| BackgroundIn1998, the Standing Committee of the National People’s Congress passed "Law for Licensing Medical Practitioners in People’s Republic of China ", which made clear of the practicing physician responsibilities, wherein, the fourteenth stipulation says:"registered physicians can be in the field of medical, prevention, health care institutions according to the registered place, practice type, scope of business, engaged in the corresponding medical, prevention, health care services" This means, practicing physicians engaged in business by practice location, practice scope constraints cannot freely active. In the2009"Reform views on deepening the medical and health system of CPC Central Committee and State Council" input forward clearly first explore multi-point registration of doctors to practice. At the same year, the health ministry issued" the Ministry of health on physician practice more related issues notice" marks the doctor multi-sited licensed officially kicks off. Guangdong Province as the first doctor multi-sited licensed pilot province, since carried out in January1,2010, appeared to the awkward situation-media fever, coldness towards hospital and so on.How to solve the bottleneck problem of pilot process becomes the key policy of the doctor multi-sited license. This study bases on pilot current situation, from the public hospital perspective, in order to find the problems and put forward some scientific countermeasures. The focus of the doctor multi-sited licensed this pathway, and the greatest degree of regional health talent resource make excellent health professionals helping grassroots medical and health institutions development, gradually improve the basic medical and health institutions service capability and level of service to better serve the people.ObjectivesUnderstanding the status quo of the Guangdong Province physician practice, from the perspective of public hospitals, in order to build the basic framework, Guangdong Province physician practice implementation are summarized as follows:1. A survey of Guangdong Province physician practice status quo and analysis of existing problems;2. To explore the Guangdong Province physician practice implementation process, the roles and responsibilities of all levels;3. For the basic framework and the path of the Guangdong Province physician practice implementation.Methods1. Literature analysisUtilizing the library and related web sites, through the CNKI database, resource database of Wanfang, VIP Chinese Journal Database, PubMed, ScienceDirect and other electronic resource search and relevant documents of physicians to practice, literature and health policy implementation, framework, system related literature.2. Stakeholder analysisThrough stakeholder analysis to reach the role of the government, public hospitals, private hospitals, medical institutions, practitioners and patients in doctor multi-sited licensed and position of policy. Selected the perspective of public hospital, doctor multi-sited licensed is not only a theoretical need, but also the need of the practice, at the same time, as the item pool construction providing a basis, which make the item pool created more targeted and persuasion.3. Questionnaire survey method This paper respectively researched in15hospitals of425physicians,10public hospital managers (mainly for medical or medical department managers) and the Southern Medical University, Guangzhou Medical College in2medical institutions which engaged in health policy research experts (mainly for health management professional professor) was used to survey119, mainly about the two groups on the doctor multi-sited licensed attitude, advantages and disadvantages of cognitive and suggestions, this analysis of the Guangdong province doctor multi-sited licensed and the status of the existing problems, to construct the doctor multi-sited licensed the implementation framework of item pool reference.4. BrainstormingInviting south hospital in medical management, quality management, medical dispute management, personnel management, educational management, clinical and other experts on the item pool design for open discussion, the purpose is to analyze the content item pool, quantity and classification, finally selected a more scientific and rational, feasible index to form the preliminary entry pool.5. Delphi expert consultation methodIn the investigation and literature research foundation, designed expert consultation form, and through the brains storm law, expert interview, further improve the consultation form structure and content, according to the study of the nature to select good experts at the same time. Subjects before and after a total of3round survey:preliminary investigation and two formal investigation.6. Coefficient of variation analysisThe coefficient of variation is also called" standard deviation", which is a measure of information in the observed values of the degree of variability of a statistic, i.e., the ratio of standard deviation to mean. By using the coefficient of variation of index of expert consensus degree, the coefficient of variation is larger, opinion is more dispersive, the coefficient of variation is smaller with more focused views. Based on the discussion, with a coefficient of variation of0.4for the standard, less than0.4is to be retained; greater than0.4, it is recommended to remove.7. Expert authority coefficient analysis method Index of authority coefficient Cr is equal to the index judging coefficient Ca and the index of the familiar degree coefficient Cs of the arithmetic average, namely:Cr=(Ca+Cs)/2. Cr in0-1, Cr, illustrate expert power level is higher, the result is desirable.8. Consistency coefficient analysis methodConsistency coefficient can be judged by experts on each indicator to evaluate whether the differences, or finding a highly coordinated expert group and holding heretical opinions of experts. Consistency coefficient0-1in between, consistency coefficient is close to1, said the coordination degree is better, consistency coefficient is close to0, description of expert opinion on the coordination degree is of the difference. Combination of χ2test is to test expert advice on the coordination degree of the significance, if there is a significant difference after the consistency coefficient of the χ2test a, the results of the desirable.Result1. Health managers and physicians survey results(1) Positive motivation:for health managers, and distributed130questionnaires were125recovered, the recovery rate was96.15%,119valid questionnaires, the effective rate was95.2%. For physicians,450questionnaires were distributed and recovered433, the recovery rate was96.22%,425valid questionnaires were efficiency of98.15%.(2) Description of the findings:health managers and physician groups, physician practice of prospect evaluation inconsistent; physician practice of the pros and cons of view is more consistent; more consistent evaluation of the physician multi-practice stakeholder; physicians point of the practice-related measures have a high demand for.2. Delphi expert consultation results(1) Positive motivation:pre-survey issued10copies and recovered in total10, the recovery rate was100%, a formal send30copies of the first round of expert consultation,29copies of recycling, recovery rate was96.67%, a formal send29copies of the second round of expert advice, recovery of29, the recovery rate was100%. (2) The coefficient of the authority:the first round of expert authority coefficient Cr was0.70, indicating that the authority was of a higher degree.(3) level indicators of the weight:the first round of expert consultation:laws and regulations level weight to40.86%, the government level, the government weight34.31%, public hospital level weight24.83%, consistency coefficient (Kendall,’s the W)0.226, by the x2test, P value0.001<0.05; the second round of expert advice:the level of laws and regulations, the weight was of42.07percent, government level, the weight of32.76%,25.17%of public hospital level weights, the consistency coefficient of0.305, by the x2test, P=0.000<0.05. Consulting two experts, an index weight ratio close to the expert is more consistent with a target weight distribution advice, and the consistency coefficient of the second round than the first round of improvement.(4) consistency factor:a formal two experts consulted by the consistency coefficient was respectively0.161and0.191, the second round was higher than the first round of0.03, low Description experts consistency coefficient, the second round of the opinions of experts over a consistency of views have improved. Two formal expert advice, experts consistency coefficient test, P values are equal to0.000, were less than0.05, the results of the consultation to achieve the target of this topic, the results desirable.(5) indicators of the importance of evaluation results:the official first round of expert mean evaluation of the importance of each indicator between4.69-6.55, but the coefficient of variation of the four indicators is higher than0.4:Modify the "Physicians go out consultation regulations ", the establishment of physician practice medical dispute management approach ", the establishment of inter-provincial physician practice system and means,""the general medical system". The second round of formal investigation of the experts was on the evaluation of the importance of each indicator between4.76-6.83, and the coefficient of variation less than0.4.(6) indicators of the reliability of evaluation results:the mean statics of the first round of the formal investigation expert evaluation of operability of the various indicators between4..62-6.14, but the coefficient of variation of the three indicators above was0.4:developing multi-physician practice medical dispute management,"the" highlight the Hospital Association, Medical Association, medical supervision and management role,"the establishment of inter-provincial physician practice system and means. Formal investigation into the second round of expert operability evaluation of various indicators mean statics was between4.28-6.14, but there was a coefficient of variation of the index is higher than0.4:"the establishment of inter-provincial physician practice system and means.Through Data analysis and discussion, to delete the index "to establish interprovincial physician practice system and means", and ultimately the formation of the25two indicators:the laws and regulations, the institutional level indicators8,10at the government level indicators, level indicators in public hospitals7.Strategy discussion1. Improve physician management laws and regulations2. The physicians to practice more (the third) the implementation of category management3. Reform of the health personnel management system, increase the investment of the government4. Doctor multi-sited licensed access and elimination mechanism5. The establishment of a full range of doctor multi-sited licensed supervision platform6. Exploring regional medical group or medical consortium under doctor multi-sited licensed mode7. PPP model to explore the doctor multi-sited licensed underConclusion1. Health policy framework should be consistent with the regional medical health status and characteristics. This study believes that doctor multi-sited licensed to carry out the progress and the depth, a breakthrough in public hospitals, difficulty also is in a public hospital, selected from public hospitals from the perspective of constructing doctor multi-sited licensed to carry out basic framework is the need of practice. 2. Health policy framework should be established on the basis of present situation investigation and analysis. The study on119health management425physicians conducted a questionnaire survey, which provides a reference to form entry pool, fielding research situation as the item pool based, makes the frame more scientific and persuasive.3. Delphi expert consultation to other health policy framework for reference. Delphi experts as a management method, system analysis method in theory and value in the field of a useful extension, on other health policy framework has practical significance to popularize. Using Delphi expert consultation method, construction of health policy framework should pay attention to two aspects:one is the level of dimensions of the indicators, which should be selected carefully. The level of index weight should be through several rounds of expert consultation, anteroposterior views are more consistent. The two is attached to the expert choice. Experts selection is the key to the success of Delphi expert consulting method. |
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