【摘要】：目的本研究旨在探討針對(duì)性與普通干預(yù)方法在全科醫(yī)療服務(wù)模式轉(zhuǎn)型中對(duì)目標(biāo)設(shè)定、行動(dòng)計(jì)劃及團(tuán)隊(duì)績(jī)效的影響。背景全科醫(yī)療服務(wù)模式的轉(zhuǎn)型在醫(yī)療改革中至關(guān)重要,但是轉(zhuǎn)型帶來(lái)的工作量可造成全科醫(yī)務(wù)人員疲憊。積極干預(yù)可能會(huì)減輕全科醫(yī)務(wù)人員的疲憊感,幫助其實(shí)現(xiàn)轉(zhuǎn)型目標(biāo),但其較既往研究推薦的方法更明確具體。方法本項(xiàng)為期1年的整群隨機(jī)試驗(yàn)在8個(gè)全科診所中進(jìn)行。為達(dá)到高基準(zhǔn)服務(wù)水平(HVEs,基于低服務(wù)成本和低資源利用的高服務(wù)質(zhì)量),干預(yù)組(4個(gè)診所)給予針對(duì)干預(yù),對(duì)照組(4個(gè)診所)給予普通干預(yù)。對(duì)兩組的改進(jìn)質(zhì)量目標(biāo)選擇、行動(dòng)項(xiàng)目選擇、改進(jìn)質(zhì)量結(jié)果、HVEs達(dá)到程度及協(xié)作醫(yī)療情況進(jìn)行定量和定性分析,從而評(píng)價(jià)兩組干預(yù)效果。結(jié)果試驗(yàn)期間,兩組均每月選擇改進(jìn)工作質(zhì)量目標(biāo)。1年內(nèi)干預(yù)組平均選擇7個(gè)改進(jìn)總體質(zhì)量和改進(jìn)HVE的目標(biāo)、29個(gè)行動(dòng)項(xiàng)目;對(duì)照組平均選擇8個(gè)改進(jìn)總體質(zhì)量和改進(jìn)HVE的目標(biāo)、40個(gè)行動(dòng)項(xiàng)目。干預(yù)組選擇的目標(biāo)83%與HVEs相關(guān),對(duì)照組僅27%與HVEs相關(guān)。干預(yù)組1年內(nèi)累計(jì)選擇101個(gè)HVE目標(biāo),達(dá)標(biāo)率為68%;對(duì)照組累計(jì)選擇41個(gè)HVE目標(biāo),達(dá)標(biāo)率為61%。干預(yù)前后調(diào)查結(jié)果表明,干預(yù)組在協(xié)作醫(yī)療8個(gè)維度中的4個(gè)有了很大改進(jìn)。結(jié)論在全科醫(yī)療服務(wù)模式轉(zhuǎn)型工作中,針對(duì)性干預(yù)更有利于實(shí)現(xiàn)高價(jià)值目標(biāo),促進(jìn)團(tuán)隊(duì)凝聚力、團(tuán)隊(duì)能力及團(tuán)隊(duì)責(zé)任心的提高。
[Abstract]:Objective to explore the effects of targeted and common intervention on goal setting, action plan and team performance in the transformation of general practice medical service model. Background the transformation of the general medical service mode is very important in the medical reform, but the workload brought by the transformation can cause fatigue of the general medical staff. Active intervention may alleviate the fatigue of general practitioners and help them to achieve the goal of transformation, but it is more specific than the methods recommended by previous studies. Methods A 1-year cluster randomized trial was conducted in 8 general practice clinics. In order to achieve a high standard service level (HVEs, based on low service cost and high quality of service with low resource utilization), the intervention group (4 clinics) was given intervention, while the control group (4 clinics) was given general intervention. Quantitative and qualitative analysis was carried out on the choice of improving quality goal, the selection of action items, the degree of HVEs' achievement and the medical condition of cooperation between the two groups, so as to evaluate the effect of intervention between the two groups. Results during the trial period, the two groups selected the goal of improving the quality of work every month. Within one year, the intervention group selected 7 targets to improve the overall quality and improve the HVE, 29 action items. The control group selected an average of 8 goals to improve overall quality and improve HVE, and 40 action items. In the intervention group, 83% of the selected targets were related to HVEs, while only 27% in the control group were related to HVEs. In the intervention group, 101 HVE targets were selected in one year, and the rate of reaching the standard was 68. In the control group, 41 HVE targets were selected, and the rate of reaching the standard was 61. The results before and after intervention showed that the intervention group had a great improvement in 4 of the eight dimensions of collaborative medical care. Conclusion in the transformation of general practice medical service mode, targeted intervention is more conducive to achieving high value goals, promoting team cohesion, team ability and team responsibility.
【分類(lèi)號(hào)】：R197.1

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