基于标化工作量的社区卫生服务机构家庭医生团队工作开展现状研究  

Standardized Workload-based Analysis of the Services Delivered by a Family Doctor Team in a Community Health Institution

作　　者：徐佳玙 颜骅 方军波 王海琴 郭佩 沈福来 王形松 XU Jiayu;YAN Hua;FANG Junbo;WANG Haiqin;GUO Pei;SHEN Fulai;WANG Xingsong(Community Health Service Center,Xietu Street,Xuhui District,Shanghai 200032,China;Standardized Workload Reform Project Team of Xietu Street Community Health Service Center,Xuhui District,Shanghai 200333,China)

机构地区：[1]上海市徐汇区斜土街道社区卫生服务中心,200032 [2]上海市徐汇区斜土街道社区卫生服务中心标化工作量改革项目组,200333

出　　处：《中国全科医学》2023年第13期1641-1647,共7页Chinese General Practice

基　　金：上海市公立医院高质量发展试点工作(沪卫医改[2022]11号)。

摘　　要：背景家庭医生团队在运行过程中存在着工作内容条理不清、分工不合理和“高能低用”等问题,制约了家庭医生团队的整体发展。目的基于标化工作量对上海市中心城区社区卫生服务机构家庭医生团队工作开展现状进行分析,了解阻碍家庭医生团队发展的主要因素,为家庭医生团队工作模式改进提供指导。方法于2021年7—11月,以上海市徐汇区斜土街道社区卫生服务中心的家庭医生团队为研究对象,收集该机构家庭医生团队于2019年8—9月和2021年8—9月所开展的服务项目、各项目标化工作量相关参数、各项目发生数量。一是根据服务项目的性质,将家庭医生团队服务分为基本医疗服务和公共卫生服务,计算其基本医疗和公共卫生工作的标化工作总量和总时间;二是根据医防融合的思路,将家庭医生团队工作拆分为社区动员、社区筛查、社区诊断、社区干预、社区随访5个环节,计算各工作环节的标化工作总量和总时间;三是运用优劣解距离法(TOPSIS)对家庭医生社区动员、社区筛查、社区随访环节的所有服务项目的价值水平进行综合评价。结果2021年8月和9月家庭医生团队公共卫生服务的标化工作总量分别为16961和18089,2019年的同期数据分别为11486和10433,平均涨幅为59.9%。Pearson相关分析结果显示,家庭医生团队的基本医疗服务标化工作总量与公共卫生服务标化工作总量无相关关系(r=-0.72,P=0.27)。家庭医生团队在各环节的标化工作总量从大到小依次为:社区诊断、社区随访、社区干预、社区筛查、社区动员。社区动员、社区筛查、社区随访环节的标化工作量/总时间相对较低。根据TOPSIS评价结果,更新慢性病患者健康档案、高血压和糖尿病患者随访管理、签约居民信息维护等13个项目可考虑外包或降低执行人力成本。结论家庭医生团队尚未形成有效的工作方式来�Background Problems existing in the operation of a family doctor team,such as unclear work content,inappropriate division of labor,and assigning a team member to a position below his true potential,restrict the overall development of the family doctor team.Objective To perform a standardized workload-based analysis of the services delivered by the family doctor team in a central urban community health institution in Shanghai,to understand the major factors associated with the development of the family doctor team,and to provide guidance for the improvement of the work pattern of the team.Methods The family doctor team of Xietu Subdistrict Community Health Center,Xuhui District,Shanghai was selected during July to Novermber 2021.The service projects,parameters of standardized workload and the number of services carried out by the team between August and September 2019,and between August and September 2021 were collected,respectively.The team services were analyzed from three aspects:1.dividing the team services into essential medical services and public health services according to the nature of the service items,then calculating the total amount of standardized workload and total time used in performing the two kinds of services;2.dividing the team services into five parts(involving community-based mobilization,screening,diagnosis,intervention and follow-up) according to the idea of integration of medical and preventive services,then calculating the total amount of standardized workload and total time used in performing each part;3.using the TOPSIS method to comprehensively evaluate the value of all service items included in community-based mobilization,screening and follow-up.Results The standardized workload of the team in delivering public health services increased to 16 961 in August 2021 from 11 486 in August 2019,and increased to 18 089 in September 2021 from 10 433 in September 2019,demonstrating an average increase of 59.9%.Pearson correlation analysis showed that the standardized workload involved in del

关 键 词：标化工作量法 家庭医生团队 社区卫生服务 家庭医生签约服务 医防融合 优劣解距离法 

分 类 号：R197[医药卫生—卫生事业管理] R179[医药卫生—公共卫生与预防医学]