Research Of The Information System Of Family Doctor Under The Environment Of Grading Treat System

BackgroundWith the development of the new reform of health system,it has been a common trend to build the family doctor system.At present,due to the imbalance of the levels of hospital informatization,plus the infor,the current information system is not able to support effective grading diagnosis management information platform.By optimizing the electronic health records and services process,strengthen the collaboration and data sharing between medical institutions,improving the working efficiency of the family docto and family doctor system construction,this research is to make sure that the family system works well and ease the difficulty of seeing the doctor in shanghai.ObjectiveFirstly,to combing the research progress about family doctor health management system and grading treat system by article review.Secondly,building the theory constructure of the informatization of family doctor system via Stakeholder analysis,PEST analysis and expert consultation method.On the basis of the first two steps,raise the objective and strategy for improving the current information system of family doctor of shanghai.MatierialsThe research materials come from three aspects.One is the field survey for 113 family doctors,189 specialized subject doctor and 300 community residents in the county of zhabei of shanghai.The second one is to consult the administrative department managers,community and hospital managers,medical insurance related management and information system maintenance personnel,which have a total of 38 m.Last is the article review which 120 papers were included.MethodsThe method of literature research,depth interview method,questionnaire investigation,case analysis,stakeholder analysis,PEST analysis and business process analysis were Integrated applicated in the research.Using these tools,we handle the field survey of the Family doctors health management information platform,standard and the content of the recognition and satisfaction,which makes the contracture of the system clear.The working principle of each function module and comb business process analysis,complete theoretical framework of family doctor information platform.Results1.Current situation of theory and practice of family doctor system information under graded medical treatment systemFamily doctor service mode abroad is matured,wihle the key problem of Shanghai family doctor system has not been broken through.Firstly,the general mode of initial medical care at community and two-way referral are not in the form of rules,secondly,qualified general practioners are lacked and distributed uneven,thirdly,the information sharing mechanism needs to be opened up further,which affected the construction of referral system,lastly,treatment didn't reach expected level due to lack of motivation.2.Everyone is fully aware of the importance of grading treatment systemAll parties are fully aware of the importance and necessity of graded medical treatment system,proposing carring out two-way referral step by step,and improve system from top-level design,model construction and regular process at the same time.Problems reflected by all parties including that enthusiasm of tertiary hospitals is low in the process of constructing graded medical treatment system,resulting in the limited transfer of patients in rehabilitation period to community hospital,information sharing can not be fully realized,the whole two-way referral process is not reasonable,the guiding function of medical insurance policy is limited.3.The questionnaire survey results(1)Understanding of the diagnosis and classification systemThe investigated specialist and family doctor share the same opinion of necessity of graded medical treatment system.88.9% doctors and 78.8% family doctors believe that the establishment of building two-way referral system between community health service center and secondary or tertiary hospital is quite necessary(?2 ?=14.130,P<0.05).The participation of specialist joining in the building graded medical treatment system is limited(?2?=127.04,P<0.05).The route of initial diagnosed by community hospital and then referral to secondary or tertiary hospital is judged idel by specialist and family doctor,there were 57.1% specialist and 50.4% family physicians chose this pattern as the ideal mode.Willness of residents about initial diagnosed by community or referral is low,only 38.2% community residents surved will choose community health service center for initial diagnose.The first three reasons encourageing residents to choose community initial diagnose are home nearly(84.3%),no need to go to big hospital after suffering from minor illnesses(57.4%),and inexpensive(42.6%).(2)The two-way referral process analysisFirstly,willness of referring patients to superior hospital by family doctor is high,92.9% family doctors had referred patients to superior hosplitals,the average referral number is 56±37.85.8% family doctors thought that the most reasonable method of referring patients is through unified information system.The main reason for referral is lack of necessary drugs.Secondly,only 31.7% specialist had referred patients to community,suggesting that willness of referral to community by specialist is not high,the main reason for referral is that patients are diagnosised clearly and are in stable condition,and can return to the community for rehabilitation.Thirdly,14.4% community residents surveyed said that they had received community referral service,showing that referral rate within community family doctors is low.(3)Information communication and sharing86.7% family doctors still think paper material is reasonable channel of two-way referral information communication,while specialist considered the best communication channels should be "unified information system".85.8% family doctors thought that information sharing had been realized,most computer work platform of community family doctors were embedded in two-way referral module and health management module,however,repeated examination rate in general hospital is 78.9%.(4)The management system of supervision and examination57.5% family doctors and 34.9% specialists think that ladder reimbursement is not reasonable,and that proportion of medicare reimbursement between community and general hospital should ben further enlarged,in order to attract residents for community intinial diagnosis.4.Theory system construction of graded medical treatment system informationFirstly,search for the stakeholders involved in the informatization process of graded medical treatment system systematically,then identify the critical needs of key interest groups through expert consultation,under the base of stakeholder analysis theory.Secondly,identify the political,economic,social and technological environment in the face of the construction of graded medical treatment system and family doctor information platform through PEST model.Thirdly,construct theoretical implementation model of graded medical treatment system,then build the architecture of information platform of family doctor and identify its function and information transferring process.Lastly,take the two-way referral as an example,summing up and carried out the main task of two-way referral,laying the foundation of constructing the information platform under the base of business process analysis method.Conclusions and Policy recommendationsUsing the management of chronic disease as breakthrough,to establish a third party information sharing cloud platform under the lead of government.Each department formulate unified referral standards together.Improve the cooperation between Community health service centers and The general hospital.Make sure the health insurance has its role in the system.