| The aging population is an important practical problem that the world urgently needs to address and solve.The report of the 20th National Congress of the Communist Party of China proposed a national strategic policy of "actively addressing population aging",clarifying the urgency and long-term nature of the aging problem.The core issue of elderly care services lies in the increasing degree of aging,which prolongs the lifespan of elderly people.In retirement and daily life,they need to face risks such as illness,disability,daily care,and health care,thereby increasing the demand for elderly care services,medical services,and health care services.China’s elderly population is large and rapidly aging,and the burden of old-age care will be further aggravated in the future.It is urgent to have an economic,convenient,rehabilitation,and nursing function of the "combination of medical care and nursing" service to meet the elderly’s continuous demand for health care and elderly care services of "medical care,health care,nursing care-Palliative care care".Community home care and nursing services are the most important form of supply,Its aim is to provide sustainable healthy elderly care,care,and medical care services centered around the place of residence and within the radius of community and family services.Its convenient service supply form and broad population coverage have quickly become the mainstream model of integrated medical and elderly care services.At the same time,China has basically formed a multilevel elderly care service system based on "home as the foundation,community as the support,and institutions as the supplement".This special supply and demand structural feature also highlights the importance of community home medical and elderly care integrated services.Therefore,actively promoting the integration of community home care and medical care services is of great significance at this stage.At present,China has gained some experience in the development and practice of community home medical and nursing integrated services,but overall,it is still in the preliminary exploration stage.The current situation of imbalanced and insufficient development of community home care integrated services has not changed,and so far,a mature,replicable,and scalable application model that can meet current needs has not been formed.From the existing research,there is a lack of a rational interpretation of the integration of community home care and medical care services,a lack of in-depth exploration of the theoretical basis and corresponding practical mechanisms of community home care and medical care services,and a failure to systematically sort out,summarize,and extract the experience gained in the development process of community home care and medical care services in China based on the practical model of community home care and medical care integration services,And construct a scientific evaluation index system to comprehensively evaluate the practical mode,further optimize the mode and test the implementation effect,in order to select typical and replicable mature community home care integrated service practice modes with Chinese practical characteristics that can be promoted and replicated,taking into account theoretical significance and practical characteristics.Therefore,on the basis of expanding the theoretical analysis framework of "embeddedness" proposed by Karl Polanyi to interpret the cross sectoral collaboration mechanism,this paper integrates the theoretical connotation of collaboration theory,healthy aging theory and social Ecological systems theory,and takes "model classification comprehensive evaluation model optimization effect test" as the research logic thread,A systematic analysis framework of "embedded classification,comprehensive evaluation,mode optimization,and effect analysis" for the practical model of community home care integrated services in China has been proposed.The aim is to comprehensively evaluate and analyze the system,case analysis,qualitative analysis,empirical analysis,and combine field research,interviews,and other methods to analyze and extract the optimal mode of community home care integrated services in China,and further test the implementation effect of the optimal mode,To form a continuous and in-depth study from the theoretical to practical level,providing theoretical guidance and decision-making reference for further summarizing,optimizing,and promoting a community based home care integrated service model that is more in line with China’s current needs.Specifically,it includes the following aspects:Firstly,based on the phased characteristics of population aging development and the severe situation faced by the intensification of aging,and based on the current development status of integrated medical and elderly care services in China and the characteristics of community home-based elderly care services,the necessity,development process,and existing problems of community home-based medical and elderly care services in China were analyzed.Based on a review and sorting of domestic and foreign literature,the research significance of this article was clarified Research ideas and methods.Secondly,the core concepts of this article are elaborated from three perspectives:elderly care services,integrated medical care services,and community home-based elderly care.Based on the theoretical perspectives of healthy aging theory,new public service theory,embedding theory,and collaborative theory,the theoretical logic,theoretical connotation,and corresponding practical mechanisms of community homebased medical care integrated services are systematically elaborated,And based on the research logic of "pattern classification comprehensive evaluation mode optimization effect testing",a theoretical analysis framework of "embedded classification comprehensive evaluation mode optimization effect analysis" for the practical model of community home care and medical care in China was constructed,providing theoretical support for subsequent research.Thirdly,an analysis was conducted on the current situation of community home care integration services in China from the aspects of development,pilot projects,establishment,practical practices,service enjoyment and willingness.The main problems that urgently need to be solved in practice of community home care integration services in China were summarized.Further,using the practice cases in the "Best Practice of Combination of Medical Care and Nursing Care in China" jointly carried out by the National Health Commission and the World Health Organization in2019,a simple analytical framework of "two-way collaborative embedding" was proposed and constructed based on the embedding theory,and Grounded theory was used to try to analyze the general characteristics of the theoretical level of the practice model of combination of medical care and nursing care at home in communities,The paper summarizes the classification of practice models of community home-based care services in China,that is,the "integration and embedding model of community homebased care services",the "integration and embedding model of community grassroots medical and health services" and the "Internet plus+integration of medical care and elderly care" platform integration and embedding model.Fourthly,a three-dimensional evaluation and analysis framework of "whole system subjective" is proposed.From the perspective of the overall environmental effect of the practice model,the "input output" efficiency and the subjective evaluation of the model,the three types of community home based medical care integration service practice models are comprehensively and systematically evaluated using the community home based medical care integration service environment evaluation index model,DEA Malmquist index model and AHP Delphi method method.Research has found that the trend of environmental development index changes in the integrated embedding model of community grassroots medical and health services is significantly higher than that of the integrated embedding model of community home-based elderly care services;From the analysis results of DEA Malmquist index model,the rising trend of Total factor productivity of the integration and embedding model of community home-based medical services is more obvious than that of the integration and embedding model of community home-based elderly care services,and it also shows this feature in the regression analysis results;After using AHP Delphi method method to analyze,it is found that the community grassroots medical and health service integration and embedding model has better practice effect than the community elderly care service integration and embedding model,while the "Internet plus+medical and nursing" platform integration and embedding model takes into account the practical characteristics of community home elderly care service embedding and community grassroots medical service embedding.Fifthly,according to the evaluation research results and combined with the firsthand data obtained from the field survey,the paper proposes and constructs the operation mechanism analysis model(SQ-SES)of the community home care service practice model based on the social Ecological systems theory,and deeply analyzes the core subsystems of the three types of practice models in the resource system(RS),resource unit(RU),governance system and actor(A)and the operation mechanism between them,And conduct practical path restoration,analysis,and comparison.Research has found that the integration and embedding model of community grassroots medical and health services exhibits a characteristic of "bidirectional embedding" in the collaborative process.Not only can community medical and nursing service institutions provide professional grassroots medical and nursing services(such as family doctor signing,family bed,chronic disease management,bidirectional referral,etc.)to daytime care,community elderly care service institutions,or elderly people in home communities through institutional contracts,Community grassroots medical service institutions can also establish internal elderly care service institutions/beds to provide more diversified medical care services for the elderly in need.This practical measure breaks the drawbacks and shortcomings of other single practice models.This model has good resource endowment and reflects good results in the comprehensive evaluation of the model.The efficiency of the practical model is significantly better than other models,and the analysis results are significant both at the resource supply level and the subjective evaluation level.Sixth,from the background of China’s population aging,healthy aging,changes in family structure and high-quality development of elderly care services,based on the theory of healthy aging,using the China Health and Retirement Longitudinal Study(CHARLS)2011,2013,2015 and 2018 Panel data,based on the 2016 national level pilot of integrated medical and nursing services as a quasi Natural experiment,We empirically tested the implementation effect of the optimal selection model(community grassroots medical and health service integration embedded model)using the double difference method(DID).Specifically,while considering its heterogeneity characteristics and corresponding practical mechanisms,the focus is on demonstrating the actual impact of practical models on elderly individuals(physical function,health self-evaluation,mental depression level),health and medical service utilization(primary care,total medical expenditure,personal medical expenditure),and intergenerational care(probability of child care,indirect care expenditure)at the micro individual utility level,Furthermore,regional heterogeneity was further demonstrated,and on this basis,empirical tests were conducted to compare the effectiveness differences brought by the other two practical models at the individual and intergenerational levels,with the aim of comprehensively and systematically evaluating the implementation effectiveness,impact mechanism,and macro level impact of the optimal selection model.Unlike existing literature,this article focuses on the research of the practical mode of community home medical and nursing integrated services in China.Based on indepth analysis of the behavioral logic and practical mechanism of the main body of community home medical and nursing integrated services,a problem oriented research centered on "problem interpretation,experience induction,mode evaluation,and effect analysis" is implemented,expanding the theoretical and logical connotation of the collaborative process of community home medical and nursing integrated services,And it breaks the limitations of existing literature in terms of research perspectives,research methods,material data acquisition,and policy recommendations,and overall enriches the practical research of the integration of medical and nursing care.Compared with existing literature,the marginal contribution of this article lies in the fact that,from a research perspective,typical cases released by the Health Commission in collaboration with the World Health Organization,as well as on-site research and interview data conducted by the research group,can be used as first-hand data materials to systematically and comprehensively reflect the overall situation of community home care integration services in China at present,breaking the fragmentation,modular regionalization,and one-sided perspective of academic research on medical care integration;In terms of research methods,based on interdisciplinary collaboration,it realizes the interaction and collaboration between research methods,and comprehensively uses quantitative research,qualitative analysis,Field research,case analysis and other research methods to comprehensively and comprehensively evaluate the implementation effect of the practice model of home based medical care services in China from point to surface;Summarize and refine the model optimization path that is more in line with China’s practical characteristics at the current stage in the conclusion,forming a continuous in-depth study from the theoretical to practical level,providing theoretical guidance and decision-making reference for improving and optimizing the development of China’s community home medical and nursing integrated service model.Based on the above research,this article proposes the following suggestions: firstly,further expand the integrated embedding model of community grassroots medical and health services for the overall embedding effect in community home care integrated services,streamline its resource integration logic and service supply logic,establish and consolidate the core role of community grassroots medical and health integrated embedding model in community home care integrated services,Further grasp the respective advantages of the two practice modes of community grassroots elderly care service integration embedded mode and "Internet plus+medical care" platform integration service.On the basis of enriching their embedded forms,actively use the Internet integration platform to realize the cooperation mechanism between practice modes and the transformation of different service groups.Further,optimize the resource integration logic and service precision supply logic of the community’s home based medical and nursing integrated service resource supply end,and improve the matching degree between the optimized model and elderly people of different demand levels on the basis of the existing model,to achieve precise supply of community home based medical and nursing integrated services;Secondly,it is necessary to further refine and classify the service mode of combination of medical care and nursing care at home in the community.Starting with the main Logical framework of the service mode of combination of medical care and nursing care at home in the community,it is necessary to further refine the three sub modes of "tight","loose" and "intermediate" on the existing preferred mode,and strengthen the policies,funds The construction of hardware equipment and other support systems,as well as the consolidation and establishment of a dynamic collaborative mechanism for optimizing,refining,and promoting the practical model of community home care and medical care integration services.In the future,more attention should be paid to the supply scope and demand level of community home-based medical and nursing integrated services.On the basis of achieving wide coverage,further efforts should be made to achieve multi-level and cross regional coverage of community home-based medical and nursing integrated services from the perspective of model classification,pay attention to the comprehensive trend of population aging,dynamically adjust the matching mechanism between elderly people with different health levels’ needs and practical models,and achieve the integration of medical and nursing integrated services with population structure The combination of changes in family structure and other external factors has incorporated the optimization,development,and practice of the integrated medical and elderly care service model into the long-term task of elderly care services and population aging,continuously improving the comprehensive development and service capabilities of the integrated medical and elderly care service,and effectively playing a role in actively responding to population aging. |
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