摘要
目的在县域医疗卫生共同体建设背景下,构建以健康价值为导向的基层医疗卫生机构绩效评价指标体系。方法2021年5月至2022年2月,通过文献研究初步筛选基层医疗卫生机构绩效评价核心指标;采用立意抽样法,选取社区卫生服务中心分管绩效考核的院长/副院长、医疗服务工作负责人和公共卫生服务工作负责人,就基层医疗卫生机构绩效评价考核方案及存在问题等进行半结构式访谈;依据"投入-过程-产出"绩效评价模型,采用主题框架分析法分析访谈资料,并结合文献研究结果初步构建健康价值导向下的基层医疗卫生机构绩效评价指标体系。2022年3—5月,通过德尔菲专家咨询法对各级指标的重要性和可操作性进行评分,运用界值法进行指标筛选,采用层次分析法计算指标权重。结果形成包括3个一级指标、9个二级指标和50个三级指标的健康价值导向下的基层医疗卫生机构绩效评价指标体系。其中,一级指标按权重由高到低依次为产出(0.3773)、投入(0.3363)和过程(0.2864);二级指标中权重排名前3位者为卫生人力(0.1778)、健康素养和健康结局(0.1576)、反应性与满意度(0.1426);三级指标包含医疗指标17个、预防指标16个以及医防融合指标17个,三级指标权重排名前2位者为就诊居民满意度(0.0524)和医务人员满意度(0.0501)。结论本研究构建的健康价值导向下的基层医疗卫生机构绩效评价指标体系科学性较好,有助于推动基层医疗卫生机构向以健康为中心转变并提升运行效率。
Objective To construct a primary health care institutions performance evaluation index system from the perspective of health value orientation under the background of countywide medical alliances construction.Methods From May 2021 to February 2022,preliminary screening was made on core performance evaluation indexes via literature review;purposive sampling was used to select the dean/vice dean,persons in charge of medical service,and those in charge of public health service responsible for performance evaluation at the community health service center.Then semi-structured interviews were made on the existing performance evaluation and assessment plans as well as existing problems of primary medical and health institutions.Based on the"input-process-output"performance evaluation model,the thematic framework analysis method was used to analyze the interview data,and combined with literature research results,a preliminary performance evaluation index system for primary medical and health institutions was built under the guidance of health value.From March to May 2022,the Delphi expert consultation method was used to evaluate the importance and operability of indexes.The threshold method was used to screen indexes,and analytic hierarchy process was used to calculate the weights of evaluation indexes.Results The health value oriented performance evaluation index system for primary healthcare institutions included 3 first-level indexes,9 second-level indexes,and 50 third-level indexes.The first-level indexes were output(0.3773),input(0.3363),and process(0.2864)in descending order of weight.The top three weighted second-level indexes were health manpower(0.1778),health literacy and health outcomes(0.1576),as well as responsiveness and satisfaction(0.1426).The third-level indexes included 17 medical indexes,16 prevention indexes,and 17 medical prevention integration indexes.The top three weighted indexes for inpatient services were resident satisfaction with medical treatment(0.0524),medical staff satisfaction(0.0501),and responsiveness of residents seeking medical treatment(0.0401);The top three weighted third-level indexes excluding inpatient services were resident satisfaction with medical treatment(0.0524),medical staff satisfaction(0.0501),and surplus funds used for personnel incentives(0.0455).Conclusions The performance evaluation index system of primary health care institutions built under the health value orientation is scientific,conducive to promoting the health-orientated transformation and improving the efficiency of primary health care services.
作者
赖思宏
李旭
陈静纯
施译楠
周驰
Lai Sihong;Li Xu;Chen Jingchun;Shi Yinan;Zhou Chi(School of Medical Imaging,Hangzhou Medical College,Hangzhou 310053,China;School of Public Health,Hangzhou Normal University,Hangzhou 311121,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2023年第12期889-895,共7页
Chinese Journal of Hospital Administration
基金
国家自然科学基金(72274050)
浙江省哲学社会科学规划课题(22NDJC135YB)。
关键词
卫生服务管理
健康价值导向
基层医疗卫生机构
绩效评价
指标体系
Health services administration
Health value orientation
Primary health care institutions
Performance evaluation
Index system
