目的 分析上海市公立医疗机构的互联网诊疗服务现状,为提升公立医疗机构互联网医院服务效能和创新互联网医院业务服务模式提供思考建议。方法 通过文献综述、专家访谈、现场考察等方法设计互联网医院服务现状调查问卷,以上海市持有互联网医院执业许可的公立医疗机构作为研究对象,从服务流程、服务项目、服务量、服务效率等维度评估互联网医院服务效能。结果 上海市公立医疗机构互联网医院服务入口统一,服务项目有所创新。每家市级医院、区属医院、社区卫生服务中心平均每年服务46 352人次、4 319人次、202人次,各级医疗机构间的互联网诊疗人次差异具有统计学意义(H=80.27,P<0.001),但互联网诊疗服务量前5个病种基本一致。被调研医疗机构平均每日每位医生接诊量线下为46.9人次,线上为3.3人次,医生线上和线下每日接诊人次的差异具有统计学意义(T=-9.460,P<0.001)。结论 上海市公立医疗机构互联网医院服务已实现线上线下一体化服务流程,但基层医疗机构互联网诊疗服务效能较低,各级医疗机构互联网诊疗服务差异化发展不明显。建议开展患者调研,立足自身发展定位,多渠道强化运营管理,提升互联网诊疗服务效率;利用人工智能技术进一步融合服务流程,开展主动式健康服务,挖掘差异化发展空间。

Objective This study analyzes the current status of internet-based medical services in public medical institutions in Shanghai,aiming to provide insights and suggestions for improving the service efficiency of internet hospitals in public medical institutions and innovating their business service models.Methods A questionnaire on the current status of internet hospital services was designed through literature review,expert interviews,and on-site investigations.Public medical institutions in Shanghai that hold internet hospital practice licenses were selected as the research objects.The service efficiency of internet hospitals was evaluated from dimensions including service processes,service items,service volume,and service efficiency.Results Public medical institutions in Shanghai have unified service portals for their internet hospitals,with innovations in service items.The average annual number of patients served by municipal hospitals,district-affiliated hospitals,and community health service centers was 46,352,4,319,and 202,respectively.The difference in the number of internet-based medical consultations among medical institutions at various levels was statistically significant(H=80.27,P<0.001),but the top five disease categories with the highest internet-based consultation volumes were largely consistent.The average daily number of patients seen by each doctor in surveyed medical institutions was 46.9 offline and 3.3 online,with a statistically significant difference in daily patient encounters between online and offline settings(T=-9.460,P<0.001).Conclusion sInternet hospitals of public medical institutions in Shanghai have realized the integrated online-offline service process.However,the service efficiency of internet-based medical services in primary medical institutions is relatively low,and the differentiated development of internet-based medical services among medical institutions at all levels is not obvious.It is suggested to conduct patient surveys,base on their own development positioning,strengthen operation management through multiple channels,and improve the efficiency of internet-based medical services;further integrate service processes using artificial intelligence technology,develop proactive health services,and explore room for differentiated development.