基于熵权TOPSIS法的县域医共体改革进展评价

目的评价全国200个县域医共体改革进展,挖掘县域医共体改革经验。方法采用熵权TOPSIS法对县域医共体改革进展进行综合评价,采用案例分析方法寻找县域医共体改革共性经验。结果权重占比前5位的县域医共体改革进展指标分别为统一后勤服务(8.76%)、统一绩效考核(7.82%)、统一信息化平台(6.94%)、统一财务(6.47%)、统一人力资源管理(5.10%)。紧密型县域医共体(平均Ci=0.403,排序为99.5)改革进展快于松散型医共体(Ci=0.391,排序为102)。熵权TOPSIS综合评价结果表明,山东省A医院、浙江省B医院、福建省C医院3个县级医院为县域医共体改革进展最优的3个县级医院。县域医共体改革进展最优医院的主要经验为政府主导,法人制度变革,政府全面赋能医共体,但其对于服务能力和质量的提升关注较少。结论在县域医共体建设过程中,应考虑到医共体内各成员单位业务范围的适配,并注重基层医疗卫生服务能力的提升。建议进一步推进紧密型县域医共体改革,促进分级诊疗格局形成。

Evaluation of the Progress of County Medical Alliance Reform Based on Entropy TOPSIS

Objective To evaluate the progress of the reform of the medical alliance in 200 counties,and to explore the experience of reforming the county medical alliance in China.Methods Entropy TOPSIS method was used to comprehensively evaluate the progress of county medical alliance reform,and case analysis method was used to find the common experience of county medical alliance reform.Results The top five county medical alliance reform progress indicators with weights are unified logistics services(8.76%),unified performance assessment(7.82%),unified information platform(6.94%),unified finance(6.47%)and unified manpower resource management(5.10%).The reform of the compact county medical alliance(average C_i=0.403,ranking 99.5)is faster than the loose type medical alliance(C_i=0.391,ranking 102).Entropy weight TOPSIS comprehensive evaluation results show that the three county-level hospitals of A hospital in Shandong Province,B hospital in Zhejiang Province and C hospital in Fujian Province are the three county-level hospitals with the best progress in the reform of county medical community.The main experience of the county-level medical community reform progress is that the best hospitals are government-led,the legal person system is reformed,and the government fully empowers the medical alliance,but it pays less attention to the improvement of service capabilities and quality.Conclusion During the construction of the county medical alliance,consideration should be given to the adaptation of the business scope of each member unit within the medical alliance,and attention should be paid to the improvement of primary medical and health service capabilities.It is recommended to further promote the reform of the close county medical alliance and promote the formation of a hierarchical diagnosis and treatment pattern.