基于Donabedian模型的县域医共体同质化护理质量管理模式的应用实践

Construction and Practice of Homogeneous Nursing Quality Management Model in County Medical Consortium Based on Donabedian Model

摘要: 目的：构建符合县域特色的医共体同质化护理质量管理模式，提升基层医疗机构护理服务质量和患者满意度，进一步推进县域基层护理高质量建设。方法：选取重庆市黔江中心医院牵头的紧密型县域医共体内10家基层医疗机构(6家社区卫生服务中心、4家中心乡镇卫生院)为研究对象。基于结构、过程、结果三维质量结构(Donabedian模型)构建并实践一种以系统性同质化培训为核心的护理质量管理模式，对比该模式实施前后护理质量核心指标合格率及患者满意度变化，并分析不同类型基层医疗机构的成效差异。结果：经过该同质化护理质量管理模式为期1年的运行，基层机构护理质量核心指标均有所提升。基层机构护理安全管理平均合格率提升21.11%，临床护理质量管理平均合格率提升11.07%，护理文书书写质量平均合格率提升16.24%，住院患者满意度由(87.62 ± 3.99)分提升至(96.03 ± 1.91)分。结论：基于Donabedian模型的县域医共体同质化护理质量管理模式可有效提升基层医疗卫生机构护理质量与患者满意度，对推动基层医疗卫生机构护理服务能力整体提升具有重要实践意义。

Abstract: Objective: To construct a homogeneous nursing quality management model for medical consortiums tailored to county-specific characteristics, improve the quality of nursing services and patient satisfaction in primary medical institutions, and further advance the high-quality development of primary nursing care at the county level. Methods: Ten primary medical institutions (6 community health service centers and 4 central township health centers) within the compact county medical consortium led by Chongqing Qianjiang Central Hospital were selected as the research objects. Based on the three-dimensional quality structure of structure, process and outcome (Donabedian Model), a nursing quality management model centered on systematic homogeneous training was constructed and put into practice. The qualified rates of core nursing quality indicators and patient satisfaction before and after the implementation of the model were compared, and the differences in effectiveness among different types of primary medical institutions were analyzed. Results: After one year of operation of this homogeneous nursing quality management model, all core nursing quality indicators of the primary medical institutions were improved. The average qualified rate of nursing safety management in primary medical institutions increased by 21.11%, that of clinical nursing quality management by 11.07%, and that of nursing document writing quality by 16.24%. The inpatient satisfaction score increased from (87.62 ± 3.99) to (96.03 ± 1.91). Conclusion: The homogeneous nursing quality management model for county medical consortiums based on the Donabedian Model can effectively improve the nursing quality and patient satisfaction of primary medical and health institutions, and has important practical significance for promoting the overall improvement of nursing service capacity of primary medical and health institutions.