Analysis And Countermeasures Of The Status Of Classification Diagnosis And Treatment In Tianjin

Objective:To compare the advanced modes at home and abroad through the research of classification diagnosis and treatment in developed countries and provinces and cities in China.This paper discusses the advanced experience and development status in the implementation of the hierarchical diagnosis and treatment system at home and abroad,combined with the history and operation of Tianjin in the implementation of the hierarchical diagnosis and treatment system,in-depth discussion of the problems in the implementation of hierarchical diagnosis and treatment in Tianjin,and gives the corresponding improvement measures.Methods:1.Literature method:retrieving the key words from pub med,web of science,CNKI,wanfang data database,Chinese medical literature database,etc.and find the relevant literature data about the classification diagnosis and treatment at home and abroad,involving the information at all levels of the country,province,city,etc.2.Interview method:selected representative medical institutions and health departments in Tianjin to conduct qualitative interviews,the main contents are:the current status of medical services in the implementation of classification and treatment,the main existing problems and promote the implementation of the classification and treatment policies.3.Questionnaire survey:for doctors,patients,health departments to make questionnaires related to hierarchical diagnosis and treatment,and calculate the reliability and validity of the relevant questionnaires,collect and process information,establish the corresponding database,and apply the statistical software SPSS 24.0 input analysis,?~2 test and regression analysis,?=0.05as the test level,P<0.05,it is considered that the results are statistically significant.Results:1.Through the multiple logistic regression analysis of 12 indicators,such as social demographic factors and service quality factors,the statistical results show that the main factors affecting patients'choice of graded medical treatment include age,education level of the investigated patients,and satisfaction of patients with convenient and fast medical treatment,medical price,medical quality,service ability and the proportion of medical insurance reimbursement.convenient and fast medical treatment,medical quality,service capacity,reimbursement ratio and other service quality factors are protective factors.2.There are still differences in the distribution of health resources between primary medical institutions and hospitals in Tianjin.For example,there is a gap between the number of registered nurses and the ratio of doctors to nurses and the requirements of the state.There is still a gap between the level of qualified personnel and professional titles of grass-roots medical staff and hospitals.There is a big gap between the input of equipment in grass-roots hospitals and the level of second and third hospitals.3.After the implementation of graded diagnosis and treatment system in Tianjin,the proportion of outpatients in community hospitals increased significantly in 2017compared with the previous two years,but there are still some problems such as low awareness and satisfaction rate of graded diagnosis and treatment,low willingness to two-way referral,and poor referral within the medical union.4.Tianjin has taken various measures to ensure the operation of the graded medical policy,but the data show that the proportion of"multi-point practice"of medical staff in recent three years is low and changes are small,mainly considering the risk of medical quality,lack of legal protection,imperfect personnel system and other issues;there is a small proportion gap in the graded pricing of medical insurance reimbursement and insufficient incentive.Conclusion:The distribution of health resources in Tianjin gradually inclines to primary medical institutions,but there is still a gap between Tianjin and tertiary hospitals.Graded diagnosis and treatment work in Tianjin achieves shunting patients to a certain extent,leaving patients in the primary care.The goal of level medical institutions,however,needs to be further improved in the recognition of graded diagnosis and treatment,and the internal two-way referral of the medical association needs to be improved in terms of system and standards.The policy guarantees of graded diagnosis and treatment in Tianjin need to be supplemented.For example,the safety of"multi-point practice"and the perfection of law in personnel system,and the medical insurance reimbursement policy need to be innovated and improved.