社区公共卫生服务绩效评价研究
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摘要
研究目的
建立一套科学、简便、易用的符合杭州实际的社区公共卫生服务绩效评价指标体系,为政府考核提供工具。并通过该评价体系在社区卫生服务中心的现场实测,了解当前杭州市社区公共卫生服务的开展情况,为今后改进工作、制定政策提供参考。
研究内容
国内外社区公共卫生服务评价体系和卫生系统绩效评价现状;社区公共卫生服务绩效评价指标体系；社区公共卫生服务绩效评价实证；实施社区公共卫生服务绩效管理的政策。
研究方法
1、文献回顾法：查阅相关文献资料,在此基础上初步拟订社区公共卫生服务绩效评价的指标框架。
2、德尔菲法：选择社区卫生、公共卫生、全科医学、卫生管理等领域专家35名,采用信函的方式进行两轮德尔菲专家咨询,请专家对拟订的指标作出评价和提供修改建议。根据专家咨询结果选择指标,计算指标权重,确定社区公共卫生服务绩效评价指标体系。
3、实证研究：采用分层抽样的方法,从杭州市六个主城区(上城、下城、西湖、江干、拱墅、滨江)中各抽1家社区卫生服务中心作为调查对象(共6家),运用建立的指标体系对其公共卫生服务绩效现状进行评价分析。
研究结果
1、经两轮专家咨询最终构建了以支持、业务和效果三大类指标为主要结构的具有层次性的社区公共卫生服务绩效评价指标体系,包括一级指标3个,二级指标16个,三级指标41个,并通过百分权重法和乘积法计算了每项指标的权重。
2、运用建立的指标体系对6家社区卫生服务中心公共卫生工作进行评价,机构总得分在64.98-83.25之间,平均得分为74.37。
研究结论
1、从总体上看,整套指标体系结构合理、内容全面,体现了社区公共卫生和绩效评价的核心思想。
2、从6家社区卫生服务中心的评价结果来看,可以肯定在公共卫生工作上取得的一系列成绩,但也存在一些问题,如健康档案利用更新率低、精神疾病检出率低、慢病管理覆盖率低、社会支持系统不健全等。
3、对杭州市社区公共卫生服务工作提出了一些建议,如改进绩效考核方法、搭建区域卫生信息平台、加强慢病管理广度深度和健全社会支持系统。
Objectives
To establish a scientific evaluation index system for Hangzhou community public health service performance for government assessment. We try to find the current situation of community public health service after using the evaluation index system to evaluate 6 community health service centers.
Contents
Evaluation system for community health services at home and abroad; community public health service performance evaluation index system; evaluation index system application; government policy for community public health service performance management.
Methods
1. Literature review method:Develop an initial evaluation index system based on policy research and literature study.
2. Delphi method:35 experts who specialized in the field of community health, public health, general practice and health management were selected to participate in Delphi consultation. The evaluation indexes and their weights were determined after two rounds Delphi consultation.
3. Empirical study:Choose 6 community health service centers of Hangzhou by stratified sampling, and use established index system to evaluate the public health service performance.
Results
1. Construct a hierachical index system composed of three groups, namely supporting, service and effects, including three first class index,16 second ones and 41 third ones after two rounds Delphi consultation.
2. Use established index system to evaluate 6 community health service centers. The score of them ranged from 64.98 to 83.25, the average score is 74.37.
Conclusions
1.Overall, the index system has reasonable structure and comprehensive contents, reflecting the core idea of community public health and performance evaluation.
2. According to the appraisal results, we can find the 6 community health service centers have got some achievements in public health service, but there are still some issues, such as using and update rate of health record is low, detection rate of mental illness is low, coverage rate of chronic disease management is low, social support system is not perfect, and so on.
3. Propose some suggestions for improving community public health service performance of Hangzhou, such as improve the performance examination method, build regional health information platform, strengthen the breadth and depth of chronic diseases management, and improve social support system.
建立一套科学、简便、易用的符合杭州实际的社区公共卫生服务绩效评价指标体系,为政府考核提供工具。并通过该评价体系在社区卫生服务中心的现场实测,了解当前杭州市社区公共卫生服务的开展情况,为今后改进工作、制定政策提供参考。
研究内容
国内外社区公共卫生服务评价体系和卫生系统绩效评价现状;社区公共卫生服务绩效评价指标体系；社区公共卫生服务绩效评价实证；实施社区公共卫生服务绩效管理的政策。
研究方法
1、文献回顾法：查阅相关文献资料,在此基础上初步拟订社区公共卫生服务绩效评价的指标框架。
2、德尔菲法：选择社区卫生、公共卫生、全科医学、卫生管理等领域专家35名,采用信函的方式进行两轮德尔菲专家咨询,请专家对拟订的指标作出评价和提供修改建议。根据专家咨询结果选择指标,计算指标权重,确定社区公共卫生服务绩效评价指标体系。
3、实证研究：采用分层抽样的方法,从杭州市六个主城区(上城、下城、西湖、江干、拱墅、滨江)中各抽1家社区卫生服务中心作为调查对象(共6家),运用建立的指标体系对其公共卫生服务绩效现状进行评价分析。
研究结果
1、经两轮专家咨询最终构建了以支持、业务和效果三大类指标为主要结构的具有层次性的社区公共卫生服务绩效评价指标体系,包括一级指标3个,二级指标16个,三级指标41个,并通过百分权重法和乘积法计算了每项指标的权重。
2、运用建立的指标体系对6家社区卫生服务中心公共卫生工作进行评价,机构总得分在64.98-83.25之间,平均得分为74.37。
研究结论
1、从总体上看,整套指标体系结构合理、内容全面,体现了社区公共卫生和绩效评价的核心思想。
2、从6家社区卫生服务中心的评价结果来看,可以肯定在公共卫生工作上取得的一系列成绩,但也存在一些问题,如健康档案利用更新率低、精神疾病检出率低、慢病管理覆盖率低、社会支持系统不健全等。
3、对杭州市社区公共卫生服务工作提出了一些建议,如改进绩效考核方法、搭建区域卫生信息平台、加强慢病管理广度深度和健全社会支持系统。
Objectives
To establish a scientific evaluation index system for Hangzhou community public health service performance for government assessment. We try to find the current situation of community public health service after using the evaluation index system to evaluate 6 community health service centers.
Contents
Evaluation system for community health services at home and abroad; community public health service performance evaluation index system; evaluation index system application; government policy for community public health service performance management.
Methods
1. Literature review method:Develop an initial evaluation index system based on policy research and literature study.
2. Delphi method:35 experts who specialized in the field of community health, public health, general practice and health management were selected to participate in Delphi consultation. The evaluation indexes and their weights were determined after two rounds Delphi consultation.
3. Empirical study:Choose 6 community health service centers of Hangzhou by stratified sampling, and use established index system to evaluate the public health service performance.
Results
1. Construct a hierachical index system composed of three groups, namely supporting, service and effects, including three first class index,16 second ones and 41 third ones after two rounds Delphi consultation.
2. Use established index system to evaluate 6 community health service centers. The score of them ranged from 64.98 to 83.25, the average score is 74.37.
Conclusions
1.Overall, the index system has reasonable structure and comprehensive contents, reflecting the core idea of community public health and performance evaluation.
2. According to the appraisal results, we can find the 6 community health service centers have got some achievements in public health service, but there are still some issues, such as using and update rate of health record is low, detection rate of mental illness is low, coverage rate of chronic disease management is low, social support system is not perfect, and so on.
3. Propose some suggestions for improving community public health service performance of Hangzhou, such as improve the performance examination method, build regional health information platform, strengthen the breadth and depth of chronic diseases management, and improve social support system.
引文
1 陈叙,程晓明.社区卫生服务与公共卫生服务的关系.卫生经济研究,2005(5)：14.
2 吴春容.再论社区卫生服务的基本概念.中华全科医师杂志,2004,3(1)：39-41.
3 冯显威,陈曼莉.现代公共卫生的概念特征及发展方向研究.医学与哲学,2005,26(8)：11-13.
4 徐林山,程晓明,周召梅,等.城市社区公共卫生服务项目分类研究.中华医院管理杂志,2005,21(2)：86-88.
5 周勇,张亮,罗乐宣,等.城市社区公共卫生服务特征与项目界定原则.医学与社会,2006,19(7)：8-9.
6 梁万年.卫生事业管理学.第2版.北京：人民卫生出版社,2007.227-228,230,234.
7 徐勇勇,刘丹红,王霞,等.国家卫生系统绩效测量与统计指标的概念框架.中国卫生统计,2006,23(5)：386-389,392.
8 任苒.卫生系统绩效评估及其思考-《2000年世界卫生报告》的启示与思索.医学与哲学,2001,22(4)：19-22.
9 梁万年,郭爱民.全科医学基础.第1版.北京：人民卫生出版社,2008.206-207.
10 Radford A, Pink G, Ricketts T. A comparative performance scorecard for federally funded community health centers in North Carolina. J Healthc Manag, 2007,52(1):20-31.
11 Jolley GM. Performance measurement for community health services: opportunities and challenges. Aust Health Rev,2003,26(3):133-138.
12 Stekelenb, urg J, Kyanamina SS, Wolffers I. Poor performance of community health workers in Kalabo District, Zambia. Health Policy,2003,65(2):109-118.
13 Kaiser KL, Rudolph EJ. Achieving clarity in evaluation of community/public health nurse generalist competencies through development of a clinical performance evaluation tool. Public Health Nurs,2003,20(3):216-227.
14 McAlearney JS. The financial performance of community health centers, 1996-1999. Health Aff (Millwood),2002,21(2):219-225.
15 Kelly JM, Osamba B, Garg RM. Community health worker performance in the management of multiple childhood illnesses:Siaya District, Kenya,1997-2001. Am J Public Health,2001,91 (10):1617-1624.
16 Wright RA. A performance evaluation system for primary care providers in a community health services program. J Ambul Care Manage,1997,20(4):74-86.
17周俊安,卢祖洵,程锦泉,等.深圳市社区卫生服务绩效评价概述.中国全科医学,2005,8(5)：356-358.
18 周长强,李士雪.社区卫生服务绩效评价概述.中国全科医学,2007,10(19)：1640-1642.
19王芳.社区卫生服务绩效评价指标体系研究.武汉.华中科技大学,2006：2
20景琳,李玉强,张媚,等.城市社区公共卫生服务财政补偿绩效评价机制研究.中国卫生经济,2009,28(4)：42-44.
21 田晓洁,鲍勇.上海市社区卫生服务中心公共卫生服务费用研究.中国全科医学,2007,10(15)：1237-1240.
22刘利群.社区卫生服务-公共卫生体系建设不可忽视的基础环节.中国初级卫生保健,2003,17(11)：9.
23 曾光.现代流行病学方法与应用.第1版.北京：北京医科大学与中国协和医科大学联合出版社,1994.250,257.
24汪云,熊巨洋,程勇,等.区级社区卫生服务系统绩效评价指标体系研究.中国初级卫生保健,2008,22(9)：13-16.
25鲍勇.基于社区诊断的健康管理服务.中华全科医学,2009,7(1)：1-2.
26李芳健,周红伟,黄青林,等.广州市某区12家社区卫生服务机构满意度调查分析.中华全科医学,2008,6(9)：955-956.
27 胡春松,胡大一.高血压治疗原则的进展及我国高血压治疗策略的特点与变化.中国中西医结合杂志,2007,27(4)：380-382.
1 《国务院关于发展城市社区卫生服务的指导意见》(国发[2006]10号)
2蔡志明,陈春涛,王光明,等.绩效、绩效评估与绩效管理——基于对建立医院绩效评价体系有借鉴作用的述评.中国医院,2005；9(3)：67-72
3刘聪,张亮.中心乡镇卫生院绩效与功能关系研究.医学与社会,2006；19(8)：54-56
4何惠宇,陈校云,董立友,等.建立医院绩效评价系统的理论与实践.中华医院管理杂志,2003；19(6)：331-333
5任苒.卫生系统绩效评估及其思考-《2000年世界卫生报告》的启示与思索.医学与哲学,2001；22(4)：19-22
6胡善联.评价卫生系统绩效的新框架——介绍2000年世界卫生报告.卫生经济研究,2000；(7)：5-7
7杨芬,段纪俊.世界卫生系统绩效现状及其改进建议.国外医学·社会医学分册,2002；19(3)：108-113
8徐勇勇,刘丹红,王霞,等.国家卫生系统绩效测量与统计指标的概念框架.中国卫生统计,2006；23(5)：386-388,392
9梁万年.卫生事业管理学.第2版.北京：人民卫生出版社,2007.234.
10梁万年,郭爱民.全科医学基础.第1版.北京：人民卫生出版社,2008.206-207,210-212
11 Radford A, Pink G, Ricketts T.A comparative performance scorecard for federally funded community health centers in North Carolina. J Healthc Manag. 2007;52(1):20-31; discussion 32-3.
12 Jolley GM.Performance measurement for community health services:opportunities and challenges. Aust Health Rev.2003;26(3):133-8.
13 Stekelenburg J, Kyanamina SS, Wolffers I. Poor performance of community health workers in Kalabo District, Zambia. Health Policy.2003;65(2):109-18.
14 Kaiser KL, Rudolph EJ. Achieving clarity in evaluation of community/public health nurse generalist competencies through development of a clinical performance evaluation tool. Public Health Nurs.2003;20(3):216-27.
15 McAlearney JS. The financial performance of community health centers,1996-1999. Health Aff (Millwood).2002;21(2):219-25.
16 Kelly JM, Osamba B, Garg RM, et al. Community health worker performance in the management of multiple childhood illnesses:Siaya District, Kenya,1997-2001. Am J Public Health.2001;91 (10):1617-24.
17 Wright RA. A performance evaluation system for primary care providers in a community health services program. J Ambul Care Manage.1997;20(4):74-86.
18卢祖洵,姚岚,金建强,等.各国社区卫生服务简介及特点分析.中国全科医学,2002；5(1)：38-39
19黄存瑞,叶文彬,李国鸿.英国社区卫生服务制度及启示.国外医学·卫生经济分册,2004；21(4)：150-154
20张泽, 祁素文.国外社区卫生服务现况及启示.中国全科医学,2005；8(15)：1283-1284
21 Jacobs LM, Elligers JJ. The MAPP approach:using community health status assessment for performance improvement. J Public Health Manag Pract.2009 Jan-Feb;15(1):79-81.
22谭晓红.绩效提升中的指标应用：美国、英国、澳大利亚绩效提升的最新实践.中国卫生质量管理,2005；12(2)：69-72
23李林贵,刘春宏,韩春艳.国内外社区卫生服务评价研究进展.中国卫生经济,2008；27(12)：46-48
24卢祖洵,金生国主编.国外社区卫生服务.北京：人民卫生出版社,2001：111
25周俊安,卢祖洵,程锦泉,等.深圳市社区卫生服务绩效评价概述.中国全科医学,2005；8(5)：356-358
26周长强,李士雪.社区卫生服务绩效评价概述.中国全科医学,2007；10(19)：1640-1642
27王芳.社区卫生服务绩效评价指标体系研究[博士学位论文].武汉.华中科技大学；2006：2
28尹文强,博华.社区卫生服务综合评价构想.中国卫生经济,2001；20(5)：21-22
29孙振球主编.医学统计学.第2版.北京：人民卫生出版社,2006：497,536,537,541
30张祖芸,李琳,沈建华,等.卫生系统绩效的评价、责任和策略.中国卫生政策,2002；(3)：27-28
2 吴春容.再论社区卫生服务的基本概念.中华全科医师杂志,2004,3(1)：39-41.
3 冯显威,陈曼莉.现代公共卫生的概念特征及发展方向研究.医学与哲学,2005,26(8)：11-13.
4 徐林山,程晓明,周召梅,等.城市社区公共卫生服务项目分类研究.中华医院管理杂志,2005,21(2)：86-88.
5 周勇,张亮,罗乐宣,等.城市社区公共卫生服务特征与项目界定原则.医学与社会,2006,19(7)：8-9.
6 梁万年.卫生事业管理学.第2版.北京：人民卫生出版社,2007.227-228,230,234.
7 徐勇勇,刘丹红,王霞,等.国家卫生系统绩效测量与统计指标的概念框架.中国卫生统计,2006,23(5)：386-389,392.
8 任苒.卫生系统绩效评估及其思考-《2000年世界卫生报告》的启示与思索.医学与哲学,2001,22(4)：19-22.
9 梁万年,郭爱民.全科医学基础.第1版.北京：人民卫生出版社,2008.206-207.
10 Radford A, Pink G, Ricketts T. A comparative performance scorecard for federally funded community health centers in North Carolina. J Healthc Manag, 2007,52(1):20-31.
11 Jolley GM. Performance measurement for community health services: opportunities and challenges. Aust Health Rev,2003,26(3):133-138.
12 Stekelenb, urg J, Kyanamina SS, Wolffers I. Poor performance of community health workers in Kalabo District, Zambia. Health Policy,2003,65(2):109-118.
13 Kaiser KL, Rudolph EJ. Achieving clarity in evaluation of community/public health nurse generalist competencies through development of a clinical performance evaluation tool. Public Health Nurs,2003,20(3):216-227.
14 McAlearney JS. The financial performance of community health centers, 1996-1999. Health Aff (Millwood),2002,21(2):219-225.
15 Kelly JM, Osamba B, Garg RM. Community health worker performance in the management of multiple childhood illnesses:Siaya District, Kenya,1997-2001. Am J Public Health,2001,91 (10):1617-1624.
16 Wright RA. A performance evaluation system for primary care providers in a community health services program. J Ambul Care Manage,1997,20(4):74-86.
17周俊安,卢祖洵,程锦泉,等.深圳市社区卫生服务绩效评价概述.中国全科医学,2005,8(5)：356-358.
18 周长强,李士雪.社区卫生服务绩效评价概述.中国全科医学,2007,10(19)：1640-1642.
19王芳.社区卫生服务绩效评价指标体系研究.武汉.华中科技大学,2006：2
20景琳,李玉强,张媚,等.城市社区公共卫生服务财政补偿绩效评价机制研究.中国卫生经济,2009,28(4)：42-44.
21 田晓洁,鲍勇.上海市社区卫生服务中心公共卫生服务费用研究.中国全科医学,2007,10(15)：1237-1240.
22刘利群.社区卫生服务-公共卫生体系建设不可忽视的基础环节.中国初级卫生保健,2003,17(11)：9.
23 曾光.现代流行病学方法与应用.第1版.北京：北京医科大学与中国协和医科大学联合出版社,1994.250,257.
24汪云,熊巨洋,程勇,等.区级社区卫生服务系统绩效评价指标体系研究.中国初级卫生保健,2008,22(9)：13-16.
25鲍勇.基于社区诊断的健康管理服务.中华全科医学,2009,7(1)：1-2.
26李芳健,周红伟,黄青林,等.广州市某区12家社区卫生服务机构满意度调查分析.中华全科医学,2008,6(9)：955-956.
27 胡春松,胡大一.高血压治疗原则的进展及我国高血压治疗策略的特点与变化.中国中西医结合杂志,2007,27(4)：380-382.
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