基于IMOI模型的北京市家庭医生签约服务团队有效性评估指标构建

Development of an IMOI Model-based Evaluation System for Effectiveness of a Family Doctor Team in Beijing

背景以团队为单位开展工作正在成为我国家庭医生签约服务的主要提供形式,但是目前尚缺乏专门针对团队的、能够反映团队整体有效性的评估工具。目的在投入-中介-产出-再投入(IMOI)模型基础上建立一套北京市家庭医生签约服务团队有效性评估指标,以指导家庭医生签约服务团队的自我改进与持续发展。方法通过文献分析法和个人访谈法,初步构建家庭医生签约服务团队有效性评估指标体系。2021年5—7月,采用德尔菲法分别对24、21名专家进行两轮专家咨询,结合课题组分析与专家建议确定评估指标。运用网络层次分析法确定指标权重。结果两轮专家咨询的问卷回收率分别为87.5%(21/24)、100.0%(21/21),专家权威系数为0.88~0.91。两轮专家咨询的指标重要性协调系数分别为0.138(P<0.001)、0.255(P<0.001),可行性协调系数分别为0.263(P<0.001)、0.257(P<0.001)。最终构建了71个家庭医生签约服务团队评估指标,其中一级指标7个(团队建设、成员素质、团队关系、团队过程、团队服务结果、认知及满意度、团队再发展,权重分别为0.155、0.155、0.097、0.141、0.155、0.155、0.141)、二级指标16个、三级指标48个。结论本研究构建了基于IMOI模型的北京市家庭医生签约服务团队有效性评估指标,从团队视角反映了家庭医生签约服务团队的有效性,可为北京市家庭医生签约服务团队的考评与发展提供参考。

Background In China,team-based service delivery model is a major emerging model for contracted family doctor services,but there is a lack of a tool for assessing the overall effectiveness of the family doctorteam.Objective To develop a IMOI model-based system for assessing the effectiveness of family doctor teams in Beijing,aiming at proving a tool for guiding the improvement and continuous development of the family doctor team.Methods The first draft of the Family Doctor Team Effectiveness Evaluation System(FDTEES)was developed using literature review and personal interview.Then the indicators of the system were assessed and revised according to consensuses of our analysis and the results of two rounds of consultations carried out between May and July 2021 using the Delphi technique(one was conducted with 24 experts,and the other with 21 experts).The weight of the indicators of the system was determined by and analytic network process.Results The response rate of experts in the first,and second round of consultation was 87.5%(21/24),and 100.0%(21/21),respectively.The authority coefficients for the consultations ranged from 0.88 to 0.91.Kendall's W for the importance and applicability of the indicators of the FDTEES was 0.138(P<0.001),and 0.263(P<0.001),respectively,in the first round of consultation,was 0.255(P<0.001),and 0.257(P<0.001),respectively,in the second round of consultation.The final FDTEES consists of 71 indicators,including 7 first-level indicators〔team building(0.155),quality of team members(0.155),team member relationship(0.097),team process(0.141),team service results(0.155),perception and satisfaction(0.155),team redevelopment(0.141)〕,16 second-level indicators,and 48 third-level indicators.Conclusion The IMOI model-based FDTEES developed by us assesses the effectiveness of family doctor teams in Beijing from a team perspective,which may be a reference for effectiveness evaluation and development of family doctor teams in Beijing.