CAJ | 학술논문

目的：：分析典型地区社区卫生服务机构签约服务模式进展，为社区首诊、有序转诊等分级诊疗体系的建立提供实践依据。方法：采取目的抽样，选取全科医生制度探索较早且具有代表性的北京市、上海市、郑州市、成都市共12家社区卫生服务中心进行现场调查。采用主题框架法，围绕签约服务的关键要素展开描述性分析。结果：调研地区签约服务的开展主体是以全科医生为核心的服务团队；以慢性病患者等重点人群为签约对象，并辐射至其家庭成员，签约人数控制在1500~2000人；以提供防治结合的基本公共卫生和基本医疗服务为主要内容，多为免费服务；以家庭医生工作室为服务平台，主动服务意识凸显；建立物质激励、精神激励、医保政策优惠、绿色转诊等机制保障签约服务的有效落实。结论：以信息平台为基础，调研地区签约服务的开展对预约服务、转诊服务、居民自我健康管理起到促进作用，有助于稳固医患关系，改善患者体验，形成有序就医格局。
목적：：분석전형지구사구위생복무궤구첨약복무모식진전，위사구수진、유서전진등분급진료체계적건립제공실천의거。방법：채취목적추양，선취전과의생제도탐색교조차구유대표성적북경시、상해시、정주시、성도시공12가사구위생복무중심진행현장조사。채용주제광가법，위요첨약복무적관건요소전개묘술성분석。결과：조연지구첨약복무적개전주체시이전과의생위핵심적복무단대；이만성병환자등중점인군위첨약대상，병복사지기가정성원，첨약인수공제재1500~2000인；이제공방치결합적기본공공위생화기본의료복무위주요내용，다위면비복무；이가정의생공작실위복무평태，주동복무의식철현；건립물질격려、정신격려、의보정책우혜、록색전진등궤제보장첨약복무적유효락실。결론：이신식평태위기출，조연지구첨약복무적개전대예약복무、전진복무、거민자아건강관리기도촉진작용，유조우은고의환관계，개선환자체험，형성유서취의격국。
Objective:To analyze the progress of the contracting service model in community health centers in the typical areas in China, and provide empirical evidence for the hierarchical system targeted to make first contact and orderly dual transfer. Methods: Purposive sampling was adopted. Twelve community health centers in Beijing, Shanghai , Zhengzhou and Chengdu areas where the general practitioner model was conducted earlier and set to be the representative one, were selected as the field survey sites. A thematic framework analysis was used to describe the key factors around the contacting service model. Results:This model was developed around the following key factors:using the general practice team as the main service provider, taking the patients with chronic diseases as the main contracting groups and extending to their family members with the number of contracted ranging around 1500~2000 , freely providing both essential public health and medical services, fully using the family physician room as the con-tracting service platform and highlighting the actively serving concept, building the financial and non-financial incen-tives, health insurance benefits and green transfer mechanisms in order to efficiently guarantee the contracting service development. Conclusions: Based on the information platform, the contracting service model in the sample sites played a great role in the appointment and referral services development as well as the self-health management among residents, improving the relationship between physicians and patients, and promoting the formation of orderly health service pursuing pattern.