关键词: 医联体, 医院, 综合, 社区卫生中心, 知识共享, 范畴

Abstract: Objective　To explore the scope of knowledge sharing in a medical consortium，providing a reference for the development of inter-agency knowledge sharing mechanism in the medical consortium.Methods　From July 26 to August 22，2016，we conducted semi-structured interviews with 39 persons from Zhoukanghangxin Medical Consortium〔including the managers and general practitioners from 4 community health centers（CHCs） and the managers and specialty physicians from Shanghai Pudong New District Zhoupu Hospital〕 for collecting the data mainly about needed support concerning clinical，scientific and research，and other aspects from higher-level or lower-level institutions，and support can be provided for higher-level or lower-level institutions.Data from interviews were organized into two themes covered by the scope of knowledge shared in the Zhoukanghangxin Medical Consortium：CHCs-centered needs and Shanghai Pudong New District Zhoupu Hospital-centered needs.Then，based on the CHCs-centered needs，we developed a CHCs-centered Needs in the Medical Consortium Questionnaire（CNMCQ），and used it to survey 90 primary care providers from the 4 CHCs from November 15 to December 12，2016 for obtaining the importance assessment of the items and subscales.Results　Participants from Shanghai Pudong New District Zhoupu Hospital said that they could basically satisfied the needs of CHCs，such as clinical and scientific research support，cooperative training of young doctors and professional development guidance，but did not give any response to the needs of CHCs concerning the establishment of a clinical testing center，administrative and health management，and informatization construction.Participants from CHCs said that they could not yet fully meet the needs of Shanghai Pudong New District Zhoupu Hospital.The CNMCQ consists of 3 subscales，namely，clinical support〔knowledge about the standardized diagnosis and treatment of 92 diseases，doctor-patient communication（4 items），auxiliary resources（11 items）〕，scientific research support（10 items） and other support（5 items），with the importance score of 4.16-4.96，4.58-4.62，4.66-4.76，respectively.Furthermore，according to the importance score，the most needed knowledge listed in the clinical support subscale was the standardized diagnosis and treatment of 6 diseases〔hypertension（4.96），coronary atherosclerotic heart disease（4.94），chronic obstructive pulmonary disease（4.94），diabetes（4.94），cerebral infarction/cerebral embolism（4.94） and stroke（4.94）〕；the most needed doctor-patient communication skill was the communication guidance for coping with acute or critical conditions（4.91）；the most needed important knowledge about auxiliary examinations was the indications，contraindications，pre-test preparation and guidance for the auxiliary examinations（4.89）．Meanwhile，the most needed knowledge listed in the scientific research support subscale was the guidance or special training for research paper writing（4.62）；the most needed knowledge listed in the other support subscale was cooperative training of young doctors（4.76）．Conclusion　At present，the knowledge，most about the standardized diagnosis and treatment of common chronic diseases in community-dwelling residents，shared in a medical consortium is mainly for meeting the needs of CHCs.Sharing knowledge in the medical consortium is of great significance in improving the clinical service capabilities of CHCs via the consortium management of such common chronic diseases.

Key words: Medical cluster；Hospitals, general；Community health centers；Knowledge sharing；Scope