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

摘要： 目的　建立基于PZB模型的修订后SERVQUAL量表，为社区责任医师团队进行自身医疗服务质量评价，改进服务质量提供工具；了解社区高血压、2型糖尿病患者对健康管理的总体评价，找出影响健康管理服务质量的要素，提出针对性建议，为有效评价服务质量和提高管理水平提供参考依据。方法　于2015年选择湖州市吴兴区东林镇辖区社区卫生服务站进行规范健康管理的高血压、2型糖尿病患者360例为调查对象，通过文献法、焦点组访谈、德尔菲专家咨询法、预调查等方法修订SERVQUAL量表，评价修订后SERVQUAL量表信效度，主成分分析法提取公因子。采用Likert 5级评价服务感知、服务期望评分，服务质量评分=服务感知评分-服务期望评分；计算各指标服务质量总体评价得分和百分制得分；比较不同基本情况患者服务质量评分的差异。结果　共发放问卷360份，回收有效问卷346份，有效回收率为96.11%。346例患者中单纯高血压患者265例，占76.59%，单纯2型糖尿病患者32例，占9.25%，高血压合并2型糖尿病患者49例，占14.16%。修订后SERVQUAL量表5个维度为有形性、响应性、可靠性、保证性、移情性。修订后SERVQUAL量表Cronbach’s α系数为0.802。KMO值为0.708，Bartlett’s球形检验χ2=3 556.00，共提取5个公因子，累计方差贡献率为71.14%。5个因子与指标体系的5个维度基本吻合，问卷具有较好的结构效度。修订后SERVQUAL量表二级指标中的健康知识宣教、干预效果、遵守承诺、服务安全、沟通、信任、尊重的服务质量评分比较，差异均无统计学意义（P>0.05）；修订后SERVQUAL量表二级指标中的就医环境、医务人员仪表、优质服务、服务及时、解答疑问、医风医德、考虑患者特殊需要、个性化、适用性、全面、主动关心、便民服务的服务质量评分比较，差异均有统计学意义（P<0.05）。服务质量总体评价得分结果显示，一级指标中移情性为反向计分，有形性服务质量总体评价得分为正值，响应性、可靠性、保证性服务质量总体评价得分为负值；各二级指标中，仅健康知识宣教、就医环境、干预效果、信任的服务质量总体评价得分为正值，其余均为负值。服务质量百分制得分结果显示，各一级指标和二级指标服务质量百分制得分均小于100.00。不同性别、年龄、职业、学历、家庭年收入、子女数量患者服务质量评分比较，差异均无统计学意义（P>0.05）；所患疾病不同患者服务质量评分比较，差异有统计学意义（P<0.05）。结论　基于PZB模型的修订后SERVQUAL量表为考察现有慢性病健康管理服务质量提供了方法支持；社区卫生服务中心对高血压、2型糖尿病患者进行的健康管理服务中仍存在诸多不足之处，在今后的健康管理服务中，应根据患者具体患病情况，给予个性化的关怀和指导，提高服务质量。

关键词: 高血压, 糖尿病,2型, 健康管理, 社区卫生服务