西部边疆省城市“1+1+1”分级诊疗模式实施状况调查分析

摘要： 目的-调研西部边疆省城市“1+1+1”分级诊疗模式实施状况， 了解实施问题及难题，提出难题破解建议。方法-采用访谈、网络调研和问卷调查定性、定量相结合的研究方法，随机抽取云南、贵州、广西三省的18家二、三级医院、18个社区卫生服务中心和600位社区居民三大层面对该模式相关实施的认识及态度展开调查。结果-三大层面均欢迎该模式，但都认为实施存有诸多难题。结论-建议加强该模式各个层面的水平与动力促进机制及信誉形象宣传建设，并予以灵活地分步实施；建议实施问题监督暴光问责追究制和完善的补偿制、以及家庭医生团队活力运行机制及其专业水平评估。

Abstract： Objective： In order to study the status of implementation of West NWFP cities "1+1+1" classified diagnosis and treatment pattern； Understanding issues and challenges of implementation； Putting forward the solution to problems. Methods： Qualitative and quantitative research methods were used in this study. The main source of information from interview，network research and questionnaire survey. The method is to extract randomly three provinces' 18 hospitals， 18 community health service centers and 600 community residents to develop survey in Yunnan， Guizhou and Guangxi province so that we can learn of their recognition and attitude about the relevant implementation of this pattern. Results： Most of hospitals， community health service centers， community residents are welcomed to "1+1+1" classified diagnosis and treatment pattern， but they believe that there are many difficulties in the process of implementing. Conclusions： Suggesting improving the levels of medical service， building mechanism of power and prestige image construction. At the same time， we should implement flexibly step by step. Recommending the system for monitoring exposure and improve the compensation system as well as family doctors group dynamics mechanism and professional evaluation.

关键词： 西部边疆省城市；“1+1+1”分级诊疗模式；实施状况

Key words： West NWFP cities；"1+1+1" classified diagnosis and treatment；status of implementation

中圖分类号：F279.23 文献标识码：A 文章编号：1006-4311（2017）09-0028-03

0 引言

2015年《国务院办公厅关于推进分级诊疗制度建设的指导意见》就如何推进分级诊疗制度的建设及实施，提出具体指导意见和实施的具体考评指标。旨在由此促进形成“基层首诊、双向转诊、急慢分治、上下联动”的分级诊疗模式，切实解决社区居民“看病难、看病贵”等问题。2016年《国务院深化医药卫生体制改革领导小组关于进一步推广深化医药卫生体制改革经验的若意见》进一步把城市“分级诊疗制度”明确细化到“1+1+1”的分级诊疗模式（后面一律简称“三个一”模式），即1家社区卫生服务中心与1家二级医院、1家三级医院共建相互配合协作的分级诊疗医联体，进而再由社区卫生服务中心医生与二、三级医院专家组建“家庭医生团队”与社区居民签约。……