Page 43 - 2022-01-中国全科医学

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6.Shanghai Changning District Chengjiaqiao Community Service Center，Shanghai 201103，China
7.Shanghai Hongkou District Quyang Road Community Service Center，Shanghai 200437，China
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Corresponding author：YU Dehua，Professor，Chief physician，Doctoral supervisor；E-mail：ydh1404@sina.com
【Abstract】 Background Strengtheningclinical quality control and supervision is one of the effective ways to ensure
medical quality. Supervising the quality of general medical care in primary care settings in the local region could contribute to the
systematical assessment of general medical care quality and identification of relevantproblems in such settings. Objective To analyze
the supervision of quality of general medical care in Shanghai's primary care settings conducted in 2019 and 2020，and based on
this，to give targeted，rational recommendations on the identified problems in quality management of general medical care. Methods
The quality of general medical care in a cluster sample of community health centers（CHCs）of Shanghai was supervised in 2019
and 2020 by relevant experts from Shanghai's municipal and district general practice quality control departments using the Clinical
Quality Control and Supervision Standards for General Medical Care in Shanghai's Community Health Centers（hereinafter referred
to as CQCSS）developed by Shanghai General Practice Clinical Quality Control Center. In May 2021，the supervision results of the
two years were analyzed using descriptive analysis，then compared，and the identified problems were summarized and analyzed.
Results Two hundred and forty-three CHCs were involved in the 2019 supervision，and 244 were involved in the 2020 supervision.
The average total CQCSS score for 2019 was（87.32±5.97）points，and that for 2020 was （86.67±5.36）points. Compared
to the results in 2019，the scores of first-level indicators of basic conditions（99.93% vs 99.80%），staffing and determining
job responsibilities of general practitioners（GPs）（93.44% vs 91.90%），diagnosis and treatment ability of GPs （85.82% vs
85.72%），chronic disease management ability of GPs（81.07% vs 80.95%）and scientific research and teaching levels （29.99%
vs 28.87%）increased in 2020. The problems mentioned were mainly distributed in five aspects: staffing〔176（22.03%）〕，GPs'
clinical management ability〔154（19.27%）〕，quality of inpatient medical records〔92（11.51%）〕，quality of home sickbed
patients' medical records〔91（11.39%）〕，allocation of facilities〔91（11.39%）〕. In terms of the mentioned frequency，the
top five problems were: ineligible senior GPs to registered GPs ratio〔84（10.51%）〕，poor scientific research〔84（10.51%）〕，
less than 3.5 GPs per 1 000 residents〔61（7.63%）〕，unsatisfactory clinical skills〔40（5.01%）〕，and insufficient number
of home sickbeds〔36（4.51%）〕. Conclusion These two years of quality control supervision has initially promoted the quality
improvementof general medical care in CHCs. To further improve it，it is suggested to take actions to deepen the core essence of general
medical care quality management，improve the diagnosis and treatment ability of GPs，as well as their teaching and research ability.
【Key words】 General practice；Community health services；Health care quality，access，and evaluation；Quality
management；Quality improvement；Shanghai

加强临床质控督查是提高医疗质量的有效途径。通 1.2.1 调查工具 采用“质控中心”制定的《上海市社
过全科临床质控督查可对区域内基层医疗卫生机构全科 区卫生服务中心全科医学临床质控督查标准（基层医疗
临床质量进行系统评价，进而发现全科临床质量管理中 机构版）》（简称《标准》），对上海市社区卫生服务
存在的问题，最终达到“以评促建”“以评促改”“评 中心进行“全覆盖式”的全科临床质控督查。在前期调
建结合”的目的 ［1］ 。上海市在全国率先开展了基层医 研和文献研究基础上，结合上海市医疗质量控制管理事
疗卫生机构全科临床质量管理工作，于 2018 年成立了 务中心管理规范，“质控中心”以系统论为指导，以“结
上海市全科医学临床质量控制中心（简称“质控中心”）。 构 - 过程 - 结果”评估模型为依据，从资源配置、过程
“质控中心”通过连续两年对上海市全市社区卫生服务 质量管理和结果质量 3 个层面确定了评价框架；采用德
中心开展全科临床质控督查，建立、健全全科临床质量 尔菲法（于 2018 年 12 月组建了由 33 名来自上海市 16
管理考核评价制度与规范，逐步建立了市、区两级全科 个行政区的社区卫生服务中心管理者、综合性医院全科
临床质量管理体系，助力了上海市全科医学学科的建设 医学科管理者、高校全科医学教育师资及卫生管理研究
和发展。本研究通过对历次全科临床质控督查结果进行 员组成的专家小组）与层次分析法，建立了包括 7 个一
分析、比较，旨在为持续改进与提升上海市基层医疗卫 级指标、16 个二级指标、55 个三级指标的上海市全科
生机构全科临床质量提供参考。 医学临床质量控制标准督查体系。以上海市全科医学临
1 对象与方法 床质量控制标准督查体系为依据，制定了《标准》和《上
1.1 研究对象 于 2019 年 5 月和 2020 年 7 月，整群 海市社区卫生服务中心全科医学临床质控督查评分表》
抽取上海市全市社区卫生服务中心为研究对象。 （简称《评分表》）。7 个一级指标及其权重分别为基
1.2 研究方法 本条件（10 分）、全科医生人员配备及岗位职责（10 分）、