摘要目的:以北京朝阳医院医疗联盟为例，通过分析慢性病患者门诊就诊人次和次均门诊费用的变化情况，探究分级诊疗制度阶段性建设效果。方法:收集2014年和2016年北京朝阳医院医疗联盟内2个社区和医疗联盟外2个社区高血压患者在北京朝阳医院的27 983条诊疗记录，对门诊诊疗人次、次均门诊费用、次均药费，采用描述法和双重差分法进行数据分析。结果:实施医疗联盟慢性病管理后，联盟内社区高血压患者在三级医院的就诊人次和人数均有下降，幅度在30%左右；联盟内社区高血压患者在三级医院的门诊次均诊疗费用增长18.45元。结论:医联体建设初步起到引导慢性病患者回归社区的作用；医联体建设有利于医疗机构服务回归功能定位；城市医联体建设长效工作机制尚待形成。

abstractsObjective:With Beijng Chao-Yang hospital′s medical alliances taken as an example, to explore the outcomes of phased development of the hierarchical medical system via analysis of the changes of outpatient visits and average outpatient expenses of patients with chronic diseases.Methods:27 983 medical records of hypertensive patients of Chao-Yang hospital in 2014 and 2016 were collected from two communities within Chao-Yang hospital medical alliance and two communities outside. Outpatient visits, outpatient expenses per visit, and drug expenses per visit were analyzed. All these data were subject to descriptive method and double difference method in statistical analysis.Results:Since the implementation of chronic disease management program within the alliance, the number of visits and number of patients with hypertension in the experimental group decreased by about 30%, and the per-visit expenses of hypertensive outpatients within the alliance at tertiary hospitals increased by 18.45 yuan.Conclusions:The medical alliance has begun to help guide patients with chronic diseases to visit initially their community health centers; the alliance is conducive to the functional positioning of medical institutions; long-term working mechanism of urban medical alliances is yet to be formed.