中国全科医学2016，Vol.19Issue(34)：4178-4182,5.DOI:10.3969/j.issn.1007-9572.2016.34.006
上海市社区卫生服务中心舒缓疗护项目投入与产出效果评价研究
Evaluation of the Palliative Care Input and Output Effect of Community Health Service Centers in Shanghai
摘要
Abstract
Objective To systematically evaluate the efficacy of palliative care service offered by community health service centers(CHSCs)in Shanghai. Methods The data of this study were the results of a survey conducted in 18 CHSCs offering palliative care services in Shanghai and the health statistical and financial reports of relevant institutions. For evaluating the efficacy of palliative care service in Shanghai,we developed a ” structure - process - result” evaluation index system by ourselves,of which,the structure indicators include capital investment,establishment of institutions,beds arrangement, manning and so on;process indicators covered service quantity,service efficiency,employee growth and so forth;result indictors consisted of cost control,service efficacy,economic benefit of organization and so on. We selected part of the main quantitative indicators and analyzed and evaluated them. Results By the end of 2013,the total amount of capital invested in the palliative care project was 31. 96 million yuan,57. 58% of which was from the financial allocation of district and county. The 18 CHSCs arranged 234 palliative care beds,and had a medical staff of 295 persons,including 123 practicing physicians and 172 registered nurses with a doctor - nurse ratio of 1: 1. 40. The mean utilization rate and turnover time of palliative care beds was 43. 83% ,6. 49 times,respectively. The average hospital days of patients with palliative care were 26. 31 d. For discharged palliative care patients,the mean medical cost and mean daily cost of per bed was 5 500. 48 yuan,and 189. 67 yuan, separately. In 2013,the palliative care departments of the 18 pilot CHSCs earned 20. 397 8 million yuan,spent 28. 199 9 million yuan,lost 7. 802 1 million yuan,the average loss was 0. 433 4 million yuan. Conclusion The study showed that some problems exist in the 18 CHSCs offering palliative care service:the financing channel of palliative care is limited,and there is significant deficit in recent years;under the overall shortage of beds,the existing bed utilization rate is significantly lower;the total medical cost of per discharged patient is relatively lower,but the daily cost of per bed is higher. Therefore,we suggest strengthening the top - level design and governmental institutional guarantee,broadening the palliative care financing source, popularizing life education multidimensionally,improving the palliative charging items and adding them to medical insurance directory.关键词
舒缓疗护/社区卫生服务中心/评价研究/上海Key words
Palliative care/Community health service centers/Evaluation studies/Shanghai分类
医药卫生引用本文复制引用
荆丽梅,刘红炜,刘坤,杨超,李水静,白洁,舒之群,娄继权..上海市社区卫生服务中心舒缓疗护项目投入与产出效果评价研究[J].中国全科医学,2016,19(34):4178-4182,5.基金项目
国家自然科学基金资助项目（71503170）；上海市卫生和计划生育委员会课题（2015HP022，201540134，201540400）；浦东新区卫生计生项目 （）
