基层卫生服务医防融合：概念框架及指标体系构建

目的本研究致力于构建医疗服务和预防服务融合的概念框架, 设计医防融合水平测量的指标体系,并用实证数据测试指标体系的信度和适用性。方法结合现有整合型卫生服务体系的概念框架和我国卫生体系的特征,构建基层卫生服务提供中医防融合的概念框架;利用德尔菲专家咨询法构建医防融合水平测量的指标体系;测试指标体系的调查数据来自广西两县中6个乡镇的医疗机构、医务人员、重点疾病患者以及常住居民。结果我国基层卫生服务提供机构在“基本公共卫生服务”和“基本医疗服务”上的融合表现在个人、机构和体系三个层次上,融合的实现需要在筹资激励、组织、信息系统和人才培养等方面的支持环境,供方融合行为可促进需方预防性服务利用和健康行为的改善。基于此框架开发了包括5个维度、共28个指标的测量指标体系。在广西两县测试指标体系,显示测量结果与两县整合导向改革阶段相符合,并识别出医防融合支持环境中需要加强“激励”和“组织”维度。结论本研究指标体系整体信度较好,能识别需要加强的支持政策,在整合型卫生体系改革背景下,有在全国不同卫生体系发展水平地区测试和应用的价值。

Integration of medical care and preventionin primary health care system: Construction of conceptual framework and measurement index system

ObjectiveThis study aims to construct a conceptual framework for the integration of medical services and prevention services, design an index system for measuring the level of integration, and test the credibility and feasibility of this system with emprical data.MethodsConstruct the conceptual framework of integrating medical and preventive services in China''s primary health service system on the basis of exsiting conceptual frameworks of integrated health systems and the characteristics of China''s health system; build index system for measuring the integration level of medical and prevention services with Delphi expert consultation method; testify data from medical service providers, medical and health workers, patients with chronic diseases and average citizens in two counties of Guangxi Province.ResultsIntegration of services in primary public health care and fundamental medical service in China can be seenon individuals, service providers, and systems. And its realization requiressupport in financeand relavant incentive measures, organization cooperation, information system and training system for health workers. This is expected to promote the residents'' utilization of preventive services and the improvement of health behavior. Based on this framework, a measurement index system with 28 indicators is developed, including 5 dimensions. Test results of the index system in two counties in Guangxi show conformancewith the stage of integration oriented reform carrying out in these two counties, and identifies necessity of "incentives" and "organization" in supportingintegration between medical care and prevention.ConclusionsThe reliability of the index system proposed in this study is good. With integration oriented reform taking place nationally in China, it is a testimony and application, as well as a reminder of the weak points in regions with different levels of health system development.