研究目的：乳腺癌防治作为我国重大疾病防治体系的重要一环，背负着巨大的医疗服务需求压力。但是对如何建立一套高效、优质且持续的乳腺癌防治体系，各方机构都在进行着不同尝试。同时近几年随着紧密型医联体的快速出现，深圳市结合自身情况，探索建设出以专科联盟为架构的乳腺癌防治组织。本文希望从该组织建设质量情况出发，深入解析内部维度结构和运行情况，总结服务效果，以期为国家继续推进专科联盟以及创新癌症防治模式给出宝贵经验参考。研究方法：通过调研联盟内164名基层医师，52名指导专家，57名管理人员，555名患者，把深圳市乳腺癌防治联盟所建设成果作为案例，采用文献资料分析、临床数据调查、专家质性访谈、问卷量性调查等方法进行分析统计和实证探索。研究结果：（1）乳腺癌防治联盟的产生是由于现实医疗服务资源和患者需求矛盾的结果，因此有98.2%的联盟内部成员支持建设，并且成为联盟顺利准备的决定力量。（2）乳腺癌防治联盟基层单位数量大幅增加，团队平均人员数量差异较大，大部分成员希望团队保持在4-5人，现实情况无法满足预期目标。联盟内人员学历和职称水平较高，但是教学人才略显不足，且结构比例，特别是初级职称医师占比有待调整。（3）乳腺癌防治联盟在2020-2021年建设过程中间的筛查、质控、转诊工作量增长明显，但是转诊时间有待缩短优化。联盟内培训指导、上下转诊、胜任力这三个体系运转良好，但是信息化支撑和绩效考核体系的评价较低。在对联盟整体服务流程流畅性的评价中，总体满意度均值达到了4.52分。（4）乳腺癌防治联盟的相关服务得到患者的较高评价，整体满意度在4.68分。患者从基层来源比例和确诊年龄提前比例得到提高，特别是早诊早治率在2021年提高到78%，适龄妇女乳腺癌平均检出成本下降到10.5万元。并且联盟内规范化服务、人才培养和学科建设的平均满意度得分为4.72、4.61、4.58。研究结论：深圳市乳腺癌防治联盟建设质量良好，整体建设情况受到各方的认可，建设效果经过分析也达到了其建设目标。通过建立一套包含人员培训、信息支撑、考核评价和胜任力激励的组织体系，联盟实现了“医、教、研、防、管”协同发展。同时联盟联合指导专家、基层医师和管理人员多类人才，构建了乳腺癌预防控制、临床治疗、学科研究的一系列有效协同机制。乳腺癌防治联盟对医疗服务模式进行优化升级，从而完善了“市-区-社康”三位一体化的筛查、诊疗、康复管理全过程闭环管理体系。
Objectives Breast cancer prevention and treatment, as an important part of chinese major disease prevention and control system, bears huge pressure on medical service demand. However, various institutions are making different attempts on how to establish an efficient, high-quality and sustainable breast cancer prevention and control system. At the same time, with the rapid emergence of close medical alliances in recent years, Shenzhen City has explored the construction of a breast cancer prevention and treatment organization with a specialist alliance as its structure in light of its own conditions. This article hopes to start from the quality of the organization's construction, deeply analyze the internal dimension structure and operation, summarize the service effect, in order to provide valuable experience and reference for the country to continue to promote the specialist alliance and innovate the cancer prevention and control model.Methods Through the investigation of 164 grassroots physicians, 52 guidance experts, 57 managers, and 555 patients in the alliance, taking the construction achievements of Shenzhen Breast Cancer Prevention and Control Alliance as a case, using literature analysis, clinical data investigation, expert qualitative interviews, Questionnaire quantitative survey and other methods are used for analysis, statistics and empirical exploration.Results (1) The formation of the Breast Cancer Prevention and Control Alliance is the result of the contradiction between the actual medical service resources and the needs of patients. Therefore, 98.2% of the internal members of the alliance support the construction and become the decisive force for the smooth preparation of the alliance. (2) The number of grassroots units of the Breast Cancer Prevention and Control Alliance has increased significantly, and the average number of team members varies greatly. Most members hope that the team will remain at 4-5 people, but the actual situation cannot meet the expected goal. The academic qualifications and professional titles of the personnel in the alliance are relatively high, but the teaching talents are slightly insufficient, and the proportion of the structure, especially the proportion of doctors with junior professional titles, needs to be adjusted. (3) The workload of screening, quality control, and referral of the Breast Cancer Prevention and Control Alliance during the construction process in 2020-2021 has increased significantly, but the referral time needs to be shortened and optimized. The three systems of training and guidance within the alliance, referrals from top to bottom, and competency work well, but the evaluation of the information support and performance appraisal system is low. In the evaluation of the fluency of the overall service process of the alliance, the overall satisfaction average reached 4.52 points. (4) The related services of the Breast Cancer Prevention and Control Alliance were highly rated by patients, with an overall satisfaction score of 4.68. The proportion of patients from grassroots sources and the proportion of early diagnosis age have been increased, especially the rate of early diagnosis and early treatment will increase to 78% in 2021, and the average detection cost of breast cancer in women of the right age will drop to 105,000 yuan. And the average satisfaction scores of standardized services, talent training and discipline construction within the alliance are 4.72, 4.61, and 4.58.Conclusions The construction quality of Shenzhen Breast Cancer Prevention and Control Alliance is good, the overall construction situation has been recognized by all parties, and the construction effect has achieved its construction goals after analysis. By establishing an organizational system that includes personnel training, information support, assessment and evaluation, and competency incentives, the alliance has realized the coordinated development of "medicine, teaching, research, prevention, and management". At the same time, the alliance has jointly guided experts, grass-roots physicians and management personnel to build a series of effective synergistic mechanisms for breast cancer prevention and control, clinical treatment, and disciplinary research. The Breast Cancer Prevention and Control Alliance has optimized and upgraded the medical service model, thereby improving the "city-district-social health" three-in-one closed-loop system of screening, diagnosis and treatment, and rehabilitation management. This provides practical significance for building a high-quality development of a close medical alliance in the country.
