Analysis On The Status Of The Implementation Of Graded Diagnosis And Treatment In Medical Union Mode From The Perspective Of Community

ObjectiveTo analyze the operation condition and developmental disorders of medical association,explore the first contact care of community,dual referral and working mechanism of division of labor and coordination of work in medical association.Also, this article puts forward corresponding policy recommendations to provide basis and reference for the national strategies.MethodsLiterature study, site investigation, questionnaire, interviews and other research methods are adopted in this study to study the development of medical association and obstacles in operation,etc.ResultsThere were 2302 patients of upwards referral and 43 patients of downwards referral. Consultations were held for 1862 pantients through teleconsultation platform.The number of participants reached 725 units,and the content covered neurology, pediatric,radiology, emergency,care etc.There were 25 experts made visits in community health centers.Residents:(1)The rate of acquaintance of medical association was 43.7%.The multivariable analysis showed that the more the residents understands about dual referral, the higher the rate can be.(2) The satisfaction level for medical association was 52.8%.The multivariable analysis showed that education,the rate of acquaintance of medical association and dual referral,the rate of recognition of dual referral can influence it.(3)Ranking first in the needs for medical institutions was community health centers (57.7%).The multivariable analysis showed that education, the rate of recognition of first contact care of community can influence it.(4) The rate of recognition of first contact care of community was 66.4%. The multivariable analysis showed that the satisfaction level for medical association, the rate of recognition of dual referral and referral willingness can influence it.(5)The rate of acquaintance and recognition of dual referral were 30.4% and 67.8% respectively.The multivariable analysis showed that the satisfaction level for medical association,the rate of recognition of first contact care of community, the rate of acquaintance of dual referral,referral willingness can influence the recognition of dual referral.Medical personnel:(1) The rate of acquaintance of medical association was 87.2%.The single factor analysis showed that professional category,the level of concern of medical association,the rate of recognition of medical association and its policies,the recognition of whether medical associationcan can improve the healthcare environmentand and whether the dual referral channel was unobstructed, the satisfaction level for the dual referral mode, the acquaintance of operation of the first contact care of community can influence it.(2)The rate of recognition of medical association was 87.2%. The single factor analysis showed that the rate of acquaintance of medical association, the level of concern of medical association,the rate of recognition of medical association policies,the recognition of whether medical associationcan can improve the healthcare environment and whether the Dual referral channel was unobstructed,the work that the medical personnel joined.the satisfaction level for the dual referral mode, the acquaintance of operation of the first contact care of community can influence it.(3)51.2% of medical personnel considered that the Dual referral channel is unobstructed, the satisfaction level for the dual referral mode was 61.5%.The single factor analysis showed that the rate of acquaintance of medical association, the level of concern of medical association,the rate of recognition of medical association and its policies,the work that the medical personnel joined,the recognition of whether the Dual referral channel was unobstructed,the acquaintance of operation of the first contact care of community can influence it.(4) 56.4% of medical personnel considered that the operation of the first contact care of community was a good situation,and the affecting factors were the limited service ability of community health centers,the distrust of residents, the poor conditions of community health centers, few types of drugs etc.ConclusionsThe establish of medical association has made some initial results. However, some areas should be strengthened and perfected:the rate of acquaintance of medical association should also be improved;the operation of dual referral faces some obstacles;the service ability of community health centers is limited;supporting policies cann’t meet the demands;some members have the low enthusiasm for lacking long-acting mechanism.Suggestions are put forward in order to improve the development of medical association:booster the propaganda to improve the acquaintance and recognition of medical association;keep the dual referral channels open;strengthen services ability of community health centers;give full play to the leading role of the government to provide policy protection for graded medical treatment; make the profit of members united perfectly to promote graded medical treatment.