【摘要】 目的分析肺癌医联体的实践效果与存在的问题,为构建以项目为载体的专病医联体提供循证依据与政策参考。方法以Donabedian模型为理论框架,从结构、过程、结果3个维度对上海市胸科医院与徐汇区共建的肺癌医联体实践效果进行综合分析。结果肺癌医联体的组织架构清晰合理、分工明确、区域全覆盖,建成肺癌专病防治信息系统,制定具有可操作性的双向转诊流程,形成肺癌高危人群的防治一体化闭环式管理,减少患者就诊次数,缩短就医等候时间,节省一定的就医费用;但考核激励机制尚未健全,医联体内上下帮扶不密切,基层医疗服务水平仍需提高。结论该医联体实现肺癌防治闭环管理,形成专病分级诊疗新模式,但在落实绩效考核、促进资源下沉、加强专科建设等方面仍需改进。更多还原

【Abstract】 Objective To analyze the practical effect and existing problems of lung cancer medical alliance and to provide evidences and policy reference for the specialized disease medical alliance construction based on project.Methods Taking Donabedian model as the theoretical framework,the practice effect of lung cancer medical alliance jointly constructed by Shanghai Chest Hospital and Xuhui District was comprehensively analyzed from structure,process and outcome. Results The organization structure and division of labor of lung cancer medical alliance was clear and reasonable,and the regional coverage was full. Lung cancer prevention and treatment information system has been completed. A two-way referral process with operability has been formulated. The closed-loop management of prevention and treatment for high-risk population of lung cancer has been integrated. Medical alliance could reduce the number of visits,shorten the waiting time,and save a certain amount of medical expenses. However,the evaluation and incentive mechanism of the core hospital has not yet been established,and the upper and lower hospital is not close,and the level of primary medical service still needs to be improved. Conclusion The medical alliance has realized the closed-loop management of lung cancer prevention and treatment,and formed a new mode of the specialized disease hierarchical diagnosis and treatment,but the work needs to be improved in the implementation of performance appraisal,the promotion of resource sinking,and the enhancement of radiation driving.更多还原