基于省级临床重点专科建设实践与国家战略的全科医学专科建设路径研究

何佳; 穆琼; 何茜

doi:10.16766/j.cnki.issn.1674-4152.004397

基于省级临床重点专科建设实践与国家战略的全科医学专科建设路径研究

doi: 10.16766/j.cnki.issn.1674-4152.004397

贵州医科大学附属医院全科医学科，贵州贵阳 550004

基金项目:

贵州省临床重点专科建设项目 S-2023ZDZK-10

详细信息

通讯作者:
何茜，E-mail：569116084@qq.com

中图分类号: R499
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- 文章访问数: 28
- HTML全文浏览量: 17
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2025-08-13
- 网络出版日期: 2026-06-02

Research on the development pathway of general practice specialty: based on provincial clinical key specialty construction practices and national strategies

Department of General Practice, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China

摘要

摘要: 目的基于省级临床重点专科建设项目实践与国家战略需求，探索全科医学临床重点专科建设的有效路径与成效，为深化医疗改革、落实分级诊疗提供实践参考。方法以贵州医科大学附属医院2023年省级临床重点专科建设项目为载体，实施人才梯队建设、诊疗体系创新及科研教学协同等干预措施，基于2020—2025年上半年的各项关键数据，分析医疗服务效率、分级诊疗能力等指标变化并评估实施效果，并对比东西部地区医学模式的差异。结果项目实施后，医疗服务效率显著提升，2025年上半年全科住院患者805人次，较2024年同比增长27.6%，平均住院时间由9.7 d降至8.2 d，床位周转率由90%提高至95%；分级诊疗成效明显，上转、下转患者分别增长75.8%与108.6%；慢性病规范管理率从65%提升至91%，社区满意度由92%升至98%；住培医师执业医师考试通过率由55.8%(24/43)提升至95.0%(38/40)；近3年教学科研成果总量增长188%；东西部地区在技术支持、人力配置与适用条件等方面呈现显著差异。结论通过“人才、技术、管理”三维下沉路径，有效增强基层服务能力，推动分级诊疗落实，实现服务效率、慢病管理与人才培养的全面提升。未来应强化政策协同与数字赋能，推动全科医学向质量内涵转型。本研究为西部欠发达地区全科专科建设提供了可复制、高效益的实践范式。
- 全科医学 /
- 临床重点专科 /
- 分级诊疗 /
- 慢性病管理 /
- 住培医师
Abstract: Objective Drawing on provincial key clinical specialty construction practices and national strategic priorities, this study explores effective pathways and outcomes for developing key clinical specialties in general practice. It aims to provide practical references for deepening healthcare reform and advancing the implementation of hierarchical diagnosis and treatment. Methods Taking the 2023 provincial-level clinical key specialty construction project at the Affiliated Hospital of Guizhou Medical University as a platform, a series of interventions were implemented, including the development of a structured talent echelon, innovation in diagnosis and treatment systems, and the integration of research and teaching. Based on key data collected from 2020 to the first half of 2025, changes in indicators such as medical service efficiency and hierarchical diagnosis and treatment capacity were analyzed to evaluate the effectiveness of implementation. Additionally, differences in medical models between eastern and western regions were compared. Results Following the implementation of the project, healthcare service efficiency significantly improved. In the first half of 2025, the number of general practice inpatients reached 805, representing a 27.6% year-on-year increase compared to the same period in 2024. The average length of hospital stay decreased from 9.7 days to 8.2 days, while the bed turnover rate improved from 90% to 95%. The hierarchical diagnosis and treatment system achieved notable outcomes: referrals from primary to tertiary hospitals and from tertiary to primary care institutions increased by 75.8% and 108.6%, respectively. The standardized management rate for chronic diseases improved from 65% to 91%, and community satisfaction increased from 92% to 98%. The pass rate for resident physicians in the national licensing examination rose from 55.8% (24/43) to 95.0% (38/40). Over the past three years, the total output of teaching and research achievements grew by 188%. Significant differences were observed between eastern and western regions in terms of technical support, human resource allocation, and applicable conditions. Conclusion Through the "three-dimensional integration" approach encompassing talent, technology, and management, primary care service capacity was effectively enhanced, the implementation of hierarchical diagnosis and treatment was promoted, and comprehensive improvements were achieved in service efficiency, chronic disease management, and talent cultivation capabilities. In the future, policy coordination and digital empowerment should be strengthened to advance the transformation of general practice toward quality-driven development. This study offers a replicable and cost-effective practical model for the development of general practice specialties in underdeveloped western regions.
- General practice /
- Key clinical specialty /
- Hierarchical medical system /
- Chronic disease management /
- Resident physician

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图 1 2023年至2025年上半年住院患者平均住院时间统计

Figure 1. Average length of hospital stay for inpatients from 2023 to the first half of 2025

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图 2 2022—2024年全科医学临床、教学与科研成果对比图

Figure 2. Comparison of clinical, teaching and scientific research achievements of general practice in 2022—2024

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表 1 2023年至2025年上半年贵医附院全科医学科关键指标对比

Table 1. Comparison of key indicators of general practice in the Affiliated Hospital from 2023 to the first half of 2025

指标	2023年	2024年	2025年1—6月
全科门诊量(万·人次)	2.582 4	2.387 6	1.260 5
住院患者量(千·人次)	1.263	1.343	0.805
床位周转率(%，占用床日数/开放床日数)	90%(11 826/13 140)	93%(12 254/13 176)	95%(6 190/6 516)
上转患者(例/年)	120	183	211
下转患者(例/年)	70	107	146
慢性病规范管理率(%，规范管理人数/总患病人数)	65%(312/480)	82%(430/524)	91%(510/560)
社区满意度(%，满意人数/调查人数)	92%(276/300)	95%(304/320)	98%(343/350)
注：慢性病规范管理率定义为高血压、糖尿病患者按照《国家基本公共卫生服务规范》要求，年度内完成至少4次面对面随访和1次健康体检；慢性阻塞性肺疾病患者完成其规范所要求的随访和评估；且各项记录完整、评估准确的患者所占的比例。

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表 2 2020—2024年全科住培医师执业医师考试通过率

Table 2. Pass rate of the national medical licensing examination for general practice resident physicians (2020—2024)

年度	人数	人员构成(人)			通过率(%)
年度	人数	单位人	社会人	并轨研究生	通过率(%)
2020年	43	40	1	2	55.8(24/43)
2021年	39	36	0	3	71.8(28/39)
2022年	37	34	0	3	59.5(22/37)
2023年	40	35	0	5	95.0(38/40)
2024年	25	22	0	3	88.0(22/25)

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表 3 西部(贵州)与东部(浙江)医学模式主要特征对比

Table 3. Comparison of main characteristics of medical models in Western (Guizhou) and Eastern (Zhejiang) China

对比维度	西部模式(以贵州省为例)	东部模式(以浙江省为例)	全国性政策目标/参考
核心建设路径	“资源整合与下沉”驱动：以人才、技术、管理“三维下沉”为路径，通过专科联盟等形式实现有限资源的协同与优化。	“技术赋能与创新”驱动：依托数字基础设施，在医共体建设中深度融合人工智能、大数据技术，迈向智能化管理。	国家强调加强临床专科建设，推动公立医院高质量发展，并要求分层(国家、省、县级)建设临床重点专科。
关键资源指标	全科医生：3.33人/万人口(2023年)。财政与居民收入：2023年全省居民人均可支配收入27 098元。	全科医生：4.56人/万户籍人口(2019年)，计划2030年达5人/万居民。财政与居民收入：2023年全体居民人均可支配收入63 830元。	全科医生：3.99人/万人口(2023年全国平均水平)。
典型成效指标	慢性病规范管理率：91%(本研究数据)。技术支持方式：以远程会诊、线下培训为主。	技术支持水平：数字化、人工智能化应用水平居全国领先，已建立省级健康大数据平台。	慢病管理目标：到2025年，高血压、糖尿病患者规范管理率≥70%。
主要适用场景	适用于财政基础相对薄弱、数字基础设施建设处于追赶阶段的欠发达地区。	适用于财政实力较强、数字基础设施完善、医共体建设较为成熟的地区。	为各地区探索符合自身实际的发展路径提供战略框架和目标指引。
数据来源	本研究调研；《2023年贵州省卫生健康事业发展统计公报》；《贵州省2023年国民经济和社会发展统计公报》。	《浙江省健康产业发展“十四五”规划》；《浙江省卫生健康委员会关于省十三届人大二次会议湖33号建议的答复》；《2023年浙江省国民经济和社会发展统计公报》。	《2023年我国卫生健康事业发展统计公报》；《中国防治慢性病中长期规划(2017—2025年)》。

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