目的：了解家庭医生制服务模式实施前后家庭病床（家床）服务情况的变化，为优化社区卫生服务提供依据。方法收集2009年1月—2014年12月上海市虹口区全部8家社区卫生服务中心的家床服务报表数据及工作资料。采用回顾性调查方法，对家庭医生制服务模式实施前后的家床服务工作量、质控考核结果、患者医保结算费用等数据进行比较分析。结果家庭医生制服务模式实施前后3年，家床服务年建床总数增加720张，上升14.68%（720/4906）；专职家床医生减少28人，下降50.00%（28/56）；充实家庭医生124人；家床医生总数增加152人，上升171.43%（96/56）；家床医生人均建床数减少51张次，减负57.95%（51/88）；平均每名家床医生每月上门诊疗数减少84次，减负58.74%（84/143）。家床服务质控考核平均分提高2.03分，上升2.18%（2.03/92.95）；其中，管理质量提高1.70分，上升4.40%（1.70/38.64）；病史质量提高0.51分，上升1.34%（0.51/38.17）；护理质量降低0.18分，下降1.11%（0.18/16.15）。家床服务年医保结算支付增加192.57万元，上升21.31%（192.57/903.49）；医保结算人次增加725人次，上升21.06%（725/3443）；人均建床天数减少5 d，下降3.50%（5/143）；人均医保费用减少5.56元，下降0.21%（5.56/2624.14）；人均床日费减少0.77元，下降4.20%（0.77/18.35）。结论实施家庭医生制服务后，家床服务医生数增加，年建床总数和赴家床诊疗数增加，而人均建床数和上门诊疗数减少；管理和病史质量提高，护理质量降低。在医保费用方面，家床服务的医保支付、结算人次增加，但是人均医保费用和床日费减少。家庭医生制对家庭病床服务有积极的促进作用，但仍需不断完善。%Objective To explore the changes of home sickbed service before and after the implementation of family doctor service mode,in order to provide references for the optimization of community health service. Methods From January 2009 to December 2014,we collected report data and working data of home sickbed service of all 8 community health service centers in Hongkou District in Shanghai. Retrospective investigative method was employed to analyze the home sickbed service volume,quality control evaluation result,medical insurance settlement fee of patients and other data before and after the implementation of home doctor service mode. Results By comparison of the annual average indexes between the three years before and the three years after implementation of family doctor service,we found the following changes. The annual number of home sickbeds increased by 720,an increase of 14. 68% (720 / 4 906);the number of full - time home sick - bed doctors decreased by 28,a decrease of 50. 00% (28 / 56);the number of family doctors increased by 124;the total number of home sickbed doctors increased by 152,an increase of 171. 43% (96 / 56);the number of sickbeds per family doctor decreased by 51,a decrease of 57. 95% (51 / 88);the monthly times of home visit per doctor decreased by 84,a decrease of 58. 74% (84 / 143);the average score of home sick bed service quality control evaluation increased by 2. 03,an increase of 2. 18% (2. 03 / 92. 95);the score of management quality increased by 1. 70,an increase of 4. 40% (1. 70 / 38. 64);the score of medical history quality increased by 0. 51,an increase of 1. 34% (0. 51 / 38. 17);the score of quality of care decreased by 0. 18,an decrease of 1. 11% (0. 18 / 16. 15);the medical insurance settlement fee of home sickbed service increased by 1 925. 7 thousand,an increase of 21. 31% (192. 57 / 903. 49);the person - times of medical insurance settlement increased by 725,an increase of 21. 06% (725 / 3 443);the average days with home sickbed per person decreased by 5 days,a decrease of 3. 50% (5 / 143);the average medical insurance expense per person decreased by 5. 56 yuan,a decrease of 0. 21% (5. 56 / 2 624. 14);daily expense of sickbed per person decreased by 0. 77 yuan,a decrease of 4. 20% ( 0. 77 / 18. 35 ) . Conclusion After the implementation of family doctor service system,the number of home sickbed doctors has increased,and annual number of home sickbeds and the times of home visits have increased,while the per capita number of sickbeds and per capita times of home visits have decreased. The quality of management and medical history has increased,while quality of care has decreased. In the aspect of medical insurance expense,medical insurance expense of home sickbed service and person times of settlement have increased, while per capita medical insurance expense and daily sickbed expense have decreased. Family doctor system could promote the development of home sickbed service,and further improvement should be made in future practice.
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