Development of a Family Doctor Performance Evaluation System Using the Delphi Method

doi:10.12114/j.issn.1007-9572.2019.00.193

Abstract

Abstract: Background　The development of a standardized system for the evaluation of the performance of family doctors is of great significance for strengthening the training of primary care providers.However，the evaluation methods for family doctors' training and performance in China are not comprehensive and systematic.Objective　To develop a comprehensive，scientific and systematic family doctor performance evaluation system.Methods　We developed the initial version of the Family Doctor Performance Evaluation System（FDPES）.Then，we conducted a two-round Delphi consultation in a judgment sample of 15 representatives invited from 15 medical institutions from October 2017 to November 2017 on the issues of the significance and integrity of the indicators in the initial version of the FDPES.According to the Delphi consultation results，we developed the final version of the FDPES after revising the initial version.Results　On average，the experts aged（51.7±9.9）years and had（28.4±11.2）years as a healthcare provider.The response rates of the two rounds of consultation were 100.0%.The authority coefficient of the experts was 0.93 and the Kendall's W for the primary and secondary indicators was 0.403（P<0.001），and 0.427（P<0.001），respectively.The final version of the FDPES consisted of three domains：（1） theoretical knowledge and clinical skills（including two primary indicators）；（2） professional capability（including 6 primary indicators and 30 secondary indicators）；（3） patient satisfaction（including 5 primary indicators）.Conclusion　The sampled experts for the Delphi consultation were highly representative，positive and authoritative.And the FDPES can comprehensively evaluate family doctors' levels of theoretical medical knowledge，clinical skills，clinical thought，professional capability，service quality，which can be used as an aid tool for family doctor performance evaluation.

Key words: General practitioners, Service ability, Assessment, Indicator system, Delphi method

摘要： 背景　建立标准化、规范化的家庭医生服务能力评估体系，对加强基层医疗卫生机构的人才培养具有重要意义，而我国目前对家庭医生的培养和评估手段缺乏综合性和系统性。目的　探索建立综合、科学、系统性的家庭医生服务能力评估体系。方法　在初步构建家庭医生服务能力评估维度的基础上，于2017年10—11月，根据判断抽样原则，邀请15例基层医疗机构的专家，进行2轮Delphi咨询，咨询内容包括家庭医生服务能力评估指标的重要性和完整性评价。根据评价结果，构建家庭医生服务能力评估指标体系。结果　咨询专家平均年龄为（51.7±9.9）岁，平均工作年限为（28.4±11.2）年，有效回收率为100.0%，专家权威系数为0.93，专家在一级和二级指标上的意见协调系数分别为0.403（P<0.001）和0.427（P<0.001），建立的家庭医生服务评估指标体系包括临床理论知识与技能评估（包括2个一级指标）、业务能力评估（包括6个一级指标和30个二级指标）及满意度评价（包括5个一级指标）3个维度。结论　本研究咨询专家代表性强，积极性和权威性高，初步构建的体系全面反映了社区家庭医生的临床理论、技能、思维能力、业务能力及服务质量，可作为家庭医生服务能力评价的参考依据。

关键词: 家庭医生, 服务能力, 评估, 指标体系, Delphi法

LI Miqiong,WU Yumiao,ZHU Jie, et al. Development of a Family Doctor Performance Evaluation System Using the Delphi Method 　[J]. Chinese General Practice, 2019, 22(16): 1989-1995. DOI: 10.12114/j.issn.1007-9572.2019.00.193.
李觅琼,吴玉苗,朱捷等. 基于Delphi法的家庭医生服务能力评估体系的建立[J]. 中国全科医学, 2019, 22(16): 1989-1995. DOI: 10.12114/j.issn.1007-9572.2019.00.193.

References

［1］国务院医改办，原国家卫生计生委，国家发展改革委.关于印发推进家庭医生签约服务指导意见的通知（国医改办发〔2016〕1号）［Z］．2016.
［2］国务院办公厅.国务院办公厅关于推进分级诊疗制度建设的指导意见（国办发〔2015〕70号）［Z］．2015.
［3］祝墡珠.人才队伍建设是强基层的关键［J］．中华全科医师杂志，2016，15（8）：599-600．DOI：10.3760/cma.j.issn.1671-7368.2016.08.007.
ZHU S Z.Building talented workforce teams is the key to strengthened primary care［J］．Chinese Journal of General Practitioners，2016，15（8）：599-600．DOI：10.3760/cma.j.issn.1671-7368.2016.08.007.
［4］American Academy of Family Physicians.Patient care［EB/OL］．（2017-12-01）［2017-12-11］．https：//www.aafp.org/patient-care.html.
［5］前沢政次，高屋敷明由美，藤原靖士.诊疗所で教えるプライマリ#ケア［M］．大阪：日本株式会社プリメド社，2007.
［6］原卫生部.关于印发《全科医生规范化培养标准（试行）》的通知（卫科教发〔2012〕48号）［Z］．2012.
［7］李慧，彭明辉，傅士杰，等．上海市规范化培训全科医生社区卫生服务能力评估研究［J］．中华全科医师杂志，2016，15（9）：672-676．DOI：10.3760/cma.j.issn.1671-7368.2016.09.005.
LI H，PENG M H，FU S J，et al．Assessment of community health service ability of general practitioners after standardized training in Shanghai［J］．Chinese Journal of General Practitioners，2016，15（9）：672-676．DOI：10.3760/cma.j.issn.1671-7368.2016.09.005.
［8］李慧，彭明辉，张向杰，等．上海市社区青年全科医生医疗服务能力初步评估［J］．中华全科医师杂志，2016，15（1）：25-29．DOI：10.3760/cma.j.issn.1671-7368.2016.01.009.
LI H，PENG M H，ZHANG X J，et al．Evaluation of clinical capability of young general practitioners in communities of Shanghai［J］．Chinese Journal of General Practitioners，2016，15（1）：25-29．DOI：10.3760/cma.j.issn.1671-7368.2016.01.009.
［9］许龙龙，苏婷婷，王爽，等．社区全科医生临床基本能力评估指标体系的初步研究［J］．中国全科医学，2013，16（28）：3358-3361．DOI：10.3969/j.issn.1007-9572.2013.28.022.
XU L L，SU T T，WANG S，et al．A preliminary study on the assessment index system of clinical core competencies for the community general practitioners［J］．Chinese General Practice，2013，16（28）：3358-3361．DOI：10.3969/j.issn.1007-9572.2013.28.022.
［10］王宇，张先福，吴学谦，等．英国与中国全科医疗绩效考核比较研究［J］．中国全科医学，2017，20（25）：3067-3071．DOI：10.3969/j.issn.1007-9572.2017.25.001.
WANG Y，ZHANG X F，WU X Q，et al．Comparative study on the performance appraisal of the general practice between UK and China［J］．Chinese General Practice，2017，20（25）：3067-3071．DOI：10.3969/j.issn.1007-9572.2017.25.001.
［11］张铎龄，张译丹，项雪，等．基于先进国家评估标准的大连市社区医生业务能力自评调查［J］．中国全科医学，2016，19（34）：4262-4266．DOI：10.3969/j.issn.1007-9572.2016.34.023.
ZHANG D L，ZHANG Y D，XIANG X，et al．Self-assessment of community physicians' professional capabilities in Dalian based on the evaluation criteria of developed countries［J］．Chinese General Practice，2016，19（34）：4262-4266．DOI：10.3969/j.issn.1007-9572.2016.34.023.
［12］潘小炎.广西全科医生综合素质评价指标体系研究［D］．长沙：中南大学，2013.
PAN X Y.Evaluation index system of general practitioner quality in Guangxi［D］．Changsha：Central South University，2013.
［13］滕菲，关丽征，王亚东，等．基于欧洲满意度调查量表的社区卫生服务满意度评价方法探讨［J］．中国全科医学，2011，14（25）：2844-2847．DOI：10.3969/j.issn.1007-9572.2011.25.004.
TENG F，GUAN L Z，WANG Y D，et al．Evaluation of community health service satisfaction by method based on the EUROPEP-Questionnaire［J］．Chinese General Practice，2011，14（25）：2844-2847．DOI：10.3969/j.issn.1007-9572.2011.25.004.
［14］张赛，张莹，杜蕾，等．全科医疗评估问卷在社区卫生服务患者满意度调查中的应用与评价［J］．中华全科医师杂志，2011，10（7）：463-467．DOI：10.3760/cma.j.issn.1671-7368.2011.07.004.
ZHANG S，ZHANG Y，DU L，et al．Application and evaluation of general practice assessment questionnaire Chinese version for patients' satisfaction in community health-care service［J］．Chinese Journal of General Practitioners，2011，10（7）：463-467．DOI：10.3760/cma.j.issn.1671-7368.2011.07.004.
［15］张颖，季聪华，李秋爽，等．中医临床实践指南制修订中德尔菲法的统计分析方法［J］．中华中医药杂志，2018，33（1）：249-251.
ZHANG Y，JI C H，LI Q S，et al．Statistical analysis method of Delphi technique used in clinical practice guideline of traditional Chinese medicine［J］．China Journal of Traditional Chinese Medicine and Pharmacy，2018，33（1）：249-251.
［16］EPSTEIN R M，HUNDERT E M.Defining and assessing professional competence［J］．JAMA，2002，287（2）：226-235．DOI：10.1001/jama.287.2.226.
［17］DUFFY F D，GORDON G H，WHELAN G，et al．Assessing competence in communication and interpersonal skills：the Kalamazoo Ⅱ report［J］．Academic Medicine，2004，79（6）：495-507．DOI：10.1111/j.1567-1364.2008.00386.x.
［18］VAN ZANTEN M，BOULET J R，MCKINLEY D.Using standardized patients to assess the interpersonal skills of physicians：six years' experience with a high-stakes certification examination［J］．Health Communication，2007，22（3）：195-205．DOI：10.1080/10410230701626562.
［19］江孙芳，寿涓，张向杰，等．客观结构化临床考核方法在上海市全科医师规范化培训学员临床能力毕业考核中的运用［J］．中华全科医师杂志，2009，8（12）：856-859．DOI：10.3760/cma.j.issn.1671-7368.2009.12.007.
JIANG S F，SHOU J，ZHANG X J，et al．Objective structured clinical examination in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai［J］．Chinese Journal of General Practitioners，2009，8（12）：856-859．DOI：10.3760/cma.j.issn.1671-7368.2009.12.007.
［20］张勘，沈福来.大力开展社区科研是一项重要而迫切的学科人才建设任务［J］．上海医药，2014，35（6）：15-19.
ZHANG K，SHEN F L.Vigorously carry out scientiifc research is a community important and urgent subject talent construction tasks［J］．Shanghai Medical and Pharmaceutical Journal，2014，35（6）：15-19.
［21］杨辉，Shane Thomas.全科医学服务体验和满意度调查的国际进展及借鉴［J］．中国全科医学，2006，9（11）：878-880．DOI：10.3969/j.issn.1007-9572.2006.11.003.
YANG H，THOMAS S.Patients' experience and satisfaction survey on general practice：international development and Australian experience［J］．Chinese General Practice，2006，9（11）：878-880．DOI：10.3969/j.issn.1007-9572.2006.11.003.

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