Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical Colleage, Beijing, China.
Peking University Huilongguan Clinical Medical School, Beijing, China.
BMJ Open. 2022 Feb 1;12(2):e057063. doi: 10.1136/bmjopen-2021-057063.
This study aims to present the perspectives of primary healthcare professionals (PHPs) on the impacts of implementation of vertical integration and on the underlying interprofessional collaboration process on achievement of the policy goals in China.
A qualitative study involving individual interview and group interview was conducted between 2017 and 2018.
Primary healthcare institutions (PHIs) in five counties/districts of China.
The major participants include 12 heads of PHIs (by 12 individual interviews) and 38 PHPs (by 12 group interviews). We also interviewed other stakeholders including 24 health policy-makers (by 5 group interviews) and 5 hospital leaders (by 5 individual interviews) for triangulation analysis.
Our study indicates that PHPs perceived vertical integration has resulted in improved professional competency, better care coordination and stronger capacity to satisfy patients' needs. The positive impacts have varied between integration types. Contributing factors for such progress are identified at administrative, organisational and service delivery levels. Other perceived effects are a loss of autonomy, increased workload and higher turnover of capable PHPs. Higher level hospitals play a dominant role in the interprofessional collaboration, particularly regarding shared goals, vision and leadership. These findings are different from the evidence in high-income countries. Incentive mechanisms and the balance of power with hospitals management are prominent design elements in the future.
Our findings are particularly valuable for other countries with a fragmented health service system and low competency of PHPs as China's experience in integrated care provides a feasible path to strengthen primary care.
本研究旨在呈现基层医疗保健专业人员（PHPs）对实施垂直整合的影响，以及对实现中国政策目标的潜在跨专业合作过程的看法。
这是一项于 2017 年至 2018 年期间进行的定性研究，涉及个人访谈和小组访谈。
中国五个县/区的基层医疗机构（PHI）。
主要参与者包括 12 名 PHI 负责人（通过 12 次个人访谈）和 38 名 PHPs（通过 12 次小组访谈）。我们还采访了其他利益相关者，包括 24 名卫生政策制定者（通过 5 次小组访谈）和 5 名医院领导（通过 5 次个人访谈）进行三角分析。
我们的研究表明，PHPs 认为垂直整合提高了专业能力，改善了医疗协调，增强了满足患者需求的能力。不同类型的整合带来的积极影响有所不同。在行政、组织和服务提供层面上确定了促进这一进展的因素。其他被认为的影响包括自主权丧失、工作量增加和有能力的 PHPs 离职率增加。上级医院在跨专业合作中发挥主导作用，特别是在共同目标、愿景和领导方面。这些发现与高收入国家的证据不同。激励机制和与医院管理部门的权力平衡是未来设计的突出要素。
我们的研究结果对于那些医疗服务系统分散、PHPs 能力较低的国家尤其有价值，因为中国在综合医疗方面的经验为加强基层医疗提供了一条可行的途径。
