医科院校及其附属医院参与社区卫生建设的模式和评价指标体系研究
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摘要
1、概述
社区卫生服务是满足居民基本医疗保障需求的基层卫生服务,是城市卫生服务的重点,是城市公共卫生和基本医疗服务体系的基础,是实现“人人享有基本医疗卫生服务”的基本途径,也是促进社会公平、维护社会稳定、构建和谐社会的重要内容。
我国现阶段社区卫生服务网络不健全、全科医生严重短缺、居民对其技术水平信任度不高、双向转诊制度不健全、社区卫生服务的利用率不高,“看病难、看病贵”的矛盾还是非常突出。
国家政策明确要求高等医学院校和大中医院积极参与社区卫生服务,为加快社区卫生事业的发展作出更大的贡献。全国有医科类本科院校280多所和附属医院1000多家,集中了高知名度的品牌、高水平的学科、高素质的人才、精湛的技术、高精尖的设备、高密度的信息和大批科研成果,医教研资源和优势非常显著,应该是国家社区卫生事业发展的重要力量,但其在社区卫生建设方面的作用还没有充分发挥。
国内医科院校及其附属医院,也包括部分不是医科院校附属医院的城市大医院,参与社区卫生服务建设的形式非常多,效果存在较大的差别,还没有一个比较完善的操作模式,影响了整个工作的的效果、效率和大家的积极性,更没有对此项重要工作的评价指标,缺少决策和检查的科学依据。
应用管理流行病学方法,对医科院校及其附属医院参与社区卫生服务的模式和评价指标体系进行研究。收集卫生信息,开展社区诊断,进行卫生服务调查、评价和监督,调整社区卫生政策,从而提高决策科学性,措施的合理性,管理的准确性,服务的有效性。
国内外类似课题研究不多。到目前为止,国内外尚无见到系统的相关研究,只有极少数几篇关于医科院校在社区医疗机构建立教学和实践基地的经验报道,以及个别专家对医科院校应该为社区培养更多全科医生的呼吁。
2、研究目的
2.1通过本课题研究,系统分析医科院校及其附属医院参与社区卫生服务的不同形式的内涵和困难,提出医科院校及其附属医院参与社区卫生服务的主要途径,建立模式图,为医科院校及其附属医院参与社区卫生服务提供可借鉴的简捷、有效的操作模式。
2.2建立一套科学、有效、可操作性较强的评价指标体系,对医科院校及其附属医院参与社区卫生服务模式进行适时评价,提高政府的关注度,并对具体工作进行指导和干预。
3、研究对象
一是国外主要国家社区卫生服务发展模式;二是国内部分医科院校及其附属医院,也包括不是附属医院的城市大医院,参与社区卫生服务的模式;三是广州市卫生局正式确认的,广州市各大医院对口帮扶130个社区卫生服务中心。
4、研究方法
4.1医科院校及其附属医院参与社区卫生建设的模式研究
4.1.1设计调查表
采用定量研究和定性研究相结合的方法,通过查阅文献、专家咨询、访问社区管理者,结合我校参与和管理附属医院对口支援基层医院的经验,自行设计医科院校及其附属医院参与社区卫生建设的“社区卫生机构帮扶需求调查表”(附件1)。
4.1.2调查方法
成立了调查小组,培训了调查员,先进行预调查,然后组织正式调查,根据管理流行病学的质量控制要求进行调查质量控制。在广州市行政区范围内,对100%的社区卫生服务中心进行问卷调查、座谈或现场交流,以社区卫生服务中心的负责人为主体进行进行问卷调查。
4.1.3数据整理
对调查表收集回来的结果,进行汇总后,用excel 2003版统计软件进行分析。
4.2参与模式的评价指标体系研究
4.2.1建立评价指标
由南方医科大学医院管理处、第三附属医院工作人员和卫生事业管理专业本科实习生组成评价小组,在文献研究的基础上,应用Delphi法,选择从事本研究相关专业工作10年以上专家30名,通过3轮函询征求专家们的意见,并将每一轮的意见进行汇总整理,建立意见比较一致的评价指标。
4.2.2确定指标权重
在确定一级指标权重时,要求专家对4个一级指标的相对重要性依据Saaty相对重要性等级表进行两两对比,并根据AHP法的求解步骤进行求解。从而求得每一位专家所赋的一级指标权重,将所有专家同一指标的权重进行算术平均,得出代表专家群体集中意见的综合权重。在确定二、三级指标权重时,利用问卷调查得出各评价方面和其内在指标的相对重要性赋值均数,利用重要性赋值均数的差值确定Saaty标度,再根据AHP法的求解步骤进行求解。
5.研究结果
5.1医科院校及其附属医院参与社区卫生建设的“一核两翼”模式
“一核”指以提高诊疗质量为核心;“两翼”指以教育训练为主翼、业务管理合作为辅翼,促进社区卫生服务的建设与发展。概括起来主要有7个方面的内涵:一是加强全科医学教育,迅速扩充全科医生队伍;二是建立医科院校(附属医院)-社区卫生中心紧密型二级医疗网络;三是发挥教育资源优势,提升社区卫生服务机构人员学历结构;四是发挥人才资源优势,提高社区卫生服务机构人员技术水平;五是发挥医疗资源优势,为社区病人提供方便的双向转诊服务;六是搭建信息共享平台,提高健康教育水平和健康信息资源利用效益;七是医学教育与社区实践紧密结合,提高医学生的社区卫生服务能力和综合素质。
5.2建立医科院校及其附属医院参与社区卫生建设模式的评价指标体系
应用Delphi法,经过3轮专家咨询,逐步建立比较一致的三级评价指标体系,再用AHP法计算出各级指标的权重。最终确立了三级评价指标体系,一级指标由人才培养、技术水平、服务能力和满意度4个组成;二级指标有13个:全日制毕业生、学历提高教育、脱产培训、非脱产培训、支持人力、常规、技术、科研促进、双向转诊、社区健康教育、健康信息管理、病人满意率、居民信任率和工作人员满意率;三级指标有27个。对评价指标体系中的各级各项指标的权重进行赋值。
1. Introduction
Community health service, a grass-root service for meeting the fundamental basic health care needs of residents, is the basis of urban public health and the basic medical service system. It is critical to realize the goal of "everyone enjoys fundamental health care services", to reduce disparity of society, promote social justice, safeguard social stability and building a harmonious society.
Currently, China's community health service network does not well organized and most community health service centers are short of funds and qualified health staff, resulting in poor confidence and reliability from the public. The contradiction of "difficult to find a competent doctor and cannot afford health care" is still very prominent.
National policy requires medical schools and large hospitals participate actively in community health services in order to rapidly develop community health services. There are more than 280 medical schools and about 1000 affiliated hospitals with high reputation, prestigious experts, well-developed faculty, high-tech equipment and a large number of scientific studies. These should be an important power to promote quality of community health services, but their role has not yet brought into full play.
There are many medical universities and their affiliated hospitals, including large municipal hospitals involving in community health services. However effect varies tremendously. There is still no a perfect model. Moreover, lack of a scientific evaluative index system has impaired efficiency, effectiveness of the entire work, lowered enthusiasm of those who joined the work. This also resulted in unscientific decision-making and over subjective supervision of government.
Application of epidemiological methods to model involvement of medical schools and their affiliated hospitals in community health services and to formulate evaluation index system is able to collect health information, appreciate finished work, evaluation and supervision of health services. This will help improve scientific quality of decision-making, reasonableness of intervention, accuracy of management and effectiveness of services.
So far, there has not been a systematic relevant study on this issue, only one or two experience reports and individual expert's appeal.
2. Objectives
2.1 The purpose of this study is to systematically analyze different models in which medical schools and their affiliated hospitals join community health services and to work out a major way for medical schools and their affiliated hospitals to participate in community health services.
2.2 To set up a scientific, effective and practical evaluation index system evaluating effect of medical school and its affiliated hospitals participating in community health services in a real time fashion. It will attract government's attention, enhance guidance and intervention.
3. Subjects
Firstly, developmental models of community health services in main developed countries; Secondly, models of some domestic medical schools and affiliated hospitals, including large municipal hospitals that do not affiliate any medical school, participating in community health services; Thirdly, 130 community health service centers sanctioned by Guangzhou Health Bureau.
4. Methods
4.1 A model for promoting quality of community health services by medical school and its affiliated hospitals
4.1.1 Design of questionnaire
It was designed based on both quantitative and qualitative research methods.
4.1.2 Investigative Method
A survey was conducted among leaders, senior doctors and nurses in community health service centers around Guangzhou. In addition to the survey, expert consult, interactive discussion with staff of the centers, intensive interview with main stake-holders, were also added.
4.1.3 Data collection and analysis
Date collected by questionnaire was subject to statistical analysis with excel 2003 Software.
4.2 Evaluation Index System
4.2.1 Establishment of evaluation index
The evaluation team was composed of staff in the Office of Hospital Management Southern Medical University, the Third Affiliated Hospital and the forth-year undergraduate interns of health services management program. After reviewing relevant literature, evaluative index were formulated on the basis of consulting a panel of 30 independent experts in three rounds.
4.2.2 Weight Determination via Saaty's Method
Using pair wise comparisons via Saaty's method, experts determined relative weights of I-level indicators. In accordance with the AHP method, each expert's I level indicator weight was worked out. The arithmetic average of the weights represents the expert group's general view. In determining the secondary and tertiary index weight, a questionnaire survey and evaluation of the relative importance of the internal indicators was employed via Saaty's method and AHP method.
5. Results
5.1 A model for getting involved in the campaign of community health promotion by medical university-affiliated hospitals was formulated.
The first is to produce more general practitioners through recruiting more medical students specialized in primary care; the second is to set up an intimately cooperative network between community health centers and medical university affiliated hospital; the third is to make staff who work in community health centers well educated make good use of educational resources in medical universities; the forth is to get staff who work in community health services well trained; the fifth is to provide community patients with convenient double-way referral services; the sixth is to promote health education through building up an information-sharing infrastructure; the seventh is to improve quality of community health services of medical students through academic medical education getting closely integrated with community health services.
5.2 An index system evaluating effect of the model was formulated
The system includes 4 I-level, 13 II-level and 27 III-level indicators, evaluating effect of the model from the following aspects: personnel training, technology, competencies and satisfaction. Weight value of each indicator at all levels was also defined.
社区卫生服务是满足居民基本医疗保障需求的基层卫生服务,是城市卫生服务的重点,是城市公共卫生和基本医疗服务体系的基础,是实现“人人享有基本医疗卫生服务”的基本途径,也是促进社会公平、维护社会稳定、构建和谐社会的重要内容。
我国现阶段社区卫生服务网络不健全、全科医生严重短缺、居民对其技术水平信任度不高、双向转诊制度不健全、社区卫生服务的利用率不高,“看病难、看病贵”的矛盾还是非常突出。
国家政策明确要求高等医学院校和大中医院积极参与社区卫生服务,为加快社区卫生事业的发展作出更大的贡献。全国有医科类本科院校280多所和附属医院1000多家,集中了高知名度的品牌、高水平的学科、高素质的人才、精湛的技术、高精尖的设备、高密度的信息和大批科研成果,医教研资源和优势非常显著,应该是国家社区卫生事业发展的重要力量,但其在社区卫生建设方面的作用还没有充分发挥。
国内医科院校及其附属医院,也包括部分不是医科院校附属医院的城市大医院,参与社区卫生服务建设的形式非常多,效果存在较大的差别,还没有一个比较完善的操作模式,影响了整个工作的的效果、效率和大家的积极性,更没有对此项重要工作的评价指标,缺少决策和检查的科学依据。
应用管理流行病学方法,对医科院校及其附属医院参与社区卫生服务的模式和评价指标体系进行研究。收集卫生信息,开展社区诊断,进行卫生服务调查、评价和监督,调整社区卫生政策,从而提高决策科学性,措施的合理性,管理的准确性,服务的有效性。
国内外类似课题研究不多。到目前为止,国内外尚无见到系统的相关研究,只有极少数几篇关于医科院校在社区医疗机构建立教学和实践基地的经验报道,以及个别专家对医科院校应该为社区培养更多全科医生的呼吁。
2、研究目的
2.1通过本课题研究,系统分析医科院校及其附属医院参与社区卫生服务的不同形式的内涵和困难,提出医科院校及其附属医院参与社区卫生服务的主要途径,建立模式图,为医科院校及其附属医院参与社区卫生服务提供可借鉴的简捷、有效的操作模式。
2.2建立一套科学、有效、可操作性较强的评价指标体系,对医科院校及其附属医院参与社区卫生服务模式进行适时评价,提高政府的关注度,并对具体工作进行指导和干预。
3、研究对象
一是国外主要国家社区卫生服务发展模式;二是国内部分医科院校及其附属医院,也包括不是附属医院的城市大医院,参与社区卫生服务的模式;三是广州市卫生局正式确认的,广州市各大医院对口帮扶130个社区卫生服务中心。
4、研究方法
4.1医科院校及其附属医院参与社区卫生建设的模式研究
4.1.1设计调查表
采用定量研究和定性研究相结合的方法,通过查阅文献、专家咨询、访问社区管理者,结合我校参与和管理附属医院对口支援基层医院的经验,自行设计医科院校及其附属医院参与社区卫生建设的“社区卫生机构帮扶需求调查表”(附件1)。
4.1.2调查方法
成立了调查小组,培训了调查员,先进行预调查,然后组织正式调查,根据管理流行病学的质量控制要求进行调查质量控制。在广州市行政区范围内,对100%的社区卫生服务中心进行问卷调查、座谈或现场交流,以社区卫生服务中心的负责人为主体进行进行问卷调查。
4.1.3数据整理
对调查表收集回来的结果,进行汇总后,用excel 2003版统计软件进行分析。
4.2参与模式的评价指标体系研究
4.2.1建立评价指标
由南方医科大学医院管理处、第三附属医院工作人员和卫生事业管理专业本科实习生组成评价小组,在文献研究的基础上,应用Delphi法,选择从事本研究相关专业工作10年以上专家30名,通过3轮函询征求专家们的意见,并将每一轮的意见进行汇总整理,建立意见比较一致的评价指标。
4.2.2确定指标权重
在确定一级指标权重时,要求专家对4个一级指标的相对重要性依据Saaty相对重要性等级表进行两两对比,并根据AHP法的求解步骤进行求解。从而求得每一位专家所赋的一级指标权重,将所有专家同一指标的权重进行算术平均,得出代表专家群体集中意见的综合权重。在确定二、三级指标权重时,利用问卷调查得出各评价方面和其内在指标的相对重要性赋值均数,利用重要性赋值均数的差值确定Saaty标度,再根据AHP法的求解步骤进行求解。
5.研究结果
5.1医科院校及其附属医院参与社区卫生建设的“一核两翼”模式
“一核”指以提高诊疗质量为核心;“两翼”指以教育训练为主翼、业务管理合作为辅翼,促进社区卫生服务的建设与发展。概括起来主要有7个方面的内涵:一是加强全科医学教育,迅速扩充全科医生队伍;二是建立医科院校(附属医院)-社区卫生中心紧密型二级医疗网络;三是发挥教育资源优势,提升社区卫生服务机构人员学历结构;四是发挥人才资源优势,提高社区卫生服务机构人员技术水平;五是发挥医疗资源优势,为社区病人提供方便的双向转诊服务;六是搭建信息共享平台,提高健康教育水平和健康信息资源利用效益;七是医学教育与社区实践紧密结合,提高医学生的社区卫生服务能力和综合素质。
5.2建立医科院校及其附属医院参与社区卫生建设模式的评价指标体系
应用Delphi法,经过3轮专家咨询,逐步建立比较一致的三级评价指标体系,再用AHP法计算出各级指标的权重。最终确立了三级评价指标体系,一级指标由人才培养、技术水平、服务能力和满意度4个组成;二级指标有13个:全日制毕业生、学历提高教育、脱产培训、非脱产培训、支持人力、常规、技术、科研促进、双向转诊、社区健康教育、健康信息管理、病人满意率、居民信任率和工作人员满意率;三级指标有27个。对评价指标体系中的各级各项指标的权重进行赋值。
1. Introduction
Community health service, a grass-root service for meeting the fundamental basic health care needs of residents, is the basis of urban public health and the basic medical service system. It is critical to realize the goal of "everyone enjoys fundamental health care services", to reduce disparity of society, promote social justice, safeguard social stability and building a harmonious society.
Currently, China's community health service network does not well organized and most community health service centers are short of funds and qualified health staff, resulting in poor confidence and reliability from the public. The contradiction of "difficult to find a competent doctor and cannot afford health care" is still very prominent.
National policy requires medical schools and large hospitals participate actively in community health services in order to rapidly develop community health services. There are more than 280 medical schools and about 1000 affiliated hospitals with high reputation, prestigious experts, well-developed faculty, high-tech equipment and a large number of scientific studies. These should be an important power to promote quality of community health services, but their role has not yet brought into full play.
There are many medical universities and their affiliated hospitals, including large municipal hospitals involving in community health services. However effect varies tremendously. There is still no a perfect model. Moreover, lack of a scientific evaluative index system has impaired efficiency, effectiveness of the entire work, lowered enthusiasm of those who joined the work. This also resulted in unscientific decision-making and over subjective supervision of government.
Application of epidemiological methods to model involvement of medical schools and their affiliated hospitals in community health services and to formulate evaluation index system is able to collect health information, appreciate finished work, evaluation and supervision of health services. This will help improve scientific quality of decision-making, reasonableness of intervention, accuracy of management and effectiveness of services.
So far, there has not been a systematic relevant study on this issue, only one or two experience reports and individual expert's appeal.
2. Objectives
2.1 The purpose of this study is to systematically analyze different models in which medical schools and their affiliated hospitals join community health services and to work out a major way for medical schools and their affiliated hospitals to participate in community health services.
2.2 To set up a scientific, effective and practical evaluation index system evaluating effect of medical school and its affiliated hospitals participating in community health services in a real time fashion. It will attract government's attention, enhance guidance and intervention.
3. Subjects
Firstly, developmental models of community health services in main developed countries; Secondly, models of some domestic medical schools and affiliated hospitals, including large municipal hospitals that do not affiliate any medical school, participating in community health services; Thirdly, 130 community health service centers sanctioned by Guangzhou Health Bureau.
4. Methods
4.1 A model for promoting quality of community health services by medical school and its affiliated hospitals
4.1.1 Design of questionnaire
It was designed based on both quantitative and qualitative research methods.
4.1.2 Investigative Method
A survey was conducted among leaders, senior doctors and nurses in community health service centers around Guangzhou. In addition to the survey, expert consult, interactive discussion with staff of the centers, intensive interview with main stake-holders, were also added.
4.1.3 Data collection and analysis
Date collected by questionnaire was subject to statistical analysis with excel 2003 Software.
4.2 Evaluation Index System
4.2.1 Establishment of evaluation index
The evaluation team was composed of staff in the Office of Hospital Management Southern Medical University, the Third Affiliated Hospital and the forth-year undergraduate interns of health services management program. After reviewing relevant literature, evaluative index were formulated on the basis of consulting a panel of 30 independent experts in three rounds.
4.2.2 Weight Determination via Saaty's Method
Using pair wise comparisons via Saaty's method, experts determined relative weights of I-level indicators. In accordance with the AHP method, each expert's I level indicator weight was worked out. The arithmetic average of the weights represents the expert group's general view. In determining the secondary and tertiary index weight, a questionnaire survey and evaluation of the relative importance of the internal indicators was employed via Saaty's method and AHP method.
5. Results
5.1 A model for getting involved in the campaign of community health promotion by medical university-affiliated hospitals was formulated.
The first is to produce more general practitioners through recruiting more medical students specialized in primary care; the second is to set up an intimately cooperative network between community health centers and medical university affiliated hospital; the third is to make staff who work in community health centers well educated make good use of educational resources in medical universities; the forth is to get staff who work in community health services well trained; the fifth is to provide community patients with convenient double-way referral services; the sixth is to promote health education through building up an information-sharing infrastructure; the seventh is to improve quality of community health services of medical students through academic medical education getting closely integrated with community health services.
5.2 An index system evaluating effect of the model was formulated
The system includes 4 I-level, 13 II-level and 27 III-level indicators, evaluating effect of the model from the following aspects: personnel training, technology, competencies and satisfaction. Weight value of each indicator at all levels was also defined.
引文
[1]蔡怡嘉,张文昌.构建社区卫生服务模式的难点与对策分析[J].中国卫生事业管理,2007,8:565-568.
[2]梁万年,王亚东.全国社区卫生服务现状调查——医院服务与社区卫生服务的可及性比较[J].中国全科医学,2006,11(9)::908.
[3]李士雪,郝晓宁,张伟燕.城市社区卫生服务机构服务功能与运行机制研究分析[J].医学与哲学(人文社会医学版),2006,(8):19-21.
[4]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006:19(9):1400-1402.
[5]鲍勇.中国城市社区卫生服务模式探讨[J].社区卫生保健,2003,2:14-17.
[6]丁胜,周云,吕海涛.关于大型综合性医院开展社区卫生服务的探讨与研究[J].南京医科大学学报,2005,,4:319.
[7]姜艳,姜波,张秀玲.三级医院领办社区卫生的大庆模式[J].现代医院,2008,8(4):106-108.
[8]陈俊国,王燕,郭华.建立综合型医院辐射社区医疗服务网络模式的几点思考.重庆医学,2008,37(1):41-42。
[9]杨柳,王健.社区卫生服务机构与医院双向转诊制度有效运作的探讨[J].中国卫生经济,200726(5):22-23.
[10]叶柄昌.“双向转诊”,是喜?还是忧?[J].医药世界,2006,(8):10-11.
[11]宋文舸.组建医院集团的基础与政府的作用[J].中国医院管理杂志,2001;21(1):91-93.
[12]毛一萍 社区卫生服务可持续性发展的思考[J]中国卫生经济杂志,2004;23(11):30-31.
[13]王山,张琪琪.加拿大魁北克省社区卫生服务新模式[J].现代医院管 理,2008,22:71-72.
[14]裴颖.从荷兰模式谈我国城市社区卫生服务的政府导向[J].齐齐哈尔大学学报(哲学社会科学版),2008,5:65-67.
[15]吴健明,刘朝杰.中澳社区卫生服务筹资与补偿机制的比较和启迪[J].中国全科医学,2005,10(9):42-43.
[16]张泽,祁素文.国外社区卫生服务现状及启示[J].中国全科医学,2005,8:28-31.
[17]韩方群.中澳社区卫生服务的比较及启示[J].中国全科医学,2005,8:15-16.
[18]陈渊青,罗乐宣,王跃平,等.国内外社区卫生服务的进展[J].中国全科医学,2004,7:96-98.
[19]刘朝杰.澳大利亚的卫生体制与卫生政策[J].中国全科医学,2004,7:15-16.
[20]张立威,王家骥.高等医学院校开展全科医学教育的SWOT分析[J].实用全科医学,2008,6(4):380-381.
[21]崔树起,郭爱民,,路孝琴,等.加强全科医学学科建设 深入发展全科医学教育[J].中华医学教育杂志,2007,27(3):52-53.
[22]孟群,解江林,吴沛新,等.我国全科医学教育培训现状与思考[J].中国全科医学,2006,9(3):176-177.
[23]李迎春,胡传来.医学生本科阶段全科医学教育实践与体会[J].实用全科医学,2006,4(2):193-194.
[24]杨韵宏,谢圣兰,曹玲,等.我国城市社区卫生服务模式及其走向[J].中国全科医学,2005,8:59-61.
[25]张宇,肖十力,张拓红,等.社区卫生机构与医院双向转诊实现途径和管理办法的研究.中国全科医学2002,2002.5(2):123-125.
[26]刘小平,等.“以病人为中心”理念下的双向转诊管理探讨[J].中国全科 医学杂志,2005;5(5):369.
[27]刘达恩 论我国医院集团化的基本模式和政府的作用[J].广西医科大学学报,2002;17(6):81-83.
[28]Leiyu Shi,Barbara Starfield.Primary Care Quality:Community Health Center and Health Maintenance Organization[J].Southern Medical Journal,2003.
[29]Lou Ann Hartley.Using the primary care assessmentsurvey in an ambulatory setting[J].Nursing Economics,2002.
[30]蒲昭谦.社区卫生服务健康档案及其管理运作模式探讨[J]。中国卫生事业管理,2007,23(9):639-640。
[3l]刘运国,张亮,等.初级卫生保健机构绩效评价[M].北京:中国财政经济出版社,2007.
[32]马起龙.我国社区卫生服务综合评价研究现状及展望[J].中国卫生经济,2008,27(7):35-37.
[33]任晓晖,李宁秀,毛立坡.四川省社区卫生服务机构建设评价指标筛选[J].四川大学学报(医学版),2008;39(3):471-473.
[34]王芳,卢祖洵.社区卫生服务综合评价指标体系方法学研究.中国全科医学,2006,9(5):422-424.
[35]汪云,陈霞,程勇,等.区域社区卫生服务绩效评价构想[J].卫生经济研究,2008,2:21-23.
[36]王芳,卢祖洵.社区卫生服务综合评价指标体系方法学研究[J].中国全科医学,2006,(9)5:423-426.
[37]孙振球,徐勇勇.医学统计学.2002年,第二版,北京:人民卫生出版社:510-514.
[38]陈平雁,黄浙明.病人满意度的调查与评价[J].中国医院管理,1999,19(7):40-43.
[2]梁万年,王亚东.全国社区卫生服务现状调查——医院服务与社区卫生服务的可及性比较[J].中国全科医学,2006,11(9)::908.
[3]李士雪,郝晓宁,张伟燕.城市社区卫生服务机构服务功能与运行机制研究分析[J].医学与哲学(人文社会医学版),2006,(8):19-21.
[4]卢杨,张鹭鹭,欧崇阳,等.城市医院与社区卫生服务中心互动模式及问题分析[J].中国全科医学,2006:19(9):1400-1402.
[5]鲍勇.中国城市社区卫生服务模式探讨[J].社区卫生保健,2003,2:14-17.
[6]丁胜,周云,吕海涛.关于大型综合性医院开展社区卫生服务的探讨与研究[J].南京医科大学学报,2005,,4:319.
[7]姜艳,姜波,张秀玲.三级医院领办社区卫生的大庆模式[J].现代医院,2008,8(4):106-108.
[8]陈俊国,王燕,郭华.建立综合型医院辐射社区医疗服务网络模式的几点思考.重庆医学,2008,37(1):41-42。
[9]杨柳,王健.社区卫生服务机构与医院双向转诊制度有效运作的探讨[J].中国卫生经济,200726(5):22-23.
[10]叶柄昌.“双向转诊”,是喜?还是忧?[J].医药世界,2006,(8):10-11.
[11]宋文舸.组建医院集团的基础与政府的作用[J].中国医院管理杂志,2001;21(1):91-93.
[12]毛一萍 社区卫生服务可持续性发展的思考[J]中国卫生经济杂志,2004;23(11):30-31.
[13]王山,张琪琪.加拿大魁北克省社区卫生服务新模式[J].现代医院管 理,2008,22:71-72.
[14]裴颖.从荷兰模式谈我国城市社区卫生服务的政府导向[J].齐齐哈尔大学学报(哲学社会科学版),2008,5:65-67.
[15]吴健明,刘朝杰.中澳社区卫生服务筹资与补偿机制的比较和启迪[J].中国全科医学,2005,10(9):42-43.
[16]张泽,祁素文.国外社区卫生服务现状及启示[J].中国全科医学,2005,8:28-31.
[17]韩方群.中澳社区卫生服务的比较及启示[J].中国全科医学,2005,8:15-16.
[18]陈渊青,罗乐宣,王跃平,等.国内外社区卫生服务的进展[J].中国全科医学,2004,7:96-98.
[19]刘朝杰.澳大利亚的卫生体制与卫生政策[J].中国全科医学,2004,7:15-16.
[20]张立威,王家骥.高等医学院校开展全科医学教育的SWOT分析[J].实用全科医学,2008,6(4):380-381.
[21]崔树起,郭爱民,,路孝琴,等.加强全科医学学科建设 深入发展全科医学教育[J].中华医学教育杂志,2007,27(3):52-53.
[22]孟群,解江林,吴沛新,等.我国全科医学教育培训现状与思考[J].中国全科医学,2006,9(3):176-177.
[23]李迎春,胡传来.医学生本科阶段全科医学教育实践与体会[J].实用全科医学,2006,4(2):193-194.
[24]杨韵宏,谢圣兰,曹玲,等.我国城市社区卫生服务模式及其走向[J].中国全科医学,2005,8:59-61.
[25]张宇,肖十力,张拓红,等.社区卫生机构与医院双向转诊实现途径和管理办法的研究.中国全科医学2002,2002.5(2):123-125.
[26]刘小平,等.“以病人为中心”理念下的双向转诊管理探讨[J].中国全科 医学杂志,2005;5(5):369.
[27]刘达恩 论我国医院集团化的基本模式和政府的作用[J].广西医科大学学报,2002;17(6):81-83.
[28]Leiyu Shi,Barbara Starfield.Primary Care Quality:Community Health Center and Health Maintenance Organization[J].Southern Medical Journal,2003.
[29]Lou Ann Hartley.Using the primary care assessmentsurvey in an ambulatory setting[J].Nursing Economics,2002.
[30]蒲昭谦.社区卫生服务健康档案及其管理运作模式探讨[J]。中国卫生事业管理,2007,23(9):639-640。
[3l]刘运国,张亮,等.初级卫生保健机构绩效评价[M].北京:中国财政经济出版社,2007.
[32]马起龙.我国社区卫生服务综合评价研究现状及展望[J].中国卫生经济,2008,27(7):35-37.
[33]任晓晖,李宁秀,毛立坡.四川省社区卫生服务机构建设评价指标筛选[J].四川大学学报(医学版),2008;39(3):471-473.
[34]王芳,卢祖洵.社区卫生服务综合评价指标体系方法学研究.中国全科医学,2006,9(5):422-424.
[35]汪云,陈霞,程勇,等.区域社区卫生服务绩效评价构想[J].卫生经济研究,2008,2:21-23.
[36]王芳,卢祖洵.社区卫生服务综合评价指标体系方法学研究[J].中国全科医学,2006,(9)5:423-426.
[37]孙振球,徐勇勇.医学统计学.2002年,第二版,北京:人民卫生出版社:510-514.
[38]陈平雁,黄浙明.病人满意度的调查与评价[J].中国医院管理,1999,19(7):40-43.