信息化视角下上海市家庭医生有效履约困境分析及路径构建

Predicament analysis and path construction of the effective contract fulfillment of family doctors in Shanghai from the perspective of informatization

  • 摘要:
    目的 基于信息化视角,系统探究上海市家庭医生有效履约的实践现状、核心困境与优化路径,为签约服务高质量发展提供实证支撑与政策参考。
    方法 采用混合研究方法,通过政策文件梳理、关键知情人深度访谈,以及对全市16个区的45家社区卫生服务中心的问卷调查,明确有效履约内涵、信息化支撑现状及需求优先级。
    结果 上海市家庭医生签约服务已形成“做准签约”与“做实服务”双核心框架,但仍存在系统互联互通不足、健康信息整合滞后、服务触达工具单一等问题。在45家受访的社区卫生服务中心中,信息化整合端综合使用率仅为50.74%。医院信息系统(HIS)与公共卫生系统的签约状态横向联通、“医-防-管”信息整合、健康评估自动生成为3大核心需求。基于此,本研究构建了“标签生成-任务管理-服务触达-数据回流”的闭环履约路径。
    结论 为促进签约服务高质量发展,建议转变签约服务理念,确立以个人整体健康为服务对象的服务视角(全人视角),并依托信息化建设促进医防融合;加强市级顶层设计和区级平台建设,完善数据治理和应用;大力培养业务与信息化复合型人才,强化业务与信息工作融合。

     

    Abstract:
    Objective To systematically explore the current practical status, core predicaments, and optimization paths of effective contract fulfillment by family doctors in Shanghai from the perspective of informatization, and to provide empirical support and policy references for the high-quality development of contracted services.
    Methods A mixed research approach was adopted. The connotation of effective contract fulfillment, the current status of informatization support, and the priority of demand were comprehensively analyzed through policy document review, in-depth interviews with key informants, and a questionnaire survey covering 45 community health service centers across all 16 districts of Shanghai.
    Results The family doctor contract service in Shanghai has formed a dual-core framework of “accurate contracting” and “substantive service delivery”, yet challenges persist in system interoperability, health data integration, and the limited diversity of service outreach tools. The comprehensive utilization rate of the information integration terminal in the 45 surveyed community health service centers was merely 50.74%. Three prioritized demands were identified: horizontal connectivity between the Hospital Information System (HIS) and the public health system for contract status updates, integration of “medical-prevention-management” information, and automated generation of health assessments. Based on these findings, this study proposed a closed-loop fulfillment pathway of “tag generation-task management-service delivery-data return”.
    Conclusion To facilitate the high-quality development of contracted services, it is recommended to transform the concept of contracted services and promote the integration of medical care and disease prevention through information system construction from a holistic perspective. Concurrently, municipal top-level design and district-level platform development should be reinforced to refine data governance and application. Furthermore, substantial efforts should be devoted to cultivating interdisciplinary talents bridging clinical practice and information technology, thus strengthening the convergence of clinical and information operations.

     

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