Study On The Status Of Hierarchical Healthcare In Township Health Centers Based On Medical Information Sharing

[Purpose]The purpose of this study is to analyze the status of implementation of hierarchical healthcare of township health centers based on medical information sharing.The analyses of the top-level design and main exploration of the national hierarchical healthcare system and the construction exploration of medical information sharing are theoretical basis,do empirical analyses on medical information sharing environment and the implementation status of hierarchical healthcare of township health centers.In order to discover the achievements and obstacles of the construction of hierarchical healthcare of township health centers,and put forward countermeasures and improvement ideas.[Methods](1)Literature research:To systematically collect domestic and foreign literatures,policy documents,and relevant health statistical yearbook data,including hierarchical healthcare,medical information sharing,primary health care institutions,the township health centers,etc.On this basis,the current status of medical information sharing and the construction of hierarchical healthcare are summarized,and to detemine the analysis framework and methods of this study.(2)Empirical research:Adopting Stratified cluster sampling method,two remote suburbs are selected from Wuhan,in which all township health centers are used as sample institutions for investigation.The survey methods includes:(1)questionnaire survey:27township health centers,2085 medical staff,478 patients;(2)in-depth interviews;(3)Collect relevant informations such as the organization’s existing policy documents.(3)Descriptive statistical analysis:Descriptive statistical analysis methods are used in analysis of qualitative and quantitative data and relevant policy documents of sample institutions.Theχ~2test analysis method is used in medical staff’s evaluation for the effect of two-way referrals and patients’willingness of the primary diagnosis.[Results](1)Medical information sharing:The first and second phases of the municipal population health information platform have been completed basically,and district-level population health information platform has been completed trial operation in Wuhan.However,the development of regional health information platforms is uneven and inadequate.The proportion of township health centers participating in the construction of the Close Medical Association is not high.The unified and standardized directory system of big data of health care has not been established.The foundation of grass-roots informatization needs to be consolidated."Information barrier"of hierarchical healthcare still exists.(2)Implementation status of hierarchical healthcare:Since the hierarchical healthcare has been implemented,the allocation of health resources in township health centers has been continuously optimized,and the hierarchical healthcare related work continued to advance and achieved certain results.The supply of medical services reflects the unsatisfactory primary diagnosis system:First,the number of outpatient services decreased;second,the supply of inpatient services is still difficult to meet the needs of patients.The basic medical and health service capabilitiesneeds to be improved.(3)Cognition and evaluation of hierarchical healthcare between urban grassroots m edical staff and patients:Both medical staff and patients have a high recognition on the construction of hierarchical healthcare system,93.3%of the medical staff believe that it is necessary to implement the primary diagnosis;More than 80%of patients receive the primary diagnosis,95.2%of the patients agree to be transferred to primary medical institutions for rehabilitation treatment during the recovery period.There are significant differences in the evaluation of the implementation effect of two-way referral among different genders,professional titles,positions,working hours,working years and types of engagement of medical staff.And the higher the recognition and understanding of hierarchical healthcare,the better the evaluation of the implementation effect of two-way referral.Patients with types of agricultural household registration,male,undergraduate degree and older have a greater willingness to primary diagnosis than other types of patients.[Conclusions](1)Hierarchical healthcare is helpful to the development of township health centers:The construction of population health information platform is basically completed,95%of primary medical institutions have completed the deployment and application of primary medical information system,the allocation of health resources in township health centers has been continuously optimized,and the hierarchical healthcare related work continued to advance.Both medical staff and patients have a high recognition on the construction of hierarchical healthcare system.(2)There are still obstacles to the construction of hierarchical healthcare in township health centers:A sound mode of medical information sharing has not yet been established.The overall medical service ability is not ideal.The scale of referral is not large,and it is easier to transfer upward than downward,and the form is valued and the content is despised,so the efficiency of referral is not high.Lack of breakthrough effect in the construction of the medical association.The staff allocation of family doctor team is insufficient and lacks core manpower support.The relevant guarantee mechanism of hierarchical healthcare needs to be improved.(3)Countermeasures and suggestions for further promoting the construction of hierarchical healthcare:Improve the top-level design and strengthen the rigid regulations for the primary diagnosis system.Promote the reform of personnel management system and improve the capacity of primary medical services.Formulate unified two-way referral standards,establish an orderly referral system.Accelerate the construction of close medical associatio.We will improve the hierarchical healthcare guarantee mechanism,which is key to the reform of the medical insurance payment system.We should strengthen the policy publicity of family doctors’signing service system.Implement grassroots informatization construction and promote the sharing of medical resources and information.