摘要
背景人群管理是基层医疗卫生机构实现全科医学管理的重要方法,国际疾病统计分类(ICD)是通过诊断分类记录人群特征的重要分类方法,但在基层医疗卫生机构使用和研究较少。目的通过对成都市武侯区在社区卫生服务机构统一实施ICD-10诊断规范化干预行动,提炼诊断规范干预实施的影响因素和实施效果。方法根据实施研究综合框架(CFIR)设计问卷,对武侯区的13家社区卫生服务中心的所有门诊医生及其所在机构管理者进行调查,调查ICD-10诊断规范化行动可能存在的应用障碍和风险;通过医院信息管理系统后台数据库自动提取2017年6月—2020年10月不同阶段诊断种类的触发记录及规范化率,以及行动实施过程(2019年11月—2020年7月)中的咨询数据。结果83.1%(133/160)的调查对象认为推动基层医疗的诊断规范化非常重要。对应用ICD-10促进家庭医生签约服务的作用预期集中(50%以上选择率)在人群管理(59.4%,95/160)、风险分层(55.6%,89/160)和诊断质量(53.8%,86/160)。多重线性回归分析结果显示,干预特征中人群管理(群体干预)、风险分层、患者沟通、团队内部工作安排、诊断质量、基于管理人群的科研数据获取、建立患者信任感、与外部资源沟通对家庭医生签约服务有促进作用是推动基层医疗诊断规范化重要性的影响因素(P<0.05)。项目实施观察9个月中,总门诊诊断数为161.09万人次,通过微信咨询群提出的问题率仅为0.01%,频次最高的是信息系统操作相关(19.5%,38/195)。干预期间未新增需自定义的ICD外诊断名称,干预后大部分疾病诊断占比上升,诊断结构及顺位均有较大变化。结论基层医疗卫生机构有必要尽快实施诊断规范化干预工作;ICD-10是适宜的规范化分类工具;国家需加强对基层医疗相关数据化标准的协同研发和应用管理工作,为数据驱动的基层医疗服务业务奠定基础。
Background Population management is an important general practice service provided by primary care.The International Classification of Diseases(ICD)is a key diagnostic tool that is used to code and classify the morbidity data from patients'medical records,but is rarely used in primary care and research.Objective To investigate the use of ICD-10 in primary care and its associated factors based on analyzing the practices of community health care,Chengdu's Wuhou District,for achieving the standardization of diagnosis.Methods A questionnaire was designed in accordance with the constructs of the Consolidated Framework for Implementation Research,and used to investigate all the outpatient physicians and managers from 13 community health center(s CHCs)in Wuhou District,for understanding their perceptions of barriers and risks for achieving standardization of diagnosis by using the ICD-10.Through the back-end database of the hospital information system,trigger records and standardized rates of diagnoses made at different stages from June 2017 to October 2020,and consultation data during the application of ICD-10 between November 2019 and July 2020 were extracted.Results 83.1%of the respondents thought it was essential to promote the standardization of diagnosis in primary care.The effect of ICD-10 on the promotion of contracted family doctor service was expected to focus on population management(59.4%,95/160),risk stratification(55.6%,89/160)and diagnostic quality(53.8%,86/160).Multiple linear regression analysis showed that population management,risk stratification,patient communication,work arrangement within the team,diagnosis quality,scientific research data acquisition based on management population,establishment of patient trust,and communication with external resources promoted the signing service of family doctors were the influencing factors of promoting the standardization of primary medical diagnosis(P<0.05).During the use of ICD-10,the rate of questions raised by the consultation group was only 0.01%,mainly f
作者
黄艳丽
倪志刚
吴行伟
HUANG Yanli;NI Zhigang;WU Xingwei(Hospital Management Center of Wuhou District,Chengdu 610041,China;Chengdu Shangyi Active Health Technology Co.,Ltd,Chengdu 610041,China;Department of Pharmacy,Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital,Chengdu 610041,China)
出处
《中国全科医学》
CAS
北大核心
2021年第13期1607-1615,共9页
Chinese General Practice
基金
武侯区家庭医生签约服务重点科研项目(成武医管2020-A01)。
关键词
社区卫生服务
国际疾病统计分类
实施研究综合框架
真实世界研究
影响因素分析
Community health services
International Classification of Diseases(ICD)
Consolidated Framework for Implementation Research Constructs(CFIR)
Real world study
Root cause analysis
