医生工作生态视角下的分级诊疗机制建模与实证研究

项目名称： 医生工作生态视角下的分级诊疗机制建模与实证研究

项目编号： No.71503040

项目类型： 青年科学基金项目

立项/批准年度： 2016

项目学科： 管理科学

项目作者： 谢波

作者单位： 东南大学

项目金额： 18万元

中文摘要： 影响我国临床医生满意度和稳定性，导致患者“看病难”的重要原因之一是未能实现有序诊疗，缺乏对各级各类医生工作生态（工作性质、工作内容和工作环境）的科学界定，进而缺乏可操作性的分级诊疗标准、程序、管理和监督机制。分级诊疗是一个涉及宏观社会环境，微观心理、工作因素的复杂系统，以往的研究多局限于政府层面、制度层面，以及卫生服务供给层面，而从系统和生态角度，从医生工作层面考虑的较少。本研究基于生态系统理论和医生工作生态视角，应用系统动力学分析方法，将医生及其工作生态环境作为整体并置于分级诊疗系统，进行医生工作生态的理论界定和作用机制的探讨,构建医生工作生态机制和分级诊疗机制的数学模型并进行实证验证，寻找医生最佳工作“生态区”，为我国建立分级诊疗机制，提高医疗服务的及时性和连续性,促进和完善医疗机构卫生服务体系建设以及创建合理有序的医疗环境提供理论和技术支持。

中文关键词： 分级诊疗；系统动力学；生态学；医疗保险制度；卫生改革

英文摘要： Failure to achieve orderly diagnosis and treatment is one of the important factors that influence doctors' satisfaction and social stability in our country and is one of the important reasons leading to difficulties of patients in getting medical treatment. Also, working ecology of all kinds of doctors at all levels hasn't been defined scientifically including the nature and content of their work and their working environment. Furthermore, we lack practical hierarchical diagnosis and treatment standards, procedures, management and oversight mechanisms. Hierarchical diagnosis and treatment is a complex system involving macro-social environment, micro-psychology and work factors. System dynamics and ecosystems are important methods and tools to conduct complexity science research, and they can be used to conduct comprehensive research on a large, complex multi-level multi-sectoral system. Based on systematical analysis theory and working ecology of doctors, this research puts an integrity of doctors and their working ecological environment into hierarchical diagnosis and treatment system and theoretically defines and discusses the working mechanism of doctors' working ecology from both the macro and micro level. By researching on factors that influence hierarchical diagnosis and treatment, constructing and verifying doctors’ working ecology mechanism and mathematical model to define hierarchical diagnosis and treatment by empirical evidences, this research tries to explore the optimal working ecological zone of doctors. Thus, it provides coping strategies to the hierarchical diagnosis and treatment mechanism in China. Moreover, it provides theoretical and technical support to improve timeliness and continuity of medical services, to promote the construction of grassroots medical institutions and health service system, and to create a reasonable and orderly medical environment.

英文关键词： Hierarchical diagnosis and treatment ;System Dynamics;Ecology;Medical Insurance;Health reform