]卢国强.分级诊疗须防陷入利益博弈僵局[N].经济参考报,2016-11-15(005).
[9]陈玲丽,余昌胤,魏来,等.博弈论视角下的医疗联合体运行模式探讨[J].中国医药导报,2016,13(21):131-133.
[10]程苏华,杨照,孙玮.北京某医联体医患双方对分级诊疗模式认知的调查研究[J].医院管理论坛,2017,34(3):19-22.
[11]王海旭,贾慧萍,陈在余.我国医疗联合体发展的问题及对策分析--基于分工协作的角度[J].卫生经济研究,2017(12):22-24.
[12]杨立成,鲍琳辉,田义娟,等.医联体模式下构建双向转诊机制的探讨[J].中国医院,2015,19(7):33-35.
[13]王玲,赵琨,赵锐,等.分级诊疗实施后对医务人员的影响及其认知状况调查[J].中国卫生政策研究,2018,11(1):53-57.
[14]鲁超,姬芳勤,汪卓谟,等.安徽省医务人员对医联体建设及认知情况研究[J].中国医院管理,2016,36(11):42-45.
[15]胡安霞,闰娟娟.山西省医务人员对分级诊疗认知、态度及影响因素分析[J].卫生软科学,2017(11):6-9.
[16]曾微,李跃平,叶晶晶,等.我国医疗联合体模式的对比与研究[J].中国全科医学,2016,19(25):3003-3007.
[17]黄培,易利华.博弈论视角下双向转诊路径选择研究[J].中国初级卫生保健,2013,27(11):3-5.
[18]杨妍玮.基于博弈论的“医联体”合作对策研究[J].医院管理论坛,2015,32(12):6-8.
[19]黄丞.医疗联合体建设“要”在强基层[J].中国医院,2018,22(1):6-8.
[20]方鹏骞,蒋帅,杨兴怡,等.我国分级诊疗制度实施的关键问题与对策探讨[J].中国医院管理,2016,36(11):1-3.
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