Research On The Integration Path And Effect Evaluation Framework Of Medical Institutions

Objective:The purpose of this paper was to define the concept of integration of medical institutions,summarize the basic path of refining the integration of medical institutions,explore the sustainable development conditions of medical institution integration,and construct a framework for evaluating the integration effect of medical institutions,thus to provide practical and decision-making reference and expand thoughts for related researches.Contents:This paper proposed the conceptual definition and operational definition of medical institution integration in China from three perspectives:policy documents,scientific research literature and specific case analysis.It sorted out the integration path of medical institutions in China and summarized and refined them,to explore further sustainable integration of medical institutions.It also built an evaluation framework for the integration effect of medical institutions,and finally provided relevant recommendations to promote the integration of medical institutions.Methods:This paper summarized the concepts,integration paths and integration effects evaluation methods of medical institution integration through studying literature,and summanzed the policy requirements for the integration of medical institutions.Samples of several medical associations in Beijing were selected for individual-case study,and in-depth interviews with key informants were used,in order to provide an in-depth understanding of the actual operation of medical institution integration and summarized the main practices and practical issues of medical institution integration.Combined with literature research,based on the main practices of medical institution integration learned from interviews,the integration path of medical institutions was refined.This paper discussed the conditions for the sustainable development of medical institutions based on the actual problems reflected by the interviewees.Finally,based on the policy requirements of medical institution integration and the interviewees’ views on evaluation indicators,a medical institution integration effect evaluation framework was constructed.Results:The basic paths of medical institution integration were vertical integration and horizontal integration,vertical integration was to meet people’s continuous health needs and horizontal integration was to meet people’s diversity health needs.Vertical integration and horizontal integration were similar in integration content,but different in integration goals,the former focused on improving the service capabilities of primary health care institutions in order to promote graded diagnosis and treatment,while the latter focused on helping cooperative hospitals to develop cooperative disciplines and to achieve consultation or referral for patients with critical illness.This paper summarized the policy goals and practical problems of medical institution integration from the medical service managers,providers and demanders.Based on this,it was proposed that the sustainable development of medical institutions required the integration of "demand" within the medical institutions,and government departments and residents to provide external support and assistance were also necessary.This paper used Structure-Process-Outcome Model to construct a medical institution integration evaluation framework.The "structural" dimension meant the management of medical organization,and its specific indicators were the unified management of personnel,finance and materials.The "process" dimension meant the collaboration of medical institutions,and vertical integration mainly assessed patient referrals,while horizontal integration mainly assessed talent exchange.The "outcome"dimension meant medical service indicators,including medical service utilization,medical service efficiency,and medical expenses.Discussions:The integration of medical institutions was a project led by the government department from top to bottom,and this paper defined the concept of medical institution integration by combing and analyzing the relevant policy documents of medical institutions.This paper used in-depth interviews to understand the actual situation of medical institutions’integration,so as to provide first-hand information for this new research field in integration of medical institutions.This paper explored the sustainable development conditions of medical institution integration from internal and,medical institutions should be integrated based on their actual demands,and government departments should provide relevant supports while residents and patients should take part in medical institution integration and feedback suggestions timely from external perspective.Based on the interview results,this paper constructed a medical institution integrated evaluation framework,selected specific indicators based on the actual problems reflected by interviewees;and designed the quantitative scale of medical organization management for the first time to ensure the sensitivity of the indicator system.Suggestions:Government departments played an important role in promoting the integration of medical institutions,thus all relevant government departments should work together to promote the integration of medical institutions.Medical institutions should integrate based on their"demands" and then should innovate mechanisms in order to achieve sustainable development.It was necessary to further conduct evaluation of medical institution integration based on the integration of sustainable development factors in medical institutions,and further explore the role of medical institution integration evaluation in promoting the integration of medical institutions in China.