School of Health Management, Shandong University of Traditional Chinese Medicine, 4655 University Road, Jinan, Shandong, 250355, China.
School of Health, Shandong University of Traditional Chinese Medicine, 4655 University Road, Jinan, Shandong, 250355, China.
BMC Health Serv Res. 2024 Oct 7;24(1):1193. doi: 10.1186/s12913-024-11659-9.
To improve the capacity of county medical and health services, China encourages all localities to pilot the close-type county medical alliance. In Shandong Province, medical alliances have been piloted in 47 counties, ranking first in the country. The objective of this study is to comprehensively evaluate the implementation of close-type county medical alliance in Shandong Province, identify the differences between different county regions, and analyze the reasons, so as to provide a reference for the construction of a new county medical and health service system with clear goals, powers and responsibilities, and division of labor.
The implementation of the close-type county medical alliance was comprehensively evaluated in 47 national pilot counties in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method. Variance analysis was used for comparison of the comprehensive evaluation results.
The weight coefficient of evaluation indicators was highest for information interconnection, at 18.06%, and lowest for orderly referral of patients, at 3.64%. There was no difference in results of the comprehensive evaluation of entropy weight TOPSIS method and non-integer rank sum ratio method. Comprehensively order the implementation status of each pilot county according to the relative paste progress, 13 counties Y, Y, Y, Y, Y, Y, Y, Y, Y, Y, Y, Y and Y were ranked highest, whereas county Y was ranked lowest. Non-integer rank sum ratio method graded counties into three grades: excellent, good and average. Kruskal-Wallis nonparametric test showed that the difference between the grades was statistically significant (H[Formula: see text]37.099, p[Formula: see text]0.001). Variance analysis based on comprehensive evaluation results showed that implementation status was not correlated with the county economic development level, the level of health resources input and the medical service ability of the lead hospital.
Our findings indicated that the implementation of the close-type county medical alliance is significantly different between pilot counties, with a marked differentiation within the same urban area. Therefore, effective measures are recommended to reduce this gap, including promoting informatization empowerment of the county medical community, strengthening government responsibility and improving policy effectiveness.
为提升县级医疗卫生服务能力，我国鼓励各地开展紧密型县域医共体试点。山东省在 47 个县开展了医共体试点工作，数量位居全国首位。本研究旨在全面评价山东省紧密型县域医共体建设实施情况，识别不同县区间的差异，并分析原因，为建设目标明确、权责清晰、分工协作的新型县域医疗卫生服务体系提供参考。
采用熵权 TOPSIS 法和非整数秩和比法对山东省 47 个国家级试点县的紧密型县域医共体建设实施情况进行综合评价，运用方差分析对综合评价结果进行比较。
评价指标权重系数中，信息化互联互通最高，为 18.06%，患者有序转诊最低，为 3.64%。熵权 TOPSIS 法和非整数秩和比法的综合评价结果无差异。按照相对贴进度对各试点县的实施情况进行综合排序，Y、Y、Y、Y、Y、Y、Y、Y、Y、Y、Y、Y、Y 等 13 个县排名靠前，Y 县排名靠后。非整数秩和比法将县分为 3 个等级：优秀、良好和一般。Kruskal-Wallis 非参数检验显示，等级间差异具有统计学意义（H[Formula: see text]37.099，p[Formula: see text]0.001）。基于综合评价结果的方差分析显示，实施情况与县域经济发展水平、卫生资源投入水平和牵头医院医疗服务能力无关。
本研究发现，试点县紧密型县域医共体建设实施情况差异显著，且同一城市内存在明显分化。因此，建议采取有效措施缩小差距，包括推进县域医共体信息化赋能、强化政府责任和提高政策实效。
