中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
31期
3777-3780,3791
,共5页
徐静%钱东福%张丹%李亚运%鲁翔
徐靜%錢東福%張丹%李亞運%魯翔
서정%전동복%장단%리아운%로상
社区卫生服务机构%下转服务%疾病类型
社區衛生服務機構%下轉服務%疾病類型
사구위생복무궤구%하전복무%질병류형
Community health service settings%Downward referral services%Types of diseases
目的：探讨社区卫生服务机构适宜接受下转服务的疾病类型，为促进机构间开展有针对性的协作服务提供建议。方法2014年7月，采用典型抽样法选取镇江某“医疗集团”协作模式和武汉某“直管模式”下的知情者51名为研究对象，对其进行问卷调查，内容包括知情者的基本情况及对适宜协作疾病特点、形式等认知评价，要求知情者按重要程度由“第一位”到“第三位”对相关问题进行评价，并分别赋值为3、2、1分。结果54．9%(28/51)的知情者认为疾病处于稳定康复期是适宜下转疾病应具备的首要特点；按重要程度得分排序显示，适宜下转疾病应具备的特点前三位分别为疾病处于稳定康复期(115分)、疾病本身适宜社区照护(84分)、有下转的意愿(52分)。49．0%(25/51)的知情者认为社区医疗水平是医院下转患者到社区需注意的首要问题；按重要程度得分排序显示，医院下转患者到社区需注意的问题前三位分别为社区医疗水平(109分)、患者自身下转意愿(77分)、大医院帮助社区合作建立联合病房(75分)。45．1%(23/51)的知情者认为脑卒中等脑血管疾病是疾病稳定期后适宜下转到社区住院治疗的首要疾病；54．9%(28/51)的知情者认为高血压是出院后适宜在社区进行门诊治疗的首要疾病；39．2%(20/51)的知情者认为脑卒中等脑血管疾病是出院后有必要定期进行家庭随访的首要疾病。按重要程度得分排序显示，疾病稳定期后适宜下转到社区住院治疗的疾病前三位分别为脑卒中等脑血管疾病(91分)、高血压(62分)、糖尿病(57分)；出院后适宜在社区进行门诊治疗的疾病前三位分别为高血压(112分)、糖尿病(86分)、脑卒中等脑血管疾病(40分)；出院后必要进行定期家庭随访的疾病前三位分别为高血压(82分)、脑卒中等脑血管疾病(77分)、糖尿病(73分)。结论疾病处于稳定康复期是判断患者适宜下转的首要因素；社区医疗水平是大医院考虑是否下转患者的首要因素；不同病程中适宜协作疾病种类不同。建议通过明确转诊标准，提高社区卫生服务机构医疗服务水平，建立机构间联合病房等方式，对适宜疾病开展机构间协作服务，引导患者接受协作服务。
目的：探討社區衛生服務機構適宜接受下轉服務的疾病類型，為促進機構間開展有針對性的協作服務提供建議。方法2014年7月，採用典型抽樣法選取鎮江某“醫療集糰”協作模式和武漢某“直管模式”下的知情者51名為研究對象，對其進行問捲調查，內容包括知情者的基本情況及對適宜協作疾病特點、形式等認知評價，要求知情者按重要程度由“第一位”到“第三位”對相關問題進行評價，併分彆賦值為3、2、1分。結果54．9%(28/51)的知情者認為疾病處于穩定康複期是適宜下轉疾病應具備的首要特點；按重要程度得分排序顯示，適宜下轉疾病應具備的特點前三位分彆為疾病處于穩定康複期(115分)、疾病本身適宜社區照護(84分)、有下轉的意願(52分)。49．0%(25/51)的知情者認為社區醫療水平是醫院下轉患者到社區需註意的首要問題；按重要程度得分排序顯示，醫院下轉患者到社區需註意的問題前三位分彆為社區醫療水平(109分)、患者自身下轉意願(77分)、大醫院幫助社區閤作建立聯閤病房(75分)。45．1%(23/51)的知情者認為腦卒中等腦血管疾病是疾病穩定期後適宜下轉到社區住院治療的首要疾病；54．9%(28/51)的知情者認為高血壓是齣院後適宜在社區進行門診治療的首要疾病；39．2%(20/51)的知情者認為腦卒中等腦血管疾病是齣院後有必要定期進行傢庭隨訪的首要疾病。按重要程度得分排序顯示，疾病穩定期後適宜下轉到社區住院治療的疾病前三位分彆為腦卒中等腦血管疾病(91分)、高血壓(62分)、糖尿病(57分)；齣院後適宜在社區進行門診治療的疾病前三位分彆為高血壓(112分)、糖尿病(86分)、腦卒中等腦血管疾病(40分)；齣院後必要進行定期傢庭隨訪的疾病前三位分彆為高血壓(82分)、腦卒中等腦血管疾病(77分)、糖尿病(73分)。結論疾病處于穩定康複期是判斷患者適宜下轉的首要因素；社區醫療水平是大醫院攷慮是否下轉患者的首要因素；不同病程中適宜協作疾病種類不同。建議通過明確轉診標準，提高社區衛生服務機構醫療服務水平，建立機構間聯閤病房等方式，對適宜疾病開展機構間協作服務，引導患者接受協作服務。
목적：탐토사구위생복무궤구괄의접수하전복무적질병류형，위촉진궤구간개전유침대성적협작복무제공건의。방법2014년7월，채용전형추양법선취진강모“의료집단”협작모식화무한모“직관모식”하적지정자51명위연구대상，대기진행문권조사，내용포괄지정자적기본정황급대괄의협작질병특점、형식등인지평개，요구지정자안중요정도유“제일위”도“제삼위”대상관문제진행평개，병분별부치위3、2、1분。결과54．9%(28/51)적지정자인위질병처우은정강복기시괄의하전질병응구비적수요특점；안중요정도득분배서현시，괄의하전질병응구비적특점전삼위분별위질병처우은정강복기(115분)、질병본신괄의사구조호(84분)、유하전적의원(52분)。49．0%(25/51)적지정자인위사구의료수평시의원하전환자도사구수주의적수요문제；안중요정도득분배서현시，의원하전환자도사구수주의적문제전삼위분별위사구의료수평(109분)、환자자신하전의원(77분)、대의원방조사구합작건립연합병방(75분)。45．1%(23/51)적지정자인위뇌졸중등뇌혈관질병시질병은정기후괄의하전도사구주원치료적수요질병；54．9%(28/51)적지정자인위고혈압시출원후괄의재사구진행문진치료적수요질병；39．2%(20/51)적지정자인위뇌졸중등뇌혈관질병시출원후유필요정기진행가정수방적수요질병。안중요정도득분배서현시，질병은정기후괄의하전도사구주원치료적질병전삼위분별위뇌졸중등뇌혈관질병(91분)、고혈압(62분)、당뇨병(57분)；출원후괄의재사구진행문진치료적질병전삼위분별위고혈압(112분)、당뇨병(86분)、뇌졸중등뇌혈관질병(40분)；출원후필요진행정기가정수방적질병전삼위분별위고혈압(82분)、뇌졸중등뇌혈관질병(77분)、당뇨병(73분)。결론질병처우은정강복기시판단환자괄의하전적수요인소；사구의료수평시대의원고필시부하전환자적수요인소；불동병정중괄의협작질병충류불동。건의통과명학전진표준，제고사구위생복무궤구의료복무수평，건립궤구간연합병방등방식，대괄의질병개전궤구간협작복무，인도환자접수협작복무。
Objective To investigate the types of diseases suitable for downward referral from hospitals to community health centers and to provide suggestions for targeting and coordinated services provided by different medical settings. Methods In July 2014, we enrolled 51 subjects who participated in a " medical group" coordination mode in Zhenjiang and a" straight pipe mode" in Wuhan. Questionnaire survey was conducted concerning the basic information and the cognitive appraisal of the features and modes of diseases suitable for coordinated service. The subjects were asked to rank relevant items from " the first grade" to " the third grade" based on their importance by assigning 3, 2 and 1 to the items. Results Among the subjects,54. 9% (28/51) thought that the primary feature for downward referral is that the disease is at stable convalescence; the rank of importance shows that first three features are that the disease is at stable convalescence ( 115 ) , the disease itself is suitable for community care (84) and the patient has the intention for downward referral (52) . Among the subjects, 49. 0% (25/51) thought the primary issue hospitals should consider in downward referral is community medical level; the rank of importance shows that first three issues hospitals should consider in downward referral are community medical level (109), the intention of patient for downward referral (77) and united wards established in communities with the help of large-scale hospitals (75) . Among the subjects, 45. 1% (23/51) thought that cerebrovascular diseases like stroke are the primary diseases that are suitable for downward referral after disease get stabilized; 54. 9% (28/51) thought that hypertension is the primary disease that is suitable for outpatient services in communities after discharge; 39. 2% (20/51) thought that cerebrovascular diseases like stroke are the primary diseases that need regular home follow-up visits after discharge. The rank of importance shows that the first three diseases that are suitable for downward referral to communities after disease get stabilized are cerebrovascular diseases like stroke ( 91 ) , hypertension (62) and diabetes (57); the first three diseases that need outpatient treatment in communities after discharge were hypertension (112), diabetes (86) and cerebrovascular diseases like stroke (40); the first three diseases that need regular family follow-up visits are hypertension (82), cerebrovascular diseases like stroke (77) and diabetes (73) . Conclusion Diseases being at stable convalescence is the primary factor that should be considered in downward referral; community medical level is the primary factor that large-scale hospitals should consider when they make downward referral; the types of diseases suitable for coordinated service vary with different courses of diseases. We suggest definite referral criteria should be made, the level of medical services in community service settings should be improved, united wards between different medical settings should be established, coordinated services for appropriate diseases between different settings should be conducted, and patients should be given guidance to accept coordinated services.
