深圳市光明新区社区卫生服务绩效管理效果评价研究

Performance Management of Community Health Service in Guangming New District,Shenzhen

目的了解社区卫生服务绩效管理的现状,评估其运行效果,并分析面临的问题,以对进一步健全和完善社区卫生服务绩效管理体系提供参考。方法采用整群分层抽样方法对深圳市光明新区6个社康中心服务业务质量进行典型调查;采用出口拦截方式调查了720名就诊患者对社康服务的满意度;采用电话访谈方式调查了116名规范管理慢性病患者对社康服务的满意度。结果 6个社康中心门诊抗菌药物2联及以上联用处方百分比平均为13.0%;门诊激素处方百分比平均为9.5%;门诊静脉输液百分比平均为34.0%;门诊处方基本药物使用百分比平均为97.3%;门诊处方书写合格率平均为91.7%。2010年,社康中心计划免疫建卡率为100.0%,平均五苗全程接种率为97.6%,孕产妇系统管理率为84.3%,高血压患者规范管理率为83.3%等。就诊患者对社康服务总体满意度达到83.1%,慢性病管理患者对社康医生的诊疗态度表示很满意及较满意的比例达96.6%。91.4%的居民到社康中心花费时间在20 min以内。结论社区卫生服务绩效管理结构基本建立,并形成了一定的绩效评价机制。社区医疗的安全性较高,方便程度较高,群众服务满意度均超过80%。但与国家基层医疗机构综合改革的要求尚存在一定差距,机构与人员考核评估机制仍不完善。今后应继续加大机构管理改革力度,深化人事与分配制度,确保实现综合改革目标,不断提高社康服务整体绩效水平。

Objective To evaluate the situation of performance management of community health service （ CHS）, and to analyze the problems so as to provide reference for developing the CHS performance management system. Methods A total of 6 community health service units in Guangming New District in Shenzhen were chosen through stratified cluster sampling. The condi- tion of these health service units was collected and analyzed. Seven hundred and twenty patients chose randomly at the community health service units were interviewed, and another 116 patients with chronic diseases were interviewed via telephone. Results In the 6 community health units, the prescriptions of two antibiotics and more took up 13.0% of the total prescriptions, the propor- tion of the prescriptions of steroids was 9. 5%, the proportion of intravenous infusion was 34.0%, about 97. 3% drugs prescribed in these units were the essential drugs, and 97.1% prescriptions were qualified. In 2010, the rate of planed immunization records was 100. 0%, of which 97.6% received all the five vaccines. About 84. 3% pregnant women and 83.3% hypertension patients received standard health management services. Approximately 83. 1% patients felt satisfied with the services in the units, and 96. 6% patients with chronic disease were satisfied with the doctors＇ attitudes. For 91.4% residents, it only took less than 20 mi- nutes to get to the community health units. Conclusion The structure of the performance management of CHS and the perform- ance evaluation system have already been established to some extent. Health services provided by community health units are safe, effective, and satisfactory. Over 80% of the residents are satisfied with the health services. But there are still certain gaps between the situation and the reform target of our country, and the performance evaluation system needs to be refined. It is necessary to deepen the reform and improve the whole performance of the CHS system.