上海市浦东新区社区全科医疗质量控制测评分析

宋徽江; 秦卫; 黄熙涯; 杨丽萍

doi:10.16766/j.cnki.issn.1674-4152.002461

上海市浦东新区社区全科医疗质量控制测评分析

doi: 10.16766/j.cnki.issn.1674-4152.002461

1.
上海市浦东新区北蔡社区卫生服务中心，上海 201204
2.
上海市浦东新区曹路社区卫生服务中心，上海 201209
3.
上海市浦东新区陆家嘴社区卫生服务中心，上海 200135

基金项目:

上海市卫生健康委员会科研项目 201940049

详细信息

通讯作者:
杨丽萍，E-mail：2546821635@qq.com

中图分类号: R197.61
计量
- 文章访问数: 96
- HTML全文浏览量: 63
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-03
- 网络出版日期: 2022-09-05

Analysis and evaluation of quality control of community general practice in Pudong New District, Shanghai

1.
Beicai Community Health Service Center, Pudong New Area of Shanghai, Shanghai 201204, China

摘要

摘要: 目的分析上海市浦东新区社区全科质控测评结果，以期为上海市浦东新区社区全科医学优化发展指明方向。方法于2019年5月6—31日，由上海市东片区负责人组织质控小组，通过实地调查对上海市浦东新区共计47家社区卫生服务中心进行全科质量控制测评。测评内容包括机构基本条件、全科医生人员配备和岗位职责、全科医疗质量管理、全科医生疾病诊疗能力、全科医生慢病管理与处置能力、全科医师教育与培养，以及附加项——科研教学状况。结果浦东新区47家社区卫生服务中心标准分为(87.9±4.7)分，总得分为(90.2±6.0)分；总得分属于C档的机构数最多，有29家(61.7%)。与全市平均水平相比，浦东新区全科医师教育与培养排全市第一，其余则无明显优势，且全科医生疾病诊疗能力和科研教学均低于全市平均水平；城区和郊区全科医生疾病诊疗能力得分在全市中均是最后一名。相关性分析结果显示，科研教学与全科医生人员配备及岗位职责、全科医生疾病诊疗能力具有正相关关系(均P < 0.05)。差异性分析结果显示，城、郊社区全科质控测评科研教学得分差异有统计意义(P < 0.05)。结论上海市社区全科质控中，浦东新区未能展示出“浦东”品牌效应，一些核心能力(全科医生诊疗能力、科研教学)甚至表现很差，有待落实区域内分级诊疗、配套全科绩效考核、加大科研投入和扶持力度，同时需注意科研教学和临床两手抓，以及城郊发展的均衡性，以全面改善当前较差的现状。
- 社区全科 /
- 质量控制 /
- 科研 /
- 教学 /
- 诊疗能力
Abstract: Objective To analyse the quality control evaluation results of community general practice in Pudong New Area, Shanghai, in order to determine the direction for the optimised development of community general practice in Pudong New Area. Methods From May 6 to 31, 2019, a quality control team was organised by the person in charge of Shanghai East District to conduct general practice quality control evaluations on 47 community health service centres in Pudong New District, through field investigations. The assessment content included the basic conditions of the institution, staffing and job responsibilities of general practitioners, general medical quality management, disease diagnosis and treatment capabilities of general practitioners, chronic disease management and treatment capabilities of general practitioners, education and training of general practitioners, and additional items of scientific medical research and teaching status. Results The average standard score of 47 community health service centres in Pudong New Area was (87.9±4.7) points, and the total score was (90.2±6.0) points. The number of institutions with total score of C was the largest [29 (61.7%)]. Compared with the city's average level, the education and training of general practitioners in Pudong New Area ranked first in the city, whereas the rest were without obvious advantages. The disease diagnosis and treatment capabilities of general practitioners and the additional points of scientific research and teaching were lower than the city's average; the disease diagnosis and treatment capability scores of urban and suburban general practitioners were the lowest in the city. Correlation analysis results showed that scientific research and teaching was positively correlated with the staffing and job responsibilities and disease diagnosis and treatment capabilities of general practitioners (all P < 0.05). The results of the difference analysis showed that there was a statistically significant difference in the scientific medical research and teaching status scores between the urban and suburb (P < 0.05). Conclusion In the quality control of community general practice in Shanghai, Pudong New Area fails to show the 'Pudong' brand effect, and some core competencies (diagnosis and treatment capabilities of general practitioners, scientific research and teaching) even shows poor performance. It is necessary to implement hierarchical diagnosis and treatment in the region, complete the performance evaluation of general practice and increase scientific research investment and support. At the same time, attention should be paid to scientific research and teaching and clinical practice, and the balance of the urban and suburb development, so as to comprehensively improve the current poor situation.
- Community general practice /
- Quality control /
- Scientific research /
- Teaching /
- Diagnosis and treatment capabilities

HTML全文

图 1 浦东新区社区全科质控测评得分均值与全市比较

注：A为基本条件(10分)；B为全科医生人员配置及岗位职责(10分)；C为全科医疗质量管理(25分)；D为全科医生疾病诊疗能力(25分)；E为全科医生慢病管理与处置能力(20分)；F为全科医师教育与培养(10分)；G为标准总分；H为科研教学附加分(10分)；I为总评分。

Figure 1. Comparison of the average scores of community general practice quality control in Pudong New Area with the whole city

下载: 全尺寸图片幻灯片

图 2 浦东新区城区和郊区平均得分在全市中排名

注：A为基本条件(10分)；B为全科医生人员配置及岗位职责(10分)；C为全科医疗质量管理(25分)；D为全科医生疾病诊疗能力(25分)；E为全科医生慢病管理与处置能力(20分)；F为全科医师教育与培养(10分)；G为标准分(100分)；H为科研教学附加分(10分)；I为综合总评分(110分)。上海按行政区(共16个)统计，属于城区的共涉及10个行政区，属于郊区的共涉及7个行政区，其中浦东新区既有城区又有郊区。

Figure 2. The average scores of the urban and suburban areas of Pudong New Area rank among the whole city

下载: 全尺寸图片幻灯片

表 1 浦东新区47家社区卫生服务中心各全科质控维度测评得分(分)

Table 1. Assessment scores of general practice quality control dimensions in 47 Community health service centers in Pudong New Area (points)

维度	得分
基本条件(10分，x±s)	10.0±0.0
全科医生人员配备及岗位职责(10分，x±s)	9.4±0.5
全科医疗质量管理(25分，x±s)	21.9±3.2
全科医生疾病诊疗能力(25分，x±s)	20.8±1.8
全科医生慢病管理与处置能力(20分，x±s)	16.5±2.1
全科医师教育与培养(10分，x±s)	9.5±0.8
科研教学附加分[10分，M(P₂₅, P₇₅)]	1.0(0.5, 5.3)

下载: 导出CSV

表 2 各维度得分之间的相关性分析(r值)

Table 2. The correlation between each dimension score (r value)

维度	B	C	D	E	F
全科医生人员配备及岗位职责(A)	0.089	0.126	0.002	-0.125	0.389^a
全科医疗质量管理(B)		-0.085	0.152	0.113	0.107
全科医师教育与培养(C)			0.042	-0.079	0.217
全科医生疾病诊疗能力(D)				0.160	0.303^a
全科医生慢病管理与处置能力(E)					0.170
注：^aP＜0.05。F为科研教学。

下载: 导出CSV

表 3 浦东新区社区全科质控测评结果城郊比较

Table 3. Comparison of quality control results of community general practice in Pudong New Area

测评维度	城区(n=23)	郊区(n=24)	统计量	P值
基本条件(x±s, 分)	10.0±0.0	10.0±0.0
全科医生人员配备及岗位职责(x±s, 分)	9.4±0.5	9.3±0.5	0.655^a	0.516
全科医疗质量管理(x±s, 分)	21.6±3.5	22.1±2.9	-0.558^a	0.579
全科医生疾病诊疗能力(x±s, 分)	21.0±1.5	20.6±2.0	0.870^a	0.389
全科医生慢病管理与处置能力(x±s, 分)	17.1±2.1	15.9±2.0	1.918^a	0.061
全科医师教育与培养(x±s, 分)	9.5±0.7	9.5±0.8	0.017^a	0.986
科研教学[M(P₂₅, P₇₅)，分]	2.1(0.8, 5.5)	0.7(0.3, 1.0)	-2.769^b	0.006
标准分(x±s, 分)	88.5±4.4	87.4±5.0	0.841^a	0.405
总评分(x±s, 分)	91.7±5.4	88.7±6.2	1.746^a	0.088
注：^a为t值，^b为Z值。

下载: 导出CSV

参考文献(15)

[1]	饶线明, 洪丰颖, 周文, 等. 关于医疗质量控制中心建设的思考[J]. 中国社会医学杂志, 2017, 34(4): 324-326. doi: 10.3969/j.issn.1673-5625.2017.04.003 RAO X M, HONG F Y, ZHOU W, et al. Consideration of the construction of medical quality control center[J]. Chinese Journal of Social Medicine, 2017, 34(4): 324-326. doi: 10.3969/j.issn.1673-5625.2017.04.003
[2]	上海市杨浦区人民政府. 医疗单位. 上海市杨浦区中心医院[EB/OL]. (2019-02-12)[2020-05-27]. http://www.shyp.gov.cn/shypq/ggfw-yldw/20190212/319687.html. Shanghai Yangpu District People's Government. Medical unit. Shanghai Yangpu District Central Hospital[EB/OL]. (2019-02-12)[2020-05-27]. http://www.shyp.gov.cn/shypq/ggfw-yldw/20190212/319687.html.
[3]	上海市杨浦区人民政府, 上海市黄浦区卫生健康委员会. 中心开展上海市全科质控模拟督查[EB/OL]. (2019-03-28)[2020-05-27]. https://www.shhuangpu.gov.cn/yqyw/010001/010001012/010001012001/010001012001001/20190328/7fba4e8e-d1a2-4379-beb9-ff92d6c21d81.html. Shanghai Yangpu District People's Government, Shanghai Huangpu District Health Commission. The Center carries out simulated inspection of general practice quality control in Shanghai[EB/OL]. (2019-03-28)[2020-05-27]. https://www.shhuangpu.gov.cn/yqyw/010001/010001012/010001012001/010001012001001/20190328/7fba4e8e-d1a2-4379-beb9-ff92d6c21d81.html.
[4]	邵黎兵, 吴晓东, 黄栩, 等. 上海市全科医学规范化培训医师就业现状[J]. 解放军医院管理杂志, 2018, 25(7): 655-657. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201807019.htm SHAO L B, WU X D, HUANG X, et al. Current situation of general practitioners'standardized training in Shanghai[J]. Hospital Administration Journal of Chinese People's Liberation Army, 2018, 25(7): 655-657. https://www.cnki.com.cn/Article/CJFDTOTAL-JFYG201807019.htm
[5]	周徐红, 荆丽梅, 刘坤, 等. 卫生人才激励机制改革背景下医务人员满意度研究[J]. 中国全科医学, 2017, 20(19): 2334-2337. doi: 10.3969/j.issn.1007-9572.2017.19.008 ZHOU X H, JIN L M, LIU K, et al. Rural healthcare workers'satisfaction levels with the reform incentive polices for rural healthcare professionals implemented[J]. Chinese General Practice, 2017, 20(19): 2334-2337. doi: 10.3969/j.issn.1007-9572.2017.19.008
[6]	李娅玲, 罗冬梅, 张芳, 等. 上海市浦东新区全科医师临床能力水平考试结果分析[J]. 中华全科医师杂志, 2017, 16(8): 598-601. LI Y L, LUO D M, ZHANG F, et al. Analysis of clinical competence test result of general practitioners in Shanghai Pudong New area[J]. Chin J Gen Pract, 2017, 16(8): 598-601.
[7]	上海市浦东新区人民政府财政局. 浦东新区2019年科教兴医项目绩效评价报告[EB/OL]. (2020-12-02)[2021-02-16]. http://www.pudong.gov.cn/shpd/InfoOpen/InfoDetail.aspx?DeptId=003009&CategoryNum=003003007&InfoId=aa8d23b7-5c67-4369-8563-63f6b7a85f40. Shanghai Pudong New Area People's Government Finance Bureau. Education and Medical Development Project in Pudong New Area in 2019[EB/OL]. (2020-12-02)[2021-02-16]. http://www.pudong.gov.cn/shpd/InfoOpen/InfoDetail.aspx?DeptId=003009&CategoryNum=003003007&InfoId=aa8d23b7-5c67-4369-8563-63f6b7a85f40.
[8]	徐筱婧媛, 刘英杰, 姜爱凤, 等. 社区师资对临床医学本科生全科医学社区实习评价研究[J]. 中华全科医学, 2019, 17(7): 1167-1170. doi: 10.16766/j.cnki.issn.1674-4152.000892 XU X J Y, LIU Y J, JIANG A F, et al. Evaluation on community internship of clinical medicine undergraduates from general practitioner trainers' perspectives[J]. Chinese general practice, 2019, 17(7): 1167-1170. doi: 10.16766/j.cnki.issn.1674-4152.000892
[9]	王朝昕, 陈宁, 刘茜, 等. 我国全科医学科研发展的回溯与展望: 发展历史、研究领域及瓶颈分析[J]. 中华全科医学, 2019, 17(7): 1069-1072, 1141. doi: 10.16766/j.cnki.issn.1674-4152.000865 WANG Z X, CHEN N, LIU Q, et al. The retrospect and prospect of the development of general practice research in Chinathe analysis of development, research fields and bottlenecks[J]. Chinese general practice, 2019, 17(7): 1069-1072, 1141. doi: 10.16766/j.cnki.issn.1674-4152.000865
[10]	李幼子, 胡丽萍, 盖红梅. 上海市浦东新区社区全科医生科研现况调查分析[J]. 中国初级卫生保健, 2020, 34(4): 25-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCW202004008.htm LI Y Z, HU L P, GAI H M. Investigation and analysis of the current research work of community general practitioners in Pudong New area of Shanghai[J]. Chinese Primary Health Care, 2020, 34(4): 25-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCW202004008.htm
[11]	赵欣欣, 李觉, 吴恒璟. 社区全科医生科研培养路径的实践与思考[J]. 中华全科医学, 2019, 17(12): 1979-1981, 2091. doi: 10.16766/j.cnki.issn.1674-4152.001107 ZHAO X X, LI J, WU H J. Practice and reflection on the scientific research cultivate pathway of general practitioner in community[J]. Chinese general practice, 2019, 17(12): 1979-1981, 2091. doi: 10.16766/j.cnki.issn.1674-4152.001107
[12]	史晓晓, 于德华, 王朝昕, 等. 2017-2018年我国社区卫生中心与社康中心学术论文分析[J]. 中华全科医学, 2019, 17(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.000630 SHI X X, YU D H, WANG Z X, et al. The analysis on academic papers published by community health center and community rehabilitation center of China in 2017-2018[J]. Chinese general practice, 2019, 17(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.000630
[13]	荆丽梅, 刘坤, 周徐红, 等. 上海市浦东新区卫生人才激励机制改革实施效果研究[J]. 中国全科医学, 2017, 20(19): 2329-2333. doi: 10.3969/j.issn.1007-9572.2017.19.007 JIN L M, LIU K, ZHOU X H, et al. Effectiveness evaluation of the reform in incentive system for healthcare professionals Implemented[J]. Chinese General Practice, 2017, 20(19): 2329-2333. doi: 10.3969/j.issn.1007-9572.2017.19.007
[14]	李幼子, 张韬, 王洪兴, 等. "卫生八条"背景下上海市浦东新区全科医生离职倾向及相关因素的横断面研究[J]. 中国全科医学, 2019, 22(34): 4261-4265. doi: 10.12114/j.issn.1007-9572.2019.00.453 LI Y Z, ZHANG T, WANG H X, et al. General practitioners ' turnover intention and related factors in Pudong New Area, Shanghai during the implementation of the "Eight Incentive Policies": A cross-sectional survey[J]. Chinese General Practice, 2019, 22(34): 4261-4265. doi: 10.12114/j.issn.1007-9572.2019.00.453
[15]	石念. 基于人口与地理分布的上海市卫生资源配置状况分析[J]. 卫生软科学, 2021, 35(1): 51-56. https://www.cnki.com.cn/Article/CJFDTOTAL-WRKX202101013.htm SHI N. Analysis on health rsource allocation in Shanghai based on population and geographical distribution[J]. Soft Science of Health, 2021, 35(1): 51-56. https://www.cnki.com.cn/Article/CJFDTOTAL-WRKX202101013.htm