摘要分析了县域内分级诊疗实施过程中的关键环节和主要挑战,即服务、医保、信息和管理4个方面.以县域医共体连续性服务为切入点,阐述了连续性服务的概念与应用,包括指导和规范县乡两级医护人员跨机构服务的连续性路径;增强协作动力的整合型支付;促进技术性和非技术性信息传递及时性和有效性的信息互联互通;建立起配套保障和运行机制的"三维双向"管理模式.各地可根据实际情况逐步推进,转变各方的理念与行为习惯,最终完成分级诊疗这项长期、复杂的系统性工程.

abstractsThis study analyzed the key links and main challenges in the implementation of hierarchical medical system within the county, namely such aspects as medical services, medical insurance, information and management. We took the continuity of medical care in countywide medical community as an entry point, in order to expound the concept and application of continuous service. This program covers continuous clinical pathway guiding and normalizing the inter-agency services between county and township level medical staff;the integrated payment strengthening the motivation of collaboration; the interconnected information promoting timeliness and effectiveness of technical and non-technical information transfer; and the three-dimensional and bi-directional management mode of the supporting and operating mechanisms. Local governments can propel the program gradually according to the actual situation, change the ideas and habits of each parties, and eventually achieve a long-term, and complex systematic hierarchical medical system.