广西基层医疗卫生机构家庭医生签约服务绩效评价及实证研究

The family doctor contract service is one significant measure to achieve a universal access to primary health care, the ultimate goal set up by the New Health Care System Reform in China, and one essential way to actualize both the stratified healthcare system and the strategy of “Health China”. The family doctor-led teams have become the key force among primary health caregivers, since family doctor contract service began in Guangxi in 2017. The performance of family doctor-led teams directly affect the whole health care system. Hence, a comprehensive evaluation over performance of family doctor-led teams in the contract service possesses important reality significance. This study includes the following several contents in order to soundly accomplish the performance evaluation. (1)To build up a performance evaluation indicator pool of family doctor contract service in Guangxi, by combining multiple methods, including theoretical study, systemic assessment based on a structure-process-outcome-effect model; (2)To establish an performance evaluation index system of family doctor-led teams in the contract service of Guangxi via a combination of multiple methods, including key figure interviewing and Delphi survey; (3) To develop questionnaires assessing family doctor-led team performance based on the evaluation index system and to conduct an empirical study over the evaluation index system in sample regions; (4)To verify scientificity of the evaluation index system according to the above empirical study; (5)To comprehensively assess the performance of the family doctor-led teams by synthetic scoring method and rank sum ratio test. Results of the study can provide sound methodology and assessment tools for performance evaluation of family doctor-led teams, and evidence-based references to health administrations for further promotion of primary healthcare development.

家庭医生签约服务是实现新医改“人人享有基本医疗卫生服务”总体目标的重大举措，是实现分级诊疗和“健康中国”战略的重要途径。2017年广西启动家庭医生签约服务，家庭医生团队成为基层卫生服务的核心，其绩效的好坏直接影响整个卫生服务体系。因此，针对家庭医生团队进行绩效评价，具有重要现实意义。本课题组拟(1)基于“结构-过程-结果-影响”模型，通过文献研究、系统评价、内容分析建立广西家庭医生签约服务绩效评价模型框架(2)通过关键人物访谈、Delphi专家咨询法等方法，构建家庭医生团队绩效评价指标体系(3)根据确定的评价体系，设计适宜的家庭医生团队调查问卷，选取具有代表性的地区开展实证研究(4)基于现场调查资料，印证评价指标的科学性(5)采用综合评分法和秩和比法进行家庭医生团队的综合评价。研究结果可为开展家庭医生团队绩效评价提供方法学参考和评价工具，同时为政府部门加强基层卫生服务建设提供循证依据。

家庭医生签约服务是深化医疗卫生体制改革和实现分级诊疗制度的重大制度安排，目前家庭医生签约服务工作进入高质量发展阶段，评价其工作成效成为急需开展的重要任务。本研究通过定性与定量相结合的研究方法建立综合的评价指标体系，开展广西家庭医生签约服务绩效评价。本研究有助于发现广西家庭医生签约服务工作的薄弱环节，为优化广西家庭医生签约服务工作提供测量工具和循证依据，具有重要的现实意义。.本研究通过理论分析、文献研究和专家咨询，基于“结构-过程-结果”模型初步构建了广西家庭医生签约服务绩效评价指标体系，采用两轮Delphi专家咨询和关键人物访谈，最终确定形成包括3个维度，11个一级指标和48个二级指标的广西家庭医生签约服务绩效评价指标体系，应用层次分析法计算各项指标的权重系数，并界定出各项指标的内涵及计算方式。根据广西家庭医生签约服务绩效评价指标体系设计评价测量工具，制定出相应的评价量表和问卷调查表。在系统分析广西基层卫生服务体系的基础之上，按照广西地理及人口情况选取南宁、柳州、桂林、梧州、贵港5个地市的6家社区卫生服务中心和13家乡镇卫生院对评价指标体系进行了实际试用，并应用样本基层医疗卫生机构的数据对广西家庭医生签约服务绩效现状进行了实证研究。基于现场调查数据资料，运用加权TOPSIS法和RSR法相结合对19家基层医疗卫生机构进行绩效状况评价，并提出促进绩效改进的对策建议。本研究构建的广西家庭医生签约服务绩效评价指标体系，具有较好的科学性和可操作性，有助于丰富和发展绩效评价管理的理论，同时有助于促进家庭医生签约服务工作绩效的改进，为推进健康广西战略实施和保障人民群众健康水平提供理论指导和技术工具。

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