初步界定上海市社区卫生基本诊疗项目体系的德尔菲法研究

Development of basic medical service items in Shanghai community health service system

目的 了解目前上海社区卫生服务中心基本诊疗项目的分类,界定社区卫生服务基本诊疗项目.方法 选择上海市从事全科医疗、全科教学、内科医疗、公共卫生事业及卫生行政管理等36位专家,进行两轮德尔菲法咨询,通过数据统计,分析结果及意见汇总,来界定上海市社区卫生基本诊疗项目.结果 上海社区卫生服务中心基本诊疗项目分为门诊诊疗、住院诊疗、家床诊疗及临时出诊三大类.界定的上海市社区卫生基本诊疗项目包括3个一级项目（门诊诊疗、住院诊疗、家床诊疗及临时出诊）、22个二级项目和26个二级项目细则,并将26个二级项目细则分为基线项目（17个二级项目细则）、可选项目（8个二级项目细则）和限制项目（1个二级项目细则）.两轮咨询的专家积极系数均为100％,专家权威程度均为0.825,指标重要性协调系数分别为0.361和0.488（均P＜0.01）.结论 采用德尔菲专家咨询法初步界定了上海市社区卫生基本诊疗项目体系,可为社区基本诊疗项目开展提供建议.

Objective To define basic medical service items in Shanghai community health centers.Methods Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice,general practitioner training,internal practice,public health and health management,then the scope of medical service system was set up based on experts＇ opinions.Results The newly-defined system consisted of three first-grade items：outpatient medical service,hospital medical service and medical service for home beds and temporary home visits.The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items,including 17 baseline items,8 optional items and 1 restrained item.In two rounds of Delphi consultation the activity coefficient of experts was all 100％,authority coefficients of experts was 0.825,and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 （all P ＜ 0.01）,respectively.Conclusion The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making.