【摘要】：目的:本課題來(lái)源于國(guó)家“863計(jì)劃”的“數(shù)字化”課題,研究目的就是為了探索區(qū)域醫(yī)療數(shù)據(jù)共享解決途徑,探索具有一般性指導(dǎo)意義的區(qū)域醫(yī)療協(xié)同模式范式,并且相應(yīng)地實(shí)證區(qū)域醫(yī)療協(xié)同模式設(shè)計(jì)和應(yīng)用。因此,本課題立足國(guó)家醫(yī)療衛(wèi)生發(fā)展趨勢(shì),瞄準(zhǔn)有利于實(shí)現(xiàn)“首診下沉、分級(jí)醫(yī)療以及雙向轉(zhuǎn)診”的總體目標(biāo),致力于推動(dòng)新形勢(shì)下醫(yī)療體制改革事業(yè),從更加有利于實(shí)現(xiàn)醫(yī)療公平并降低社會(huì)整體醫(yī)療成本而使人民群眾能更方便快捷就醫(yī)的角度而言,本研究課題具有重大的應(yīng)用價(jià)值和社會(huì)意義。方法:本課題遵循管理研究課題一般思路,運(yùn)用文獻(xiàn)分析法、問(wèn)卷調(diào)查法、訪談法、比較分析法、橫斷面調(diào)查法、歸納法、系統(tǒng)分析法、實(shí)證研究法、個(gè)案研究法、理論構(gòu)建等方法,分析國(guó)內(nèi)外區(qū)域醫(yī)療協(xié)同現(xiàn)狀和存在問(wèn)題以及經(jīng)驗(yàn)啟示;選擇某市區(qū)域作為研究對(duì)象,調(diào)研醫(yī)療機(jī)構(gòu)區(qū)域醫(yī)療協(xié)同信息化服務(wù)現(xiàn)狀;在研究醫(yī)療數(shù)據(jù)中心一般個(gè)案的基礎(chǔ)上,比較分析醫(yī)療數(shù)據(jù)中心的數(shù)據(jù)存儲(chǔ)模式和數(shù)據(jù)分享模式區(qū)別,并運(yùn)用“結(jié)構(gòu)-功能”理論,概括區(qū)域醫(yī)療數(shù)據(jù)中心主要結(jié)構(gòu)和功能及技術(shù)支撐;繼而在協(xié)同理論和理論構(gòu)建方法的指導(dǎo)下,提出區(qū)域醫(yī)療協(xié)同機(jī)構(gòu)間三種協(xié)同形式和一般性區(qū)域醫(yī)療協(xié)同模式;最后以醫(yī)院區(qū)域醫(yī)療協(xié)同信息化建設(shè)實(shí)踐進(jìn)行協(xié)同模式應(yīng)用的實(shí)證研究。結(jié)果:一是明確醫(yī)療數(shù)據(jù)中心結(jié)構(gòu)和功能;二是提出區(qū)域醫(yī)療協(xié)同三種形式:區(qū)域內(nèi)多級(jí)醫(yī)療機(jī)構(gòu)“縱向”醫(yī)療業(yè)務(wù)應(yīng)用;異地不同等級(jí)醫(yī)療機(jī)構(gòu)間的“遠(yuǎn)程”醫(yī)療業(yè)務(wù)應(yīng)用;大型醫(yī)療機(jī)構(gòu)間的“橫向”醫(yī)療業(yè)務(wù)應(yīng)用;三是在研究個(gè)案、總結(jié)共性的基礎(chǔ)上歸納論證得出區(qū)域醫(yī)療協(xié)同一般性模式:”1+2+3+N”的一般模式,即一個(gè)區(qū)域醫(yī)療數(shù)據(jù)中心;兩種協(xié)同:政策協(xié)同和質(zhì)控協(xié)同;三種醫(yī)院間協(xié)同三種形式;N種業(yè)務(wù)協(xié)同元素,包括一系列業(yè)務(wù)系統(tǒng)軟件為載體的信息化協(xié)同等。結(jié)論:(1)全國(guó)各地區(qū)雖然各種區(qū)域醫(yī)療探索試點(diǎn)模式較多,但是總體上都存在頂層設(shè)計(jì)不足、規(guī)劃不統(tǒng)一、信息化水平支撐不足、數(shù)據(jù)不規(guī)范難共享的問(wèn)題,區(qū)域信息化服務(wù)水平調(diào)研數(shù)據(jù),建立統(tǒng)一標(biāo)準(zhǔn)的醫(yī)療數(shù)據(jù)中心是區(qū)域醫(yī)療需要經(jīng)歷的階段;(2)提出建立醫(yī)療數(shù)據(jù)中心“結(jié)構(gòu)-功能”相統(tǒng)一,滿足“五大核心功能”,以承載復(fù)雜的業(yè)務(wù)數(shù)據(jù)轉(zhuǎn)換流;(3)提出區(qū)域醫(yī)療協(xié)同模式機(jī)構(gòu)間協(xié)同的三種形式,具有更高的概括性;(4)提出“1+2+3+N”模式,即基于醫(yī)療數(shù)據(jù)中心的區(qū)域醫(yī)療協(xié)同模式,具有一般性的指導(dǎo)作用。
[Abstract]:Objective: this subject comes from the "digitization" project of the National "863 Program". The purpose of the research is to explore the solution of regional medical data sharing, and to explore the pattern of regional medical cooperation, which is of general guiding significance. And the corresponding empirical regional medical cooperation model design and application. Therefore, based on the trend of national medical and health development, this subject aims at achieving the overall goal of "first diagnosis sinking, graded medical treatment and two-way referral", and is committed to promoting the cause of medical system reform under the new situation. From the point of view that it is more beneficial to realize the medical fairness and reduce the whole medical cost of the society and make the people more convenient and quick to seek medical treatment, this research topic has great application value and social significance. Methods: this subject followed the general thinking of management research, and used literature analysis, questionnaire, interview, comparative analysis, cross-sectional investigation, induction, system analysis, empirical research, case study. This paper analyzes the status quo, problems and experience of regional medical cooperation at home and abroad, selects a certain city as the research object, and investigates the current situation of regional medical cooperation information service of medical institutions. On the basis of studying general cases of medical data center, this paper compares and analyzes the difference between data storage mode and data sharing mode of medical data center, and applies "structure-function" theory. This paper summarizes the main structure, function and technical support of regional medical data center, and then, under the guidance of coordination theory and theory construction method, puts forward three kinds of cooperation forms and general regional medical cooperation mode among regional medical coordination agencies. Finally, the empirical study on the application of collaborative mode is carried out with the construction practice of hospital regional medical cooperation information. Results: firstly, the structure and function of the medical data center should be defined; secondly, three forms of regional medical cooperation should be put forward: the application of "longitudinal" medical service in multi-level medical institutions in the region, the application of "remote" medical service among different medical institutions in different places; The application of "horizontal" medical service among large medical institutions; thirdly, the general pattern of regional medical cooperation is concluded on the basis of studying individual cases and summarizing the commonness: the general pattern of "123N", that is, a regional medical data center; There are two kinds of cooperation: policy coordination and quality control coordination, three kinds of hospital cooperation and three forms of service cooperation elements, including a series of information collaboration based on business system software. Conclusion: (1) although there are many regional medical exploration pilot models in various regions of the country, there are problems such as inadequate top-level design, inconsistent planning, insufficient support for information level, and difficulty in sharing data. The research data of regional informatization service level and the establishment of unified standard medical data center are the stages of regional medical needs. (2) the establishment of medical data center "structure-function" is unified to meet the "five core functions". (3) bring forward three forms of regional medical collaboration model with higher generality; (4) propose "123N" model, that is, regional medical collaboration model based on medical data center. Has the general guidance function.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R-05

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