常态化应对重大传染病流行事件的医疗机构协作网络研究——基于社会网络分析视角

 目的 分析常态化应对重大传染病流行事件医疗机构的网络特征和区域协作关系,为优化平急结合的区域医疗救治体系提供参考。方法 以湖南省344所发热门诊和120所定点救治医院为研究对象,采用地理信息系统方法构建发热门诊和定点医院的空间关联,采用社会网络分析方法对医疗机构协作网络进行中心性和聚类分析,并基于Yifan Hu力导向算法进行网络可视化展示。结果 发热门诊与定点救治医院的协作网络节点数共344个,边数共887个;在省市县三个层级的定点救治医院中,长沙市第一医院、湘潭市中心医院、望城区人民医院较同级别机构辐射能力更强,南华大学附属第一医院、娄底市中心医院、涟源市人民医院处于相对"独立"状态,南华大学附属第一医院、邵阳市中心医院、涟源市人民医院在协作网络中发挥"桥梁"作用;协作网络的模块度值为0.687,空间上聚类形成5个群组。结论 湖南省常态化应对重大流行病事件的医疗协作网络呈现出"四片区一枢纽"的结构关系,包括围绕4个省级定点医院、覆盖多个市州的区域型子网络,以及覆盖单一市州、与多个片区连接的枢纽型子网络;协作网络中的定点医院可以分为中心型、支援型、替补型三种类别;建议通过按照定点医院的类型细化功能定位以及依据主要协作区签订城际合作协议,以形成有效、有序的区域性应急协同合作机制。

Collaborative network of medical institutions in regular response to epidemic events of major infectious diseases——Based on the perspective of social network analysis

Objective To analyze the network characteristics and regional collaborative relationship of medical institutions that regularly respond to epidemic events of major infectious diseases,and provide reference for the optimization of regional medical treatment system with the combination of regular and emergency.Methods 344 fever clinics and 120 designated treatment hospitals in Hunan Province are selected as the research objects,geographic information system(GIS)method is adopted to construct the spatial association between fever clinics and designated hospitals,social network analysis(SNA)is adopted to analyze the centrality and cluster of collaborative network of medical institutions,and based on Yifan Hu force-directed graph drawing show algorithm for network visualization.Results There are 344 nodes and 887 edges in the collaborative network between fever clinics and designated hospitals;among the designated hospitals at the provincial,municipal and county levels,the First Hospital of Changsha,Xiangtan Central Hospital,and the People’s Hospital of Wangcheng Distric have stronger radiation capacity than institutions of the same level,the First Affiliated Hospital of University of South China,Loudi Central Hospital,and the People’s Hospital of Lianyuan are relatively“independent”.The First Affiliated Hospital of University of South China,Central Hospital of Shaoyang and the People’s Hospital of Lianyuan play the role of“Bridges”in the collaborative network;the modularity value of the collaborative network is 0.687,and the spatial clustering forms 5 groups.Conclusion Medical collaborative network in regular response to epidemic events of major infectious diseases in Hunan Province presents the structure of“four districts and one hub”,including the regional sub-network cove-ring four provincial designated hospitals and multiple cities,as well as the hub-type sub-network covering a single ci-ty and connecting with multiple districts;the designated hospitals in the collaborative network can be divided into three types:central type,support type and substitute type.In order to form an effective and orderly regional emergency coordination mechanism,it is suggested to refine the function positioning according to the types of designated hospitals and sign inter-city collaborative agreements according to the main collaborative areas.