以人为中心的主动健康管理服务模式下签约服务核心团队配置研究
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摘要
背景以人为中心的主动健康管理服务(PCAC)模式以提高服务质量、提升患者体验和服务效率为目标,在PCAC模式下,如何进行团队成员配置、职责分工、团队运行管理是亟待解决的问题。目的探讨PCAC模式下家庭医生核心团队的人员配置和职责分工。方法于2018年1—2月选取成都市武侯区已开展PCAC模式下家庭医生签约服务的家庭医生团队24个,向206例团队成员发放问卷,调查其对团队各岗位职责分工的认知;于2017年11月记录并梳理各岗位的实际工作任务。借鉴国际先进经验,根据问卷调查结果,结合目前各岗位的实际工作内容,确定各岗位的职责分工。结果分别有62.1%(128/206)、30.6%(63/206)的成员了解医生助理、健康促进师的角色定位和任务分工,92.2%(190/206)、79.1%(163/206)的成员认为团队配置医生助理、健康促进师重要。以签约1 000名居民为基数,核心团队的人员配置为家庭医生∶医生助理∶健康促进师=1∶1∶1。家庭医生的职责包括:领导团队,管理团队,促进团队协作,解决问题;负责解决居民疾病问题;居民转诊的决策;为居民制定医疗计划,分析诊断结果;团队内部人员培训。医生助理的职责包括:协助团队长制定年度工作计划,完成团队长安排的工作;协助团队长监督团队工作完成质量,督促团队长,防止差错事故发生;协助团队长做好报表统计工作。健康促进师的职责包括:协助签约工作的进行;协助管理团队内部各项事务;协调团队与外部的沟通;以数据驱动进行人群管理;负责健康教育的推进工作。结论家庭医生团队对PCAC模式内涵的认知有待提高。本研究构建的核心团队任务条和各岗位职责分工可以为各社区重塑服务团队、梳理岗位职责提供依据。
Background People-centered Active Care(PCAC) model aims to improve the service quality and efficiency with good patient experience while based on such a model how to allocate team members,divide responsibilities and manage team operations has become an urgent problem to be solved.Objective To explore the personnel allocation and division of responsibilities of the family doctor team members under PCAC model.Methods During January and February in 2018,24 family doctor teams who had started the contracted family doctor service under the PCAC model were selected in Wuhou District of Chengdu,and questionnaires were distributed to 206 members in these 24 teams to investigate their cognition of physician assistants and health facilitators as well as the division of tasks in each position.The actual work tasks of each position were recorded and sorted out in November 2017. According to the results of the questionnaire and combined with the actual work and international advanced experience in medical care,the responsibilities of each position will be determined.Results Among 206 medical staff,62.1%(128/206) of them knew the role and division of tasks of physician assistants;92.2%(190/206) of them thought that the physician assistants were important.And 30.6%(63/206) of the medical staff understood the role of health facilitators,and 79.1%(163/206) of the medical staff thought the health facilitators were important.Taking 1 000 contracted residents as the base,the proportion of members in the core family doctor team was family doctor:physician assistant:health facilitator=1∶1∶1.The duties of family doctors were leading and managing the team,coordinating the teamwork,solving problems.Family doctors were responsible for diagnosing and treating residents,making decisions for residents' referral,developing treatment plans for residents,analyzing diagnosis results,and training the medical staff.The duties of the physician assistants were assisting family doctors to formulate the annual work plan,completing the work arranged by family doctors,assisting the family doctors to supervise the service quality of the whole team,supervising family doctors to prevent the occurrence of mistakes,and assisting family doctors to complete the statistical report.The duties of the health facilitators were assisting the signing of the contracts,assisting the management of internal affairs of the team,coordinating the communications outside the team,managing the crowd by data driven,and promoting health education.Conclusion It is suggested to raise the awareness of PCAC model in the family doctor team.The task items of core family doctor team and the division of tasks for each position constructed in this study can provide a basis for other communities to reshape their family doctor teams and sort out the responsibilities of each position.
Background People-centered Active Care(PCAC) model aims to improve the service quality and efficiency with good patient experience while based on such a model how to allocate team members,divide responsibilities and manage team operations has become an urgent problem to be solved.Objective To explore the personnel allocation and division of responsibilities of the family doctor team members under PCAC model.Methods During January and February in 2018,24 family doctor teams who had started the contracted family doctor service under the PCAC model were selected in Wuhou District of Chengdu,and questionnaires were distributed to 206 members in these 24 teams to investigate their cognition of physician assistants and health facilitators as well as the division of tasks in each position.The actual work tasks of each position were recorded and sorted out in November 2017. According to the results of the questionnaire and combined with the actual work and international advanced experience in medical care,the responsibilities of each position will be determined.Results Among 206 medical staff,62.1%(128/206) of them knew the role and division of tasks of physician assistants;92.2%(190/206) of them thought that the physician assistants were important.And 30.6%(63/206) of the medical staff understood the role of health facilitators,and 79.1%(163/206) of the medical staff thought the health facilitators were important.Taking 1 000 contracted residents as the base,the proportion of members in the core family doctor team was family doctor:physician assistant:health facilitator=1∶1∶1.The duties of family doctors were leading and managing the team,coordinating the teamwork,solving problems.Family doctors were responsible for diagnosing and treating residents,making decisions for residents' referral,developing treatment plans for residents,analyzing diagnosis results,and training the medical staff.The duties of the physician assistants were assisting family doctors to formulate the annual work plan,completing the work arranged by family doctors,assisting the family doctors to supervise the service quality of the whole team,supervising family doctors to prevent the occurrence of mistakes,and assisting family doctors to complete the statistical report.The duties of the health facilitators were assisting the signing of the contracts,assisting the management of internal affairs of the team,coordinating the communications outside the team,managing the crowd by data driven,and promoting health education.Conclusion It is suggested to raise the awareness of PCAC model in the family doctor team.The task items of core family doctor team and the division of tasks for each position constructed in this study can provide a basis for other communities to reshape their family doctor teams and sort out the responsibilities of each position.
引文
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[7]魏学娟,吴浩,于海洋,等.家庭医生服务团队在社区糖尿病综合管理中的作用探索[J].中国全科医学,2017,20(27):3349-3352.DOI:10.3969/j.issn.1007-9572.2017.00.026.WEI X J,WU H,YU H Y,et al.Role of family doctor service team in community-based integrated management of diabetes[J].Chinese General Practice,2017,20(27):3349-3352.DOI:10.3969/j.issn.1007-9572.2017.00.026.
[2]陈燕莉.上海浦东某社区开展基于家庭医生服务制度的“1+1+1”医疗机构组合签约过程中的问题和对策[J].医学理论与实践,2018,31(19):3003-3004.DOI:10.19381/j.issn.1001-7585.2018.19.088.CHEN Y L.Problems and countermeasures in the process of"1+1+1"medical institution combination contract signing based on family doctor service system in a community in Pudong,Shanghai[J].The Journal of Medical Theory and Practice,2018,31(19):3003-3004.DOI:10.19381/j.issn.1001-7585.2018.19.088.
[3]蒋羽萍,张莲芳,张齐苑,等.条块结合的全科服务团队管理模式研究与实践[J].中华全科医师杂志,2012,11(8):594-595.DOI:10.3760/cma.j.issn.1671-7368.2012.08.014.JIANG Y P,ZHANG L F,ZHANG Q Y,et al.Research and practice on the management mode of general service team[J].Chinese Journal of General Practitioners,2012,11(8):594-595.DOI:10.3760/cma.j.issn.1671-7368.2012.08.014.
[4]苏宁,彭迎春.基于工作分析的社区卫生服务团队社区护士人力资源配置研究[J].中国全科医学,2013,16(16):1833-1835.DOI:10.3969/j.issn.1007-9572.2013.06.005.SU N,PENG Y C.Study on community nurses manpower deployment of community health service team:based on job analysis[J].Chinese General Practice,2013,16(16):1833-1835.DOI:10.3969/j.issn.1007-9572.2013.06.005.
[5]袁莎莎,王芳,李陈晨,等.社区卫生服务中心全科团队构成模式分析[J].中国卫生政策研究,2014,7(12):37-42.DOI:10.3969/j.issn.1674-2982.2014.12.007.YUAN S S,WANG F,LI C C,et al.Analysis on general practice teams in community health service centers[J].Chinese Journal of Health Policy,2014,7(12):37-42.DOI:10.3969/j.issn.1674-2982.2014.12.007.
[6]潘公益,杨烨.我国家庭医生团队服务模式的研究现状[J].中国全科医学,2017,20(28):3457-3462.DOI:10.3969/j.issn.1007-9572.2017.28.002.PAN G Y,YANG Y.The current situation of family doctor team services mode[J].Chinese General Practice,2017,20(28):3457-3462.DOI:10.3969/j.issn.1007-9572.2017.28.002.
[7]魏学娟,吴浩,于海洋,等.家庭医生服务团队在社区糖尿病综合管理中的作用探索[J].中国全科医学,2017,20(27):3349-3352.DOI:10.3969/j.issn.1007-9572.2017.00.026.WEI X J,WU H,YU H Y,et al.Role of family doctor service team in community-based integrated management of diabetes[J].Chinese General Practice,2017,20(27):3349-3352.DOI:10.3969/j.issn.1007-9572.2017.00.026.
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