| [Purpose]This research take the MRCTCH as the breakthrough point, to understand the current situation of the MRCTCH in rural China, to back the reasons why the current cross class service is unconformable, establish the management model to promote cross level integration of hospital service in rural area.[Methods]Firstly, based on the study of literature research, the study features seven sample counties distributed in the eastern, middle and western part of our country. Based on the database of the inpatients with New Rural Cooperative Medical System (NCMS), then it can reflect the level of readmission, path distribution, disease distribution, temporal variation by descriptive analysis. Where after, the research specify three target diseases of the respiratory system and two target diseases of cerebrovascular system and select630sets of medical records of the hospitals in county and township according to the selected database. And then it based on the interlinked medical records of the hospitals in county and township analyzing by experts at the county level and information extraction tools to carry out the evaluation and reflect the degree of the current integration.[Results]The degree of integration of MRCTCH means the degree of harmony or coordination of readmissions cross township-county hospitals service for the inpatients who are hospitalized across township-county hospitals, which is called "quality" of the MRCTCH. There are three integration indication--clinical integration, utilizing integration, and optimizable integration in the evaluation of the two level service integration for the inpatients who are MRCTCH.Annual incidence of readmission within30days was7.65%on average in2012in the seven sample counties. About70%of the time interval of cross level hospital occur in2weeks, and the proportion of readmission within one day reached about30%.Found that patients who are40-59years old and their hospitalization time interval within1week, or suffer from urinary system diseases and obstetrics and gynecology diseases are more likely to choose county hospital to be hospitalized.The probability of referral hospital for630MRCTCH is nearly60%, and other38.7%patients just for consultation; the probability of patients who are not cured reached80.8%in initial treatment stage; The average hospitalization time intervals is5.49days for630MRCTCH, and44.1%is the transfer that day among them. At the same time, nearly50%of the patients who did not complete the treatment in township hospital were required to transfer.From the medical records of600crossing levels hospitalized patients to conclude that the consistency of two-stage treatment ideas reached71.3%, only23.73%of the treatment is effective in health clinics in towns and townships. Only73.1%of patients with secondary hospital will reflect its previous visits to doctors in the county hospital, and only68.2%of this patient’s information is usefu.By comparing across levels hospitalized patients suffering from respiratory diseases in the county hospital and individual patient single county hospital we found that the level of fees between the county hospital in across level hospitals and a single hospital is same, not being a significantly fall.[Conclusion]The evaluation of integration is a guide evaluation index which based on the economy, effectiveness and continuity of the two level cohesion part of service.There are mainly two key nodes in actualizing the across level hospital, one thing is choosing hospital first diagnosis; another is choosing the medical institutions and timing in the follow-up treatment of township hospital.The status of integration of the current MRCTCH is almost in a state of "0" integration, it mainly shows a non-reasonable structure of level across, an impediment of effective information dissemination, doctors in the county hospital lacking of consideration of villages and towns information. From the result point of view, there are no difference of fees between the MRCTCH and a single hospital.The less-integration of MRCTCH mainly manifested in three aspects:the parties in the system is insufficient of attention for level across hospital, the difficulty of the information transmission of patient medical records, and the low degree of utilization of the information on the county and township by doctors in the county hospitals.The current reform of integration lack of the concept of integrated services fundamentally, it is more focused on how to improve the service efficiency of single institutions, but it did not set up the service concept which is based on the perspective of patients and considering a continuous, economical and coordinating medical service for patients.The integration of MRCTCH in county should be based on the following four basic principles:setting specific goals as the key, promoting profit increasing as the center, holding information support as the foundation, keeping department of cooperation as the guarantee. [Innovation and Deficiency]The subject of this study is one of the traditional cross-sectional researches, but I apply6pioneering kinds of research techniques in the investigation and analysis. They are Microsoft Office Excel programming technology, the diagnosis related group re-coding technology based on system disease, the matching technology of the model of self-conditions, the application of Google map retrieval technology, the application of ArcGIS10.0technology, the application of tracking technology. The research mainly has the following three shortcomings: Fail to reflect the regional differences of level across hospital in different regions of china; Due to the adjustment of the research idea, the adjustment of sample size cannot represent the overall fully and there exists risk of errors in the transmission between results; The depth of the analysis of qualitative data. |
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