Zheng Ying, Hu Jia, Li Li, Dai Tao
Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, CN.
Center for Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, CN.
Int J Integr Care. 2023 Aug 10;23(3):6. doi: 10.5334/ijic.7550. eCollection 2023 Jul-Sep.
It is currently the most cost-effective management model to have multiple professionals from relevant institutions collaborate so as to provide integrated chronic disease management services. The "classified, color-coded, hierarchical and regionalized" chronic disease management model in Youxi County, Fujian Province is a typical case in China. However, related research is limited. This paper aims to analyze the practice measures and lessons learned in Youxi County, focusing on the professional integration of service providers.
From January to March 2021, interviews with 15 key informants in Youxi County were conducted to collect qualitative data, which was analyzed by the thematic framework method as well as the policy data, using the professional integration dimension in the evaluation framework of the integrated healthcare system.
A series of measures were taken, such as improving the professional division and collaboration mechanism, establishing the incentive and restraint mechanism geared toward chronic disease management, formulating norms and standards of chronic disease management for patients with different color labels, and promoting the compatibility of inter-professional value and culture under the governmental institutional supply and the organizational support of the tight county healthcare alliance in Youxi County, to prompt professionals of different levels and types to collaborate in order to provide integrated chronic disease management services. However, some problems remained, such as limited capacity of primary health care, the relatively narrow range and weak effect of the incentive and restraint mechanism, inadequate implementation of the norms and standards, and so forth.
Our findings provide reference for other regions in China and other low- and middle-income countries in exploring the integrated chronic disease management model. Long-term follow-up surveys and mixed research designs are required in the future to enrich relevant evidence.
目前，让相关机构的多个专业人员协作以提供综合慢性病管理服务是最具成本效益的管理模式。福建省尤溪县的“分类、分色、分级、分区”慢性病管理模式是中国的一个典型案例。然而，相关研究有限。本文旨在分析尤溪县的实践措施和经验教训，重点关注服务提供者的专业整合。
2021年1月至3月，对尤溪县15名关键 informant 进行访谈以收集定性数据，采用主题框架法以及政策数据，运用整合医疗体系评估框架中的专业整合维度进行分析。
采取了一系列措施，如完善专业分工协作机制、建立面向慢性病管理的激励约束机制、为不同颜色标签患者制定慢性病管理规范和标准，以及在尤溪县政府机构供给和紧密县医疗联盟的组织支持下促进跨专业价值和文化的兼容性，促使不同层次和类型的专业人员协作以提供综合慢性病管理服务。然而，仍存在一些问题，如基层医疗卫生服务能力有限、激励约束机制范围相对较窄且效果较弱、规范和标准执行不到位等。
我们的研究结果为中国其他地区以及其他低收入和中等收入国家探索综合慢性病管理模式提供了参考。未来需要进行长期随访调查和混合研究设计以丰富相关证据。
