政策干预对上海市家庭医生签约服务的影响:基于间断时间序列模型

The impact of policy intervention on family doctor contracting services in Shanghai:a disrupted time series model analysis

目的分析上海市家庭医生签约服务政策对签约相关指标的影响,为家庭医生签约服务的发展提供决策参考。方法通过上海市信息化数据平台(上海市社区卫生综合管理平台),收集2022年8月—2024年4月上海市16个区的签约服务管理动态监测数据,包括签约人数、签约覆盖率、社区签约饱和度、签约社区依从性、签约社区就诊率、签约组合内就诊率和重点人群签约覆盖率。以2023年6月为政策干预点,运用间断时间序列模型分析家庭医生签约目标管理政策实施前后签约指标的变化情况。结果政策实施后,签约人数(1088.49万人对929.62万人)、签约覆盖率(43.7%对37.4%)和重点人群签约覆盖率(84.2%对79.1%)均比签约前增加(P均<0.001)。回归分析结果显示,政策实施后,签约人数、签约覆盖率、重点人群的签约覆盖率均呈上升趋势(P均<0.05),但社区签约饱和度的长期时间趋势无显著变化(P=0.441);签约社区就诊率呈下降趋势(P<0.01),签约社区依从性呈增长趋势(P<0.05),签约社区组合内就诊率无显著变化(P>0.05)。结论政策干预对签约覆盖和签约流向的短期效果显著,但存在递减趋势。建议未来政策注重解决增长趋势放缓的问题,并优化签约服务的质量和效率。

Objective To analyze the impact of the family doctor contract service policy in Shanghai on relevant contract indicators,providing decision-making references for the development of family doctor contract services.Methods Through the Shanghai Informationization Data Platform(Shanghai Community Health Comprehensive Management Platform),dynamic monitoring data of contract service management from August 2022 to April 2024 in 16 districts of Shanghai were collected.The data includes the number of contractees,contract coverage rate,community contract saturation,compliance of contracted communities,community visit rates,visit rates within contract groups,and coverage rates for key populations.With June 2023 as the policy intervention point,the interrupted time series model was utilized to analyze changes in contract indicators before and after the implementation of the family doctor contract target management policy.Results After the policy implementation,the number of contractees(10.8849 million VS.9.2962 million),contract coverage rate(43.7%VS.37.4%),and key population contract coverage rate(84.2%VS.79.1%)all increased,when compared to those before the contract with statistically significant differences(all P<0.001).Regression analysis showed that after the policy implementation,the number of contractees,contract coverage rate,and contract coverage rate of key populations all presented an upward trend(all P<0.05).However,there was no significant change in the long-term trend of contract saturation(P=0.441).The contract community visit rate indicated a downward trend(P<0.01),while compliance of contract community revealed an increasing trend(P<0.05),and there was no remarkable change in visit rates within the contract groups(P>0.05).Conclusions The policy intervention has a significant short-term effect on contract coverage and contract flow,but there is a decreasing trend over time.It is recommended that future policies address the slowing growth trends and optimize the quality and efficiency of contract services.