互联网背景下城市家庭医生服务能力建设研究

发布时间：2018-01-11 18:24

本文关键词：互联网背景下城市家庭医生服务能力建设研究　出处：《中国科学技术大学》2017年博士论文　论文类型：学位论文

【摘要】：家庭医生制度创新是中国医改的一个重要基础,它着力于解决中国医改的三大基础性问题。即如何构建以社区服务为基础的新型城市医疗服务体系,实现"社区首诊、双向转诊、逐级诊疗"的政策目标,最终解决由供需失衡导致的"看病难"问题和过度就医导致的"看病贵"问题。同时如何适应我国当前医学模式的转变和人口老龄化的现实状况,突破目前防治分离的传统服务模式,真正做到防治结合,从而整体提高医疗卫生服务的质量和效率。互联网医疗呈现了强劲的发展势头,互联网成为我国解决"看病难,看病贵"的关键要素之一,能为家庭医生的诊疗能力提供强大的临床决策辅助系统和技术性指导。新技术的发展,实现人的数字化能力与数字资源的无缝集成与利用,建立人与计算机系统之间更为紧密、更富成效的伙伴关系,提供了"人机协同"的可能性,可以让家庭医生得到前所未有的医疗卫生信息系统的帮助。随着移动互联网的发展和普及,家庭医生甚至能够随时随地的获得外部信息系统和其他高水平医生的实时指导。在医疗卫生领域,家庭医生是最适宜也是最需要开展"人机协同"研究的对象。家庭医生的性质和在医疗服务体系中所处的位置,让家庭医生在处理问题方面不同于专科医生。家庭医生往往"单独作战",在实际工作中,很难在物理空间中形成与同事的协同配合和技术支持。家庭医生面对的问题也是点多面广,相应的,对知识结构和能力要求,也是要具备足够的宽度和广度,在此基础上增加深度提升精度。借助互联网技术,实现家庭医生的"人机协同",对于提升家庭医生的服务能力具有重要意义,但是国内较少有研究关注互联网背景下的家庭医生服务能力建设研究。本研究通过梳理国内外家庭医生制度演变过程和归纳国内部分地区家庭医生试点情况,系统介绍了家庭医生制度实践发展的具体情况。通过从制度经济学、福利经济学、管理心理学等多学科角度对家庭医生制度的构建进行了理论分析。采用多源流理论的研究方法和视角对我国家庭医生制度建设和政策出台过程进行分析和总结。在定性研究基础上,通过对合肥市包河区和蜀山区内家庭医生现状进行问卷调查,归纳总结了家庭医生的实践运行情况。结合文献分析,对影响家庭医生服务能力建设的隐性变量进行构建的测量,对相关关系和作用进行回归分析,对结果进行讨论,并提出研究结论。在对家庭医生服务能力隐性影响因素的论证下,结合对我国家庭医生的服务模式、服务内容进行的分析和对我国互联网医疗发展的模式进行归纳总结。在此基础上,针对服务模式和服务内容所指向的服务能力,在人机协同理念指导下,提出互联网背景下我国家庭医生服务能力提升的意见建议和实现路径。
[Abstract]:The innovation of family doctor system is an important foundation of Chinese medical reform. It focuses on solving the three basic problems of Chinese medical reform, that is, how to build a new urban medical service system based on community service. Realize the policy goal of "community first consultation, two-way referral, step by step diagnosis and treatment". Finally solve the problem of "difficult to see a doctor" caused by imbalance between supply and demand and "expensive" caused by excessive medical treatment. At the same time, how to adapt to the change of current medical model and the reality of aging population in China. Break through the traditional mode of prevention and treatment separation, truly achieve the combination of prevention and treatment, so as to improve the overall quality and efficiency of health services. Internet medical care has shown a strong momentum of development. The Internet has become one of the key elements to solve the problem of "difficult and expensive to see a doctor" in our country. It can provide powerful clinical decision support system and technical guidance for the diagnosis and treatment ability of family doctors, and the development of new technology. To realize the seamless integration and utilization of human digital capability and digital resources, to establish a closer and more effective partnership between human beings and computer systems, and to provide the possibility of "man-machine cooperation". Family doctors can be helped by unprecedented medical and health information systems. With the development and popularity of the mobile Internet. Family doctors even have access to external information systems and real-time guidance from other high-level doctors anytime and anywhere. In the field of health care. Family doctor is the most suitable and the most need to carry out "man-machine coordination" research object, family doctor's nature and position in the medical service system. Let family doctors deal with problems differently from specialists. Family doctors often "work alone" in practice. It is difficult to form cooperation and technical support with colleagues in the physical space. Family doctors are faced with a wide range of problems, corresponding to the knowledge structure and ability requirements, but also to have enough width and breadth. On this basis, it is of great significance to improve the service ability of family doctors by increasing the depth of accuracy and realizing the "man-machine cooperation" of family doctors with the help of Internet technology. However, there are few researches on the capacity building of family doctor service under the background of Internet. This study summarizes the experimental situation of family doctor in some areas of China by combing the evolution process of family doctor system at home and abroad and summing up the pilot situation of family doctor in some regions of China. This paper systematically introduces the specific situation of the practice and development of the family doctor system through institutional economics and welfare economics. From the perspective of management psychology, this paper makes a theoretical analysis on the construction of family doctor system, and analyzes and summarizes the process of family doctor system construction and policy promulgation in China from the perspective of multi-source theory. On the basis of qualitative research. Based on the questionnaire survey of family doctors in Baohe District and Shushan District of Hefei City, this paper summarizes the practice of family doctors and analyzes the literature. To measure the hidden variables that affect the construction of family doctors' service capacity, to analyze the correlation and effect, and to discuss the results. And puts forward the research conclusion. Under the demonstration to the family doctor service ability recessive influence factor, unifies to our country family doctor service pattern. On the basis of the analysis of service content and the summary of the mode of development of Internet medical treatment in China, under the guidance of man-machine coordination concept, the service mode and service capability are pointed out. This paper puts forward some suggestions and ways to improve the service ability of family doctors in China under the background of Internet.
【学位授予单位】：中国科学技术大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R197.1

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