Abstract: With the deepening of the comprehensive reform of community health services in Shanghai，the number of residents signing medical contracts with family doctors has continued to expand，but the problems of imperfect supporting measures and residents signing contracts without visiting still exist.Establishing a long-term and stable service relationship between contracted residents and family doctors is the basis for the practice of family doctor services.On the basis of consolidating the existing contract-signing rate of residents，the Pujin Community Health Service Center in Minhang District of Shanghai had shifted the focus of contracted family doctor service to provide the effective service，in order to explore the reform methods of family doctor service to improve the corresponding visiting rate of contracted residents.The main methods included carrying out the "three optimizations and two extensions" model（optimizing the shift arrangement of general practitioners，the publicity model，and outpatient registration and visiting queue system；extending the telephone consultation service hours and working-day noon service hours and opening the weekend clinics）；implementing the "two more policy" for drug supply after residents signed contracts（signed residents were issued a larger number of drug types and quantities for outpatient visits）；implementing the service of long prescription and extending its advantages；promoting the reform of performance and evaluation mechanism to widen the performance gap between contracted residents and non-contracted residents receiving outpatient consultation from family doctors；and issuing quality briefings to conduct appraisal feedback in the form of rectification notice.After one year of the reform（as of June 2019），the rates of consulting the contracted family doctor，visiting the contracted family doctor for outpatient services，and extending period of prescriptions by the contracted family doctor reached 38.53%，31.99% and 87.03%，respectively，which increased by 30.54，26.98 and 60.02 percentage points compared with the beginning of the reform（July 2018）.At the same time，the resource utilization of family doctor services，the awareness rate of family doctor services，and satisfaction degree of residents also improved to a certain extent.The purpose of this article is to introduce the reform methods，the effect and further work priorities of Pujin Community Health Service Center，in order to provide references for other areas to improve the effectiveness of contracted family doctor services.

Key words: Contracted family doctor services, Service quality improvement, Corresponding visiting rate, Health care reform

摘要： 随着上海市社区卫生服务综合改革的进一步深入，居民签约量不断扩大，但配套措施不完善、居民“签而不约”的问题依然存在。建立签约居民与家庭医生长期、稳定的服务关系，是做实家庭医生服务的根本。上海市闵行区浦锦社区卫生服务中心在巩固现有家庭医生签约率的基础上，将签约服务工作重点向有效服务转变，探索提高签约居民门诊就诊对应率的家庭医生服务改革。主要做法包括：推行“三优化两延时”模式（优化全科医生排班、宣传模式、门诊挂号和叫号信息系统，延时电话咨询服务时间和工作日午间服务时间并开设周末门诊）；居民签约后实施药品供应“两多政策”（签约居民门诊就诊开具药品种类和数量多），落实长处方、延伸处方优势服务；推动绩效与考评机制“双改革”，拉开家庭医生门诊接诊签约居民与非签约居民的绩效差距，下发质量简报，以“整改通知书”的形式落实考核反馈。改革实施1年后（2019年6月），社区卫生服务中心的签约居民家庭医生就诊率、家庭医生门诊签约居民就诊率、签约居民家庭医生延处方率分别达到了38.53%、31.99%、87.03%，较改革初始（2018年7月）分别提高了30.54、26.98、60.02个百分点。同时，家庭医生服务资源利用情况、居民的家庭医生服务知晓率和满意度也有一定程度的提高。本文旨在对浦锦社区卫生服务中心的改革做法、成效及进一步的工作重点进行介绍，以期为其他地区提高签约服务有效性提供参考。

关键词: 家庭医生签约服务, 服务质量改进, 就诊对应率, 卫生保健改革