| 引用本文：黄蛟灵, 张宜民, 梁鸿, 储一鸣, 张伟胜, 张建敏, 陈翔, 吴建平, 宋巨庆.家庭医生制度在分级诊疗中的作用：上海经验[J].中国卫生政策研究,2019,12(8):49-53 |
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| 家庭医生制度在分级诊疗中的作用：上海经验 |
| 投稿时间：2018-09-06 修订日期：2019-04-16 PDF全文浏览 HTML全文浏览 |
| 黄蛟灵1,2, 张宜民3, 梁鸿3, 储一鸣3, 张伟胜4, 张建敏4, 陈翔4, 吴建平5, 宋巨庆5 |
1. 上海交通大学医学院公共卫生学院 上海 200025;
2. 上海交通大学中国医院发展研究院卫生技术评估研究所 上海 200025;
3. 上海市浦东卫生发展研究院 上海 200129;
4. 上海市虹口区卫生健康委员会 上海 200086;
5. 上海市虹口区欧阳路街道社区卫生服务中心 上海 200081 |
| 摘要:目的：使用实证数据探索家庭医生在引导居民首诊与转诊中发挥的作用。方法：在上海“1+1+1”签约试点区进行问卷调查，获得有效问卷1 745份。使用描述统计与Logistic回归模型检验是否签约对首诊与转诊的影响。结果：签约居民首诊比例（35.15%）显著高于未签约居民（16.87%），同时转诊比例（21.43%）也高于未签约居民（9.61%）。同时，Logistic模型在控制了基本人口学变量与认知、健康状况、满意度、需求满足状况这些相关变量后，发现签约居民首诊概率是未签约居民的1.582倍，转诊概率是未签约居民的2.087倍。结论：签约是影响居民首诊与转诊的显著变量，家庭医生在分级诊疗中已经初步发挥了引导首诊与转诊的作用。 |
| 关键词:家庭医生 分级诊疗 Logistic回归 |
| 基金项目:国家自然科学基金（71904145）；上海交通大学中国医院发展研究院2019年度地高大医院管理专项（CHDI-2019-C-01）；上海市卫生和计划生育委员会自选课题（2018HP33） |
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| Analysis of the role of family doctors inhierarchical diagnosis and treatment: Experience from Shanghai |
| HUANG Jiao-ling1,2, ZHANG Yi-min3, LIANG Hong3, CHU Yi-ming3, ZHANG Wei-sheng4, ZHANG Jian-min4, CHEN Xiang4, WU Jian-ping5, SONG Ju-qing5 |
1. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200025, China;
3. ShanghaiPudong Health Development Research Institute, Shanghai 200129, China;
4. ShanghaiHongkou District Health Commission, Shanghai 200086, China;
5. Ouyang Road Street Community Health Service Center, Hongkou District, Shanghai, Shanghai 200081, China |
| Abstract:Objective:This study explored the role of family doctors in establishing and guiding residents' first-contact and referrals to specialists. Methods:A questionnaire survey was conducted in the "1+1+1" pilot area in Shanghai, and 1 745 valid questionnaires were sampled. Descriptive statistics and logistic regression models were applied to examine whether contracted on first-contact and referral had a certain effect on hierarchical diagnosis and treatment. Results:The first-contact and referral rates for contracted residents were significantly higher than the non-contracted ones. Meanwhile, after controlling the basic demographic variables and related variables such as cognition, health status, level of satisfaction and demand satisfaction, the Logistic Regression model results showed that the odds ratio of first-contact and referrals for contracted residents was 1.582 and 2.987 times that of non-contracted ones. Conclusions:Contract signing is a significant variable that affects the residents' first-contact and referrals, and family doctors have initially played a great role in establishing and guiding the first-contact and referral behavior in the hierarchical diagnosis and treatment. |
| Key words:Family doctor Hierarchical diagnosis and treatment Logistic regression |
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