| 引用本文：陈荣,赵君,刘思琦,等.整合型长期照护体系下社区居家医养结合服务对慢病管理效率的影响及驱动路径研究[J].中国卫生政策研究,2025,18(8):38-45 |
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| 整合型长期照护体系下社区居家医养结合服务对慢病管理效率的影响及驱动路径研究 |
| 投稿时间：2025-07-28 修订日期：2025-08-20 PDF全文浏览 HTML全文浏览 |
| 陈荣1，赵君1，刘思琦1,2，王芳1,2 |
| 1.中国医学科学院北京协和医学院医学信息研究所 北京 100020;2.中国医学科学院北京协和医学院卫生健康管理政策学院 北京 100005 |
| 摘要:目的 探究社区居家医养结合服务对老年慢性病管理效率的影响机制及驱动路径。方法 基于WHO整合照护框架和老年人综合照护框架，选取我国东、中、西部35个市（区/县）为研究对象，运用数据包络分析（DEA）评估慢病管理效率，结合模糊集定性比较分析（fsQCA）解析慢病管理效率路径的条件组态。结果 DEA显示样本中6个地区（17.1%）达DEA强有效（θ=1； S-和S+=0）。fsQCA识别出3条高效路径与4条非高效路径。治理机制为所有高效路径的核心条件；非高效路径则普遍存在治理缺位、筹资单一与信息监测薄弱等缺陷。结论 整合型长期照护背景下，治理机制是提升慢病管理效率的基石，需通过跨部门协作强化制度整合；资源要素可通过动态适配弥补技术短板，而持续筹资与信息联通是突破区域发展失衡的关键。 |
| 关键词:社区居家 医养结合 慢病管理 效率 数据包络分析 定性比较分析 |
| 基金项目:中国医学科学院医学与健康科技创新工程项目（2021-I2M-1-046）；国家卫生健康委委托项目 |
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| Impacts and driving pathways of community-and home-based integrated health and social care on chronic disease management efficiency under integrated long-term care systems |
| CHEN Rong1, ZHAO Jun1, LIU Si-qi1,2, WANG Fang1,2 |
| 1.Institute of Medical Information and Library， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100020， China;2.School of Health Policy and Management， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100005， China |
| Abstract:Objective To investigate the influencing mechanisms and driving pathways of chronic disease management efficiency for older adults under community-and home-based integrated health and social care.Methods Guided by the Framework for Countries to Achieve an Integrated Continuum of Long-term Care and the Integrated Care for Older People framework， 35 cities/counties/districts from eastern， central， and western China were selected. Data envelopment analysis （DEA） was employed to evaluate comprehensive efficiency， complemented by fuzzy-set qualitative comparative analysis （fsQCA） to identify conditional configurations of high- and low-efficiency pathways.Results DEA identified six of the 35 regions （17.1%） as DEA-efficient （θ=1， S-/S+=0）. fsQCA identified three high-efficiency pathways and four low-efficiency pathways. Governance mechanisms emerged as the core condition across all high-efficiency pathways. Low-efficiency pathways exhibited systemic deficiencies， including governance gaps， fragmented financing， and inadequate health information systems.Conclusion Under integrated long-term care， governance systems form the cornerstone for enhancing chronic disease management efficacy. Cross-sectoral collaboration is critical to institutional integration， while dynamic resource allocation can mitigate technical limitations. Sustainable financing and interoperable health information systems are pivotal to addressing regional disparities. |
| Key words:Community-and home-based Integrated health and social care Chronic disease management Efficiency Data envelopment analysis Qualitative comparative analysis |
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