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目的本研究旨在探讨针对性与普通干预方法在全科医疗服务模式转型中对目标设定、行动计划及团队绩效的影响。背景全科医疗服务模式的转型在医疗改革中至关重要,但是转型带来的工作量可造成全科医务人员疲惫。积极干预可能会减轻全科医务人员的疲惫感,帮助其实现转型目标,但其较既往研究推荐的方法更明确具体。方法本项为期1年的整群随机试验在8个全科诊所中进行。为达到高基准服务水平(HVEs,基于低服务成本和低资源利用的高服务质量),干预组(4个诊所)给予针对干预,对照组(4个诊所)给予普通干预。对两组的改进质量目标选择、行动项目选择、改进质量结果、HVEs达到程度及协作医疗情况进行定量和定性分析,从而评价两组干预效果。结果试验期间,两组均每月选择改进工作质量目标。1年内干预组平均选择7个改进总体质量和改进HVE的目标、29个行动项目;对照组平均选择8个改进总体质量和改进HVE的目标、40个行动项目。干预组选择的目标83%与HVEs相关,对照组仅27%与HVEs相关。干预组1年内累计选择101个HVE目标,达标率为68%;对照组累计选择41个HVE目标,达标率为61%。干预前后调查结果表明,干预组在协作医疗8个维度中的4个有了很大改进。结论在全科医疗服务模式转型工作中,针对性干预更有利于实现高价值目标,促进团队凝聚力、团队能力及团队责任心的提高。
Objectives The purpose of this study was to explore the impact of targeted and general interventions on goal setting, action planning and team performance in the transformation of GPR services. Background The transition to a GPR model is crucial to health care reform, but the workload associated with the transition can result in the exhaustion of GPs. Positive interventions may reduce the fatigue of general practitioners and help them achieve their goals of transition, but they are more specific and specific than previous studies suggest. Methods The one-year randomized cluster trial was conducted in eight general practice clinics. In order to achieve high reference service levels (HVEs, high service quality based on low service costs and low resource utilization), intervention groups (4 clinics) were given interventions and control groups (4 clinics) were given general interventions. The quality of the two groups to improve the selection of goals, the choice of action items, quality improvement results, HVEs reach the level of collaborative medical and quantitative analysis and qualitative analysis to evaluate the effect of the two groups of interventions. Results During the trial, both groups chose to improve their work quality goals on a monthly basis. In the 1 year, the intervention group chose on average 7 goals of improving overall quality and improving HVE and 29 action items. On average, the control group chose 8 goals of improving total quality and improving HVE and 40 action items. 83% of the intervention group’s goals were associated with HVEs and 27% of the control subjects were associated with HVEs. In the intervention group, a total of 101 HVE targets were selected in a year, with a compliance rate of 68%. In the control group, 41 HVE targets were selected, achieving a compliance rate of 61%. The results of the survey before and after the intervention showed that the intervention group had greatly improved in four of the eight dimensions of the collaborative medicine. Conclusion In the transformation of GPR service mode, targeted interventions are more conducive to achieving high value goals and promoting team cohesion, teamwork and team responsibility.