医防融合下网格化家庭医生签约服务模式研究

背景　近年来基层医疗卫生机构家庭医生签约服务工作已取得一定的进展,但在医防融合式家庭医生签约中还存在辖区资源整合、履约服务、协同服务等方面的薄弱环节,促进社区卫生服务提质增效是当前重要的服务抓手。重庆市渝中区大溪沟街道社区卫生服务中心医防融合网格化家庭医生签约服务“12345”模式,形成了资源合、共签约、服务深、同管理的大健康良好格局,有一定借鉴意义。目的　介绍重庆市渝中区大溪沟街道社区卫生服务中心医防融合网格化家庭医生签约服务模式及其成效。方法　2017年10月-2019年9月,重庆市渝中区大溪沟街道社区卫生服务中心以家庭医生工作室为责任单元,抓住签约服务这个“牛鼻子”,以区域“大健康”服务为理念,在街道牵头,多部门参与下,齐抓共管,围绕一个网格体系、两种协同机制、三类宣传联动、四条共管路径、五项内涵清单,对家庭医生工作室签约服务工作汇总分析。结果　截至2019年9月,家庭医生工作室签约率为28.08%（5 086/18 109）,高于中心整体签约率〔22.98%（14 352/62 453）〕,工作室续约率达91.41%（4 649/5 086）,解约人群中84.67%（370/437）属于拆迁搬离渝中区。签约人群预约服务构成比中预约门诊、预约市级检查、预约上门服务分别提升159.07%（2 744/1 725）、12.41%（149/1 201）、21.92%（260/1 186）;预约转诊和预约专家服务分别下降48.36%（118/244）、24.55%（108/440）。2019年高血压和糖尿病规范管理率、控制率高于2018年,差异有统计学意义（P<0.05）;2019年高血压和糖尿病综合评估构成比、专家评估构成比、预约检查构成比高于2018年,差异有统计学意义（P<0.05）。2018、2019年家庭医生工作室的服务满意度分别为87.03%、92.5%,高于非家庭医生工作室的服务满意度（分别为42.91%、57.5%）,差异有统计学意义（P<0.05）。结论　重庆市渝中区大溪沟街道社区卫生服务中心医防融合网格化家庭医生签约服务“12345”新模式,提升了百姓依从性、获得感和满意度,取得了良好效果。

Effectiveness of a Mode Used in the Delivery of Preventive and Medical Services by Family Doctors Using a Grid System

Background　Recently,the implementation of family doctor services provided by primary care has achieved some improvements,but there are still poor areas in family doctors' delivery of preventive and medical services,such as integrating the local resources,keep appointments,and collaborative services,so the priority current is to improve the quality and efficiency of community health services. The "12345" mode,a new contracting mode developed by Yuzhong District Daxigou Subdistrict Community Health Center used in the delivery of family services has formed a good pattern of integrating resources,co-contracting,service deepening,and joint management. Objective　To introduce and analyze the effectiveness of a mode used in the delivery of preventive and medical services using a grid system by family doctors in Yuzhong District Daxigou Subdistrict Community Health Center,Chongqing. Methods　Data regarding family services implemented from October 2017 to September 2019 were collected from the family doctor studio established by Yuzhong District Daxigou Subdistrict Community Health Center（hereinafter referred to as the Center）,Chongqing,which were provided by the studio mainly,in coordination with other departments organized by the subdistrict office,with Big Health Care Idea as the service concept,centering on contracted services,mainly involving a grid system,two types of collaborative system,three types of publicity and cooperation,four co-management paths,and five detailed lists of services（abbreviated as the "12345" mode）. Results　As of September 2019,the contracting rate of the studio〔28.08%（5 086/18 109）〕 was significantly higher than that of the Center〔22.98%（14 352/62 453）〕. The renewal rate of the studio reached 91.41%（4 649/5 086）,and 84.67%（370/437） of the rescinding group belonged to those moving from Yuzhong District due to relocation. In the appointment services for contracted people,the proportion of outpatient services,municipal examination,and home visit services increased by 159.07%（2 744/1 725）,12.41%（149/1 201）,and 21.92%（260/1 186）,respectively,while the proportion of referrals and expert services decreased by 48.36%（118/244） and 24.55%（108/440）,respectively. Compared to 2018,the standardized management rate and control rate of hypertension and diabetes in 2019 were all significantly higher（P<0.05）. And the ratio of comprehensive evaluation,expert evaluation and appointment examination for hypertension and diabetes in 2019 were significantly higher（P<0.05）. The studio achieved higher patient satisfaction than non-family doctor studios either in 2018（87.03% vs 42.91%） or in 2019（92.5% vs 57.5%）（P<0.05）. Conclusion　The "12345" mode,a new contracting mode developed by the Center used in the delivery of family services has improved residents' compliance,sense of gain and satisfaction,achieving good results.