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14家医院细菌真菌感染诊治能力建设的定性比较
发布人：yaot 发布时间：2022/12/16 11:35:16 浏览次数：1022次
——马丽平 李娜 熊康 吴奇飞 杨威 孙晓宇 刘倩楠
【摘要】目的 探究我国二级以上医院细菌真菌感染诊治能力建设的影响因素及路径，为医院感染科建设提供依据。方法 基于三力模型，运用清晰集定性比较分析法，分析5省14家二级以上医院细菌真菌感染诊治能力建设的因素组态及作用机制。结果 形成3条影响医院细菌真菌感染诊治能力建设的路径。路径1：领导支持+配套政策+政策重视程度+会诊价值感受；路径2：领导支持+政策重视程度+培训和学习机制；路径3：领导支持+培训和学习机制+会诊价值感受。路径1属于政策驱动机制，路径2和路径3属于自主提升机制。结论 领导支持是二级以上医院细菌真菌感染诊治能力建设的关键。政策驱动机制和自主提升机制分别从外部和内部影响二级以上医院细菌真菌感染诊治能力建设。
【关键词】二级以上医院；细菌真菌感染；诊治能力；清晰集定性比较分析；三力模型
中图分类号：R197.323；R37 文献标识码：A
Qualitative Comparison of Capacity Construction for Diagnosis and Treatment of Bacteria and Fungi Infections in 14 Hospitals/MA Liping,LI Na,XIONG Kang,et al.//Chinese Health Quality Management，2022,29(11):30-33,38
Abstract Objective To explore the influencing factors and path affecting the diagnosis and treatment ability of bacteria and fungi infections in secondary and above hospitals, so as to provide evidence for the construction of infectious diseases department in hospital.Methods Based on the model of "Ability, Power and Pressure", the crisp-sets Qualitative Comparative Analysis was used to analyze the factor configuration and mechanism of bacteria and fungi infection diagnosis and treatment capacity construction in 14 secondary and above hospitals in 5 provinces.Results Three pathways affecting the capacity construction of diagnosis and treatment of bacteria and fungi infections were formed. Path 1: leadership support + supporting policies + policy emphasis + consultation value perception; Path 2: leadership support + policy emphasis + training and learning mechanism; Path 3: Leadership support + training and learning mechanism + consultation value perception. Path 1 belong to policy-driven mechanism,path 2 and path 3 belong to autonomous promotion mechanism.Conclusion Leadership support is the key factor affecting the diagnosis and treatment of bacteria and fungi infection in secondary and above hospitals. The policy-driven mechanism and autonomous promotion mechanism affect the capacity construction of diagnosis and treatment of bacteria and fungi infections in secondary and above hospitals externally and internally, respectively.
Key wordsSecondary and above Hospitals;Bacteria and Fungi Infection; Diagnosis and Treatment Capacity;the Crisp-sets Qualitative Comparative Analysis; Model of "Ability, Power and Pressure"
Firstauthor's addressNational Institute of Hospital Administration, National Health Commission, Beijing,100044, China
感染性疾病是由细菌、真菌、病毒等致病微生物引起，会对人类健康造成严重威胁。2003年“非典”疫情暴发后，我国卫生行政部门加大了对感染性疾病的重视程度，原卫生部出台了《关于二级以上综合医院感染性疾病科建设的通知》（卫医发〔2004〕292号）。但是，截至2020年，仅53.91%的二级以上医疗机构建立了感染科或传染科［1］，且各医院收治病种仍以肝病为主，不明原因发热的病因确诊率平均不足60%［2］。2016年原国家卫生和计划生育委员会办公厅发布《关于提高二级以上综合医院细菌真菌感染诊疗能力的通知》（国卫办医函〔2016〕1281号），提出二级以上综合医院需加强细菌真菌感染诊疗体系和感染性疾病科的建设，并要求感染性疾病科设立以收治细菌真菌感染患者为主的感染病区或医疗组，承担细菌真菌感染及不明原因发热患者的会诊等工作。
相关研究［1］发现，在已有感染科或传染科的医院中，建有收治细菌真菌感染患者的病区或医疗组的医院占87.10%，但建立感染科或传染科的医院占被调研医院的53.91%。基于此，本研究通过清晰集定性比较分析（crisp-sets Qualitative Comparative Analysis, csQCA）方法，基于组态视角探究二级以上医院细菌真菌感染诊治能力建设路径，以期为医院感染科建设提供依据。
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