摘要
目的对上海市家庭医生签约服务绩效考核指标的合理性进行评价,为指标修订提供参考。方法利用半结构访谈法,借助SMART原则和结构-过程-结果模型理论框架,设计调查问卷。对上海市徐汇区13家社区卫生服务中心的229名家庭医生和26名家庭医生管理者进行调查。采用EXCEL 2016和SPSS 25.0软件对数据进行整理分析。结果上海市家庭医生签约服务关键绩效考核指标体系共涵盖22个指标,家庭医生管理者在指标SMART总分以及各维度上评分显著高于家庭医生(P<0.001),签约居民人均医保费用、签约居民因高血压相关疾病住院比例、签约居民因糖尿病相关疾病住院比例得分均较低。22个指标可聚类为5类,各类指标可实现性欠佳。除过程评价外,各类指标的结构和结果评价平均得分均具有统计学意义(P<0.001)。结论家庭医生与家庭医生管理者对签约服务绩效考核指标评价存在差异。可实现性欠佳是考核指标存在的主要问题。家庭医生签约服务绩效考核指标体系的制订应征询家庭医生意见,更多地考虑家庭医生发展现状,以符合现阶段家庭医生工作实际。
Objective To evaluate the reasonableness of the performance evaluation index of contracted service of family doctors in Shanghai,and to provide reference for the revision of the index.Methods Using semi-structured inter view method,a questionnaire was designed with the help of SMART principle and structure-process-result theoretical framework.229 family doctors and 26 family doctor managers from 13 community health service centers in Xuhui District of Shanghai were investigated.EXCEL 2016 and SPSS 25.0 software were used to sort out and analyze the data.Results There were 22 indicators in the key performance evaluation index system of family doctor contract service in Shanghai,and the scores on the total SMART and all dimensions of family doctor managers were significantly higher than those of family doctors(P<0.001).The per capita medical insurance cost of signed residents,the proportion of signed residents hospitalized for hypertension-related diseases,and the proportion of signed residents hospitalized for diabetes-related diseases were all lower.The 22 indicators can be clustered into 5 categories,and the realizability of all indicators was poor.Except for the process evaluation,the average scores of each index in the structural and outcome evaluation were statistically significant(P<0.001).Conclusion There were differences between family doctors and family doctor managers in the evaluation of contract service performance evaluation indicators.The poor realization was the main problem of evaluation index.The establishment of the performance evaluation index system of the contracted service of family doctors should consult the opinions of family doctors,and more consideration should be given to the development status of family doctors,which is in line with the practical work of family doctors at the present stage.
作者
钮登
魏靖
高晶
NIU Deng;WEI Jing;GAO Jing(Community Health Service Center of Shanghai Xuhui District Xujiahui Sub-District,Shanghai,200237,China)
出处
《中国卫生质量管理》
2023年第3期87-92,98,共7页
Chinese Health Quality Management
