我国家庭医生签约服务绩效考核的关键问题确认分析

陈红; 周蓉; 石建伟; 俞文雅; 吕奕鹏; 周良; 高翔; 王朝昕; 黄雷

doi:10.16766/j.cnki.issn.1674-4152.002709

我国家庭医生签约服务绩效考核的关键问题确认分析

doi: 10.16766/j.cnki.issn.1674-4152.002709

陈红¹,
周蓉²,
石建伟¹,
俞文雅¹,
吕奕鹏¹,
周良¹,
高翔¹,
王朝昕¹,
黄雷^2, ,

1.
上海交通大学医学院公共卫生学院，上海 200025
2.
上海市黄浦区五里桥街道社区卫生服务中心，上海 200023

基金项目:

国家自然科学基金项目 72004032

上海市社区卫生协会2021年社区科研重点项目 SWX21Z02

上海市公共卫生优秀学科带头人项目 GWV-10.2-XD07

详细信息

通讯作者:
黄雷, E-mail: huangleolina@163.com

中图分类号: R192.3 R197.61
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- 文章访问数: 327
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- PDF下载量: 23
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-25
- 网络出版日期: 2022-12-30

Confirmation and analysis of critical issues in performance appraisal of family doctors ' contracted services in China

1.
School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

摘要

摘要: 目的明确当前我国家庭医生签约服务绩效考核的关键问题，并为该绩效考核体系的进一步优化提供建议。方法通过政府网站、信息公开平台等渠道系统检索收集我国国家和地区层面出台的有关家庭医生签约服务绩效考核的政策文件，在中国学术期刊全文数据库(CNKI)中以“家庭医生签约服务/全科医生/社区卫生服务中心+绩效评价/绩效考核/绩效考评”为主题词检索2022年3月1日前的相关文献，评阅和分析涉及我国家庭医生签约服务绩效考核的55篇中文文献，并对文献中涉及的问题进行收集梳理，运用文献综述法、聚类分析等方法对文献进行定性和半定量研究。结果对55篇文献中涉及的14个主要问题进行分析，发现我国家庭医生签约服务绩效考核体系的问题主要集中于结构子模，其中，“考核体系未体现出家庭医生签约服务价值的独特性”“指标权重设置不符合后疫情常态化时代的定位”和“绩效考核流于形式”是我国家庭医生签约服务绩效考核领域的关键问题。结论本研究归纳整理的问题系统以及关键问题，可以在实际工作中帮助决策和研究人员对该领域有更深入地了解并采取措施进行完善，明确日后的工作重点。问题主要集中在结构子模上，因此，未来应当以战略长远角度考虑绩效考核的方式，在政策指导下，从考核体系的指标选取、权重设置以及考核方法等方面着手进行改进，以期优化家庭医生签约服务绩效考核体系，促进基层卫生机构和人员共同进步。
- 家庭医生 /
- 签约服务 /
- 绩效考核 /
- 关键问题 /
- 卫生系统宏观模型
Abstract: Objective To verify the critical issues related to the performance appraisal of family doctors in China and provide suggestions for further optimisation in this field. Methods Policy documents related to the performance appraisal of family doctors ' contracted services issued at the national or regional levels were systematically retrieved and collected by channels such as government websites, information disclosure platforms, and so on, as well as literature before March 1, 2022 was retrieved in the CNKI with the theme of "Family doctors/General doctors/Community health service centres/Contracted services+Performance evaluation/Performance evaluation/Performance evaluation". Then, a total of 55 Chinese documents related to the performance appraisal of family doctors in China were reviewed and analysed, and qualitative and semi-quantitative research on the documents were conducted using literature review and cluster analysis. Results It was found by analysing the 14 main problems that the issues of the performance evaluation system of family doctors ' contracted services in China was mainly focused on structural submodel, among which, "the evaluation system did not reflect the uniqueness of the value of family doctors ' contracted services", "the setting of index weight did not conform to the positioning of the post epidemic normalisation era"and "performance appraisal was a mere formality" were the key issues in the field of performance appraisal of contracted services of family doctors in China. Conclusions The issue system and key issues summarised in this study can help decision-makers and researchers have a deeper understanding of this field, hence, clarifying the focus of future work. However, the problem mainly focuses on the structural submodel. Therefore, the way of performance appraisal should be considered from a strategic and long-term perspective in the future. In addition, under the guidance of policies, improvements should be made from the aspects of index selection, weight setting and appraisal methods of the appraisal system to truly achieve the results of common progress of grass-roots health institutions and personnel.
- Family doctor /
- Contracted services /
- Performance appraisal /
- Critical issues /
- Macro model of the health system

HTML全文

图 1 我国家庭医生签约服务绩效考核相关文献时间分布

Figure 1. Year of publication of documents related to performance evaluation of family doctor' contracted services in China

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图 2 我国家庭医生签约服务绩效考核问题评阅饱和曲线

Figure 2. Evaluation saturation curve of issues related to performance evaluation of family doctor' contracted services in China

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图 3 问题重要性和严重性聚类分析象限图

Figure 3. Quadrant diagram of clustering analysis of problem importance and severity

下载: 全尺寸图片幻灯片

表 1 家庭医生签约服务绩效考核领域的问题系统

Table 1. The issue system in the field of performance evaluation of family doctor' contracted services

序号	问题描述	概念或维度	子模
1	考核人员的专业素质有待于进一步提升	人力之质	资源	结构
2	信息化建设在绩效考核中的作用仍未充分发挥	物力之质
3	考核评价主体单一，影响评价的权威及科学	计划与评价机制	组织
4	绩效考核定位不清，流于形式
5	考核体系未体现出家庭医生签约服务价值的独特性
6	绩效考核指标不够全面和细化
7	考核指标体系权重设置不符合后疫情时代或者疫情常态化时代的定位
8	绩效考核机制不健全，尚未形成统一、完整的考核体系	政策工具使用	行政
9	考核实施过程中的质量控制和有效监督机制未贯彻落实	质量保证	过程	过程
10	难以做到实时评价，日常评价欠缺
11	各地数据收集、统计方法不统一，评价结果无法横向比较	效果	系统结果	结果
12	绩效考核结果反馈不及时，对考核对象没有足够的激励性
13	全科医生团队成员薪酬满意度较低	直接影响	社会经济	外部子模
14	相关人员对考核体系认知不足	技术和知识	社会文化

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表 2 家庭医生签约服务绩效考核问题的重要性、严重性和优先解决情况排序

Table 2. Ranking of importance, seriousness and priority of the issues related to performance evaluation of family doctor' contracted services

问题编号	重要性指数		严重性指数		优先解决指数
问题编号	I_i	排序	S_i	排序	R_i	排序
1	0.091 8	3	0.073 7	9	0.080 7	4
2	0.081 8	5	0.063 7	10	0.070 7	10
3	0.054 4	13	0.081 7	5	0.071 1	8
4	0.095 7	2	0.115 7	1	0.108 0	2
5	0.108 7	1	0.111 1	2	0.110 1	1
6	0.074 3	6	0.077 1	7	0.076 0	5
7	0.082 9	4	0.090 9	3	0.087 8	3
8	0.055 7	11	0.080 8	6	0.071 1	9
9	0.065 9	8	0.049 3	12	0.055 7	11
10	0.044 0	14	0.000 4	14	0.017 2	14
11	0.062 8	9	0.043 6	13	0.051 0	13
12	0.060 3	10	0.085 5	4	0.075 8	6
13	0.066 2	7	0.077 1	7	0.072 9	7
14	0.055 5	12	0.049 4	11	0.051 8	12

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