关键词: 高血压, 糖尿病,2型, 健康管理, 社区卫生服务

Abstract: Objective　To establish revised SERVQUAL scale based on PZB model,to evaluate their medical service quality of physician teams of community responsibility and improve service quality and provide tools;to understand overall evaluation of community hypertension and type 2 diabetes patients on health management,identify factors that affect service quality of health management,put forward specific recommendations and provide references for effectively evaluating service quality and raising management level.Methods　360 hypertension and type 2 diabetes patients,receiving standardized health management in the community health service station that under administration of Donglin Town in Wuxing District of Huzhou,were selected as research objects.SERVQUAL scale was revised by literature review,focus group interviews,Delphi expert consultation,pre-investigation methods.Reliability and validity of revised SERVQUAL scale were assessed,and common factors were extracted by principal component analysis method.5-point Likert scale was applied to evaluate service expectation,service perception,scores of quality of service=scores of perceived service-scores of service expectation.The score of overall evaluation of service quality of each index and score of hundred-mark system were calculated.The differences between service quality scores of patients with different basic conditions were compared.Results　360 questionnaires were sent out and 346 valid questionnaires were recovered with a response rate of 96.11%.Among the 346 patients,265 patients with simple hypertension,accounting for 76.59%,32 with simple type 2 diabetes,accounting for 9.25%,and 49 with hypertension combined with type 2 diabetes,accounting for 14.16%.The 5 dimensions of revised SERVQUAL scale were tangible,responsiveness,reliability,assurance and empathy.Cronbach’s α coefficient of revised SERVQUAL scale was 0.802.KMO value was 0.708,Bartlett’s test of sphericity χ2=3 556.00,a five common factors were extracted in total,contribution rate of cumulative variance was 71.14%.5 factors were consistent with 5 dimensions of the index system,and there was good construct validity in questionnaire.There were no significant difference in scores of service quality of propaganda and instruction of health knowledge,intervention effects,keeping commitments,service security,communication,trust,and respect of secondary indicators in revised SERVQUAL scale（P>0.05）;there were significant difference in scores of service quality of medical environment,appearance of medical personnel,high quality service,timeliness of service,answering questions,medical morals and ethics,considering special needs of patients,personalization,applicability,comprehensiveness,proactive care,and convenience services of secondary indicators in revised SERVQUAL scale（P<0.05）.Results of scores in overall evaluation of service quality showed that,empathy in first-grade indicators was reverse scoring,score in overall evaluation of service quality of tangible was positive value,scores in overall evaluation of service quality of responsiveness,reliability,and assurance were negative value;among all the secondary indicators,only scores in overall evaluation of service quality of propaganda and instruction of health knowledge,medical environment,intervention effects,and trust were positive values,the others were negative values;results of scores in hundred-mark system showed that,scores in hundred-mark system of all the first-grade and secondary indicators were less than 100.00.There were no significant difference in scores of service quality among patients with different gender,ages,occupations,educational levels,family annual incomes,numbers of children（P>0.05）;there was significant difference in score of service quality among patients with different diseases（P<0.05）.Conclusion　The revised SERVQUAL scale based on PZB model provides methodological support for examining quality of service of existing chronic health management;community health service centers are still insufficient in providing health management services for hypertension and type 2 diabetes patients,thus they should offer personalized care and guidance according to the specific condition of patients to improve service quality in the future follow-up.

Key words: Hypertension, Diabetes mellitus,type 2, Health management, Community health services