急性心肌梗死患者救治系统延迟模型构建及运行机制优化研究

就医延迟是导致中国急性心肌梗死高致死率的关键原因。急性心梗就医延迟是指从症状发作至接受有效治疗的时间和行为；前期研究表明医疗救治体系运行不畅造成的系统延迟（转运延迟和院内延迟）约占总延迟时间的70%。医疗救治体系由院前急救系统和院内救治系统共同构成，两者的有效运行和无缝衔接是缩短系统延迟的决定因素。如何优化医疗救治体系运行机制成为亟待解决的科学问题。本研究将采用定量和定性相结合的研究方法，构建急性心梗患者救治系统延迟的影响因素框架，并以此为工具实证分析体系运行机制对患者系统延迟的作用，找出关键环节问题；进而通过政策情景模拟，探索在政府财政能力和卫生资源水平的约束条件下，实现系统延迟时间最短的运行机制关键环节最优设计；最后结合中国实际情况，在实施层面，考虑组织目标的一致性和社会经济发展的适应性，确定最终优化策略。研究结果可以直接转化为医疗救治体系干预的依据，为提升急症救治能力提供科学指导。

Delay in treatment of acute myocardial infarction (AMI) is the key cause of the high mortality rate of AMI in China. The time of system delay including delays in transfer and hospital caused by the ineffective operational mechanisms of medical treatment system accounts for about 70% of the total delay time. The medical treatment system incorporates both the pre-hospital emergency system and the in-hospital treatment system, of which their effective operation and connection are the decisive factors for shortening the system delay time. It is extremely urgent to optimize the operation mechanism of the medical treatment system, in order to shorten the system delay. This study aims to use mixed methods of quantitative and qualitative studies: To construct a conception framework of the system delay of patients with AMI; To empirically evaluate the impact of the operation mechanisms of medical treatment system on the system delay of AMI patients and identify key issues leading to the system delay; To figure out the optimal design of the key issues of operational mechanisms by scenario simulation with the goal of achieving the shortest system delay time under the constraints of government financial capacity and health resource allocation; Finally, to propose optimization strategies of the operation mechanisms at the implementation level in consideration of the consistency of organizational objectives and socioeconomic development. This study can provide the implication for interventions on the medical treatment system and scientific guidance for improving the capacity of emergency medical treatment system.