县域医共体改革的焦点问题及应对策略——基于混合方法的研究OA

Objective To analyze the key issues of county-level medical communities reform in the real world,and to explore the corresponding solutions.Methods(1)Quantitative research:a typical sampling method was adopted to select one county-level medical community from each of the cities of Nanning,Guilin,and Liuzhou in Guangxi Zhuang Autonomous Region.A self-developed questionnaire was employed to investigate the construction status of county-level medical communities in 2023.(2)Qualitative research:a stratified purposive sampling method was used to select a total of 57 participants,including health administration managers from the autonomous region and various counties,heads of leading hospitals and member hospitals of county-level medical communities,and medical personnel from leading hospitals.Focus group interviews were conducted,and the interview content was evaluated using the grounded theory analysis.(3)Identification of key issues:a mixed method combined with relevant literature and typical survey data was adopted to identify the key issues of county-level medical communities reform.Results(1)Quantitative research results:in terms of resource investment,the average number of general practitioners per 10 000 population in the county-level medical communities of Shanglin County,Pingle County,and Luzhai County was 3.33.In terms of hierarchical diagnosis system,the average proportion of patients transferred downward by the leading hospitals was 0.09%.In terms of service capacity,the average county-level medical attendance rate was 83.43%.(2)Qualitative research results:a total of 101 open codes were generated from the interview content,which were then consolidated into 15 axial codes and 4 core categories(hierarchical diagnosis system,service capacity,management mode,and resource investment).(3)Mixed-method research results:4 key issues were ultimately identified,namely how to improve internal governance,how to identify support for primary healthcare personnel and information technology,how to improve two-way referral mechanism,and how to improve primary medical technology level.Conclusion The effect of county-level medical communities reform is affected by hierarchical diagnosis,service capacity,management mode,and resource investment.In order to ensure substantial progress on county-level medical communities reform,county-level medical communities should further promote the reform practice in building a benefit sharing mechanism,optimizing pharmaceutical management,two-way referral supervision mechanism,information integration and talent integration in the future.