基层医疗绩效考核改革实施情况

目的 了解上海市新一轮家庭医生绩效考核工作的实施情况,探讨绩效考核对家庭医生激励作用的影响因素.方法 采用分层整群随机抽样调查方法,从上海市65家试点社区卫生服务中心中,按中心城区、城乡接合部、郊区3个层次,抽取10家社区卫生服务中心,以抽中单位的全部在岗家庭医生作为研究对象,共收集270名家庭医生的调查问卷,调查内容包括本单位绩效考核的实施情况、有无起到激励作用等.结果 有94.4％的家庭医生知晓绩效考核改革试点工作,不同地区间有统计学差异(X2=24.425,P＜0.0001);有230人(85.2％)认为本单位绩效考核及薪酬分配方案公开透明,且不同地区间有统计学差异(X2=21.77,P＜0.0001);有198人(73.3％)表示本单位反馈绩效考核结果,不同地区之间有统计学差异(X 2=30.430,P＜0.0001).212例(78.5％)认为通过绩效考核改革能够激励自身更好地投入工作.多因素Logistics回归分析显示,所在地区、绩效考核及薪酬分配方案的形成过程是否公开透明、考核结果是否反馈、绩效工资提升的比例是家庭医生激励作用的影响因素.结论 上海市试点社区卫生服务中心的家庭医生绩效考核实施总体情况良好,家庭医生对绩效考核工作的知晓度高,其中城乡接合部的实施情况好于中心城区,郊区较差.绩效考核方案公开透明、反馈考核结果、绩效工资提升幅度是家庭医生激励作用产生的重要因素.

Analysis of the Overall Situation of Performance Appraisal Reform

Objective To describe the implementation status of performance appraisal in general practitioners on the pilot phase in partial community health service centers in Shanghai.Methods Stratified cluster random sampling method was applied to enroll 10 community health centers from 65 of three levels: city center, urban and rural areas.A total of 270 general practitioners from the centers were taken as research subjects and completed a questionnaire survey about the implementation of performance appraisal, incentive related factors and their effects.Results Among the 270 general practitioners, 225 have clear understanding of the comprehensive reform and the result is statistically significant (X2=24.425,P＜0.0001);230 hold that the process of the performance appraisal and the compensation allocation scheme are transparent and the result is statistically significant (X2=21.77,P＜0.0001);198 express that the unit gives feedback about the performance appraisal results and the result is statistically significant (X2=30.430,P＜0.0001).When it comes to the incentive effects of the performance evaluation on the family doctor, 212 family doctors(78.5％) regard the reform of performance evaluation as a good way of encouragement.According to the multi-factor Logistics regression analysis, the following four factors have incentive effect on the implementation of performance appraisal in general practitioners: location, transparency of the process of the performance appraisal and the compensation allocation scheme, feedback of the evaluation results, and increased wage based on performance appraisal.ConclusionMost of the community health service centers have launched the performance appraisal and carried out the program of family doctor according to the Shanghai Municipal Commission of Health and Family Planning.General practitioners have knowledge of the comprehensive reform and think the salary distribution program is transparent.Among all the areas, urban shows better performance.Incentive factors include transparency of the process of the performance appraisal and the compensation allocation scheme, feedback of the evaluation results, and increased wage based on performance appraisal.