行动者网络理论视角下区域医联体分级诊疗平台运行机制研究

Hierarchical medical system is the starting point for the construction of basic medical and health system in China. There are many obstacles existed in the pilot work of hierarchical medical system, and few studies have paid attention to the operative mechanism of hierarchical medical platform constructed by heterogeneous actors. Followed by the requirements of hierarchical medical system, started from the reality of regional medical alliance and combined with the research findings of the hetero-actors, by using questionnaire, content analysis and applied with the Actor-Network Theory (ANT), this program mainly focuses on the operative mechanism of hierarchical medical platform in regional medical alliance. The main research contents include: 1) research on the policy implications of hierarchical medical system; 2) study on the relationship between actors and heterogeneous actors in the pilot works of hierarchical medical platform; 3) find out the key elements which affect the coordination of heterogeneous actors on the hierarchical medical platform; 4) clarify the effects of key influencing factors and build the framework of operative mechanism; 5) propose the intervention tactics, reduce operating barriers, verify the effectiveness of interventions in aspects of diagnosis information sharing across regions and agencies, and build sustainable operation mechanism. This research satisfies the requirements of both theory and practice. Moreover, it not only enriches the research implications of operative mechanism of hierarchical medical platform in regional medical alliance, but also provides the theoretic and practical evidence for construction of hierarchical medical system.

分级诊疗制度是我国基本医疗卫生制度建设的切入点，分级诊疗试点工作中存在诸多障碍，研究较少关注异质行动者构建的分级诊疗平台运行机制。本项目遵循分级诊疗制度建设要求，从区域医联体建设实际出发，结合异质行动者构建平台的研究成果，采用问卷访谈、内容分析等定性研究方法，运用行动者网络理论及相关政策理论关注区域医联体分级诊疗平台运行机制问题。研究内容有：（1）研究分级诊疗制度政策内涵；（2）梳理和识别分级诊疗平台试点工作中异质行动者以及行动者间的关系；（3）挖掘影响分级诊疗平台中异质行动者协同的关键因素；（4）明确影响因素的作用效应并构建运行机制框架；（5）提出干预策略、削减运行障碍、验证干预效果在跨地域与跨机构就诊信息共建、共享方面的有效性，建立可持续运行机制。本项目契合理论与实践需求，不仅丰富和拓展既有医联体分级诊疗平台运行机制的研究内涵，也为分级诊疗就医秩序建立提供理论和实践依据。

分级诊疗制度是我国基本医疗卫生制度建设的切入点，分级诊疗试点工作中存在诸多障碍，研究较少关注异质行动者构建的分级诊疗平台运行机制。本项目遵循分级诊疗制度建设要求，从区域医联体建设实际出发，结合异质行动者构建平台的研究成果，采用问卷访谈、内容分析等定性研究方法，运用行动者网络理论及相关政策理论关注区域医联体分级诊疗平台运行机制问题。项目围绕如何促进跨地域、跨机构就诊信息共建、共享的建设目标，研究区域医联体分级诊疗平台运行机制问题，侧重分析平台众多行动者如何通过转译，重新界定每类行动者的利益、角色、功能和地位。.本项目，1）挖掘了分级诊疗制度政策内涵；2）明确了区域医联体分级诊疗平台运行机制的概念范围；3）梳理了行动者网络理论视角下区域医联体分级诊疗平台异质行动者以及核心行动者的构成；4）分析了区域医联体行动者网络结构；5）基于云南省第一人民医院实际情况，构建区域医联体行动者网络并实际开展对口帮扶工作；6）从实践中发掘医联体网络构建的难点；7）针对实际难点，提出科学的建议。.研究契合理论与实践需求，将医联体分级诊疗平台运行机制的理论研究与医联体网络的实际建设紧密结合在一起，并产生实际应用成果。通过研究，不仅丰富和拓展既有医联体分级诊疗平台运行机制的研究内涵，也为分级诊疗就医秩序建立提供理论和实践依据。