摘要
目的探索县域医疗卫生共同体(以下简称医共体)慢性病医防融合的影响要素与实现路径,为进一步推动医防融合及完善医防协同机制提供参考。方法2023年10—11月,依据地理位置均衡的抽样原则,选取浙江省6家医共体的6家牵头医院和18家其他成员单位的医务人员作为调查对象,采用自行设计的调查问卷进行问卷调查,内容主要包括医共体慢性病医防融合服务开展情况和服务效果评价情况,其中的服务开展情况依据协同共生管理模型设计,含协同共生场景、意愿、能力和过程4个维度及11个二级要素。以二级要素为条件变量,以慢性病医防融合效果为结果变量,运用定性比较分析法探究多个条件变量及其组合与高慢性病医防融合效果之间的关系。结果回收有效问卷571份,有效回收率为96.62%。单个二级要素(含条件非集)对高医防融合效果的一致性均<0.9,无法构成解释结果变量的必要条件。组态分析结果显示,多个二级要素交互形成的条件组合的结果一致性为0.835~0.845,显示多个要素的条件组合构成了高慢性病医防融合效果的充分非必要条件。实现高医防融合效果的组态路径可分为4类,其中场景-过程主导型的特征是以营造完善的服务场景与服务过程为主导;意愿-过程主导型的特征是通过激发医务人员的服务意愿与完善服务过程为主导;场景-意愿-能力主导型的特征是以营造完善的服务场景、激发医务人员服务意愿和提升服务能力为主导;意愿-能力-过程主导型的特征则是通过激发医务人员的服务意愿、提升服务能力和完善服务过程为主导。此外,上述4类组态路径均涵盖内生动力与专业能力两个二级要素。解的总覆盖度为0.626,总一致性为0.821。结论通过多重要素交互形成的组态路径可有效实现慢性病医防融合,医共体应基于实际情况选择适宜的组态路径。此外,应重点关注医务人员的内生动力以及专业能力建设。
Objective To explore the influencing factors and implementation paths of medical and preventive integration of chronic disease in county medical communities(CMCs),providing references for further promoting the integration of medical and prevention and improving the collaborative mechanism of medical and prevention.Methods From October to November 2023,based on the principle of geographically balanced sampling,medical staff from 6 leading hospitals and 18 other member units of 6 CMCs in Zhejiang Province were selected as survey subjects.A self-designed survey questionnaire was conducted,mainly including the development and evaluation of chronic disease medical and preventive integration services in CMCs.The service development was designed according to the collaborative symbiosis management model,including 4 dimensions of collaborative symbiosis scenarios,willingness,ability,and process,as well as 11 secondary elements.Using secondary elements as the conditional variables and the integration effect of chronic disease medical and prevention as the outcome variable,a qualitative comparative analysis method was used to explore the relationship between multiple conditional variables and their combinations with high integration effect of chronic disease medical and prevention.Results 571 valid questionnaires were collected,with an effective response rate of 96.62%.The consistency of a single secondary element(including conditional non sets)on the high effectiveness of medical and preventive integration was less than 0.9,which cannot constitute a necessary condition for explaining the outcome variable.The configuration analysis results showed that the consistency of the condition combination formed by the interaction of multiple secondary elements was 0.835-0.845,indicating that the condition combination of multiple elements constituted a sufficient non necessary condition for the high integration effect of chronic disease medical and prevention.The configuration path for achieving high integration of medical and preventive effects could be divided into four categories,among which the feature of scenario-process dominance was to create a perfect service scenario and service process as the main focus;The characteristic of the willingness-process dominant type was to stimulate the service willingness of medical staff and improve the service process as the leading factor;The characteristic of the scenario-willingness-ability dominant type was to create a comprehensive service scenario,stimulate the service willingness of medical staff,and enhance service capabilities as the main focus;The characteristic of the willingness-ability-process dominant type was to stimulate the service willingness of medical staff,enhance service capabilities,and improve the service process as the dominant factor.In addition,the four types of configuration paths mentioned above all covered the two secondary elements of endogenous dynamics and professional competence,with a total coverage of 0.626 and a total consistency of 0.821.Conclusions The configuration path formed through the interaction of multiple elements can effectively achieve the integration of chronic disease medical and prevention.The CMCs should choose the appropriate configuration path based on the actual situation.In addition,special attention should be paid to the endogenous motivation and professional capacity building of medical staff.
作者
李旭
林晓玲
黄群芳
陈静纯
赖思宏
周驰
Li Xu;Lin Xiaoling;Huang Qunfang;Chen Jingchun;Lai Sihong;Zhou Chi(School of Public Health,Hangzhou Normal University,Hangzhou 311121,China;Department of Health Service and Management,School of Health Medicine,Guangzhou Huashang College,Guangzhou 511300,China;School of Medical Imaging,Hangzhou Medical College,Hangzhou 310053,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2024年第8期571-577,共7页
Chinese Journal of Hospital Administration
基金
国家自然科学基金(72274050)
教育部人文社会科学研究青年基金项目(22YJCZH262)。
关键词
县域医疗卫生共同体
协同共生管理模型
慢性病管理
医防融合
定性比较分析
组态路径
County medical community
Collaborative symbiosis management model
Management of chronic disease
Medical and preventive integration
Qualitative comparative analysis
Configurations path
