全科医生团队快速研判新增服务可行性的工具开发和应用研究

Development of a Tool for Community Health Institutions to Rapidly Evaluate the Feasibility of New Services

背景随着社区卫生、全科医学和家庭医生制度越来越为公众所熟知,社区卫生机构的上下游供应链也越来越多地向社区及其全科团队寻求合作机会,包括优质项目、特色技术等,不仅数量多,且种类杂,全科医生一方面需要了解市场的最新进展,另一方面更重要的是需要研判哪些是值得投入时间去洽谈的项目或技术,以减少试错及对市场机遇的误判。目的开发用于研判"某项目或技术或业务能否在家庭医生工作中整合并落地实施"的决策工具,帮助迈向独立执业的全科团队快速、高效、精准决策。方法 2019年8—10月,采用头脑风暴法,共邀请5名来自上海市不同区域、不同机构、不同年资不同背景的全科医生作为意见领袖,3名社区卫生行业资深从业者、中高层管理者作为主持和组织者,并有1名项目管理背景项目专员作为信息记录者,围绕"什么样的技术才是值得落实和推广的社区适宜技术"开展头脑风暴,梳理充分必要条件和判断准则。结合各社区代表性项目的开展实情,选定7个社区样本进行试测。结果开发出包含7个判断准则的可行性研判工具,分别为:(1)能够在社区提供;(2)只能在社区提供(最大限度发挥地域便利、离患者近的优势);(3)发病率、患病率高;(4)显效期短;(5)成本低;(6)在全科医生及其团队的工作范畴内(时间、空间轨道);(7)对全科医生及其团队有相应的支付。被研判对象如全部都为"是",则具有较好的社区落实适应性;反之,则不能急于推行。7个社区试测样本,在7个准则上的得分,最高为5.8分,最低为2分,超过4分者有3个,不足50%,实际运行情况与得分有一定相符。7条准则上,最难得分的是对全科医生及其团队有相应支付,其次是成本低,再次是工作范畴内、显效时间短及只能在社区提供;最容易得分的是能够在社区提供,其次是发病率、患病率。在全科医生及其团队的工作范畴内、有相应的支付是最容易忽视的问题。结论本研究所开发的"全科团队能否引入某项新增技术或服务的可行性研判工具"包含7条准则,实践上具备可行性,性能上具备实用性,可帮助全科团队实现精准决策、高效决策、循证决策。

Background As community health,general medicine and family doctor systems become increasingly well known,the upstream and downstream supply chains for community health institutions are seeking more opportunities to cooperate with community hospitals and their general practitioner(GP)teams in an effort to implement large quantities of various types of high-quality projects and to use featured technologies,etc.During the process,GPs are required to know the latest developments in the market.What’s more,they should know how to evaluate and choose an appropriate project or technology that is worth investing time to negotiate to reduce the possibilities of making errors in attempts and misjudging market opportunities.Objective To develop an auxiliary tool for evaluating the feasibility of integrating a project,technology or business into family doctor services,to help an independent practice GP team to make decisions rapidly,efficiently and precisely.Methods From August to October 2019,we conducted a brainstorming session on technologies appropriate for community-based implementation and promotion with individuals invited from Shanghai,including 5 GPs as the session leaders with differences in seniority,background,workplace and district,3 senior community health practitioners(1 community health counselor,1 community health managers,and 1 manager of a GP team delivering family doctor services)as the session host and organizer,and 1 professional with project management experience and knowledge of community health affairs as the recorder of the session.According to the session,we summarized the necessary and sufficient conditions and evaluation criteria that are used to assess whether a technology,service or project is suitable to be implemented by a community hospital,and estimated their values by testing the ongoing representative projects in 7 sampled community hospitals.Results The finally developed tool contains 7 assessment criteria:(1)The project,service or technology can be implemented by the community hospital;(2)The service can only be accessed in the community hospital(for achieving maximum treatment convenience by using geographical advantage of community hospital);(3)The project,service or technology can be used to satisfy the needs of patients with an illness of high morbidity and prevalence;(4)The implementation of the project,service or technology can show effectiveness rapidly;(5)The implementation of a project,service or technology is low cost;(6)The project,service or technology is appropriate for GPs or a GP team to implement in working hours and normal healthcare settings;(7)The implementation of the project,service or technology shall be paid service.A project,service or technology meeting all the above criteria was defined as with good feasibility,if not,it could not be implemented hastily.With regard to the ranking of the ongoing projects of the 7 community hospitals in terms of total score assessed by the 7 criteria,the top one scored 5.8 points,and the bottom one scored 2 points;3 scored above 4 points,50%had incomplete data,which were partly consistent with the actual implementation status.Among the criteria,the one of highest difficulty was criterion 7,followed by criteria 5,6,4,and 2,and the one of highest simplicity was criterion 1,followed by criterion 3.And criteria 6 and 7 were the most easily overlooked.Conclusion Our tool with 7 criteria,has proved to be feasible for use with practicability,which may help a GP team to make evidence-based decisions accurately and high-efficiently.