家庭医生签约服务标化工作量测算及应用研究

背景　家庭医生签约服务不断推进，亟需一套科学、公平、实用、可操作的绩效管理模式，而工作量的测算是绩效管理的核心。目的　针对家庭医生签约服务新的基层卫生健康服务供给的规律和特点，核定广州市家庭医生签约服务项目，选用科学合适的方法对家庭医生签约服务标化工作量进行测算，对家庭医生团队进行科学、动态的绩效管理。方法　于2018年选取广州市60家社区卫生服务中心作为样本单位采用问卷调查、半结构化访谈、客观观察和主观评估等研究方法，测算并校正家庭医生签约服务工作量，并对标化工作量在绩效和补偿方面的应用进行探讨。结果　将广州市家庭医生签约服务项目分成6大类152项。以为居民当面建立一份健康档案（含发放居民健康卡）为1个标准点数值，综合考虑时间因素、体力因素、技术因素和压力含量因素，确定了包括152项家庭医生签约服务项目点数值，并通过最小二乘法估计结合岭回归估计建立RBRVS工作量函数关系式，拟合优度在89%以上，并以标化工作量为基础进行绩效分配的模拟。结论　以标准化工作量点数表为基础的绩效分配，在家庭医生签约服务领域标化工作量的应用使得绩效收入分配和财政补偿方案更加简单、易行，可以对机构实现更为精确有效的补偿，充分体现医生的劳动价值，鼓励医生多劳多得、优劳优得。

Measurement and Application of the Standardized Workload of Contracted Family Doctor Services

Background　The promotion of family doctor services urgently needs a practical and feasible system assessing the service performance of family doctors scientifically and fairly，and the measurement of workload is the core of the performance management. Objective　To scientifically standardize the workload of services delivered by Guangzhou family doctors using appropriate ways after determining the service scope according to the new regular pattern and features of provision of such services in primary care，to achieve scientific and dynamic performance management of the family doctor team. Methods　In 2018，a questionnaire survey was used to investigate and determine the contracted services delivered by family doctors from 60 community health centers in Guangzhou. And semi-structured interview，objective observation and subjective evaluation were adopted to measure and standardize the workload of such services. The application of standardized workload in estimating performance and compensation was also discussed. Results　The contracted services provided by Guangzhou family doctors include six categories with 152 items. With onsite health record establishment（including health card establishment） being set as one standardized point value，and a consideration of multiple factors，such as time consumption，physical consumption，technical difficulty and stress intensity in service delivery，the standardized point values for the 152 services were determined. The least square estimation and ridge regression were used to develop a RBRVS formula to calculate the workload，with goodness of fit tested to be greater than 89%. Performance allocation was simulated based on the standardized workload. Conclusion　The performance income distribution and financial compensation scheme based on the standardized workload point scale is simpler and more practicable，which may be used by the hospital to achieve compensation more accurately and effectively. And the performance management using it may fully reflect the labor value of doctors，encouraging them to get more by doing more and doing better.