家庭医生团队签约服务能力建设评估指标体系构建研究
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摘要
背景家庭医生团队签约服务能力是有效开展签约服务的关键因素,因此相应的能力建设非常重要,但目前尚缺乏客观的服务能力建设评估指标体系。目的构建一套科学、实用的用于评估家庭医生团队签约服务能力建设的指标体系,以有效监测和评估家庭医生团队签约服务能力建设的优势和不足,从而提升能力建设的方向性和内容精准性。方法在查阅相关资料、咨询专家的基础上,初步拟定评价指标体系。遴选熟悉全科医学理论、以患者为中心的诊疗之家(PCMH)、以人为本的一体化服务(PCIC)模式、以人为中心的主动健康管理服务(PCAC)模式的专家13名,分别于2017-12-14、2018-01-14开展2轮专家会议,对评价指标体系进行讨论、修改。结果 2轮会议的专家参与率分别为100.0%(13/13)、92.3%(12/13)。建立的评估指标体系包括一级指标8个、二级指标35个、三级指标113个。一级指标分别为家庭医生团队签约服务技能培训、以人为中心的照护和沟通、提供可及性和连续性服务、以团队为基础提供计划性服务、提供协同服务与管理、人群识别与管理、信息系统和工具的应用、质量的监测与改进。结论构建出的家庭医生团队签约服务能力建设评估指标体系,充分体现了家庭医生签约服务的以人为中心、健康促进及可及性、连续性服务内涵,具有很强的操行性和目标导向性,可以为家庭医生团队签约服务能力建设提供参考。
Background The capability of family doctor teams is a key factor involved in effective delivery of the contracted services,so corresponding capability building is very important.But there is still lack of a system that can objectively evaluate the building.Objective To construct a scientific and practical service capability building evaluation system to assess the advantages and disadvantages of service capability building in family doctor teams,improving the orientation and accuracy of the building.Methods We drew up the initial version of the family doctor service capability building evaluation system based on literature review and results of expert consultation.Then,the contents of the system were revised after being discussed in another two rounds of consultation(one was conducted on December 14,2017,and the other was on January 14,2018) with 13 experts who had a good grasp of general practice theories,and three models of care[patient-centered medical home(PCMH),person-centered integrated care(PCIC) and people-centered active care(PCAC)].Results The attending rates for the later first and second round of consultation were 100.0%(13/13),92.3%(12/13),respectively.The final system covers 8 firstlevel indicators:training of skills used for delivering contracted services,person-centered care and communication,accessible and continuous services,team-based planning services,collaborative services and management,specific group identification and management,application of information systems and tools,and quality testing and improvement.In addition,35 secondlevel indicators and 113 third-level indicators are also included.Conclusion Our family doctor team service capability building evaluation system fully demonstrates that the contracted services delivered by the team are person-centered,accessible and continuous services in essence,which can be easily conducted to promote people's health with targeted interventions,and can be referred for family doctor team service capability building.
Background The capability of family doctor teams is a key factor involved in effective delivery of the contracted services,so corresponding capability building is very important.But there is still lack of a system that can objectively evaluate the building.Objective To construct a scientific and practical service capability building evaluation system to assess the advantages and disadvantages of service capability building in family doctor teams,improving the orientation and accuracy of the building.Methods We drew up the initial version of the family doctor service capability building evaluation system based on literature review and results of expert consultation.Then,the contents of the system were revised after being discussed in another two rounds of consultation(one was conducted on December 14,2017,and the other was on January 14,2018) with 13 experts who had a good grasp of general practice theories,and three models of care[patient-centered medical home(PCMH),person-centered integrated care(PCIC) and people-centered active care(PCAC)].Results The attending rates for the later first and second round of consultation were 100.0%(13/13),92.3%(12/13),respectively.The final system covers 8 firstlevel indicators:training of skills used for delivering contracted services,person-centered care and communication,accessible and continuous services,team-based planning services,collaborative services and management,specific group identification and management,application of information systems and tools,and quality testing and improvement.In addition,35 secondlevel indicators and 113 third-level indicators are also included.Conclusion Our family doctor team service capability building evaluation system fully demonstrates that the contracted services delivered by the team are person-centered,accessible and continuous services in essence,which can be easily conducted to promote people's health with targeted interventions,and can be referred for family doctor team service capability building.
引文
[1]刘彩茵,江冬冬,王全.家庭医生服务签约居民的续签意愿及影响因素研究[J].中国全科医学,2018,21(25):3073-3078.DOI:10.12114/j.issn.1007-9572.2018.25.009.LIU C Y,JIANG D D,WANG Q.Intention and associated factors of renewing the contract with family doctors[J].Chinese General Practice,2018,21(25):3073-3078.DOI:10.12114/j.issn.1007-9572.2018.25.009.
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[14]刘仕方,余昌胤,陈玲丽,等.基于SERVQUAL量表的农村家庭医生团队模式服务质量评价[J].安徽医学,2017,38(1):93-97.DOI:10.3969/j.issn.1000-0399.2017.01.028.LIU S F,YU C Y,CHEN L L,et al.Assessmentof service quality of family doctor service modelin rural areas based on SERVQUAL[J].Anhui Medical Journal,2017,38(1):93-97.DOI:10.3969/j.issn.1000-0399.2017.01.028.
[15]韩颖,王晶,郑建中,等.全科医生岗位胜任力评价指标体系的构建研究[J].中国全科医学,2017,20(1):15-20.DOI:10.3969/j.issn.1007-9572.2017.01.004.HAN Y,WANG J,ZHENG J Z,et al.Construction of evaluation index system of post competency of general practitioners[J].Chinese General Practice,2017,20(1):15-20.DOI:10.3969/j.issn.1007-9572.2017.01.004.
[16]国家卫生健康委员会.关于做好2018年家庭医生签约服务工作的通知[Z].2018.2018122020190416
[2]彭张林,张爱萍,王素凤,等.综合评价指标体系的设计原则与构建流程[J].科研管理,2017,38(s1):210-213.PENG Z L,ZHANG A P,WANG S F,et al.Designing principles and constructing processes of the comprehensive evaluation indicator system[J].Science Research Management,2017,38(s1):210-213.
[3]张萍.农村卫生服务能力的评价研究:以J省为例[D].长春:吉林大学,2014.
[4]田常俊.基于患者体验的医疗服务质量评价研究[D].武汉:华中科技大学,2014.
[5]American College of Physicians.ACP medical home builder practice biopsy[EB/OL].[2018-11-01].https://medicalmarijuana.procon.org/view.source.php?sourceID=005408.
[6]AAFP.Patient-centered medical home checklist[EB/OL].[2018-11-01].www.aafp.org/pcmh and transformed.com.
[7]世界银行集团,世界卫生组织财政部,原国家卫生和计划生育委员会,等.建设基于价值的优质服务提供体系[R].2016.
[8]万融.商品学概论[M].北京:中国人民大学出版社,2013.
[9]尤建新,杜学美,张建同.质量管理[M].2版.北京:科学出版社,2019.
[10]梁万年.医学科研方法学[M].2版.北京:人民卫生出版社,2014.
[11]王妍,张涛,徐若鸿,等.控制成本的100种方法[M].北京:中国经济出版社,2009.
[12]国务院.关于印发推进家庭医生签约服务指导意见的通知[Z].2016.
[13]马东利.服务质量评价体系文献综述[J].农业科技与信息,2008,25(12):74-75.DOI:10.3969/j.issn.1003-6997.2008.12.047.MA D L.Literature review of service quality evaluation system[J].Information of Agricultural Science and Technology,2008,25(12):74-75.DOI:10.3969/j.issn.1003-6997.2008.12.047.
[14]刘仕方,余昌胤,陈玲丽,等.基于SERVQUAL量表的农村家庭医生团队模式服务质量评价[J].安徽医学,2017,38(1):93-97.DOI:10.3969/j.issn.1000-0399.2017.01.028.LIU S F,YU C Y,CHEN L L,et al.Assessmentof service quality of family doctor service modelin rural areas based on SERVQUAL[J].Anhui Medical Journal,2017,38(1):93-97.DOI:10.3969/j.issn.1000-0399.2017.01.028.
[15]韩颖,王晶,郑建中,等.全科医生岗位胜任力评价指标体系的构建研究[J].中国全科医学,2017,20(1):15-20.DOI:10.3969/j.issn.1007-9572.2017.01.004.HAN Y,WANG J,ZHENG J Z,et al.Construction of evaluation index system of post competency of general practitioners[J].Chinese General Practice,2017,20(1):15-20.DOI:10.3969/j.issn.1007-9572.2017.01.004.
[16]国家卫生健康委员会.关于做好2018年家庭医生签约服务工作的通知[Z].2018.2018122020190416