应用德尔菲法确定家庭医生签约服务高质量发展评价指标研究

doi:10.12114/j.issn.1007-9572.2024.0270

摘要/Abstract

摘要： 背景　家庭医生签约服务已经成为基层医疗卫生服务的主要模式，然而目前我国对家庭医生签约服务仍未形成一套完善的、权威的、可行性高的评价指标体系。目的　通过德尔菲法建立一套合理、可行性高的家庭医生签约服务高质量发展评价指标，从而推动家庭医生签约服务的高质量发展，提高基层医疗卫生服务的效率和质量。方法　2023年6月～9月，通过文献分析法、专题小组讨论总结了不同地区、不同体制评价指标的选择和权重设置异同，再经过问卷调查和现场访谈深入分析上海市家庭医生服务工作实际情况，总结出评价指标的初稿。2023年10月～2023年11月通过德尔菲法进行两轮专家问询，最终确定并形成家庭医生签约服务高质量发展评价指标，记录专家基本资料、专家积极性、专家修改建议、专家权威程度、专家意见集中程度、专家意见协调程度。结果　本研究的两轮专家咨询有效问卷回收率分别为100 %和96 %；第一轮专家咨询的熟悉程度系数（Cs）和判断依据系数（Ca）为 0.864 和 0.920，第二轮为0.872和0.921；两轮权威系数（Cr）分别为0.892和0.897，均在0.70以上；两轮肯德尔系数（Kendall’s W）分别为 0.201（χ2 =528.569，P < 0.001）和 0.236（χ2 = 607.250，P < 0.001）。专家意见逐渐趋于一致，评价结果稳定、可靠。最终确定了家庭医生签约服务高质量发展评价指标体系。结论　本研究在积极性、权威性和协调程度方面表现出较高水平，构建了一个包含“服务能力、服务质量、满意度及知晓度”3项一级指标、8项二级指标、43项三级指标的家庭医生签约服务模式效果评价指标体系，为国内各地区提供了科学客观的评估工具，以评估家庭医生签约服务模式的效果。

关键词: 家庭医生签约服务, 德尔菲法, 指标体系, 层次分析法, 上海市

Abstract: Background　Family doctor contract service has become the main mode of primary medical and health service， but there is still no perfect， authoritative and feasible evaluation index system for family doctor contract service in our country. Objective　Through the Delphi method， the development of high-quality evaluation indicators for family doctor contract services aims to promote the high-quality development of family doctor contract services and improve the efficiency and quality of primary healthcare services. Methods　From June to September 2023， through literature analysis and thematic group discussions， the selection and weighting of evaluation indicators were summarized for different regions and systems. Then， through questionnaire surveys and on-site interviews， an in-depth analysis of the actual situation of family doctor services in Shanghai was conducted， resulting in a preliminary draft of the evaluation indicators. From October to November 2023， two rounds of expert consultations were carried out using the Delphi method， ultimately leading to the finalization and formation of evaluation indicators for the high-quality development of family doctor contract services. This process included recording expert basic information， expert enthusiasm， expert modification suggestions， expert authority level， expert opinion concentration，and expert opinion coordination. Results　The effective response rates for the two rounds of expert consultations in this study were 100% and 96% respectively. The familiarity coefficient （Cs）and judgment basis coefficient （Ca）for the first round of expert consultation were 0.864 and 0.920 respectively， and for the second round were 0.872 and 0.921 respectively. The authority coefficient （Cr） for both rounds were above 0.70， with values of 0.892 and 0.897 respectively. The Kendall coefficient（Kendall’s W） for the two rounds were 0.201（χ2 =528.569， P < 0.001）and 0.236（χ2 = 607.250， P < 0.001） respectively. The expert opinions gradually converged， resulting in stable and reliable evaluation results. Finally， the evaluation indicator system for the high-quality development of family doctor contract services was determined. Conclusion　The enthusiasm， authority， and coordination level of the experts in this study were all relatively high. The evaluation indicator system for the effectiveness of the family doctor contract service model， including three primary indicators of “service capacity， service quality， satisfaction and awareness”， 8 secondary indicators， and 43 tertiary indicators， which was ultimately constructed， is reliable. Therefore， it provides a scientific and objective evaluation tool for the family doctor contract service models in various regions in China.

Key words: Contracted services of family doctors, Delphi method, Index system, Analytic hierarchy process, Shanghai

刘海燕,王海棠,杜兆辉. 应用德尔菲法确定家庭医生签约服务高质量发展评价指标研究[J]. 中国全科医学. DOI: 10.12114/j.issn.1007-9572.2024.0270.
LIU Haiyan,WANG Haitang,DU Zhaohui. Research on the Evaluation Indicators for the High-quality Development of Family Doctor Contract Services Using the Delphi Method[J]. Chinese General Practice. DOI: 10.12114/j.issn.1007-9572.2024.0270.

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应用德尔菲法确定家庭医生签约服务高质量发展评价指标研究

Research on the Evaluation Indicators for the High-quality Development of Family Doctor Contract Services Using the Delphi Method

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