农村基本医疗服务网络中的纵向连续性医疗服务质量链研究
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摘要
一、研究意义
农村基本医疗服务网络的系统和其质量可以被描述为“系统失灵”和“质量断裂”的状态。本文是一篇关于我国农村基本医疗服务网络中的纵向连续性服务质量理论建立和评价的论作。从选题来说,是有关卫生管理学中有关医疗质量评价的研究。特别是创新性地建立纵向连续性医疗服务质量链评价的关键指标并以此对农村纵向连续性医疗质量链现状的分析和评价,具有其内在的理论价值和现实价值。
二、研究内容
本研究结合连续性服务相关理论和卫生管理学、系统工程学相关方法,通过对我国农村基本医疗服务提供网络的整体研究,从安全性、经济性和信息传递的连续性三个方面建立关键评价指标框架,使用框架中指标,对中国纵向连续性基本医疗服务提供质量的现状进行描述和分析,指出我国农村在纵向连续性基本医疗服务方面存在的系统性、结构性问题,并探究其影响因素,找出造成我国医疗服务系统层级断裂的关键节点,为我国在医疗服务系统质量分析领域提供理论和技术支持。
三、资料来源与研究方法
本研究资料来源于政府公开的数据资料、卫生统计年鉴、中外文献数据库、现场调研资料和专家访谈资料等。理论部分运用了文献检索、文献分析、逻辑推理等方法,结合系统工程学、公共政策学、卫生事业管理学等相关学科理论进行分析。
四、研究结果
1.通过分析我国农村基本医疗服务网络的组织内涵,结合系统论等理论,阐述了我国连续性卫生服务、连续性医疗服务、纵向连续性医疗服务、质量链等概念的内涵与外延,创新性地初步构建了农村基本医疗服务网络中的纵向连续性医疗服务质量链理论。
2.根据已构建完成的农村纵向连续性医疗服务质量链理论,结合我国农村三级预防保健网络的现状,从安全性、经济性和信息传递的连续性三个维度,建立了农村纵向连续性医疗服务质量链评价关键指标,为实证研究提供了理论依据。
3.结果发现：农村三级保健网中的纵向连续性服务存在安全性问题,如抗生素不合理使用问题在涉及多机构连续性服务时同样存在且严重；在纵向连续性服务过程中,因为重复不合理检查而对农村患者的造成较为严重的经济影响；信息的连续性传递与共享在农村连续性医疗服务过程中也存在较为严重的断裂和滞后性。总体说来,我国农村基本医疗服务网络中的纵向连续性医疗服务质量较为低下,值得研究者和政策制定者的深刻关注。
五、讨论与建议
结论：无论是研究者还是政策制定者,都需要以整合的眼光审视我国农村基本医疗服务体系中存在的系统性质量问题,而质量链之所以发生“断裂”的根源主要在于医学科学的专业化趋势、医疗服务管理体系的断裂、医保制度在维护和促进服务整合过程中的缺位以及信息链的断裂、“信息孤岛”的形成。
针对以上情况,研究者从组织变革、机制革新、信息创新、供需双方建设几个方面提出了相应的政策建议。认为政府和医疗机构管理者必须打破以往孤立的单机构服务与质量观念,以系统、整合以及连续性的眼光对管理方和提供方进行组织变革,革新和重塑连续性服务相关内外部机制,同时以信息技术的创新和运用,辅以供需双方在理念、观念上的变革与建设,为提高纵向连续性服务的质量,形成一条高质量的纵向连续性医疗服务质量链。
六、创新和不足
文献综述结论显示,研究者们长期以来将农村医疗服务质量的研究方向定位于单类型、单层级的机构,而将纵向、多层级机构共同提供的医疗服务质量作为整体纳入质量评价的主体研究内容、赋予其评价指标并进行定量、定性分析的研究却鲜有涉及。本研究在选题上有着一定的创新思想。此外,在方法学的应用上,首次将工程管理学的质量链诊断理论运用于卫生领域的质量诊断和评价中,在方法学上也有着一定的创新性。然而,本研究的不足之处在于,由于质量链概念首次被研究者从系统工程学引用到卫生政策与管理的研究中来,对于此概念在卫生系统的应用还处于较为初级的阶段,希望在今后的工作中或其他研究者能继续深入挖掘此理念在卫生管理领域的应用。
1. Significant of research
The state of basic medical service net of rural area and its quality in China could be discribed as "system dysfunction" and "quality chasm". This paper is mainly about the theory building and evaluation of the Quality Chain of Vertical Continuity of Care in Basic Medical Service net in China. The topic selection is based on the research of medical quality evaluation which belongs to the Health Management. This paper, from a whole new aspect, built the key indicators for the Vertical Continuity of Health Care(VCOC). In the meanwhile, to analyze the situation of VCOC in rural areas based on these indicators,then put forwarded the policy proposals.
2. Objectives of research
This research, which based on the theories of Health Management, System Analysis Engineering, built the framework of the key evaluation indicators from three aspects which including safety, economy and the continuity of information transmit. To describe the current situation of VCOC, especially the issues on the system and structure of health, which using the framework mentioned before. By probing and exploring the possible influential factors, to find out the cause of medical service system and key nodes of structure, in order to provide the theory and technical suppor in the field of system quality analysis of medical care in China.
3. The Resource of data and Method.
The data comes from the data which was released by government, Health Statistics Yearbook, Literature database in China and overseas, field investigation data and expert interview material, etc. Using the theory of literature retrieval, literature logic analysis and other methods, the combined system engineering, and public policy science, health service management and related discipline theory analysis; Data of field investigation was analyzed by health statistics processing. statistical analysis software SPSS12.0was used for analysis.
4. Contents
4.1By the analyzing of China's rural basic medical service network organization connotation, combined with the theory of system, this paper expounds the connotation and denotation of continuity health service and continuity medical service, longitudinal continuity medical service, quality of chains, and other concepts. Initially constructs the rural basic medical service network in the quality chain theory of VCOC.
4.2According to the set of quality chain of VCOC theory, combined with the current state of China's rural tertiary prevention health network, established the VCOC quality evaluation key indicators from the dimensions of safety, economy and information transmission for empirical research provides theory basis.
4.3By the empirical research, to evaluate the quality chain of basic medical service net in rural from safety, economy and information transmission. The results found that there are many service safety problems in VCOC of China's rural basic medical service network, such as antibiotic is not reasonable using which involved in more institutions which related to VCOC; The VCOC process, because of unreasonable repeat examinations in hospital, rural patients caused by the more serious economic impact; The continuity of information transfer and sharing in the rural medical service in the process also has serious fracture. In general, our country rural basic medical service network in the vertical continuity medical service quality is low, and the researchers and policy makers should show their deep concern.
5. Discussion and Suggestion By the analysis of causes and affecting factors of present situation of rural vertical continuity medical service quality, the following conclusion was drew:whether the researchers or policy makers, needs the "integrate view" to survey quality problems existing in China's rural basic medical service system. The quality chain is occurring "rupture" mainly because of the tendency of medical science's specialized, the system fault of medical insurance system in maintaining and promoting the service in the process of integration and the absence of information chain rupture--"information island" formation.
In view of the above situation, the researcher put forward some suggestions from the view of organizational change,mechanism innovation and information construction of both the suppliers and the patient. Believe that the government and medical institutions'managers must break the ideas of service in single institutions only, to provide the reform in the view of system integration, continuity of management, to reshape the mechanism of continuity of internal and external service. at the same time, in information technology innovation and use, to improve the quality of VCOC with the changing of both the suppliers and patients,, forming a high quality of the vertical continuity medical service.
6. Innovations and the shortcomings of this study
Literature review conclusion shows that the researchers always focus on the quality research of single institution in rural medical service, but rare to talk about the VCOC service and its quality by using the new evaluation index and quantitative and qualitative analysis methods. In addition, the application of methodology also has a certain innovation because of the application of system engineering. However, the limitations of the study is, this is the first time the quality chain in System Engineering was referenced to the health policy and management research, the concept of health for the application of the system is still in a relatively junior stage, we hope in the future, or other researchers, can continue to dig this idea deeper in health management areas of application.
农村基本医疗服务网络的系统和其质量可以被描述为“系统失灵”和“质量断裂”的状态。本文是一篇关于我国农村基本医疗服务网络中的纵向连续性服务质量理论建立和评价的论作。从选题来说,是有关卫生管理学中有关医疗质量评价的研究。特别是创新性地建立纵向连续性医疗服务质量链评价的关键指标并以此对农村纵向连续性医疗质量链现状的分析和评价,具有其内在的理论价值和现实价值。
二、研究内容
本研究结合连续性服务相关理论和卫生管理学、系统工程学相关方法,通过对我国农村基本医疗服务提供网络的整体研究,从安全性、经济性和信息传递的连续性三个方面建立关键评价指标框架,使用框架中指标,对中国纵向连续性基本医疗服务提供质量的现状进行描述和分析,指出我国农村在纵向连续性基本医疗服务方面存在的系统性、结构性问题,并探究其影响因素,找出造成我国医疗服务系统层级断裂的关键节点,为我国在医疗服务系统质量分析领域提供理论和技术支持。
三、资料来源与研究方法
本研究资料来源于政府公开的数据资料、卫生统计年鉴、中外文献数据库、现场调研资料和专家访谈资料等。理论部分运用了文献检索、文献分析、逻辑推理等方法,结合系统工程学、公共政策学、卫生事业管理学等相关学科理论进行分析。
四、研究结果
1.通过分析我国农村基本医疗服务网络的组织内涵,结合系统论等理论,阐述了我国连续性卫生服务、连续性医疗服务、纵向连续性医疗服务、质量链等概念的内涵与外延,创新性地初步构建了农村基本医疗服务网络中的纵向连续性医疗服务质量链理论。
2.根据已构建完成的农村纵向连续性医疗服务质量链理论,结合我国农村三级预防保健网络的现状,从安全性、经济性和信息传递的连续性三个维度,建立了农村纵向连续性医疗服务质量链评价关键指标,为实证研究提供了理论依据。
3.结果发现：农村三级保健网中的纵向连续性服务存在安全性问题,如抗生素不合理使用问题在涉及多机构连续性服务时同样存在且严重；在纵向连续性服务过程中,因为重复不合理检查而对农村患者的造成较为严重的经济影响；信息的连续性传递与共享在农村连续性医疗服务过程中也存在较为严重的断裂和滞后性。总体说来,我国农村基本医疗服务网络中的纵向连续性医疗服务质量较为低下,值得研究者和政策制定者的深刻关注。
五、讨论与建议
结论：无论是研究者还是政策制定者,都需要以整合的眼光审视我国农村基本医疗服务体系中存在的系统性质量问题,而质量链之所以发生“断裂”的根源主要在于医学科学的专业化趋势、医疗服务管理体系的断裂、医保制度在维护和促进服务整合过程中的缺位以及信息链的断裂、“信息孤岛”的形成。
针对以上情况,研究者从组织变革、机制革新、信息创新、供需双方建设几个方面提出了相应的政策建议。认为政府和医疗机构管理者必须打破以往孤立的单机构服务与质量观念,以系统、整合以及连续性的眼光对管理方和提供方进行组织变革,革新和重塑连续性服务相关内外部机制,同时以信息技术的创新和运用,辅以供需双方在理念、观念上的变革与建设,为提高纵向连续性服务的质量,形成一条高质量的纵向连续性医疗服务质量链。
六、创新和不足
文献综述结论显示,研究者们长期以来将农村医疗服务质量的研究方向定位于单类型、单层级的机构,而将纵向、多层级机构共同提供的医疗服务质量作为整体纳入质量评价的主体研究内容、赋予其评价指标并进行定量、定性分析的研究却鲜有涉及。本研究在选题上有着一定的创新思想。此外,在方法学的应用上,首次将工程管理学的质量链诊断理论运用于卫生领域的质量诊断和评价中,在方法学上也有着一定的创新性。然而,本研究的不足之处在于,由于质量链概念首次被研究者从系统工程学引用到卫生政策与管理的研究中来,对于此概念在卫生系统的应用还处于较为初级的阶段,希望在今后的工作中或其他研究者能继续深入挖掘此理念在卫生管理领域的应用。
1. Significant of research
The state of basic medical service net of rural area and its quality in China could be discribed as "system dysfunction" and "quality chasm". This paper is mainly about the theory building and evaluation of the Quality Chain of Vertical Continuity of Care in Basic Medical Service net in China. The topic selection is based on the research of medical quality evaluation which belongs to the Health Management. This paper, from a whole new aspect, built the key indicators for the Vertical Continuity of Health Care(VCOC). In the meanwhile, to analyze the situation of VCOC in rural areas based on these indicators,then put forwarded the policy proposals.
2. Objectives of research
This research, which based on the theories of Health Management, System Analysis Engineering, built the framework of the key evaluation indicators from three aspects which including safety, economy and the continuity of information transmit. To describe the current situation of VCOC, especially the issues on the system and structure of health, which using the framework mentioned before. By probing and exploring the possible influential factors, to find out the cause of medical service system and key nodes of structure, in order to provide the theory and technical suppor in the field of system quality analysis of medical care in China.
3. The Resource of data and Method.
The data comes from the data which was released by government, Health Statistics Yearbook, Literature database in China and overseas, field investigation data and expert interview material, etc. Using the theory of literature retrieval, literature logic analysis and other methods, the combined system engineering, and public policy science, health service management and related discipline theory analysis; Data of field investigation was analyzed by health statistics processing. statistical analysis software SPSS12.0was used for analysis.
4. Contents
4.1By the analyzing of China's rural basic medical service network organization connotation, combined with the theory of system, this paper expounds the connotation and denotation of continuity health service and continuity medical service, longitudinal continuity medical service, quality of chains, and other concepts. Initially constructs the rural basic medical service network in the quality chain theory of VCOC.
4.2According to the set of quality chain of VCOC theory, combined with the current state of China's rural tertiary prevention health network, established the VCOC quality evaluation key indicators from the dimensions of safety, economy and information transmission for empirical research provides theory basis.
4.3By the empirical research, to evaluate the quality chain of basic medical service net in rural from safety, economy and information transmission. The results found that there are many service safety problems in VCOC of China's rural basic medical service network, such as antibiotic is not reasonable using which involved in more institutions which related to VCOC; The VCOC process, because of unreasonable repeat examinations in hospital, rural patients caused by the more serious economic impact; The continuity of information transfer and sharing in the rural medical service in the process also has serious fracture. In general, our country rural basic medical service network in the vertical continuity medical service quality is low, and the researchers and policy makers should show their deep concern.
5. Discussion and Suggestion By the analysis of causes and affecting factors of present situation of rural vertical continuity medical service quality, the following conclusion was drew:whether the researchers or policy makers, needs the "integrate view" to survey quality problems existing in China's rural basic medical service system. The quality chain is occurring "rupture" mainly because of the tendency of medical science's specialized, the system fault of medical insurance system in maintaining and promoting the service in the process of integration and the absence of information chain rupture--"information island" formation.
In view of the above situation, the researcher put forward some suggestions from the view of organizational change,mechanism innovation and information construction of both the suppliers and the patient. Believe that the government and medical institutions'managers must break the ideas of service in single institutions only, to provide the reform in the view of system integration, continuity of management, to reshape the mechanism of continuity of internal and external service. at the same time, in information technology innovation and use, to improve the quality of VCOC with the changing of both the suppliers and patients,, forming a high quality of the vertical continuity medical service.
6. Innovations and the shortcomings of this study
Literature review conclusion shows that the researchers always focus on the quality research of single institution in rural medical service, but rare to talk about the VCOC service and its quality by using the new evaluation index and quantitative and qualitative analysis methods. In addition, the application of methodology also has a certain innovation because of the application of system engineering. However, the limitations of the study is, this is the first time the quality chain in System Engineering was referenced to the health policy and management research, the concept of health for the application of the system is still in a relatively junior stage, we hope in the future, or other researchers, can continue to dig this idea deeper in health management areas of application.
引文
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