通讯作者: 周忠良, zzliang1981@xjtu.edu.cn

DOI：10.12201/bmr.202108.00021

The Impact of Health Alliance and its Models on the Quality of Primary Care in Urban China: Based on Standardized Patient Approach

• 摘要：目的:分析医疗联合体及其模式对基层医疗服务质量的影响,为进一步完善医疗联合体建设提供科学依据。方法:研究采用标准化病人方法收集医疗服务质量数据。评估效果时,首先采用广义精确匹配方法(Coarsened Exact Matching,CEM)分别将参加、未参加医疗联合体的机构及参加紧密型、松散型医疗联合体的机构进行匹配,增强可比性；其次,运用匹配后的数据,采用差异中的差异方法结合多元回归模型,评估医疗联合体及其模式的效果。结果:参加紧密型医疗联合体使临床诊疗规范依从性上升了1.35个百分点(P<0.001),正确诊断率上升了0.61个百分点(P<0.001),不必要检查比例下降了1.65个百分点(P<0.05),有害或无用药物的比例下降了2.07个百分点(P<0.05),问诊时间上升了0.36分(P<0.05),以患者为中心总得分平均上升了1.35分(P<0.001)。结论:参加医疗联合体,特别是紧密型医疗联合体有利于提高基层医疗服务质量,但其作用是有限的。原因在于尚未形成真正意义上的责任共同体和利益共同体,难以推动内部运行机制的改革,不能形成更为紧密的资源共享机制,制约着紧密型医疗联合体发挥其优势。

  关键词： 医疗联合体; 紧密型医疗联合体; 基层医疗服务质量; 标准化病人法; 差异中的差异

   

  Abstract: Objective: To evaluate the impact of Health Alliance and its models on the quality of primary care to provide a scientific basis for the improvement of Health Alliance. Methods: Standardized Patient method was employed to collect the data of the primary care quality. Coarsened Exact Matching (CEM) method was employed to match the CHCs that implemented Health Alliance with the unimplemented CHCs, and match the CHCs implemented Tight Health Alliance with Loose Health Alliance, respectively. Difference in difference and multiple regression models were used to evaluate the impact of Health Alliance and its models. Results: After controlling for the potential confounding factors and fixed effects, the Tight Health Alliance increased the clinical adherence rate by 1.35 percentage points (P<0.001), the correct diagnosis by 0.61 percentage points (P<0.05), the rate of unnecessary exams by 1.65 percentage points (P<0.05), the rate of unnecessary drugs by 2.07 percentage points (P<0.05), the consultation time by 0.36 minutes (P<0.05), and the average score of patient-centered communication by 1.35 (P<0.001). Conclusion: Health Alliance and Tight Health Alliance were more likely to improve the quality of primary care. However, the impact is limited because the community of responsibilities and interests has not yet been formed, which makes it difficult to promote the reform of the internal operation mechanism, and can not form a closer resource sharing mechanism. That restricts the close health alliance to paly its advantages.

  Key words: Health Alliance; Tight Health Alliance; Primary Care Quality; Standardized Patient; Difference in difference

  提交时间：2021-11-02

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2021-08-10	bmr.202108.00021V1	下载

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