城市社区家庭医生签约服务绩效评价指标体系构建研究

Performance appraisal index system of family doctor contracting service in urban communities

目的构建城市社区家庭医生签约服务绩效评价指标体系,以便对家庭医生签约服务实施效果进行评估。方法以家庭医生签约服务绩效评价概念框架为理论基础,采用德尔菲法、层次分析法确定城市家庭医生签约服务绩效评价体系。以广州市为例进行实测模拟检验。结果在家庭医生签约服务"结构、投入、过程、产出、结果"绩效评价概念框架基础上拟定城市社区家庭医生签约服务绩效评价候选指标库。基于此指标库制定问卷,于2018年12月至2019年6月对20名专家进行函询。根据专家函询结果,建立了包括了4个一级指标、10个二级指标及34个三级指标的广州市家庭医生签约服务绩效评价体系。其中,一级指标包括组织结构与管理(权重0.21)、资源投入(权重0.24)、签约服务过程(权重0.19)、签约服务效果(权重0.36)。以广州市某社区卫生服务中心作为实测对象对个别指标的数据获取方式或评分标准进行了调整完善。结论指标体系构建具有科学性;评价工具设计以结果产出为重点,综合从供需双方、健康管理服务规律等多角度评价签约服务质量;可为政策评估实施部门评价签约服务改革绩效提供评价工具。

Objective To build a performance evaluation index system of family doctor contracting service for urban communities,so as to evaluate the effects of such service.Methods Based on the conceptual framework of performance appraisal of family doctor contracting service,such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service.A measured simulation test was made in Guangzhou.Results A library of performance appraisal candidate indexes for such service was established,based on the performance appraisal concept framework of"structure,input,output,result"of such service.A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019.Based on results of such inquiry,a performance appraisal system for family doctor contracting service in Guangzhou was developed,consisting of 4 level-1 indexes,10 level-2 indexes and 34 level-3 indexes.In the system,level indexes include organizational structure and management(weight 0.21),resource input(weight 0.24),contracting service process(weight 0.19),and contracting service effect(weight 0.36).A community health center in Guangzhou was used as the measurement site,for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions The index system is developed scientifically;appraisal tools are designed focusing on results and outputs,ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns;the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.