我国整合型卫生服务评价体系研究
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摘要
目的:构建符合我国国情的整合型卫生服务评价指标体系。方法:基于已有的卫生系统宏观模型,采用系统文献分析法,通过对CNKI、PubMed等国内外文献库进行系统搜索,对相关评价指标进行收集整理,结合主题分析方法和专家咨询法完善相关指标的分类及体系的初步框架构建。结果:指标专家咨询得分最低为7.86分、标准差最大为1.64、变异系数最大为0.20,综合评分最高0.257,最低0.183,专家基本达成一致意见。初步建立我国整合型服务评价体系,包含制度、组织、专业和服务共一级指标3个、二级指标5个、三级指标22个。结论:整合型卫生服务体系的建立是我国医改下一步的重要方向,本指标体系基于已有公开数据资料,较为全面的对现有研究结果进行整理,能够为我国整合型卫生服务的完善提供一定的理论参考。
Objective: To construct an integrated health service evaluation system that conformed to China's conditions. Methods:Based on the existing macro model of health system, systematic literature analysis method was used to search the domestic by CNKI PubMed and so on, it collected the relevant evaluation indicators, and improved the relevant indicators system by combining subject analysis method and expert consultation method. Results: The lowest score was 7.86, the maximum standard deviation was 1.64, the maximum coefficient of variation was 0.20, the highest comprehensive score was 0.257 and the lowest was 0.183. The experts basically reached an agreement. An integrated service evaluation framework had been initially established in China, which included 3 first-level indicators(organization, profession and service), 5 second-level indicators and 22 third-level indicators of system. Conclusion: The establishment of integrated health service system was an important direction for the next step of China's health care reform. Based on the existing public data, the evaluation system comprehensively reviewed the current research results, which could provide certain theoretical references for the improvement of integrated health service in China.
Objective: To construct an integrated health service evaluation system that conformed to China's conditions. Methods:Based on the existing macro model of health system, systematic literature analysis method was used to search the domestic by CNKI PubMed and so on, it collected the relevant evaluation indicators, and improved the relevant indicators system by combining subject analysis method and expert consultation method. Results: The lowest score was 7.86, the maximum standard deviation was 1.64, the maximum coefficient of variation was 0.20, the highest comprehensive score was 0.257 and the lowest was 0.183. The experts basically reached an agreement. An integrated service evaluation framework had been initially established in China, which included 3 first-level indicators(organization, profession and service), 5 second-level indicators and 22 third-level indicators of system. Conclusion: The establishment of integrated health service system was an important direction for the next step of China's health care reform. Based on the existing public data, the evaluation system comprehensively reviewed the current research results, which could provide certain theoretical references for the improvement of integrated health service in China.
引文
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[32]VAN DER AA M J,VAN DER BROEKE J R,STRONKS K,et al.Measuring renewed expertise for integrated care among health-and social-care professionals:development and preliminary validation of the ICE-Q questionnaire[J].Journal of interprofessional care,2016,30(1):56-64.
[33]SINGER S J,BURGERS J,FRIEDBERG M,et al.Defining and measuring integrated patient care:promoting the next frontier in health care delivery[J].Medical care research&review mcrr,2011,68(1):112-127.
[34]AHGREN B,AXELSSON R.Evaluating integrated health care:a model for measurement[J].International Journal of Integrated Care,2005,5(3):e1,e3,e9.
[35]BUSETTO L,LUIJKX K.Advancing integrated care and evaluation by means of a universal typology[J].International journal of care coordination,2017,20(1-2):41-44.
[36]谢长勇.基于系统动力学模型的我国宏观卫生筹资系统机制研究[D].第二军医大学,2007.
[37]李程跃.我国疾病预防控制绩效考核的研究与实践[D].复旦大学,2011.
[38]王玮玉.基于“卫生费用核算体系2011”的政策分析框架研究[D].北京中医药大学,2017.
[39]程琮,刘一志,王如德.Kendall协调系数W检验及其SPSS实现[J].泰山医学院学报,2010,31(7):487-490.
[40]胡永宏,贺思辉.综合评价方法[M].北京:科学出版社,2000.
[41]张永光,傅薇,王晓锋,等.我国开展“以人为本的一体化卫生服务”模式的挑战及对策[J].中国卫生资源,2017,20(6):525-530.
[42]仇蕾洁,张雪文,马桂峰,等.基于供给侧视角的基层医疗机构卫生人力资源短缺问题研究[J].中国卫生事业管理,2018,35(11):804-808+838
[2]GROUP W B,ORGANIZATION W H,FINANCE P R CM.Deepening Health Reform in China[R].World Bank Publications,2016.
[3]齐凯.“三方五家”医改联合研究报告发布[EB/OL].(2016-07-22)http://www.china.com.cn/newphoto/news/2016-07/22/content_38940129.htm
[4]王欣.我国卫生服务整合的体系背景分析及实施效果评价[D].济南:山东大学,2017.
[5]许兴龙,周绿林,魏佳佳.医疗卫生服务体系整合研究的回顾与展望[J].中国卫生经济,2017(7):17-21.
[6]李伯阳,张翔,张亮.农村基本医疗服务网络中纵向连续性服务质量链的关键评价指标研究[J].医学与社会,2012,25(4):12-14.
[7]李一涵.西安市阎良区“县镇卫生管理一体化”效果评估[D].西安:西安医学院,2016.
[8]MINKMAN M M,AHAUS K T,HUIJSMAN R.A four phase development model for integrated care services in the Netherlands[J].BMC health services research,2009,9(1):42-52.
[9]Valentin P P.Rainbow of Chaos:A study into the Theory and Practice of Integrated Primary Care[J].International Journal of Integrated Care,2016,16(2):46-57.
[10]王欣,孟庆跃.国内外卫生服务整合案例的整合策略比较[J].中国卫生经济,2016(6):9-12.
[11]陈至柔.一体化医疗卫生服务体系评价框架研究[D].北京:北京协和医学院,2018.
[12]郝模.卫生政策学[M].北京:人民卫生出版社,2005.
[13]田淼淼,项远兮,袁芳,等.我国乡村卫生服务一体化管理政策效果评价研究[J].中华医院管理杂志,2014,30(11):822-825.
[14]张力文,李宁秀.基于AHP的城乡卫生一体化评价体系研究[J].软科学,2011(12):81-85.
[15]梁嘉杰,匡莉.连续性卫生服务测量指标介绍[J].中国全科医学,2013,16(1):108-112.
[16]颜琰,明栩翎,陈秋燕.城乡一体化均等化服务视角下盐城市医疗卫生体制改革[J].现代交际,2018(22):38-39
[17]项远兮.基于乡村一体化管理政策的农村卫生服务资源整合研究[D].华中科技大学,2015.
[18]王曙珏.山西省城乡基本公共服务一体化政策及效果研究[D].山西财经大学,2018
[19]孙涛,李莉,田秋野,等.城乡卫生服务体系纵向整合阻碍因素及指标框架构建[J].中国农村卫生事业管理,2015,35(02):137-139.
[20]NURJONO M,VALENTIJN P P,BAUTISTA M A,et al.Aprospective validation study of a rainbow model of integrated care measurement tool in Singapore[J].International journal of integrated care,2016,16(1):1-6.
[21]MATUSDA S,YAMAMOTO M.Long-term care insurance and integrated care for the aged in Japan[J].Int j integr care,2001(1):e28.
[22]HAYS R D,MARTINO S,BROWN J A,et al.Evaluation of a care coordination measure for the consumer assessment of healthcare providers and systems(CAHPS)Medicare survey[J].Medical care research&review mcrr,2014,71(2):192-202.
[23]STRANDBERG-LARSEN M.Measuring integrated care[J].Danish medical bulletin,2011,58(2):B4245.
[24]DE J I,JACKSON C.An evaluation approach for a new paradigm-health care integration[J].Journal of evaluation in clinical practice,2001,7(1):71-79.
[25]LYNGS?A M,GODTFREDSEN N S,H?ST D,et al.Instruments to assess integrated care:a systematic review[J].Int j integr care,2014,14(3):e027.
[26]GREAVES F,PAPPAS Y,BARDSLEY M,et al.Evaluation of complex integrated care programes:the approach in North West London[J].International journal of integrated care,2013,13(1):e006.
[27]LEGGAT S G,LEATT P.A framework for assessing the performance of integrated health delivery systems[J].Healthcare management forum,1997,10(1):11-18.
[28]OELKE N D,SUTER E,LIMA M A D D,et al.Indicators and measurement tools for health system integration:a knowledge synthesis protocol[J].Systematic reviews,2015,4(1):99-106.
[29]SUTER E,OELKE N D,ADAIR C E,et al.Ten key principles for successful health systems integration[J].Healthcare quarterly,2009,13 Spec No(Special Issue):16-23.
[30]LING T,BARDSLEY M,ADAMS J,et al.Evaluation of UK integrated care pilots:research protocol[J].International journal of integrated care,2010,10(3):301-302.
[31]RODRIGUES L B,DOS SANTOS C B,et al.Assessment of the coordination of integrated health service delivery networks by the primary health care:COPAS questionnaire validation in the Brazilian context[J].Bmc family practice,2015,16(1):1-9.
[32]VAN DER AA M J,VAN DER BROEKE J R,STRONKS K,et al.Measuring renewed expertise for integrated care among health-and social-care professionals:development and preliminary validation of the ICE-Q questionnaire[J].Journal of interprofessional care,2016,30(1):56-64.
[33]SINGER S J,BURGERS J,FRIEDBERG M,et al.Defining and measuring integrated patient care:promoting the next frontier in health care delivery[J].Medical care research&review mcrr,2011,68(1):112-127.
[34]AHGREN B,AXELSSON R.Evaluating integrated health care:a model for measurement[J].International Journal of Integrated Care,2005,5(3):e1,e3,e9.
[35]BUSETTO L,LUIJKX K.Advancing integrated care and evaluation by means of a universal typology[J].International journal of care coordination,2017,20(1-2):41-44.
[36]谢长勇.基于系统动力学模型的我国宏观卫生筹资系统机制研究[D].第二军医大学,2007.
[37]李程跃.我国疾病预防控制绩效考核的研究与实践[D].复旦大学,2011.
[38]王玮玉.基于“卫生费用核算体系2011”的政策分析框架研究[D].北京中医药大学,2017.
[39]程琮,刘一志,王如德.Kendall协调系数W检验及其SPSS实现[J].泰山医学院学报,2010,31(7):487-490.
[40]胡永宏,贺思辉.综合评价方法[M].北京:科学出版社,2000.
[41]张永光,傅薇,王晓锋,等.我国开展“以人为本的一体化卫生服务”模式的挑战及对策[J].中国卫生资源,2017,20(6):525-530.
[42]仇蕾洁,张雪文,马桂峰,等.基于供给侧视角的基层医疗机构卫生人力资源短缺问题研究[J].中国卫生事业管理,2018,35(11):804-808+838