中国全科医学 ›› 2026, Vol. 29 ›› Issue (01): 115-121.DOI: 10.12114/j.issn.1007-9572.2025.0090

• 论著·医防融合专题研究 • 上一篇    下一篇

基于居民感知的医防融合实施效果模糊综合评价研究

赵凌宇1, 郝晓宁1,2,*(), 丰志强2   

  1. 1.211166 江苏省南京市,南京医科大学医政学院
    2.100044 北京市,国家卫生健康委卫生发展研究中心
  • 收稿日期:2025-04-25 修回日期:2025-07-25 出版日期:2026-01-05 发布日期:2025-12-18
  • 通讯作者: 郝晓宁

  • 作者贡献:

    赵凌宇负责数据清洗与分析,撰写论文;郝晓宁提出研究设计,负责论文修订,对论文负责;丰志强负责研究实施,进行文章质量控制与审查。

  • 基金资助:
    国家重点研发计划项目(2021YFC2600504); 国家疾控局委托项目创新医防协同医防融合机制地方实践研究项目(CNHDRC-KJ-L-2023-39-01785); 江苏高校哲学社会科学优秀创新团队项目

Fuzzy Comprehensive Evaluation of Implementation Effect of Medical and Prevention Integration Based on Residents' Perception

ZHAO Lingyu1, HAO Xiaoning1,2,*(), FENG Zhiqiang2   

  1. 1. School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China
    2. China National Health Development Research Center, Beijing 100044, China
  • Received:2025-04-25 Revised:2025-07-25 Published:2026-01-05 Online:2025-12-18
  • Contact: HAO Xiaoning

摘要: 背景 在老龄化和疾病负担加剧的背景下,传统医疗服务模式不再适应当前健康需求,医防融合成为新服务模式,但目前医防融合模式尚处于探索阶段,集中于患者体验的研究较少。 目的 本研究从需方视角分析医防融合实施的效果,并提出对策建议。 方法 基于2023年3月北京市医防融合调查数据,采用政策导向与多阶段抽样相结合的方法,从4家三级和2家基层医疗卫生机构就诊居民中获取328份有效问卷。使用课题组自制问卷,基于Donabedian模型评估结构(医疗可及性)、过程(就诊流程、便捷性、服务态度)、结果(医疗水平、健康宣教、医患关系)7个维度的医防融合实施效果评价。运用熵权法和模糊综合评价法综合评价效果,并进行群体异质性分析。 结果 实施医防融合后,居民就医体验改善效果得分为80.07分,隶属于"提升"维度。异质性评价分析结果显示,女性评分(83.141分)高于男性(76.985分);高血压患者评分(80.818分)高于未患者(79.785分),但糖尿病患者评分(73.606分)远低于未患者(81.212分);签约家庭医生居民评分(88.163分)高于未签约者(72.811分);常就诊于基层医疗卫生机构的居民评分(86.317分)高于常就诊于二/三级综合医院者(72.502分)。 结论 医防融合已取得一定成效,但仍需优化就诊流程。对高血压患者的医防融合管理工作开展良好,但糖尿病患者的医防融合体验有待提升。基层卫生和家庭医生签约服务发挥了积极作用,但二/三级综合医院的医防融合建设工作有待加强。建议进一步加强信息化建设、优化就诊流程,以提升医防融合效率;建议强化糖尿病患者的医防融合管理,重视二/三级综合医院医防融合工作开展,以增强居民的健康获得感和满意度。

关键词: 医防融合, 模糊综合评价法, 居民感知, 糖尿病管理, 高血压管理, 家庭医生服务

Abstract:

Background

Against the backdrop of an aging population and an increasing disease burden, the traditional medical service model is no longer suitable for current health needs. The integration of medical care and disease prevention has emerged as a new service model. Currently, the integration model is in the exploratory stage, with relatively few studies focusing on patient experience.

Objective

This study aims to analyze the implementation effect of the medical and preventive care integration from the perspective of demand and put forward countermeasures and suggestions.

Methods

Based on the March 2023 Beijing Medical-Prevention Integration Survey data, this study employed a policy-guided approach combined with multi-stage sampling to collect 328 valid questionnaires from residents visiting four tertiary and two primary healthcare institutions. Using a self-designed questionnaire developed by the research team, we evaluated seven dimensions of the Donabedian model: accessibility, process (including procedures, convenience, and attitudes), and outcome (including quality, education, and relationships). The effectiveness was comprehensively evaluated using entropy weighting and fuzzy comprehensive evaluation methods, followed by group heterogeneity analysis.

Results

The improvement score of residents' medical experience after the integration of medical and preventive system is 80.07, which belongs to the dimension of enhancement. The heterogeneity analysis results show that the evaluation score of females (83.141) is higher than that of males (76.985), and the score of patients with hypertension (80.818) is higher than that of non-patients (79.785). The score of patients with diabetes (73.606) is significantly lower than that of non-patients (81.212). The evaluation of residents who have signed up with a family doctor (88.163) is markedly higher than those who have not (72.811). Residents who regularly choose primary health care institutions (86.317) have a higher evaluation than those who choose secondary general hospitals (72.502).

Conclusion

The integration of medical and preventive system has achieved results, but there is still a need to optimize the medical consultation process; the management outcomes of the integration for hypertensive patients are relatively good, but the experience of diabetes patients with the integration needs to be improved; primary medical care and family doctor services have played a positive role, but the construction of the integration in comprehensive hospitals at or above the secondary level still needs to be strengthened. It is recommended to further strengthen information technology construction, optimize the medical consultation process to enhance the efficiency of medical and preventive integration, reinforce the management of diabetes patients within the integration, pay attention to the construction of the integration in comprehensive hospitals at or above the secondary level, and enhance the sense of health gain and satisfaction among residents.

Key words: Medical and preventive integration, Fuzzy comprehensive evaluation, Resident's perception, Diabetes management, Hypertension management, Family doctor services