【作者】 张璞；

【导师】 杜纲；

【作者基本信息】 天津大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 本文以社区卫生服务组织为研究对象,借鉴国内外社区卫生服务的先进经验,根据我国社区卫生服务的现实状况,归纳出我国社区卫生服务组织的两种网络结构:三级网络结构和四级网络结构。三级网络结构在中小型城市普遍存在,即街道有社区卫生服务中心,居委会有社区卫生服务站,户有家庭责任医生的社区卫生服务网络;四级网络结构适合在大城市推广,即在三级网络结构的基础上,增加区级的社区卫生服务指导中心,形成覆盖全区,统一指导协调的社区卫生服务网络。本文将轴辐式网络研究方法拓展到社区卫生服务网络研究中,在我国现有社区卫生服务网络的基础上,建立了社区卫生服务组织的轴辐式网络模型。通过模型结果分析,将社区卫生服务中心分为枢纽型和非枢纽型两类,在街道一级构成一个社区卫生服务中心的轴辐式网络。同时,社区卫生服务中心和服务站之间本身就是一个轴辐式网络结构。本文所构造的轴辐式网络与之相互配合,使其结构更加紧凑,网络服务更加便利。如此,在总体上便形成一个五级网络结构,即区有社区卫生服务指导中心,街道有枢纽型社区卫生服务中心和非枢纽型社区卫生服务中心,居委会有社区卫生服务站,户有家庭责任医生的社区卫生服务网络。两类社区卫生服务中心各自有不同的基础条件和发展方向。枢纽型中心重视医疗服务,并为非枢纽型中心提供指导和帮助,共享先进设备;非枢纽型中心重在开展公共卫生服务,为社区居民提供全面的康复和预防保健等服务。本文在矩阵型组织结构的基础上,分别为两类社区卫生服务中心设计了相适的组织结构。不同的组织形式需要有不同的管理方式与之配套。本文基于五级网络结构下的社区卫生服务组织形式,建立了相应的内外部联动模式,即非枢纽型社区卫生服务中心与枢纽型社区卫生服务中心的联动,社区卫生服务中心与社区卫生服务指导中心的联动以及社区卫生服务中心通过社区卫生服务指导中心与其他大型医院的联动。并基于内外部联动模式下的矩阵型组织绩效指标体系提出了建立枢纽型社区卫生服务中心和非枢纽型社区卫生服务中心组织绩效指标体系的方法。更多还原

【Abstract】 In this paper, community health service organizations were to study. Learned from the advanced experience of community health service at home and abroad, according to the actual situation in China, we summarized two network structures of community health service organizations: three-tier network architecture and four-tier network architecture. Three-tier network architecture was prevalent in the small and medium sized cities. There?re community health service centers in the streets, community health service stations in the neighborhood committees, family physicians with family responsibilities in three-tier network architecture. Four-tier network architecture was suitable for promotion in major cities. It increased community health service guidance centers to the three-tier network architecture, covered the whole region, unified guidance and coordination of community health service network.This paper added hub-and-spoke network research methods to community health service network to expand research, established a hub-and-spoke network model of community health service organizations based on the existing community health service network. By analysising the model, we divided the community health service center into two categories: hub center and non-hub center, created a hub-and-spoke network of community health service centers in the streets. Meanwhile, the community health service centers and service stations had formed a hub-and-spoke network structure. The hub-and-spoke network of community health service centers coordinated with this hub-and-spoke network, make it more compact in structure and more convenient for internet services. In general, a five-tier network architecture would be constituted, which contained hub centers and non-hub centers in the streets based on four-tier network architecture.The two categories have different basic conditions and future directions. Hub centers pay more attention to medical services, provide guidance and help to non-hub centers, sharing of advanced equipment; non-hub centers lie in public health services, provide comprehensive rehabilitation and preventive health care services to residents. This paper designed appropriate organizational structures for the two categories based on matrix-type organizational structure.Different management methods required to accompany different organizational forms. Based on the five-tier network architecture of community health service organizations, the corresponding internal and external linkage model was established in this paper. The model provided linkage between non-hub centers and hub centers, between community health service centers and community health service guidance centers, and provided linkage between community health service centers and other large hospitals through the community health service guidance centers. This paper also provided the method to create appropriate performance indicators systems of hub centers based on the matrix-type organizational performance indicators system under the internal and external linkage model.更多还原