Page 28 - 2022-01-中国全科医学

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Differences of Community Health Service Quality Evaluation in China and Abroad：a Systematic Review ZHANG
Qianqian 1，2，3 ，JIN Hua 1，2，3 ，YU Dehua 1，2，3*
1.Department of General Practice，Yangpu Hospital，Tongji University School of Medcine，Shanghai 200090，China
2.Shanghai General Practice Clinical Quality Control Center，Shanghai 200090，China
3.Shanghai General Practice and Community Health Development Research Center，Shanghai 200090，China
*
Corresponding author：YU Dehua，Chief physician，Professor，Doctoral supervisor；E-mail：ydh1404@sina.com
【Abstract】 Background In China，the assessment of community health services has been increasingly valued as the
development of such services advances，but relevant research is still at the exploratory stage. Therefore，establishing a community health
service quality evaluation system suitable for China's national conditions is critical to domestic development of such services. Objective To
perform a review of studies about community health service quality evaluation in China and abroad to identify the similarities and differences in
terms of assessment perspectives and contents between them，providing theoretic evidence for further implementation of such evaluations in
China. Methods Studies regarding community health service quality evaluation were systematically searched in databases of China National
Knowledge Infrastructure，CQVIP，Wanfang and PubMed from inception to October 15，2020. Two researchers performed literature
screening，data extraction，and comparative analysis of community health service quality evaluation at home and abroad by assessment
perspectives and contents，separately. Descriptive analysis was used to analyze the comparative results. Results In total，62 articles in
English，and 16 articles in Chinese were included，among which 10 in English and 7 in Chinese evaluated the quality of community health
services in terms of the major factors of features of community health services（first contact，humanization，accessibility，continuity，
coordination and comprehensiveness）. The top 3 highlights of these 10 foreign articles were coordination（7/10），humanization（6/10）
and accessibility（5/10），while those of 7 domestic articles were humanization（6/7），comprehensiveness（4/7）and accessibility（4/7）.
Fifty-two articles in English and 9 articles in Chinese assessed the quality of specific community health services，and these foreign articles
mostly focused on the management of chronic diseases〔type 2 diabetes（12/52），cardiovascular and cerebrovascular diseases（11/52），
hypertension（7/52），respiratory diseases（7/52），chronic kidney disease（5/52）〕，followed by the use of antibiotics（5/52），
cancer screening （5/52），medication safety（5/52），child health care（5/52）and geriatric care（5/52），while domestic articles
mostly focused on the management of chronic diseases〔type 2 diabetes（3/9），hypertension（3/9）〕，and maternal health management（3/9）.
Conclusion The quality of community health services is increasingly valued by relevant academic circles. Compared to foreign studies，
domestic studies are far less concerned about first contact and coordination，and the assessed specific services in which are not complete，
with no quality assessment of diagnosis and treatment of common diseases and frequently-occurring diseases. It is suggested to address
the above-mentioned issues to promote the community health service quality evaluation，and improve the depth and breadth of relevant
research，thereby the community health service quality evaluation system could be improved constantly.
【Key words】 General practice；Community health services；Health care quality，access，and evaluation；Quality
management；Quality improvement

1978 年世界卫生组织发表《阿拉木图宣言》，提出： 质量评价体系也在不断完善。目前，部分发达国家已建
基本医疗是指最基本的，人人都能得到的，人民群众和 立了较为完善的社区卫生服务质量评价体系，如英国的
政府都能负担得起的卫生保健服务 ［1］ 。社区卫生服务 质量和结果框架（QOF）、欧盟的基层保健质量和成本
是公共卫生体系的“网底”和基本医疗保障体系的基础， 计划（QUALICO-PC）、澳大利亚的全科医学标准等 ［3］ ，
其主要特点包括首诊、人性化、综合性、连续性、可及 但我国社区卫生服务质量评价相关研究仍处于探索阶
性和协调性，其水平和质量直接关系到居民的健康水平 段，尚未形成统一、标准化的社区卫生服务质量评价体
和生活质量。基层医疗质量评估是由医生或医疗机构发 系。因此，本研究通过对国内外社区卫生服务质量相关
起的，甚至是由患者主导的，旨在通过改进具体医疗服 研究进行比较、分析，旨在为我国社区卫生服务质量评
务环节，提升医疗服务质量的方法 ［2］ 。通过对社区卫 价工作开展提供现实依据，为统一、标准化的社区卫生
生服务质量进行评价，有助于及早发现社区卫生服务中 服务质量评价体系构建与应用奠定基础。
存在的问题，及时消除医疗安全隐患，促进现有卫生资 1 资料与方法
源的有效利用和合理配置，进而提升居民对社区卫生服 1.1 文献纳入与排除标准
务的利用度和满意度。因此，开展社区卫生服务质量评 1.1.1 纳入标准 纳入明确提及社区卫生服务及其质量
价对于促进我国社区卫生服务发展、持续提高居民健康 评价的研究。文献类型包括：原始研究、二次研究（综
水平具有重要的现实意义和价值。 述、系统综述）和政策文献（即政府及相关部门发布的
随着社区卫生服务的不断发展，各国社区卫生服务 通知、意见或决定）。