基于德尔菲法的广东省全科团队家庭医生式签约服务绩效考核指标体系构建研究

摘要

目的 构建广东省全科团队家庭医生式签约服务绩效考核指标体系,为客观评价广东省全科医生团队家庭医生式签约服务的实施效果,不断改善服务质量提供客观的参考.方法 结合我国和广东省相关政策,采用文献回顾等研究方法,以"结构-过程-结果(Structure-Process-Outcome)"框架为基础,初步建立绩效考核评估指标体系并编制专家咨询问卷.于2016年10月—2017年2月采用德尔菲专家咨询法,经两轮专家(n=27)咨询,确定绩效考核指标及其权重系数.结果 两轮专家咨询表的回收率分别为90.6%(29/32)和93.1%(27/29);专家对一级指标的权威系数为(0.82±0.11);第2轮咨询中指标总体协调系数为0.272(P<0.001),不同机构专家组内的协调系数均>0.453.最终构建了由3个一级指标、16个二级指标、46个三级指标及其权重构成的评价指标体系.结论 本研究构建了全科团队家庭医生式签约服务绩效考核指标体系,专家的积极程度和权威程度均较高,第2轮专家组内咨询意见趋向一致,协调性较好,咨询结果可信.%Objective To develop a performance evaluation indicator system for contractual services from a general practitioner team in Guangdong Province, offering a reference for objectively assessing the implementation effect and improving the quality of such services in Guangdong. Methods Based on the related policies of Guangdong and China as well as the review of related articles, using Donabedian's structure-process-outcome model as the framework, we developed the initial performance evaluation indicator system for contractual services from a general practitioner team in Guangdong Province (hereinafter referred to as the initial system). From October 2016 to February 2017, after a two-round Delphi expert consultation (n=27) using our pre-designed questionnaire, the indicators and their weight coefficients in the performance evaluation indicator system for contractual services from a general practitioner team in Guangdong Province (hereinafter referred to as the performance evaluation indicator system) were determined. Results The response rate of the first, and second rounds of expert consultation was 90.6% (29/32), 93.1% (27/29), respectively. The authority coefficient of the first-level indicators was (0.82±0.11). The mean Kendall coordination coefficient was 0.272 after the second round of expert consultation (P<0.001) for all the indicators, and was more thun 0.453 for expert group in each institution. Finally, we developed a performance evaluation indicator system consisting of 3 first-level indicators, 16 second-level indicators and 46 third-level indicators, with weight assigned to each indicator. Conclusion The performance evaluation indicator system developed by us is reliable for it demonstrated both satisfactory positive and authority coefficients. Moreover, it also showed good coordination coefficient for the experts reached a consensus about the content of this system during the second round of consultation.