新型冠状病毒肺炎疫情期间北京市某医联体的应对措施及实施评价

摘要/Abstract

摘要： 背景　北京市出台多项新型冠状病毒肺炎（新冠肺炎）疫情防控措施，而医联体作为推动医疗资源优化配置的重要举措，在疫情中发挥了重要作用，通过评价医联体在此期间各项措施的实施情况，为医联体应对突发公共卫生事件时可采取的措施和作用等提供参考。目的　本研究以北京市某医联体作为案例，对于该医联体在新冠肺炎疫情期间采取的主要应对措施的实施情况进行评价，了解医联体在疫情期间如何发挥作用。方法　采用典型抽样和目的抽样，从北京市某医联体中的核心医院和3家社区卫生服务中心选取受访者17例，包括1例核心医院管理人员、4例社区卫生服务中心管理人员、2例社区卫生服务中心护士长、4例全科医生、6例患者。采用个人深度半结构式访谈，于2020年3月对17例受访者进行面对面访谈。访谈主要内容包括新冠肺炎疫情期间医联体采取的应对措施，并基于规范化过程理论和复杂干预过程评价整合出评价框架，从措施与现有工作价值一致性、措施实施覆盖程度、措施实施效果、措施实施阻碍和/或促进因素及对医联体发展的影响这5个维度对各个措施进行评价。访谈经知情同意后录音、记录，访谈资料在NVivo软件的协助下，采用主题分析法进行分析。结果　该医联体在疫情期间采取的主要措施为培训、加强社区转诊预约、核心医院患者输液下转。疫情期间共举办培训2次，加强了医联体成员单位对新冠肺炎的认知、诊疗和防护水平；但需对社区卫生服务中心更有针对性和实用性。社区转诊预约在此期间覆盖16个社区卫生服务中心，共接收转诊患者50例，筛查出246例建议到发热门诊就诊的可疑人员；更多患者在此期间倾向社区就诊，促进了分级诊疗的实施；但转诊标准需更明确。核心医院输液患者下转380例，缓解了核心医院急诊输液压力，也为患者提供了更便利、安全的输液环境，增强了医联体内部的凝聚和协作；但信息共享需加强。结论　疫情期间该医联体各成员单元团结协作，体现出医联体分级诊疗的重要作用。同时发现医联体培训、转诊标准的明确及信息共享三方面仍需完善，为医联体的进一步发展提供了参考。

关键词: 新型冠状病毒肺炎, 冠状病毒感染, 传染病控制, 社区卫生服务, 医联体, 定性研究

Abstract: Background　To contain the COVID-19 pandemic，the Beijing municipal government has issued multiple measures. During the process of combating the pandemic，Beijing's regional medical consortiums，a kind of key institutions established for promoting the optimization of healthcare resources，have played an important role. Evaluating their anti-pandemic performance may provide a reference for such institutions to take actions to deal with public health emergencies and for assessing their responses to the emergencies. Objective　To evaluate the responses of a Beijing's regional medical consortium to COVID-19 pandemic to investigate the role of regional medical consortiums in containing the pandemic. Methods　Convenient and purpose sampling were used to select a core hospital and 3 community health centers（CHCs） in a medical consortium in Beijing. Semi-structured in-depth interviews were conducted in March 2020 with 17 participants in total after obtaining their informed consent：1 manager from the core hospital，and 4 managers，2 senior nursing officers，4 GPs and 6 patients from the CHCs，which mainly involved actions taken by the regional medical consortium to deal with COVID-19，and the assessment of these measures using a framework developed based on the normalisation process theory and process evaluation of complex interventions（consisting of 5 domains:coherence between the actions and actual work，coverage of actions，effectiveness of implementation，barriers and or facilitators for implementation，and impact of the actions on the development of the regional medical consortium）. The interviews were recorded，and transcribed and were analyzed using thematic analysis with NVivo. Results　The major actions taken by this regional medical consortium during the period are as follows：（1）Holding trainings. A total of 2 trainings were conducted among member institutions to improve the knowledge，diagnostic and therapeutic techniques and preventive interventions related to COVID-19，with the need to be more targeted and practical for community hospitals. （2）Strengthening the appointment for referrals in CHCs. The appointment services covered 16 community hospitals. These hospitals made 50 upward referrals，and suggested intra-hospital referrals of 246 screened suspected cases to the fever clinic. Although more patients preferred visiting CHCs，which promoted the implementation of the hierarchical medical system，the criteria for referrals should be more clear. （3）Transferring patients with infusion treatment from the core hospital to CHCs. 380 with infusion treatment were transferred to the CHCs from core hospital，which eased the pressure of emergency treatment in the core hospital，and also provided patients with a more convenient and safe infusion environment，and enhanced the cohesion and collaboration within the member institutions，but information sharing should be strengthened within the medical consortium. Conclusion　This regional medical consortium has played a hierarchical diagnostic and therapeutic role in combating COVID-19 pandemic by united and collaborative efforts of its members. The aspects need to be improved are related trainings，criteria for referrals and information sharing. This study may be referred by other regional medical consortiums in China for further development.

Key words: COVID-19, Coronavirus infections, Communicable disease control, Community health services, Medical consortium, Qualitative research

褚红玲,朴玉粉,佘瑞芳,等. 新型冠状病毒肺炎疫情期间北京市某医联体的应对措施及实施评价[J]. 中国全科医学, 2020, 23(31): 3905-3911.
CHU Hongling,PIAO Yufen,SHE Ruifang, et al. Effectiveness of Measures for Containing COVID-19 Pandemic in a Regional Medical Consortium in Beijing：a Case Study　[J]. Chinese General Practice, 2020, 23(31): 3905-3911.

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