基于信息技术平台和可信赖式专业活动-岗位胜任力理论促进三级医院构建区域医联体建设中提升全科-专科医师协作培养模式初探

doi:10.12114/j.issn.1007-9572.2020.00.046

摘要/Abstract

摘要： 背景　为实现区域医联体内分级诊疗工作，如何让全科医师与专科医师的医疗行为进行有效的协同一直是研究的难点，如何运用岗位胜任力评估也一直是研究的重点，本研究通过运用可信赖式专业活动（EPAs）进行探索也是国内首创。目的　为了缓解人民日益增长的就医需求与医疗资源的稀缺所产生的矛盾，同时为了更好地发挥三级医院的医疗资源的辐射效应，探索三级医院通过医联体制度将医疗资源纵向传导至社区的方法。方法　上海交通大学医学院附属瑞金医院北院在2018年开发分级诊疗信息平台，包含4个模块：转诊管理、联合病床、转诊随访、信息查询等功能，基于这个系统产生的数据探索针对三级医院专科医师与基层社区医院全科医师实施有效黏合度培训，同时引入国外岗位胜任力理论和EPAs。基于医联体全科医师与专科医师分级诊疗的协作行为培训，问卷主体由三部分组成：人口统计学的相关信息、〔儿科全科医师、儿科（消化）专科医师〕EPAs指标、岗位胜任力指标，于2018年8—11月依托问卷星软件随机发放问卷，共收集问卷1 476份。探索儿科全科医师与儿科专科医师的黏合度模型。结果　儿科全科医师EPAs与儿科专科医师EPAs呈正相关（P<0.05）；儿科全科医师胜任力与儿科专科医师胜任力呈正相关（P<0.05）。结论　三级医院构建区域医联体建设，基于信息技术搭建业务平台（基于全生命周期电子健康综合档案、医技预约、联合病床整合平台），同时结合业务数据引入EPAs-胜任力，促进全科医师与专科医师的共通医疗行为协作集合，通过EPAs-胜任力理论探索全科-专科医师医联体内靶点培训项目。

关键词: 医联体, 分级诊疗系统, 医教协同, 可信赖式专业活动, 岗位胜任力, 培养模型

Abstract: Background　During the implementation of hierarchical diagnosis and treatment in a regional medical consortium，how to effectively coordinate the medical behaviors of general practitioners（GPs） and specialists has always been a difficulty，and how to use post competency assessment has always been the focus of current research.We used entrustable professional activities（EPAs）to try to address the difficulty，which is a first attempt in China.Objective　To explore ways to vertically allocate medical resources from the tertiary hospital to the community hospital in a regional consortium，to alleviate the contradiction between increasing healthcare needs of the people and insufficient medical resources，and to make tertiary hospitals to better play their radiation role in sharing their resources.Methods　Ruijin Hospital（North），Shanghai Jiaotong University School of Medicine，developed a questionnaire in 2018，which consists of demographic information，EPAs evaluation indicators，and position competencies indicators for pediatric GPs and GI specialists，using introduced overseas theories of EPAs and position competencies，and data from the hierarchical diagnosis and treatment platform〔composed of 4 modules（referral management，combined use of hospital beds，follow-up services for referrals，information inquiry）〕 constructed by this hospital in 2018.Then，Ruijin Hospital（North） conducted an online survey concerning cooperation between GPs and specialists in a regional medical consortium based on the www.wjx.cn platform by randomly posting the electronic version of the questionnaire to email addresses of pediatric GPs and GI specialists.A total of 1 476 cases returned responsive questionnaires.The survey results were used to construct a cooperative training model，and to evaluate the general-specialist physician correlations in terms of EPAs and position competencies scores，and to test the model's reliability.Results　The mean evaluation scores of EPAs indicators for pediatric GPs showed prominent positive correlation with those of pediatric GI specialists（P<0.05）.Likewise，the mean position competencies scores for pediatric GPs were positively correlated with those of pediatric GI specialists（P<0.05）.Conclusion　We explored a general-specialist physician co-training model through the introduction of the theory of EPAs-DOC to facilitate the medical coordination and synergy between general physicians and specialist physicians，by integrating data from our electronic management platform（involving whole life cycle electric health records，physicians and technicians appointments and a joint sickbed integration platform） as part of the construction of tertiary hospital-led regional medical consortium.

Key words: Medical consortium, Tiered patient management system, Medicine-education synergy, Entrustable professional activities, Position competency, Training model

高深甚,顾诗皓,何奕,等. 基于信息技术平台和可信赖式专业活动-岗位胜任力理论促进三级医院构建区域医联体建设中提升全科-专科医师协作培养模式初探[J]. 中国全科医学, 2020, 23(13): 1632-1639. DOI: 10.12114/j.issn.1007-9572.2020.00.046.
GAO Shenshen,GU Shihao,HE Yi, et al. Improvement of Co-training Model for General Practitioners and Specialists Driven by EPAs-DOC Theory and Information Technology Platform in the Regional Medical Consortium Led by Tertiary Hospitals　[J]. Chinese General Practice, 2020, 23(13): 1632-1639. DOI: 10.12114/j.issn.1007-9572.2020.00.046.

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