Exploration of Specialized Medical Alliance Based on Hierarchical Diagnosis and Treatment in the Project of Joint Prenatal Examinations

doi:10.12114/j.issn.1007-9572.2019.00.233

Abstract

Abstract: Background　After the establishment of Beijing Mother and Child Health Handbook in community health service centers，pregnant women in Beijing will do all prenatal examinations and give birth in their selected midwifery institutions，which leads to much simple and repeat work and high input in prenatal examinations in midwife institutions，while in the community health service centers professional obstetricians and gynecologists have insufficient workload.Objective　To explore the development prospect of specialized medical association under the mode of hierarchical diagnosis and treatment by studying the project of Joint Prenatal Examinations for women of childbearing age.Methods　From October 2017 to October 2018，one community health service center and one tertiary midwifery institution set up a specialized medical association to carry out the project of Joint Prenatal Examinations.The pregnant women in the observation group（n=38）completed eight routine prenatal examinations in the community health service center and four prenatal examinations in the tertiary midwifery institution.After 34 weeks of gestation，they were referred to the tertiary midwifery institution for follow-up prenatal examinations and delivery.The control group（n=80）contained pregnant women in the community who were examined and delivered by other midwifery institutions at the same period and had complete records in the second phase of the Beijing Mother and Children System.Statistical analysis was carried out on the waiting time and length of visit of prenatal examinations，delivery mode and pregnancy outcome，the recovery rate of Beijing Mother and Child Health Handbook and the situation of postpartum visits of the two groups，as well as the satisfaction of parturients in the observation group.Results　The waiting time of prenatal examinations in the observation group was significantly shorter than that in the control group，and the length of visit of prenatal examinations in the observation group was significantly longer than that in the control group（P<0.05）．There was no significant difference in the delivery mode and pregnancy outcome between the two groups（P>0.05）．The recovering in time rate and total recovery rate in the observation group were higher than those in the control group（P<0.05）．The overall satisfaction score of pregnant women in the observation group who were fully involved in the project of Joint Prenatal Examinations was（90.03±1.94）.Conclusion　It is not only safe and feasible，but also scientific and advanced to establish the Joint Prenatal Examinations Project with specialized medical association under the mode of hierarchical diagnosis and treatment.

Key words: Hierarchical medical service system, Joint prenatal examination, Specialized medical treatment alliance

摘要： 背景　北京市孕产妇在社区卫生服务机构建立《北京市母子健康档案》后到选定的助产机构分娩，所有的产前检查均在助产机构完成，导致助产机构简单重复工作量大、孕妇产检投入高等问题，而社区卫生服务机构的专业妇产科医生却存在着工作量不足的现象。目的　通过对育龄妇女“联合产检”项目的研究，探讨分级诊疗模式下的专科医联体发展前景。方法　2017年10月—2018年10月，社区卫生服务中心与三级助产机构建立专科医联体，开展“联合产检”项目。观察组（n=38）孕妇在社区卫生服务中心完成孕期的8次常规产检，在三级助产机构完成4次专项检查，妊娠34周后转诊至三级助产机构完成后续产检和分娩；对照组（n=80）为同时期社区内在其他助产机构产检并分娩孕妇，且在北京市妇幼二期系统有完整记录者。对两组孕妇的产检候诊时长和就诊时长、分娩方式和妊娠结局、《北京市母子健康档案》回收率、产后访视情况以及观察组孕妇对项目的满意度进行统计分析。结果　观察组孕妇产检候诊时长短于对照组，就诊时长长于对照组，差异有统计学意义（P<0.05）；两组孕妇分娩方式和妊娠结局比较，差异无统计学意义（P>0.05）；观察组《北京市母子健康档案》回收及时率和回收率高于对照组，差异有统计学意义（P<0.05）。观察组孕妇对“联合产检”项目的总体满意度评分为（90.03±1.94）分。结论　以分级诊疗形式建立的专科医联体“联合产检”项目具有安全性、可行性、科学性和先进性。

关键词: 分级诊疗制度, 联合产检, 专科医联体

CHEN Xudong,SUN Qian,WANG Xin. Exploration of Specialized Medical Alliance Based on Hierarchical Diagnosis and Treatment in the Project of Joint Prenatal Examinations　[J]. Chinese General Practice, 2019, 22(16): 1927-1930. DOI: 10.12114/j.issn.1007-9572.2019.00.233.
陈旭东,孙倩,王欣. 基于分级诊疗的专科医联体在“联合产检”项目中的探索[J]. 中国全科医学, 2019, 22(16): 1927-1930. DOI: 10.12114/j.issn.1007-9572.2019.00.233.

References

［1］胡善联．建真正医联体难度很大［J］．中国卫生，2013，58（4）：37．
HU S L．It is very difficult to build a real medical association［J］．China Health，2013，58（4）：37.
［2］许栋，王国栋，张明，等．公立医院与基层医疗卫生机构分工协作的现状及策略［J］．中国医院管理，2013，33（4）：10-13．DOI：10.3969/j.issn.1001-5329.2013.04.005.
XU D，WANG G D，ZHANG M，et al．Present situation and strategies of collaboration-division between public hospitals and basic medical and health institutions［J］．Chinese Hospital Management，
2013，33（4）：10-13．DOI：10.3969/j.issn.1001-5329.2013.04.005.
［3］王朝君．医联体［J］．中国卫生，2013，58（12）：39-40．
WANG C J．Medical association ［J］．China Health，2013，58（12）：39-40.
［4］万祥波，朱夫，杨杨．镇江市建立紧密型医疗联合体的探索和实践［J］．中华医院管理杂志，2013，4（4）：263-265．DOI：10.3760/cma.j.issn.1000-6672.2013.04.009.
WAN X B，ZHU F，YANG Y．Exploration and practice of establishing close medical association in Zhenjiang［J］．Chinese Journal of Hospital Administration，2013，4（4）：263-265．DOI：10.3760/cma.j.issn.1000-6672.2013.04.009.
［5］LENNOX N G，DIGGENS J N，UGONI A M．The general practice care of people with intellectual disability：barriers and solutions ［J］．J Intellect Disabil Res，1997，41（5）：380-390．DOI：10.1111/j.1365-2788.1997.tb00725.x.
［6］韩树萍．母乳喂养对新生儿重症监护病房早产儿的益处［J］．中国新生儿科杂志，2015，30（3）：161-163．DOI：10.3969/j.issn.1673-6710.2015.03.001.
HAN S P．Benefits of breastfeeding for premature infants in neonatal intensive care unit［J］．Chinese Journal of Neonatology，2015，30
（3）：161-163．DOI：10.3969/j.issn.1673-6710.2015.03.001.
［7］WHO．Appropriate technology for birth［Z］．1985.
［8］李宏田，刘建蒙，刘菊芬．2008—2014中国剖宫产率变化趋势和地区差异研究［J］．中华预防医学杂志，2017，51（3）：242．DOI：10.100./jama.2016.18663.
LI H T，LIU J M，LIU J F．Geographic variations and temporal trends in cesarean delivery rates in China，2008—2014［J］．Chinese Journal of Preventive Medicine，2017，51（3）：242．DOI：10.100./jama.2016.18663.
［9］朱凡，高卫益，马捷，等．新医改背景下瑞金医院卢湾医疗联合体实践与思考［J］．中国医院管理，2013，33（5）：10-12．DOI：10.3969/j.issn.1001-5329.2013.05.004.
ZHU F，GAO W Y，MA J，et al．Practice and thinking of Luwan Medical Association of Ruijin Hospital under the background of new medical reform［J］．Chinese Hospital Management，2013，33（5）：10-12．DOI：10.3969/j.issn.1001-5329.2013.05.004.
［10］方鹏骞，林振威，陈诗亮，等．医联体联动模式及其核心医院改革前后综合效益分析：以武汉市为例［J］．中国医院，2014，18（7）：14-16．DOI：10.3969/j.issn.1671-0592.2014.07.005.
FANG P Q，LIN Z W，CHEN S L，et al．Analysis of the linkage mode of medical union and the comprehensive benefits of its core hospital before and after the reform：case of Wuhan［J］．Chinese Hospitals，2014，18（7）：14-16．DOI：10.3969/j.issn.1671-0592.2014.07.005.
［11］郭天康．医联体之甘肃模式的探讨［J］．中国卫生质量管理，2014，21（2）：71-73．DOI：10.3969/j.issn.1006-7515.2014.02.021.
GUO T K．Discussion on Gansu model of medical association［J］．Chinese Health Quality Management，2014，21（2）：71-73．DOI：10.3969/j.issn.1006-7515.2014.02.021.
［12］黄向东．福州市第一医院探索医联体新路径［J］．中国医院院长，2014，10（18）：30．
HUANG X D．Fuzhou First Hospital exploring a new path of medical consortium［J］．China Hospital CEO，2014，10（18）：30.
［13］田璐．天津某医院实施医联体建设的探索与思考［J］．中华医院管理杂志，2014，30（1）：72-75．DOI：10.3760/cma.j.issn.1000-6672.2014.01.023.
TIAN L．Exploration and reflection on the implementation of medical association construction in a hospital in Tianjin［J］．Chinese Journal of Hospital Administration，2014，30（1）：72-75．DOI：10.3760/cma.j.issn.1000-6672.2014.01.023.
［14］申曙光，张勃．分级诊疗、基层首诊与基层医疗卫生机构建设［J］．学海，2016，27（2）：48-57．DOI：10.3969/j.issn.1001-9790.2016.02.007.
SHEN S G，ZHANG B．Graded diagnosis and treatment，first diagnosis at the grass-roots level and construction of grass-roots medical and health institutions［J］．Academia Bimestris，2016，27（2）：48-57．DOI：10.3969/j.issn.1001-9790.2016.02.007．
［15］姚泽麟．何以破解初级医疗服务的“倒金字塔”困境：以医生职业为中心的考察［J］．探索与争鸣，2017，33（8）：77-84．DOI：10.3969/j.issn.1004-2229.2017.08.016.
YAO Z L．How to solve the "inverted pyramid" dilemma of primary medical services：a doctor career-centered survey ［J］．Exploration and Free Views，2017，33（8）：77-84．DOI：10.3969/j.issn.1004-2229.2017.08.016.