Abstract: Objective　To investigate and compare the health technology applications at all levels of medical institutions in Shanghai.Meanwhile the reasonability was assessed,so as to provide a basis to strengthen the technical management and capacity building of primary medical institutions for the government.Methods　First,2 third-class hospitals,6 second-class hospitals and 32 community health service centers in Shanghai were selected as the study sites via stratified random sampling method from January to December 2014.Second,a total of 920 cases,including 150 cases in every third-class hospital,50 cases in every second-class hospital and 10 cases in every community health service center were selected by systematic sampling method.According to the inclusion and exclusion criteria,889 cases of cerebral infarction patients were selected as the study objects.The basic demography characteristics （gender,age etc.）,general conditions （hospital stay,hospitalization expense and daily hospitalization expense） and health technology application （inspection items,check items,western medicines） during hospitalization were collected and compared.Meanwhile,the reasonability of health technology was assessed according to the diagnosis and treatment guidelines.Results　Compared with the community health service centers,the proportion of male,daily hospitalization expense were statistically higher,and age,hospital stay,hospitalization expense were lower in the second-class hospitals （P<0.05）;compared with the community health service centers,the hospital stay was statistically lower and hospitalization expense and daily hospitalization expense were higher in the third-class hospitals （P<0.05）;compared with the second-class hospitals,the age,hospital stay and hospitalization expense were statistically higher in the third-class hospitals （P<0.05）.184,181 and 200 inspection items were applied in the community health service centers,second-class hospitals and third-class hospitals.The application frequencies of the top 30 inspection accounted for 82.3%,64.4% and 60.1% of total application frequency.34.1% of inspection items were common in the community health service centers,second-class hospitals and third-class hospitals;8.5% of inspection items were common in the community health service centers and second-class hospitals;4.3% of inspection items were common in the community health service centers and third-class hospitals.47,59 and 62 check items were applied in the community health service centers,second-class hospitals and third-class hospitals respectively.The application frequencies of the top 15 check accounted for 92.3%,99.2% and 94.4% of total application frequency.10.0% of check items were common in the community health service centers,second-class hospitals and second-class hospitals;3.4% of check items were common in the community health service centers and third-class hospitals;3.4% of check items were common in the community health service centers and third-class hospitals.398,367 and 339 western medicines were applied in the community health service centers,second-class hospital and third-class hospitals.The application frequencies of the top 30 western medicines items accounted for 65.2%,61.2% and 71.4% respectively.6.0% of western medicines were common in the community health service centers and third-class hospitals;6.0% of western medicines were common in the community health service centers and second-class hospitals;13.4% of western medicines were common in the community health service centers and third-class hospitals.The difference of inspection items in all hospitals was small and did not cover the recommended items by the guidelines.CT,MRI and other recommended items were absent in the community health service centers.The thrombolysis,anticoagulation and other western medicines were not included in the top 30 western medicines.Conclusion　The health technology application centralized tendency of different levels of medical institutions was obvious.The similarity of health technology between the community health centers,second-class hospitals and third-class hospitals was low.The technical difference was related to the device configuration and technical capability.The health technology difference in the community service centers was larger than that of the second-class hospitals and third-class hospitals.The diagnosis and treatment capacities need to be strengthened in the community service centers.

Key words: Brain infarction, Inpatients, Care organizations, Community health centers, Health technologies, Shanghai

摘要： 目的　比较各级医疗机构卫生技术使用差异并评价其合理性，为政府加强基层医疗机构技术管理和能力建设提供依据。方法　2014年1—12月，采用二阶段随机抽样方法，首先，采用分层随机抽样法选取上海市2家三级医院、6家二级医院、32家社区卫生服务中心作为研究现场；其次，采用系统抽样法预计在每家三级医院选取150例，每家二级医院选取50例，每家社区卫生服务中心选取10例，共920例，根据纳入与排除标准，最终共选取889例脑梗死患者为研究对象。收集并比较各级医疗机构患者人口学基本特征（性别、年龄等）、住院一般情况（住院天数、住院费用、日均住院费用）、住院期间卫生技术的使用情况（检验项目、检查项目、西药使用情况），并采用诊疗指南进行卫生技术使用合理性评价。结果　二级医院患者男性所占比例、日均住院费用大于社区卫生服务中心，年龄、住院天数、住院费用小于社区卫生服务中心（P<0.05）；三级医院患者住院天数小于社区卫生服务中心，住院费用、日均住院费用大于社区卫生服务中心（P<0.05）；三级医院患者年龄、住院天数、住院费用大于二级医院（P<0.05）。社区卫生服务中心、二级医院、三级医院分别使用184、181、200种检验项目，前30位检验项目使用人次占总使用人次的比例分别为82.3%、64.4%、60.1%。社区卫生服务中心、二级医院、三级医院共有34.1%检验项目，社区卫生服务中心与二级医院共有8.5%检验项目，社区卫生服务中心与三级医院共有4.3%检验项目。社区卫生服务中心、二级医院、三级医院分别使用47、59、62种检查项目，前15位检查项目的使用人次占总使用人次的比例分别为92.3%、99.2%、94.4%。社区卫生服务中心、二级医院、三级医院共有10.0%检查项目，社区卫生服务中心与二级医院共有3.4%检查项目，社区卫生服务中心与三级医院共有3.4%检查项目。社区卫生服务中心、二级医院、三级医院分别使用398、367、339种西药，前30位西药使用人次占总使用人次比例分别为65.2%、61.2%、71.4%；社区卫生服务中心、二级医院、三级医院共有6.0%西药，社区卫生服务中心与二级医院共有6.0%西药，社区卫生服务中心与三级医院共有13.4%西药。各级医院检验项目差异较小，均涵盖诊疗指南推荐项目。社区卫生服务中心缺乏诊疗指南推荐的CT、磁共振等项目。溶栓、抗凝等方面西药均未在前30位。结论　各级医疗机构卫生技术应用集中趋势明显，卫生服务中心卫生技术同二、三级医院相似度低，其同二、三级医院卫生技术差异与设备配置及技术能力均相关。社区使用的卫生技术同诊疗指南差距较二、三级医院大，诊治能力需要加强。

关键词: 脑梗死, 住院病人, 医疗机构, 社区卫生中心, 卫生技术, 上海