家庭医生签约服务团队内部考核指标体系构建研究

背景　成都市武侯区自2014年开始“基层医疗转型”，开展以人为中心主动化健康管理服务模式（PCAC）的家庭医生签约服务，以家庭医生团队为单位进行家庭医生签约服务考核，同时团队长在团队内部进行二次考核，但是目前缺乏科学、合理、有效、易于操作的团队内部使用的考核指标体系。目的　构建一套家庭医生签约服务团队内部工作评价指标体系，为家庭医生团队合理、科学地评价团队内部工作提供指导。方法　采用文献回顾、德尔菲法等研究方法，初步建立家庭医生团队内部签约服务评估指标体系并编制专家咨询问卷。于2019年12月-2020年3月采用德尔菲专家咨询法，经两轮专家咨询，确定了家庭医生团队内部签约服务评价指标体系，通过主成分分析法确定指标权重。结果　两轮专家咨询表的回收率分别为100.0%（35/35）和100.0%（25/25）。两轮专家咨询的熟悉程度分别为（0.71±0.05）和（0.74±0.13），判断依据分别为（0.79±0.12）和（0.88±0.10），权威系数分别为（0.87±0.09）和（0.81±0.10）。两轮专家咨询的肯德尔协调系数分别为0.177（χ2=322.054，P<0.001）和0.215（χ2=242.762，P<0.001）。最终构建了一套包含3个一级指标〔面对面服务（0.400 0）、非面对面服务（0.100 0）、面对面/非面对面服务（0.500 0）〕、10个二级指标、23个三级指标及其权重的家庭医生签约服务团队内部考核指标体系。结论　本研究构建了家庭医生签约服务团队内部考核指标体系，可客观、科学地评估家庭医生签约服务团队内部服务。

Development of a System for Assessing Family Doctor Team Members' Performance by the Team Leader

Backgroud　Since 2014，Chengdu's Wuhou District has initiated primary care transformation，delivering person-centered active care by the family doctor team，and assessing the team performance as well as each member's performance（by the team leader）. However，there is no available easy-to-use system for assessing the team members' performance scientifically，rationally and effectively by the team leader. Objective　To develop a system for assessing the performance of each member of a family doctor team by the team leader，offering guidance on carrying out rational and scientific performance assessment within the family doctor team. Methods　We used literature review to develop the first draft of a system for assessing the performance of family doctor team members by the team leader. Based on this draft，we developed a questionnaire and used it to conduct two rounds of surveys with relevant experts using the Delphi technique between July 2019 and February 2020 for obtaining their ideas and opinions，and determined the content of the system after revising it according to the survey results. We determined the weight of each dimension，index and subindex of the system by principal component analysis. Results　The response rates of the two rounds of expert consultation were 100.0%（35/35） and 100.00%（25/25），respectively. The mean coefficients of Cs，Ca and Cr were（0.71±0.05）（0.79±0.12）（0.87±0.09） for the first round of survey，respectively，and were（0.74±0.13）（0.88±0.10）（0.81±0.10） for the second round of survey，respectively. The Kendall's W for the first and second consultations were 0.177（χ2=322.054，P<0.001） and 0.215（χ2=242.762，P<0.001），respectively. The final system consists of 3 dimensions，10 indices and 23 subindices，with corresponding weights assigned. Specifically，the dimensions include face-to-face services，non face-to-face services，face-to-face services/non face-to-face services，with weights of 0.400 0，0.100 0，0.500 0，respectively. Conclusion　This system for assessing the performance of family doctor team memebers by the team leader could be used as a tool for objectively and scientifically evaluating the performance of family doctor team memebers.