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目的对比分析成都市基层医疗机构(社区卫生服务中心和乡镇卫生院)住院医疗服务体系的资源配置和服务特点,为提高基层医疗服务能力提供决策依据。方法 2016年10月—11月采用普查方法,对成都市22个区(市)县所有基层医疗机构共计390家2015年度住院服务相关数据进行问卷调查。通过SPSS 19.0软件进行数据汇总分析,采用单因素和多因素logistic回归分析其影响因素。结果收回有效问卷379份,其中来自社区卫生服务中心117份,乡镇卫生院262份。社区卫生服务中心和乡镇卫生院开展住院医疗服务的比例分别为53.84%和96.18%。在开展住院服务的基层医疗机构中,社区卫生服务中心和乡镇卫生院医疗保险覆盖率分别为98.41%和90.87%,两者实行单病种临床路径的比率分别为23.81%和18.25%。社区卫生服务中心和乡镇卫生院特殊住院服务开展率分别为14.29%~17.46%、3.57%~7.54%。社区卫生服务中心和乡镇卫生院2015年住院医疗总量分别为103 912、529 611人次,乡镇卫生院全年提供的住院服务总人次数是社区卫生服务中心的5.09倍,平均每个乡镇卫生院全年提供的住院服务人次数是社区卫生服务中心的1.27倍,乡镇卫生院平均每1万居民全年享受住院医疗服务次数是社区卫生服务中心的3.01倍。社区卫生服务中心与乡镇卫生院病床使用率中位数分别为22.47%、74.47%,平均住院医疗服务强度分别为81.74、234.57住院人次/(年·医生)]。住院服务数与服务人口数(≤10万人情况下)、住院床位数、药品数、医技人员数呈正相关关系。结论成都市基层医疗机构的住院服务存在明显的城乡差异。在基层医疗机构资源配置时应充分考虑上述差异,制定更有针对性的管理措施。
Objective To compare and analyze the resource allocation and service characteristics of inpatient medical service system in primary medical institutions (community health service centers and township hospitals) in Chengdu, and provide decision-making basis for improving primary medical service capabilities. Methods From October to November, 2016, a total of 390 2015 inpatient service-related data were surveyed by census method in all grass-roots medical institutions in 22 districts (cities) in Chengdu. SPSS 19.0 software was used for data summary analysis, using univariate and multivariate logistic regression analysis of its influencing factors. Results A total of 379 valid questionnaires were retrieved, including 117 from community health service centers and 262 from township hospitals. Community health service centers and township hospitals to carry out inpatient medical services were 53.84% and 96.18% respectively. In the primary medical institutions carrying out inpatient services, the coverage rates of medical insurance in community health centers and township hospitals are respectively 98.41% and 90.87%, and the rates of practicing single-disease clinics are 23.81% and 18.25% respectively. Community-based health service centers and township hospitals special hospital services were carried out rate of 14.29% ~ 17.46%, 3.57% ~ 7.54%. In 2015, the total number of in-patient medical services in community health centers and township hospitals was 103,912,529,611 respectively. The total number of in-patient services provided by township hospitals was 5.09 times that of community-based health service centers throughout the year. On average, each township health center The number of inpatient services provided throughout the year was 1.27 times that of community health service centers and the average number of inpatient medical services per 10,000 inhabitants of township hospitals was 3.01 times that of community health service centers. The median occupancy rates of community health centers and township hospitals were 22.47% and 74.47% respectively, and the average hospitalization service intensity was 81.74 and 234.57, respectively. The number of hospital services and the number of service population (≤ 10 million cases), hospital beds, the number of drugs, medical technicians were positively correlated. Conclusion There are obvious differences between urban and rural areas in hospital services of primary medical institutions in Chengdu. In the primary health care resources allocation should take full account of the above differences, to develop more targeted management measures.