基于医疗数据中心的区域医疗协同模式研究

发布时间：2018-09-06 12:59

【摘要】：目的:本课题来源于国家“863计划”的“数字化”课题,研究目的就是为了探索区域医疗数据共享解决途径,探索具有一般性指导意义的区域医疗协同模式范式,并且相应地实证区域医疗协同模式设计和应用。因此,本课题立足国家医疗卫生发展趋势,瞄准有利于实现“首诊下沉、分级医疗以及双向转诊”的总体目标,致力于推动新形势下医疗体制改革事业,从更加有利于实现医疗公平并降低社会整体医疗成本而使人民群众能更方便快捷就医的角度而言,本研究课题具有重大的应用价值和社会意义。方法:本课题遵循管理研究课题一般思路,运用文献分析法、问卷调查法、访谈法、比较分析法、横断面调查法、归纳法、系统分析法、实证研究法、个案研究法、理论构建等方法,分析国内外区域医疗协同现状和存在问题以及经验启示;选择某市区域作为研究对象,调研医疗机构区域医疗协同信息化服务现状;在研究医疗数据中心一般个案的基础上,比较分析医疗数据中心的数据存储模式和数据分享模式区别,并运用“结构-功能”理论,概括区域医疗数据中心主要结构和功能及技术支撑;继而在协同理论和理论构建方法的指导下,提出区域医疗协同机构间三种协同形式和一般性区域医疗协同模式;最后以医院区域医疗协同信息化建设实践进行协同模式应用的实证研究。结果:一是明确医疗数据中心结构和功能;二是提出区域医疗协同三种形式:区域内多级医疗机构“纵向”医疗业务应用;异地不同等级医疗机构间的“远程”医疗业务应用;大型医疗机构间的“横向”医疗业务应用;三是在研究个案、总结共性的基础上归纳论证得出区域医疗协同一般性模式:”1+2+3+N”的一般模式,即一个区域医疗数据中心;两种协同:政策协同和质控协同;三种医院间协同三种形式;N种业务协同元素,包括一系列业务系统软件为载体的信息化协同等。结论:(1)全国各地区虽然各种区域医疗探索试点模式较多,但是总体上都存在顶层设计不足、规划不统一、信息化水平支撑不足、数据不规范难共享的问题,区域信息化服务水平调研数据,建立统一标准的医疗数据中心是区域医疗需要经历的阶段;(2)提出建立医疗数据中心“结构-功能”相统一,满足“五大核心功能”,以承载复杂的业务数据转换流;(3)提出区域医疗协同模式机构间协同的三种形式,具有更高的概括性;(4)提出“1+2+3+N”模式,即基于医疗数据中心的区域医疗协同模式,具有一般性的指导作用。
[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.
【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R-05

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