Abstract: Objective　To discuss the effects of holding body on chronic disease management in community health service center（CHSC）.Methods　48 CHSC in Haidian District of Beijing were selected as research object in June 2014.18 CHSC were held by college（CHSC held by college）,23 by health administrative department directly（CHSC held by government）,and 7 by hospital（CHSC held by hospital）.Data were collected from CHSC data in 2013 reported directly on network of management center of community health service in Haidian District,including community conditions of residents suffering from chronic,CHSC human resources condition,CHSC chronic disease management situations,and related indicators of CHSC chronic disease management stage.At the same time,directors and deputy directors in charge of medical care of five CHSC（1 CHSC held by college,3 CHSC held by government,1 CHSC held by hospital） were randomly selected to perform one-on-one interview.Results　There was significant difference in the number of community hypertension patients,diabetic patients,community doctors per thousand population and registered nurses per thousand population among CHSC held by different holding bodies（P<0.05）;while the comparison of daily average outpatient number of community doctors per capita was not significantly different（P>0.05）.The annual average community clinic visits of hypertension patients and diabetes patients among CHSC held by different holding bodies（P<0.05）;the annual average community clinic visits of hypertension patients and diabetes patients in CHSC held by college were significantly higher than those in CHSC held by government and hospital（P<0.05）;Organized by different subject CHSC there was significant difference in physical examination rate,management rate of patients with hypertension and of patients with diabetes among CHSC held by different holding bodies（P<0.05）;there was no significant difference in management rate of the elderly aged over 65（P>0.05）.The physical examination rate,management rate of hypertension patients and of diabetes patients,and upward referral rate of CHSC held by college were significantly higher than those of CHSC held by government and hospital,the physical examination rate of CHSC held by government was significantly higher than that of CHSC held by hospital（P<0.05）.Multiple linear regression analysis showed that holding bodies and management rate of hypertension patients significantly affected their annual average community clinic visits（P<0.05）;taking CHSC held by college as a reference,CHSC held by health administrative department significantly affected the annual average community clinic visits of diabetes patients（P<0.05）.The affecting mechanism of holding bodies on community chronic disease management included the following aspects:traditional advantages that CHSC held by college was closely connected with the service of managed objects of chronic disease,service disadvantage of CHSC held by government caused by diversity of residents in the area and disadvantageous status of CHSC among competitive medical and health institutions.Conclusion　In the three stages of chronic disease management,the management condition of CHSC held by college are superior to that of CHSC held by government and hospital;holding bodies and management rate of patients with chronic disease are the influencing factors.

Key words: Community health service center, Chronic diseases management, Holding bodies

摘要： 目的　探讨举办主体对社区卫生服务中心（CHSC）慢性病管理的影响。方法　于2014年6月选取北京市海淀区的48家CHSC为研究对象，其中18家由高校举办（高校CHSC），23家由卫生行政部门直接举办（政府CHSC），7家由医院举办（医院CHSC）。通过海淀区社区卫生服务管理中心的CHSC 2013年网络直报数据，进行资料收集，包括社区居民患慢性病情况、CHSC人力资源情况、CHSC慢性病管理情况、CHSC慢性病管理阶段相关指标。同时，随机抽取5家CHSC（1家高校CHSC、3家政府CHSC、1家医院CHSC）的主任和主管医疗的副主任进行一对一访谈。结果　不同举办主体CHSC的社区高血压患者数、社区糖尿病患者数、每千人口社区医生数、每千人口社区注册护士数比较，差异有统计学意义（P<0.05）；而社区医生人均每日负担门诊人次数比较，差异无统计学意义（P>0.05）。不同举办主体CHSC的高血压患者年人均社区就诊次数、糖尿病患者年人均社区就诊次数比较，差异有统计学意义（P<0.05）；高校CHSC的高血压患者年人均社区就诊次数、糖尿病患者年人均社区就诊次数高于政府CHSC和医院CHSC，差异有统计学意义（P<0.05）。不同举办主体CHSC的体检率、高血压患者管理率、糖尿病患者管理率、向上转诊率比较，差异有统计学意义（P<0.05）；65岁以上老年人健康管理率比较，差异无统计学意义（P>0.05）。高校CHSC的体检率、高血压患者管理率、糖尿病患者管理率、向上转诊率高于政府CHSC和医院CHSC，政府CHSC的体检率高于医院CHSC，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：举办主体、高血压患者管理率对高血压患者年人均社区就诊次数的影响有统计学意义（P<0.05）；以高校CHSC为参照，卫生行政部门举办对糖尿病患者年人均社区就诊次数的影响有统计学意义（P<0.05）。举办主体影响社区慢性病管理的作用机制包括：高校CHSC具有与慢性病管理对象之间服务联系密切的传统优势、辖区居民的多元化导致政府CHSC处于服务劣势、在竞争性医疗卫生机构间CHSC处于劣势。结论　在慢性病管理的3个阶段中，高校CHSC的管理情况优于政府CHSC和医院CHSC；举办主体和慢性病患者管理率是社区慢性病管理的影响因素。

关键词: 社区卫生服务中心, 慢性病管理, 举办主体