Abstract: Background　Family doctor contract service is a key measure to promote graded diagnosis and treatment. Team effectiveness is the core antecedent that affects the performance of family doctor teams, but the mechanism of its internal and external factors is currently unclear and needs to be empirically explored. Objective　To conduct empirical research on the effectiveness of family doctor teams and explore the underlying mechanisms and effects of internal and external influencing factors on team effectiveness. Methods　From March to May 2024, conducted a questionnaire survey of family doctor team members from 20 community health service centers in Shanghai's public hospital high-quality development pilot project. The questionnaire includes personal basic characteristics, team situation, team service efficiency scale, organizational support scale, and family doctor team leader leadership strength scale. The team service efficiency scale was designed by the research group and includes four sub scales: human resource allocation, ability reserve, team operation, and output execution. Single factor analysis and multiple linear regression were used to analyze the influencing factors of the scores on the output execution subscale of family doctor teams, and structural equation modeling was used to analyze the mechanism of the effects of internal and external factors on team output execution. Results　A total of 514 questionnaires were distributed, and 509 valid questionnaires were collected, with an effective response rate of 99.0%. The average score of the team output execution subscale is (3.99±0.76) points. The results of univariate analysis showed that there was a statistically significant difference (P<0.05) in the scores of the output execution subscale among teams with different ages and years of service as family doctors/general practitioners; There was a statistically significant difference (P<0.05) in the scores of the output execution subscale among teams with different numbers of family doctors and the ratio of family doctors to family doctor assistants; There was a statistically significant difference (P<0.05) in the scores of the output execution subscale between the teams with or without rehabilitation physicians, public health physicians, and third-party personnel. The results of multiple linear regression analysis showed that the scores of the team operation subscale, as well as the scores of organizational support and team leader leadership, had a positive impact on the scores of the team output execution subscale (P<0.05). The results of the structural equation model indicate that team operational factors, external factors, and internal structural factors all positively drive the execution of team effectiveness output (P<0.05), with decreasing degrees; There is a significant positive correlation (P<0.001) between external factors driving team operation and internal structural factors, with decreasing degrees; Internal structural factors significantly drive team operation (P<0.001). Conclusion　Individual years of practice, number of doctors in the team, team personnel configuration, team capacity reserve, team operation, organizational support, and leadership of family doctor team leaders all have an impact on the output and execution level of team effectiveness; The structural and procedural elements within the team positively drive team effectiveness. It is necessary to establish and configure a family doctor team reasonably, continuously improve team capabilities, and strengthen organizational support to enhance team effectiveness.

Key words: Family doctor team, Task performance, Community health services, Team work outputs, Root cause analysis

摘要： 背景　家庭医生签约服务是推进分级诊疗的关键举措。团队效能是影响家庭医生团队绩效表现的核心前因，但目前其内外部要素的作用机制尚不明确，需开展实证探讨。目的　开展家庭医生团队效能实证研究，探索内外部影响因素对团队效能的影响机制。方法　于2024年3—5月，对上海市公立医院高质量发展试点工作中20家社区卫生服务中心的家庭医生团队成员进行问卷调查。问卷内容包括个人基本特征、所在家庭医生团队情况、家庭医生签约服务团队效能评价量表、组织支持感量表、家庭医生团队长领导力量表，其中家庭医生签约服务团队效能评价量表由课题组自行设计，包括人力配置、能力储备、团队运行、产出执行4个分量表。采用单因素分析和多元线性回归分析探讨家庭医生团队产出执行分量表得分的影响因素，采用结构方程模型分析团队内外部因素对团队产出执行的作用机制。结果　共发放问卷514份，回收有效问卷509份，问卷有效回收率为99.0%。平均团队产出执行分量表得分为（3.99±0.76）分。单因素分析结果显示：不同年龄、从事家庭医生/全科医学工作年限成员的产出执行分量表得分比较，差异有统计学意义（P<0.05）；所在团队家庭医生数、家庭医生与家庭医生助理配置比例、对当前家庭医生团队工作满意度不同的成员，其产出执行分量表得分比较，差异有统计学意义（P<0.05）；所在团队是否配置康复医师、是否配置公共卫生人员、是否配置第三方人员的成员，其产出执行分量表得分比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：团队运行分量表得分、组织支持感得分、团队长领导力得分对团队产出执行分量表得分有正向影响（P<0.05）。结构方程模型结果显示：团队内部过程性因素、外部因素、内部结构性因素均正向驱动团队效能产出执行（P<0.05），程度递减；团队外部因素显著正向驱动内部过程性因素、内部结构性因素（P<0.001），程度递减；内部结构性因素显著正向驱动内部过程性因素（P<0.001）。结论　个人执业年限、团队内医生数量、团队人员配置、团队能力储备、团队运行、组织支持感、家庭医生团队长领导力均对团队效能的产出执行水平有影响；团队内部结构性要素和过程性要素正向驱动团队效能，应合理组建和配置家庭医生团队，持续提升团队能力，加强组织保障以提高团队效能。

关键词: 家庭医生团队, 工作效能, 社区卫生服务, 团队工作产出, 影响因素分析