Studies on Transformation Cases of Chinese and American Medical Service Modes Based on Transformative Learning Collaborative Theory

doi:10.12114/j.issn.1007-9572.2019.00.414

Abstract

Abstract: Background　The contracted family doctor service mode is the main carrier of medical service after the transformation of primary medical service mode，and it is an important way to develop general practice at the primary level.However，how to promote the contracted family doctor service mode and truly show the connotation of contracted service in practice is an important problem faced by all localities.Objective　By comparing two transformative healthcare practices based on the related theory and tools of Transformative Learning Collaborative（TLC） in China and the United States，we aim to explore how to effectively use TLC for promoting new healthcare mode，contracted family doctor service mode，at district/county level in China.Methods　From September 2017 to March 2019，the case of transformative contracted family doctor service mode（hereinafter referred to as Wuhou case） in Wuhou District of Chengdu in China and transformative primary medical service mode〔hereinafter referred to as Veterans Health Affairs（VHA）〕 used by People Allied Care Team（PACT）in VHA case were selected.On the basis of typical case study and combined with literature review，structured interview，questionnaire investigation and expert consultation，we analyzed the theoretical support，transformation goals，activity structure，organizational management structure（including organizational management structure in the healthcare system，and TLC architecture and faculty in service mode transformation），performance of participants and the monitoring indexes and effects in the service mode transformation based on the TLC theory，and completion situation of targeted goals in the medical system transformation.Results　Both the Chinese and American cases adopted the classic organizational structure and activity organization mode of TLC，and used TLC as the only transformation learning method to achieve good transformation promotion effects in completing the transformation goals of their systems respectively.All the trainees recognized the contribution of TLC to the transformation resources and were able to complete PDSA improvement plan well.However，there were great differences between two cases in the theoretical support，goal setting of transformation and TLC，and management structure.Conclusion　TLC plays a clear role in the transformation and promotion of primary medical service mode with various application scenarios.The systematic and professional TLC theory and the foundation of the transition atmosphere are the basis for the successful implementation of service mode transformation based on TLC theory.

Key words: Family practice, Family doctor contract service, Transformative learning collaborative, Healthcare transformation, Ability promotion

摘要： 背景　家庭医生签约服务是基层医疗服务模式转变后医疗服务开展的主要载体，是全科医学在基层体现的重要方式。但是如何推动签约服务模式，在实践中真正落实签约服务内涵，是各地面临的重要难题。目的　通过对比中国和美国利用转型学习型组织（TLC）的相关理论和工具开展医疗服务模式转型推广的应用案例，探索以区县为单位开展基于TLC理论促进家庭医生签约服务模式推广的组织运行方式。方法　2017年9月—2019年3月，选取中国成都市武侯区卫生健康局家庭医生签约服务模式转型的推广案例（以下简称武侯案例）和美国退伍军人健康管理局（VHA）在自身的医疗服务体系内推动的名为与患者结盟的医疗团队项目（PACT）的基层医疗服务模式转型的推广案例（以下简称VHA案例）。在典型案例研究的基础上，采取与文献复习、结构式访谈、问卷调查、专家咨询相结合的方法，分析武侯案例和VHA案例开展基于TLC理论的服务模式转型的理论支持、转型目标、活动开展结构、组织管理架构（包括医疗体系转型组织管理架构、服务模式转型中的TLC中的架构及师资情况），学员在基于TLC理论的服务模式转型中的参与情况，基于TLC理论的服务模式转型过程中的监测指标及效果以及医疗体系转型目标完成情况。结果　中美案例均采用了TLC的经典组织架构和活动组织方式，均使用TLC为唯一转型学习手段，在完成各自体系的转型目标上均取得较好的转型推广效果；学员均对TLC对转型的资源贡献认可，均能较好完成PDSA改进计划；但中美案例在转型理论体系支持、转型和TLC目标设置、管理架构上有较大差异。结论　TLC在基层医疗服务模式转型推广中作用明确，应用场景多样。系统化、专业化的TLC理论和在转型氛围的铺垫是成功实施基于TLC理论的服务模式转型的基础。

关键词: 家庭医学, 家庭医生签约服务, TLC, 转型推广, 能力提升

HUANG Yanli,CAO Peiya,LUO Xiaolu, et al. Studies on Transformation Cases of Chinese and American Medical Service Modes Based on Transformative Learning Collaborative Theory　[J]. Chinese General Practice, 2019, 22(28): 3424-3431. DOI: 10.12114/j.issn.1007-9572.2019.00.414.
黄艳丽,曹裴娅,罗晓露等. 基于TLC理论的中美医疗服务模式转型推广案例研究[J]. 中国全科医学, 2019, 22(28): 3424-3431. DOI: 10.12114/j.issn.1007-9572.2019.00.414.

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