基层医疗卫生机构全科临床质量管理实践探索：以上海市全科医学临床质量控制中心建设为例

在基层医疗卫生机构全科临床诊疗活动中,全科临床质量管理对于保障全科医疗质量和安全发挥着基础性作用。我国基层医疗卫生机构全科临床质量管理实践尚处于起步阶段,尚缺乏统一的基层医疗卫生机构全科临床质量管理评价标准和方法,对基层医疗卫生机构全科临床质量提升与改进的探索与实践研究相对较少。基于基层医疗卫生机构全科临床质量管理评价现状及存在的问题,本研究以上海市全科医学临床质量控制中心（简称"质控中心"）为例,从实践角度出发,对2018—2020年"质控中心"开展的基层医疗卫生机构全科临床质量管理工作进行梳理、回顾。2018—2020年,"质控中心"在明确组织目标和任务,设置组织架构,配置组织人员,建立上海市市、区两级全科医学临床质控组织网络和运行体系,并构建基层医疗卫生机构全科临床质量督查指标体系的基础上,每年对全市社区卫生服务中心全科临床质量状况进行了调研、指导、督查等。"质控中心"的建设与运行及其对基层医疗卫生机构全科临床质量管理进行的有益实践与探索,为推进基层医疗卫生机构全科临床质量水平持续提升、保障基层医疗卫生机构全科医疗安全提供了有力支撑。未来,需从完善全科临床质控网络体系建设、构建科学化全科临床质量控制评价指标体系、全面动态开展全科临床质控督查、强化对全科临床质控督查的监管力度四方面出发,不断巩固和提高基层医疗卫生机构全科临床质量管理工作水平。

Exploration of Primary General Medical Care Quality Management:a Case Study of Shanghai General Practice Clinical Quality Control Center

The general medical care quality management system plays an essential and key role in assuring the quality of general medical care and patient safety in primary care settings.There are no unified criteria and methods for assessing the primary general medical care quality,and rare relevant quality improvement research and practical explorations in China.We reviewed the primary general medical care quality management nationwide,and highlighted the problems,then particularly detailed the three-year(2018-2020)implementation status and achievements of Shanghai,in which the primary general medical care quality was managed by Shanghai General Practice Clinical Quality Control Center(hereinafter referred to as Quality Control Center)in an exploratory way.And the management actions taken by the quality control center were as follows:defining the organizational objectives and tasks;developing the organizational framework and allocating workers;establishing municipal-and district-level organizational networks and operational systems for primary general medical care quality control;developing the inspection indicators for assuring primary general medical care quality;conducting an annual investigation of the general medical care in each of the primary care settings in Shanghai,and providing targeted guidance as well as supervision.The actions of the Quality Control Center provide strong support for quality improvement and safety assurance of primary general medical care.And the practical explorations of the Quality Control Center could be a reference for improving primary general medical care quality management nationwide.To improve the primary general medical care quality management at the naitonal level,which is still in its early phase,we put forward four recommendations:improving the development of the organization system,developing a scientific system for assessing the primary general medical care quality,comprehensively and dynamically carrying out quality controlsupervision regarding primary general medical care,and strengthening the quality controlsupervision.