目的：系统评价上海市社区卫生服务中心舒缓疗护服务的效果。方法资料来源于上海市18家社区卫生服务中心开展舒缓疗护服务的调查结果、相关机构的卫生统计报表和卫生财务报表。自行设计上海市舒缓疗护评价的“结构-过程-结果”评价指标体系，其中结构指标包括资金投入、机构及床位设置、人员配备等；过程指标包括服务量、服务效率、员工成长等；结果指标包括费用控制、服务效果、组织经济效益等。本研究选取部分主要的量化指标进行分析评价。结果截止到2013年底，舒缓疗护项目资金投入总额为3196万元，其中区县财政占57.58%。18家社区卫生服务中心共设舒缓疗护住院病床234张，共有舒缓疗护医护人员295人，其中执业医师123人，注册护士172人，医护比为1：1.40。试点社区卫生服务中心舒缓疗护平均病床使用率为43.83%，平均病床周转次数为6.49次，平均住院天数为26.31 d。每例舒缓疗护出院患者的平均医药费用为5500.48元，平均床日费用为189.67元。2013年18家试点社区卫生服务中心舒缓疗护科室收入2039.78万元，支出2819.99万元，亏损了780.21万元，平均亏损43.34万元。结论舒缓疗护服务筹资渠道单一，短期内赤字明显；现有床位使用率偏低；出院患者医疗费用较低，但床日费用相对较高。建议加强顶层设计和制度保障，拓宽舒缓疗护筹资来源渠道；多维度普及生命教育；完善舒缓疗护收费项目并纳入医保目录。%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.
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