省级三甲医院托管对县级医院医疗服务能力和效率的影响OA

Objective To systematically evaluate the multi-dimensional impact of the trusteeship model of provincial top-tier tertiary hospitals on the medical service quality,service capacity,operational efficiency,and cost control of county-level hospitals,and provide empirical evidence for the sinking of high-quality medical resources and the optimization of the county-level medical service system under the background of hierarchical medical treatment.Methods A county-level hospital in Henan Province under the trusteeship of a provincial top-tier tertiary hospital was selected as the research object.Monthly data of 17 core indicators were collected on 9 months before the trusteeship and 15 months after the trusteeship,and a four-dimen-sional evaluation system covering＂medical quality,service capacity,operational efficiency,and cost control＂was constructed.The Entropy weight-TOPSIS method was used for comprehensive evaluation,and the independent samples t-test was com-bined to compare the differences in indicators before and after the trusteeship.The contribution degree analysis method was a-dopted to identify the key influencing dimensions.Results After the trusteeship,the comprehensive evaluation relative closeness(Ci value)of the hospital increased from 0.470±0.042 to 0.511±0.038,with an overall increase of 8.619%(P=0.023).From the perspective of dimensions,the medical service capacity dimension had the highest contribution degree(44.840%),among which the Case Mix Index(CMI)increased from 0.896±0.011 to 0.916±0.026(P=0.016),and the proportion of grade III/IV surgeries increased from 47.961%±3.438%to 51.498%±3.281%(P=0.020).In the operational efficiency dimension,the cost consumption index decreased from 0.664±0.046 to 0.621±0.036(P=0.018).In the cost control di-mension,the proportion of medical consumables cost significantly decreased from 19.011%±4.142%to 16.127%±1.762%(P=0.026).While there were no significant differences in the core indicators of medical quality.Conclusion Through techni-cal support,management implantation,and brand output,the trusteeship of provincial top-tier tertiary hospitals has effectively improved the medical service capacity and resource utilization efficiency of county-level hospitals,and optimized the medical cost structure,but the effect of medical quality improvement has not yet been demonstrated.This model provides a feasible path for promoting the sinking of high-quality medical resources and achieving the goal of＂treating serious diseases within the coun-ty＂.In the future,it is necessary to strengthen the construction of medical quality and safety system and the long-term assis-tance mechanism.