Effectiveness of target-based responsibility and pay-for-performance systems for family doctor service team
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摘要: 目的 分析上海市闵行区梅陇社区卫生服务中心实行家庭医生制服务责任目标绩效薪酬制度改革对医疗机构服务的影响,探讨产生影响的原因,期望为全面推进家庭医生工作提供参考和借鉴。 方法 建立梅陇社区卫生服务中心家庭医生制服务团队绩效薪酬管理体系,对实行责任目标绩效薪酬制前后,从服务数量、服务质量、服务成本/效率以及社区居民满意度4个方面进行对比,评价责任目标绩效薪酬制对中心工作的影响。 结果 与实行家庭医生团队责任目标绩效薪酬制前相比,中心诊疗人次增长了11.17%(P<0.01),家庭医生制服务工作总量增长了155.43%(P<0.01),慢病管理标化工作总量增长50.08%,妇幼保健标化工作总量增长17.03%,校园责任医生标化工作总量增长81.52%。实施绩效薪酬制后,社区抗菌药物使用率下降至8.08%,高血压有效控制率上升至92.43%,糖尿患者有效控制率上升至84.32%,居民满意度提高至98.57%。 结论 实施绩效薪酬制后,社区卫生服务数量明显提高,服务质量得到较好的保证;职工的积极性、工作热情提高,服务效率明显提高,人才结构得以优化;居民满意度、对社区卫生机构的信任感和认同感也明显改善。责任目标绩效薪酬制提高了家庭医生制服务团队的工作效率,保障了社区卫生服务中心可持续发展。Abstract: Objective To analyze the effect of target-based responsibility and pay-for-performance salary systems for family doctor service team on the service delivery in Meilong community health service center of Minhang. Methods The performance evaluation system and distribution platform of the family doctor service team were established in Meilong community health service center.The service quantity,service quality,service cost/efficiency and residents satisfaction was evaluated the implementation of target-based responsibility and pay-for-performance systems.The efficacy of this system was discussed. Results When compared with the conditions before the reformation,the number of outpatient visits per year had grown by 11.43%,the total services had grown by 155.43%,the total amount of chronic disease management standardization increased by 50.08%,the total standardized work of maternal and child health increased by 17.03%,and the standardized work of the campus doctors increased by 81.52%.The implementation of pay-for-performance system has leaded to a reduction in the use of antibacterial agents among communities to 8.08%,while an increase in the effective control rate for hypertension populations to 92.43%,and an increase in the effective control rate for diabetic population to 84.32%. Conclusion After the implementation of target-based responsibility and pay-for-performance systems,the service quantity of CHSC is significantly increased,service quality is better guaranteed.The worker’s enthusiasm and passion to work and the service efficiency can be obviously improved,the optimization of talent structure is obvious,and the resident satisfaction s also improved,and thus enhances a sense of confidence and sense of identity to the community health service.The target-based responsibility and pay-for-performance systems can improve the efficiency of the family doctor system service team,and ensure the sustainable development of Community Health Service Center.
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