Study On Operation Effect And Influencing Factors Of The County Medical Service System

Objective: Through field research to understand the operation effect of county medical service system,analyze the influencing factors,and put forward Suggestions for improving the construction of county medical service system.Methods: The qualitative research and quantitative research were combined.The quantitative study collected data on the effectiveness of county-level medical institutions and township(central)health centers of the medical and health communities in Bozhou District,Zunyi,a self-designed questionnaire was used to investigate the inpatients in district(county)level medical institutions,township(center)hospitals,village clinics and district(county)level medical institutions.Using Epidata3.1 software to establish the database,according to research purposes,using SPSS17.0 to test the effect of the operation.The qualitative study selected 12 experts,colaizzi analysis was used to analyze the interview results,and the key influencing factors were determined according to the interview results,and DEMATEL method was used to clarify the relationships among the influencing factors.Results: Operation Effect:1.The number of in-patient and out-patient and emergency cases in medical institutions in the county was on the rise,and it was higher 1 year after collaboration than before.2.After the cooperation,the ratio of the third and fourth-grade operations,the utilization rate of beds and the service income were increased,and the average hospitalization days of discharged patients were decreased.3.The number of referred patients and transferred patients in district(county)level medical institutions increased 1 year after collaboration compared with that before collaboration(p ?0.05).4.The number of medical institutions at district(county)level receiving further education from primary medical institutions and the number of people going to rural areas for help have increased.5.After cooperation,the number of chronic disease management in primary medical institutions has increased.6.After the implementation of telemedicine,the amount of examination and treatment indistrict(county)level medical institutions increased,the difference was statistically significant(p ? 0.05).But at present,patients' treatment information can not be obtained through remote information platform.Kill.There were significant differences in the evaluation of operation effect among different levels of medical staff,among which the evaluation was very good and poor(p?0.05).8.The lowest satisfaction score of patients to the first medical institution was the technical level of medical personnel,the highest was the communication between doctors and patients,and the highest score of patients to the medical service system was the follow-up after referral,however,the consistency of drug use among different medical institutions was lower than that of other medical institutions.Influencing Factors: 1.According to the diagnosis tree of health system,the results of expert interview were attributed,and 9 factors were extracted from 5 subjects,which were: conflict of interests in medical institutions;unreasonable allocation of medical resources;reform of payment method;insufficient human resources;Unclear Organization Positioning;two-way referral;incentive mechanism;Primary Health Care Capacity;information communication and sharing.2.The reasons are the reform of payment methods,the shortage of human resources,the unclear position of institutions,the two-way referral and the primary medical service capacity The result factors are the conflict of economic interests,unreasonable allocation of medical resources,information communication and sharing,and incentive mechanism The key factors to solve the problem are the conflict of economic interests,the capacity of Basic Medical Service,the incentive mechanism and the unreasonable allocation of medical resources.Conclusion:1.The construction of county medical service system is effective in improving County medical service capacity,but the service capacity of grass-roots medical institutions still can not fully meet the needs of residents for high-quality medical services.2.The two-way referral and hierarchical diagnosis and treatment in the county have been initially formed,but there are still "easy to turn up,difficult to turn down" phenomenon.3.The construction of county medical service system has strengthened the information construction in the county,but we should speed up the construction and promote the telemedicine platform to play a better role.4.Cooperation has been carried out among medical institutions in the county,but thereare conflicts of economic interests among medical institutions,resulting in poor cooperation effect,optimizing incentive mechanism and accelerating the establishment of close medical community.