基于信息分诊全科团队签约服务管理模式的实施效果研究

doi:10.12114/j.issn.1007-9572.2021.00.195

摘要/Abstract

摘要： 背景　随着签约服务工作的不断推进，一些问题也日渐显现，目前社区首诊、分级诊疗和双向转诊等均缺少政策匹配制度。提升分级诊疗和家庭医生签约服务质量，促进签约服务提质增效，进一步做实做细家庭医生签约服务工作，提高居民签约获得感是社区卫生服务的综合改革方向。目的　探索信息分诊模式下“1+1+1”全科团队签约服务管理模式的实施效果，为做实做细签约服务工作提供基础。方法　按基线可比选取2019年度上海市浦东新区远郊地区服务人口在5万~10万的5家社区卫生服务中心的签约情况（签约率、重点人群签约率、考核分）及随机分层抽取各医疗机构每位家庭医生签约居民的10%，分为干预社区和对照社区，其中1家为干预社区即基于信息分诊的全科团队签约服务管理1年；以自制问卷形式、医院信息系统和签约APP信息同步开展签约信息准确率、家庭医生签约知晓率、签约居民首诊意愿就诊率、家庭医生有效服务率、家庭医生服务满意率等指标的统计，汇总分析比较干预效果。结果　基于信息分诊的全科团队签约服务管理的干预社区签约居民首诊意愿率和家庭医生有效服务率高于4个非干预的对照社区，差异有统计学意义（P<0.05）；签约信息准确率、家庭医生签约知晓率与其中3个对照社区比较，差异有统计学意义（P<0.05）。结论　基于信息分诊的全科团队签约服务管理模式类似于政策性干预签约服务，服务效果较好，可推广应用于家庭医生签约服务工作，为进一步做实做细家庭医生签约服务工作、落实出台各项干预政策提供依据。

关键词: 家庭医生签约服务；信息分诊；&ldquo, 1+1+1&rdquo, 签约；全科管理；政策干预

Abstract: Background　With the continuous advancement of contracted services，some problems have gradually emerged，for example，there are no well-matched systems for policies regarding community-based first-contact care，tiered diagnosis and treatment，and bi-directional referrals. The comprehensive reform goal of community health services is to improve residents' sense of gain by further promoting the improvement of the quality of tiered diagnosis and treatment，and quality and efficiency of contracted family doctor services，as well as providing practical and attentive contracted services. Objective　To explore the effect of information triage used in the delivery of "1+1+1" type of contracted services by a general practice team，offering evidence for providing practical and attentive contracted health services. Methods　Five community health centers with serving population of 50 000 to 10 000，and comparable baseline data were selected from outer suburbs of Shanghai's Pudong New Area in 2019，among which one with one-year implementation of information triage and other four without were determined as intervention center，and control centers，respectively. And 10% of the people served by each family doctor from the intervention center and control centers，selected by random stratified sampling，were included in the intervention group，and control groups，respectively. A self-made questionnaire survey，the hospital information system and contracting APP platform were used to collect data regarding accurate rate of contracting information，residents' awareness rate of contracted family doctor services，rate of residents preferring community-based first-contact care，efficiency rate of contracted family doctor services，and residents' satisfaction level with contracted family doctor services，and these data were analyzed comparatively. Results　The rate of residents preferring community-based first-contact care and efficiency rate of contracted family doctor services in the intervention group was higher than that of other four control groups with statistically significant difference（P<0.05）. The rate of accurate contracting information and residents' awareness rate of contracted family doctor services of the intervention center was higher than that of other three control centers with statistically significant difference（P<0.05）. Conclusion　The information triage used in the delivery of "1+1+1" type of contracted services by a general practice team may produce good effect，which is similar to that of contracted policy-related intervention services，and can be popularized in the delivery of other types of family doctor services. Our analysis may be used as a reference for further implementing family doctor services as well as related policies.

Key words: Contracted family doctor services；Information triage；"1+1+1", contract service；General practice management；Policy intervention

樊爱青,张少晨,张鹏,等. 基于信息分诊全科团队签约服务管理模式的实施效果研究[J]. 中国全科医学, 2021, 24(16): 2067-2071. DOI: 10.12114/j.issn.1007-9572.2021.00.195.
FAN Aiqing,ZHANG Shaochen,ZHANG Peng, et al. Effect of Information Triage Used in Contracted Management Delivered by a General Practice Team　[J]. Chinese General Practice, 2021, 24(16): 2067-2071. DOI: 10.12114/j.issn.1007-9572.2021.00.195.

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