基于建立分级诊疗制度目标的家庭医生队伍建设研究

Focusing on the capacity of providing health services of family doctors, this project aims to build a tiered-system of disease diagnosis and treatment through a mixed method of literature review, theoretical research and empirical surveys. Based on the functions of primary health facilities, the responsibilities and capacity of family doctor workforce in China will be defined, and the principles, standards and an evaluation system of the capacity of providing health services of family doctors will be built. By conducting empirical surveys and assessment, the status quo of family doctor capacity will be evaluated, and the factors that influence capacity improvement and performance of family doctors will be analyzed, including economic, social, institutional, policy and behavior factors. Furthermore, data derived from the Sixth National Health Services Survey (2018) will be used to analyze the status quo, willingness, expectation and influencing factors of urban and rural residents receiving services provided by family doctors and obeying rules of the tiered-system of disease diagnosis and treatment, and to explore the principal factors that affecting capacity improvement of family doctor workforce. Grounded in the reality that the overall quality of primary health workforce is relatively low in China, this project intends to use the theory of planned behavior to identify mechanisms and measures of triggering enthusiasm and conducting vertical integrated care. The outcomes of this project will assist in effectively improving the capacity of providing health services of family doctor workforce, promoting the establishment of a tiered-system of disease diagnosis and treatment, and realizing the goal of building Health China.

本项目以建立分级诊疗制度为目标、以家庭医生卫生服务能力为核心，采用文献研究、理论研究和实证调查相结合的方法，基于基层卫生机构功能定位，界定我国家庭医生队伍的职能定位和能力要求，构建家庭医生卫生服务能力原则、标准和评价体系，并通过实证调查与评估，对家庭医生的能力现状进行评价，对影响家庭医生能力提升和能力表现的经济、社会、组织管理、政策、行为等因素进行分析；同时，利用第六次国家卫生服务调查资料，对城乡居民接受家庭医生服务、遵守分级诊疗规范的现状及意愿、期望、影响因素等，进行分析，探讨影响家庭医生队伍服务能力提升的主要因素。结合我国基层卫生队伍总体素质不高的现实，应用计划行为理论，研究调动积极性、开展纵向协作服务等机制和措施，以期更有效地提升家庭医生队伍的服务能力，促进我国分级诊疗制度建立和健康中国建设目标的实现。

在国家十三五医改规划中，明确了我国基本医疗卫生制度的基本框架，分级诊疗制度成为国家基本医疗卫生制度的关键。要实现分级诊疗制度建设目标，基层卫生队伍建设至关重要。为此，项目组选择以家庭医生队伍建设为突破口推进分级诊疗制度目标的实现，开展了深入的研究。本项目研究内容主要包括：（1）家庭医生职能定位和能力要求；（2）家庭医生服务能力标准与评价体系构建；（3）家庭医生队伍现状和分级诊疗服务运行情况调查；（4）家庭医生能力建设方案和政策措施建议。.课题组通过理论与实证研究，构建了家庭医生卫生服务能力评价指标体系，并开展了实证评价。结果显示：（1）我国基层卫生队伍整体素质不高，城乡差别明显。农村基层医生中，本科及以上学历仅占25.2%，远低于城市基层（50.8%），持执业（助理）医师资质人员占比56.5%，城市地区为74.2%，城乡地区差距明确。（2）我国基层医生的卫生服务能力，能基本满足卫生服务需要。城乡基层医生的基本医疗和公共卫生服务能力具备情况总体上较好，基本具备处理城乡居民日常健康问题的能力。基层医生卫生服务能力的主要短板在于危急重症应急处置、社区康复、中医药服务等方面。（3）基层医生的卫生服务能力，受实践训练的影响较大。基层医生卫生服务能力具备比例，呈现越到基层越高、农村高于城市的趋势，与医生的学历层次、执业资质联系不大，应该与实践锻炼有较大关系。（4）分级诊疗制度目标的实现，需要建立整合型卫生服务体系。在推进分级诊疗制度过程中，除了要加大基层卫生队伍建设力度外，更需要强化整合型卫生服务体系的建设，实现医院和基层卫生机构间卫生服务的有效协同，以支持基层卫生机构承担起“健康守门人”的责任。.基于研究发现，课题组提出了一系列加强基层卫生队伍建设、提升医生卫生服务能力的政策建议，为推进我国分级诊疗制度目标的实现，将具有重要的指导意义。