功能社区家庭医生签约服务项目体系及权重研究

背景　功能社区家庭医生签约服务内容缺乏足够的针对性，未能有效契合功能社区人群基本健康需求。目的　探索构建功能社区家庭医生签约服务项目并确定其权重系数，为确定功能社区家庭医生签约服务项目及其实施优先级等提供参考和依据。方法　在前期需求调查及专家访谈的基础上，于2020年7-10月邀请16位社区卫生等相关领域专家举行专家座谈会，初步确定功能社区家庭医生签约服务项目的一级项目、二级项目，运用德尔菲法进行两轮专家咨询，最终确定功能社区家庭医生签约服务项目，运用层次分析法计算服务项目权重。结果　两轮咨询的专家积极系数均为100%，专家熟悉程度为0.963、0.975，判断依据为0.881、0.881，权威系数为0.922、0.928，肯德尔系数为0.194、0.219（P<0.001）。确定功能社区家庭医生签约服务项目包括5项一级项目、46项二级项目，一级项目为基本服务、职业人群服务、职业人群个性化服务、学校服务、养老机构服务，权重分别为0.320、0.109、0.068、0.320、0.183，一级指标判断矩阵的一致性比例（CR）为0.008，二级项目判断矩阵的CR分别为0.018、0.027、0.027、0.006、0.009。结论　运用德尔菲法和层次分析法构建的功能社区家庭医生签约服务项目及其权重较为科学，结果可信，可为制定及实施功能社区家庭医生签约服务相关政策提供借鉴。

Defining the Scope and Weights of Services of a Family Doctor Service Project for the Functional Community

Background　Current family doctor services could not fully satisfy general healthcare needs of the functional community due to lack of sufficient appropriateness. Objective　To define the scope and weights of services of a family doctor service project for the functional community，offering help for choosing appropriate family doctor services and assessing the priority of the services for the functional community. Methods　From July to October 2020，a two-round consultation with 16 community health experts using the Delphi technique was conducted to analyze the results of previous investigation of healthcare needs of the functional community and of relevant previous expert consultation to determine the domains of family doctor services for the functional community and specific services in each domain. Analytic hierarchy process was used to calculate the weight of each service. Results　Both two rounds of consultation achieved a 100% response rate. The judgment，familiarity and authority coefficients as well as Kendall's W were 0.963，0.881，0.922，and 0.194 ，respectively，for the first round of expert consultation（P<0.001），and were 0.975，0.881，0.928，and 0.219，respectively，for the second round of expert consultation（P<0.001）. The determined 5 domains of family doctor services for the functional community include essential healthcare services，occupational health services，individualized occupational health services，school health services and nursing home health services，with 0.320，0.109，0.068，0.320，0.183，as the corresponding weights，and 0.008 as the consistency ratio of the judgment matrix. The determined services were 46 in total，and the consistency ratio of the judgment matrix for services in the 5 domains was 0.018，0.027，0.027，0.006，and 0.009，respectively. Conclusion　This family doctor service project for the functional community has been demonstrated to be scientific and reliable in terms of the scope of services and weights of services，which may be useful to the formulation and implementation of relevant supportive policies.