| Background: Under the background of hierarchical medical treatment,medical community gives full play to their role as the first option at the grass-roots level as medical resources integration,effectively relieve the insufficient of grassroots medical resource utilization and the problem of “high cost and difficulty in treatment”.Therefore,it attracted more and more attention.Various forms of medical communities were also sprung up all over the country.Borrow the reform of public hospitals,according to their own actual,Anhui province set trials to form medical community by combining county hospital and town hospital throughout the province.It aims at building up hierarchical diagnosis mechanism with first option at the grass-roots level,two-dimensional referral,acute slow partition,the upper and lower linkage to ensure consultation rates increased to 90% in county,and make people to enjoy high quality medical services nearby.At the beginning of a year,this policy shows significant efficiency.County medical communities in Anhui province provide a new perspective and a new way for practice of medical assiociation.Objective: To explore the situation of medical communit building pattern In our country,this study aims at analyzing implementation of medical community policy in Anhui province.Experiences were sum up,and problems and influencing factors were discussed to provide theoretical basis for completion of the medical community policy.Method: basing on the literature reviewing and expert discussion,we measured the main index of medical community policy running efficiency,and developed satisfaction questionnaire about relationship between medical staff and patient in medical community.According to the situation in Anhui province,stratified sampling method was performed,the questionnaire survey and insiders interview were carry out in three county at southern,middle and northern Anhui.After completion of data collection,data was processed in Epidata3.1 software,and analyzed in SPSS18.0 software using descriptive analysis,analysis of variance(ANOVA),factor analysis and regression analysis.Results:(1)Running index changes in one year after implementation of county medical community policy in Anhui province.(1)For Two-dimensional referral,the cumulative sursumversion and deorsumversion of person-time was 1509 and 1459 in M county,respectively;the cumulative sursumversion and deorsumversion of person-time was 1597 and 5739 in T county,respectively;the cumulative sursumversion and deorsumversion of person-time was 688 and 436 in J county,respectively.In county medical community,sursumversion was mainly for out-patients,and deorsumversion was given priority to hospitalized patients.Referral channels are through the publicity of attending doctors,accounted for 89.5%.The most three disease for referral are hypertension,diabetes and chronic bronchitis;(2)In medical talent support,The cumulative visits for dispatching doctor were 936 times,and give treatment of 3212 person-times in M county;The cumulative visits for dispatching doctor were 990 times,and give treatment of 3461 person-times in T county;The cumulative visits for dispatching doctor were 688 times,and give treatment of 2234 person-times in J county.Dispatching expert for support are mainly from the department of cardiovascular internal medicine,gynecology and obstetrics,pediatrics and rehabilitation medicine,etc;(3)In talent training aspect,medical community in M county held 48 times training,with 1720 person-times;medical community in M county held 108 times training,with 2289 person-times;medical community in M county held 36 times training,with 1720 person-times;(4)In Medicare payments,available compensation of NCMS was increased from 91.05% to 91.65% comparing to the same period last year in M county,and actual NCMS for hospital compensation ratio was increased from 64.18% to 68.83%;available compensation of NCMS was increased from 88.54% to 88.85% comparing to the same period last year in M county,and actual NCMS for hospital compensation ratio was increased from 57.02% to 71.34%;available compensation of NCMS was increased from 82.84% to 83.92% comparing to the same period last year in M county,and actual NCMS for hospital compensation ratio was increased from 57.29% to 66.07%;(5)In cost control aspect,inpatient fee were declined from 4068.66 to 3556.19 yuan comparing to the same period last year in M county,per capita of "three fee" dropped from 2251.45 yuan to 2146.55 yuan.In T county,inpatient fee were declined from 4637.21 to 4401.07 yuan comparing to the same period last year in M county,per capita of "three fee" dropped from 2626.63 yuan to 2589.83 yuan.In J county,inpatient fee were increased from 4222.8 to 4702.32 yuan comparing to the same period last year in M county,per capita of "three fee" were increased from 2202.28 yuan to 2508.09 yuan.(6)In the construction of clinical pathway,medical clinical pathway diseases numbers increased from 32 to 150 species in M county,the egress and ingress ratio rose 79.2% and 74.1% respectively in the same period;In T county,medical clinical pathway diseases numbers increased from 89 to 247 species,the egress and ingress ratio rose 31.6 % and 28.8% respectively in the same period;In J county,medical clinical pathway diseases numbers increased from 35 to 55 species in M county,the egress and ingress ratio rose 39.26% and 54.13% respectively in the same period;(7)In multi-sited practice,multi-sited license doctors from medical community are 149,153 and 82 in M county,T county and J county,respectively.(2)Satisfaction of medical staff(1)Awareness of medical community policy for medical staff is high,87.5% of the medical staff understand the medical policy,12.5% of medical staff just heard of medical policy without deep insight.(2)Medical staff give high assessment in implementation of medical clinical pathway and remote consultation in medical community,general assessment for the rationality of the two-dimensional referral policy and training evaluation,and negative comment to the rationality of multi-sited license policy in medical community.(3)The satisfaction score of medical staff was 3.23 ± 0.76,belong to the category of general satisfaction.Analysis of the influence factors of medical staff satisfaction showed that the medical staff area,organization,working years,understanding of policy are the main influencing factors of satisfaction.(4)Factors that influence satisfaction of medical community policy are mainly include career development,salary,job stress and job satisfaction four aspects.Career development and job pressure have the greatest effect to the satisfaction degree of the medical staff,salary treatment also has an effect,the effect of the sense of achievement in work for the medical staff is relatively small.(5)Satisfaction of medical staff from each dimension in medical community score the highest(3.83 ±0.71)for career development,close to the satisfaction category;Salary(3.39±0.94)and job satisfaction(3.02±0.53 mm)dimension belong to the category of general satisfaction;The lowest scored dimension is working pressure(2.87±0.86),belong to the category of less satisfaction.(3)Satisfaction of patients(1)Awareness of medical community policy is low for patient,only 21.8% of the patients understand the medical community policy,the main approach to get the knowledge of policy is the introduction from the medical staff,65.4% of the patients know nothing about.(2)55.9% of the patients showed no sense to the improvement due to medical community,improvement of medical level is the main reason for recognition of medical community in patients;inadequate of publicity is the main reason for unrecognition of medical community in patients.(3)Patients’ overall satisfaction score was 4.16±0.69,belong to the category of satisfactory.To analyze the influence factors of affect patient satisfaction,age,culture level,patient area,understanding of medical policy have effect on the overall satisfaction of degree for patients.(4)Factors that affect satisfaction of medical community for patients mainly include the medical level,service attitude,medical service convenience and availability,medical costs four aspects.Medical treatment charge has greatest influence on the satisfaction of patients,medical level and service attitude also have an effect,medical service convenience and availability showed relatively low effect on the satisfaction of patients.(5)Medical level score the highest for patients with different dimensions satisfaction(4.78±0.90),close to the category of completely satisfactory;Medical service convenience and availability(4.39±0.82)and the service attitude(3.92±0.79)dimension belong to the category of general satisfactory;Is the lowest scored dimension(3.56±0.64),medical costs belong to the category of dissatisfactory.(4)interview results: Health administrative personnel at all levels have support attitude to the county medical alliance policies in general.In their opinion,county medical alliance enhanced the ability of primary health services,control the unreasonable growth of medical expense,but ther still exits some problem such as "fragmentation",two-way referral,especially under the the channel is not smooth,increased the pressure of medical staff.They also suggest that the policy should be made according to the regional characteristics,establish a long-term benefit mechanism,increase of lead hospital’ s management power to the primary hospital.Conclusion(1)After a year for implementation of county medical community in Anhui province,medical and health resources were effective integration in these areas,the whole health level in these county were increased.Enhancement were visible in the cases of grassroots support and training,person-times of diagnosis and treatment,available and actual compensation of NCMS,multi-site practice.Per capita "three-fee" and average hospitalization expense were decreased with time,informationization ability of a clinical pathway is also increased,two-dimensional referral channels, especially deorsumversion channel in northern and southern Anhui is still not smooth.(2)Medical staff showed high awareness of medical community policy,gave high evaluation for the implementation of clinical pathway in medical community and remote consultation,and showed low evaluation of the rationality of the grass-roots support and training policies,two-dimensional referral and multi-sited practice.Medical staff showed low satisfaction of medical community,demographic characteristics that influence satisfaction of medical staff include work seniority,region,employers and understanding of the medical community policy.The influencing factors of satisfaction for medical staff embodied in career development,compensation,job stress and job satisfaction four aspects.(3)Patients showed low awareness of medical community policy,the main approach is the introduction from doctor.Most people make no sense to the recognition of medical community,the main reason is short of publicity.Patients showed low satisfaction of medical community,demographic characteristics that influence satisfaction of medical staff include age,education background,region and understanding of the medical community policy.The influencing factors of satisfaction for medical staff embodied in medical level,service attitude,medical service convenience and availability,medical expense four aspects. |
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