广西基层医疗卫生机构家庭医生签约服务绩效评价及实证研究

家庭医生签约服务是实现新医改“人人享有基本医疗卫生服务”总体目标的重大举措，是实现分级诊疗和“健康中国”战略的重要途径。2017年广西启动家庭医生签约服务，家庭医生团队成为基层卫生服务的核心，其绩效的好坏直接影响整个卫生服务体系。因此，针对家庭医生团队进行绩效评价，具有重要现实意义。本课题组拟(1)基于“结构-过程-结果-影响”模型，通过文献研究、系统评价、内容分析建立广西家庭医生签约服务绩效评价模型框架(2)通过关键人物访谈、Delphi专家咨询法等方法，构建家庭医生团队绩效评价指标体系(3)根据确定的评价体系，设计适宜的家庭医生团队调查问卷，选取具有代表性的地区开展实证研究(4)基于现场调查资料，印证评价指标的科学性(5)采用综合评分法和秩和比法进行家庭医生团队的综合评价。研究结果可为开展家庭医生团队绩效评价提供方法学参考和评价工具，同时为政府部门加强基层卫生服务建设提供循证依据。

The family doctor contract service is one significant measure to achieve a universal access to primary health care, the ultimate goal set up by the New Health Care System Reform in China, and one essential way to actualize both the stratified healthcare system and the strategy of “Health China”. The family doctor-led teams have become the key force among primary health caregivers, since family doctor contract service began in Guangxi in 2017. The performance of family doctor-led teams directly affect the whole health care system. Hence, a comprehensive evaluation over performance of family doctor-led teams in the contract service possesses important reality significance. This study includes the following several contents in order to soundly accomplish the performance evaluation. (1)To build up a performance evaluation indicator pool of family doctor contract service in Guangxi, by combining multiple methods, including theoretical study, systemic assessment based on a structure-process-outcome-effect model; (2)To establish an performance evaluation index system of family doctor-led teams in the contract service of Guangxi via a combination of multiple methods, including key figure interviewing and Delphi survey; (3) To develop questionnaires assessing family doctor-led team performance based on the evaluation index system and to conduct an empirical study over the evaluation index system in sample regions; (4)To verify scientificity of the evaluation index system according to the above empirical study; (5)To comprehensively assess the performance of the family doctor-led teams by synthetic scoring method and rank sum ratio test. Results of the study can provide sound methodology and assessment tools for performance evaluation of family doctor-led teams, and evidence-based references to health administrations for further promotion of primary healthcare development.