基于PCAT的签约服务模式下社区儿童健康服务质量研究

The Quality Assessment of Community Children's Health Service Under the Contract Service Mode Based on PCAT

背景基层医疗卫生机构以其综合、连续、协调、便捷和经济的特点,扮演着儿童常见病、多发病诊疗、计划免疫以及儿童健康管理的重要角色,为儿童健康服务奠定坚实基础。开展家庭医生签约管理下的儿童保健服务,对于提升儿童健康服务质量至关重要。然而,我国基层机构在儿童健康服务能力方面存在地区差异,因此,准确评价基层儿童健康服务质量,有助于及时发现问题,推动基层儿童健康服务向更高水平发展。目的了解签约儿童家长对社区儿童健康服务质量的评价情况,分析质量问题,提出优化策略,为进一步提升社区儿童健康服务质量、推进儿童签约服务高质量发展提供决策参考。方法以成都市某区为案例地区,2022年采用方便抽样,抽取该区3家社区卫生服务中心为样本机构,采用初级卫生保健服务质量评价工具(PCAT)中文版,对样本机构签约儿童家长进行社区儿童健康服务质量在线问卷调查。结果共完成3631名签约儿童家长调查。样本机构社区儿童健康服务质量PCAT中文版总得分为(58.72±13.43)分。社区儿童健康服务质量PCAT得分相对较高的维度为“持续性”“社区首诊(服务可及性和服务使用)”以及“服务综合性(服务提供)”,而“以家庭为中心”“综合性(可用服务)”和“协调性(转诊)”等维度得分相对较低。不同户籍、文化程度、平均年收入、有无熟悉的医护人员和过去1年在该中心就诊次数的调查对象PCAT中文版总得分比较,差异有统计学意义(P<0.05);多元线性回归分析结果显示,调查对象的户籍所在地,母亲的文化程度、家庭平均月收入、有无熟悉的医护人员和过去1年在该中心就诊次数均是PCAT总得分的影响因素(P<0.05)。结论案例地区签约服务模式下社区儿童健康服务质量水平有较大提升空间,应重点加强社区儿童健康服务综合性(可用服务)和服务协调性(转诊),推动以儿童及家庭为中心理念落实,关注非本地户籍儿童健康服务工作。

Background Primary medical institutions,with the characteristics of comprehensive,continuous,coordinated,convenient and economical,play an important role in the diagnosis and treatment of common and frequentlyoccurring children's diseases,planned immunization and child health management,and lay a solid foundation for children's health services.It is essential to improve the quality of child health services for children under the management of family doctor contract.There are regional differences in the ability of children's health services at primary institutions in China.Therefore,accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level.Objective To assess the quality of community children's health services for contracted children,analyze the quality problems and optimization strategies,and provide international vision and decision-making reference for further improving the quality.Methods Taking a district of Chengdu as a typical case,three community health service centers with stronger child health service ability in the district were selected as the sample institutions,and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool(PCAT).Results Totally,3631 parents of contracted children were investigated.The total PCAT score of community child health service quality in the sample centers was(58.72±13.43).The dimensions with relatively high PCAT scores of community child health service quality includes"continuity""community first consultation(service availability and service use)"and"comprehensive service(service provision)",while the dimensions"children and family-Centered""comprehensive(available services)"and"coordination(referral)"had low scores.Conclusion It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community,unblock the referral mechanism of Pediatrics,strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions,and pay attention to the health services for children with non local registered residence.