门急诊服务敏感疾病住院的管理策略研究

doi:10.12114/j.issn.1007-9572.2023.0432

中国全科医学 ›› 2024, Vol. 27 ›› Issue (34): 4241-4247.DOI: 10.12114/j.issn.1007-9572.2023.0432

• 专题研究·门急诊服务敏感疾病住院 • 上一篇下一篇

门急诊服务敏感疾病住院的管理策略研究

王健健¹^,², 张研³^,⁴, 卢珊³^,⁴^,^*(), 潘杰¹^,²

1．610041　四川省成都市，四川大学华西公共卫生学院/华西第四医院
2．610041　四川省成都市，四川大学健康城市发展研究中心/西部农村卫生发展研究中心
3．430030　湖北省武汉市，华中科技大学同济医学院医药卫生管理学院
4．430030　湖北省武汉市，湖北省人文社科重点研究基地农村健康服务研究中心

收稿日期:2024-03-25 修回日期:2024-07-26 出版日期:2024-12-05 发布日期:2024-09-13
通讯作者: 卢珊
作者贡献：
王健健、卢珊进行文章的构思与设计；王健健进行研究实施、文献整理与解释、文章撰写及修订；张研、卢珊、潘杰对文章进行修订与质量控制；卢珊、潘杰负责文章的最后修订与审校，对文章整体负责。
基金资助:
国家自然科学基金面上项目(72074163); 国家自然科学基金青年项目(72104086); 四川省科技厅重点研发项目(2022YFS0052); 四川大学"从0到1"创新研究项目(2023SCUH0025); 泰康溢彩公共卫生及流行病防治专项基金

The Management Strategies for Ambulatory Care Sensitive Hospitalization

WANG Jianjian¹^,², ZHANG Yan³^,⁴, LU Shan³^,⁴^,^*(), PAN Jay¹^,²

1. West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
2. Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu 610041, China
3. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
4. Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei, Wuhan 430030, China

Received:2024-03-25 Revised:2024-07-26 Published:2024-12-05 Online:2024-09-13
Contact: LU Shan

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摘要/Abstract

摘要： 门急诊服务敏感疾病住院（ACSH）问题造成了我国每年至少千亿元卫生资源的浪费。实施精准干预措施以减少ACSH是卫生系统健康可持续发展的重要内容，有助于减缓疾病的发生发展，提升群众健康水平，降低经济负担。本研究旨在系统分析ACSH的影响因素，总结归纳减少ACSH的国际经验并探索适用于我国医疗卫生服务体系的ACSH管理策略。研究发现，ACSH受个体因素、卫生服务系统因素和社会因素的影响。国际上主要通过医疗卫生服务模式、服务提供和服务管理三方面举措减少ACSH。本研究结合国际经验和实际情况对我国ACSH管理工作提出如下建议：首先，将ACSH纳入医疗卫生服务评价体系，对门急诊服务敏感疾病（ACSCs）进行全面监测和综合管理，其次，提高医疗卫生服务能力，推动ACSCs管理的规范化与同质化，并基于循证理念改善管理水平；再次，应深入开展ACSCs本土化研究，促进高质量证据转化实施；最后，持续提高人口健康素养，强化患者和公众对减少ACSH的正确认识。

关键词: 门急诊服务敏感疾病, 门急诊服务敏感疾病住院, 可避免住院, 管理策略, 门急诊服务, 院外服务, 基层医疗卫生服务

Abstract:

The issue of hospitalization for ambulatory care sensitive conditions (ACSH) is a significant problem worldwide, resulting in an annual waste of at least one hundred billion yuan in health resources in China. Implementing targeted interventions to reduce ACSH is an essential pathway towards sustainable health systems. It helps to reduce the occurrence and progression of diseases, improve public health levels, and reduce economic burdens. This study aims to systematically analyze the influencing factors of ACSH, summarize international experiences in reducing ACSH, and explore ACSH management strategies suitable for China's health system. ACSH are influenced by individual factors, health system factors, and social factors. Internationally, measures to reduce ACSH mainly focus on medical service models, service provision, and service management. Drawing on international experience and China's practical situation, this study proposes the following recommendations for managing ACSH in China: firstly, it is recommended to incorporate ACSH into the evaluation system of health services, comprehensively monitor and manage ambulatory care sensitive conditions (ACSCs) ; secondly, enhance health service capacity, promote the standardization and normalization of disease management based on evidence-based approach; moreover, conduct localized research on ACSH and promote the implementation of high-quality evidence; finally, continuously strengthen population health literacy, enhance patients' and the public's correct understanding of reducing ACSH.

Key words: Ambulatory care sensitive conditions, Hospitalization for ambulatory care sensitive conditions, Preventable hospitalizations, Management strategy, Ambulatory and emergency care, Out-of-hospital services, Primary health services

中图分类号:

R 197

王健健,张研,卢珊,等. 门急诊服务敏感疾病住院的管理策略研究[J]. 中国全科医学, 2024, 27(34): 4241-4247. DOI: 10.12114/j.issn.1007-9572.2023.0432.
WANG Jianjian,ZHANG Yan,LU Shan, et al. The Management Strategies for Ambulatory Care Sensitive Hospitalization[J]. Chinese General Practice, 2024, 27(34): 4241-4247. DOI: 10.12114/j.issn.1007-9572.2023.0432.

图/表 2

参考文献 50

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行动领域	关键建议与举措
服务模式	赋予公众权力，增强患者参与
	促进ACSCs相关指南的使用
	改善门急诊服务相关中高危人群的管理
服务提供	加强初级卫生保健机构的"守门人"角色和协调作用
	拓展护理人员执业范围
	促进电子医疗和远程医疗的使用
服务管理	提高门急诊服务的可及性
	促进医疗卫生服务的可负担性
	扩展ACSCs相关服务包
	建立ACSCs相关质量改进机制
	调整奖励机制，以改善门急诊服务相关疾病管理

行动领域	关键建议与举措
服务模式	赋予公众权力，增强患者参与
	促进ACSCs相关指南的使用
	改善门急诊服务相关中高危人群的管理
服务提供	加强初级卫生保健机构的"守门人"角色和协调作用
	拓展护理人员执业范围
	促进电子医疗和远程医疗的使用
服务管理	提高门急诊服务的可及性
	促进医疗卫生服务的可负担性
	扩展ACSCs相关服务包
	建立ACSCs相关质量改进机制
	调整奖励机制，以改善门急诊服务相关疾病管理

门急诊服务敏感疾病住院的管理策略研究

The Management Strategies for Ambulatory Care Sensitive Hospitalization

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