为化解城市内部医疗资源利用“倒三角”和居民就医需求“正三角”之间的对立关系，结合分级诊疗模式的主要特征，探讨社区卫生机构交通可达性主要影响因素的选取依据，通过剖析步行交通阻抗的构成要素及其作用范围有针对性地设计了测度交通可达性的改进潜能模型，将该模型应用于西安市城三区社区卫生机构交通可达性的实证分析。研究表明：准确衡量步行交通阻抗是分级诊疗模式下城市社区卫生机构交通可达性测度建模的关键点，而步行交通阻抗系数的确定需要同时考虑路段通行条件和交叉口过街设施条件；西安市城三区社区卫生机构的交通可达性呈现不均衡空间分布特征，其成因可归结为规划政策调整带来的医疗资源暂时性短缺、土地供给不足造成的设施选址不合理以及复杂城市道路环境引发的步行就医交通阻碍；因此，决策部门在构建城市分级诊疗体系时应科学合理规划社区卫生机构。%The grading treatment system (GTS)is considered an effective solution to defuse the antagonistic relations between the use of medical resources and the residents′medical treatment demands in Chinese cities,as well as to ease the faults in urban ordinary medical services.Since the urban community health institutions (UCHIs ) undertake the first diagnosis and transfer treatment in GTS,they are basic elements of GTS and their accessibilities ought to be accurately detected so as to evaluate the development of GTS. Therefore, the influential factors of accessibility of UCHIs are deliberately selected according to the general characteristics of GTS, and then the improved potential model to detect the accessibility of UCHIs is established with the analysis of pedestrian traffic impedance and its function range.At last,a case study of Xi′an city is done through the employment of the model established above.The research results indicate that accurate detection of pedestrian traffic impedance is the critical point for the accessibility modeling of UCHIs based on GTS,while both the road section conditions and crossing facilities at intersections contribute to the calculation of pedestrian traffic impedance. There is an unbalanced spatial distribution of accessibility of UCHIs in Xi′an downtown due to the temporary medical resources shortage during planning policies changing, the unreasonable site selection caused by the lack of land resources,and the variations of hospitalizing obstacles in complicated urban road system.It is suggested that traffic geography supports to the administrative planning of UCHIs under GTS will be gained with the help of this research.
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