Department of Medical, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
School of Humanities and Social Sciences, Fuzhou University, Fuzhou, Fujian, China.
Front Public Health. 2023 Mar 2;11:1008863. doi: 10.3389/fpubh.2023.1008863. eCollection 2023.
Hierarchical diagnosis and treatment, as an important measure and direction for China's medical reform, are conducive to improving the capacity of medical services and the national level of health. In this study, a hierarchical diagnosis and treatment performance evaluation index system is established to identify the effects of different influencing factors on developing hierarchical diagnosis and treatment.
In this study, samples collected from 23 representative integrated medical institutions in nine Fujian cities from 2018 to 2020 are taken as subjects. A hierarchical diagnosis and treatment performance appraisal system is established based on the mechanism of research on the operation of hierarchical diagnosis and treatment. This is combined with the evaluation index system established by the Health Development Research Center, the National Health Commission of the People's Republic of China for the evaluation of hierarchical diagnosis and treatment and the construction of the medical treatment alliance, including studies carried out by related scholars. The weight of each evaluation index is determined with the CRITIC method, and the hierarchical diagnosis and treatment effects on 23 subjects are quantitatively evaluated by the Gray correlation method based on the weight of each index.
The hierarchical diagnosis and treatment performance evaluation index system is established from three aspects, namely allocation of hierarchical diagnosis and treatment resources, establishment of the hierarchical diagnosis and treatment management system, and hierarchical diagnosis and treatment implementation effect; 27 tertiary indexes are formed in total. The Gray correlation of each year in Fujian exceeds 0.5, but <0.53.
Gray correlation of each year in Fujian has gradually increased. But there is still room for improvement. The government departments must improve the investment in medical resources with measures adjusted according to local conditions, promote a balanced allocation of resources for hierarchical diagnosis and treatment, increase communication and interaction between upper and lower medical institutions, and optimize the allocation of resources for hierarchical diagnosis and treatment. Then determine the types of disease to be treated, expand the coverage of chronic disease management, establish standardized chronic disease health management, and strengthen training of health management staff.
分级诊疗作为我国医改的重要措施和方向，有利于提高医疗服务能力和国家健康水平。本研究建立分级诊疗绩效评价指标体系，以明确不同影响因素对分级诊疗发展的作用。
本研究以 2018-2020 年福建省 9 个城市 23 家具有代表性的综合医疗机构的样本为研究对象。基于分级诊疗运行机制研究，构建分级诊疗绩效评价指标体系，结合国家卫生健康委员会卫生发展研究中心、国家卫生健康委员会分级诊疗与医疗联合体建设评价指标体系，以及相关学者的研究成果，采用 CRITIC 法确定各评价指标的权重，基于各指标权重，采用灰色关联法对 23 个研究对象的分级诊疗效果进行定量评价。
从分级诊疗资源配置、分级诊疗管理体系建立、分级诊疗实施效果三个方面构建了分级诊疗绩效评价指标体系，共形成 27 个三级指标。福建省各年的灰色关联度均超过 0.5，但均＜0.53。
福建省各年的灰色关联度均呈逐渐上升趋势，但仍有提升空间。政府部门必须采取措施因地制宜地加大对医疗资源的投入，推动分级诊疗资源均衡配置，增加上下医疗机构之间的沟通与互动，优化分级诊疗资源配置，确定适宜的治疗病种，扩大慢性病管理覆盖面，建立规范的慢性病健康管理，加强健康管理工作人员的培训。
