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中文摘要: 目的：建立科学、合理的医养结合服务绩效评价体系。方法：根据文献回顾、深度访谈，基于“投入-过程-产出-结果”框架初步构建指标体系，邀请上海市开展医养结合服务的社区卫生服务、长护险管理机构、政府卫生或民政部门的专家、管理者共计40人，采用5级量表法设计Delpihi咨询问卷，同时请专家对权威程度（Cr）、熟悉程度（Ca）开展自我评价。指标体系构建使用界值法，计算指标的算数平均值、变异系数和满分频率，根据界值考虑剔除和修改指标，最后进行权重计算，并使用Kendall协调系数评价专家意见一致性。结果：40位咨询对象在本次医养结合服务评价方面的权威程度为0.889，熟悉程度为0.73，两项均值均在0.7以上，三级指标的Kendall协调系数：第一轮为0.397，（χ2=4.678，P=0.001），第二轮为0.477（χ2=3.154，P=0.000），第一轮咨询筛选出“医疗机构内可提供医养融合服务的设备数量”等11条待剔除指标，经过再次讨论，最终剔除“居民自费支付水平”等6条指标，形成一套由4个一级指标，9个二级指标和39个三级指标构成的服务评价指标体系。结论：本研究构建医养结合养老机构服务绩效评价指标体系，具备较好的理论框架依据和现实可操作性，能够为医养结合服务的评价提供依据。
Abstract:Objective：To establish a scientific and reasonable performance evaluation system of integrated medical and nursing services. Methods：According to the literature review and in-depth interview，a preliminary index system was constructed based on the"input-process-output- result" framework. A total of 40 experts and managers from community health services，long-term nursing insurance management institutions，government health or civil affairs departments in Shanghai were invited to design the delpihi consultation questionnaire by using the 5-level scale method. At the same time，experts are invited to conduct self-evaluation on the degree of authority（CR）and familiarity（CA）. The construction of the index system uses the boundary value method to calculate the arithmetic average value，coefficient of variation and full score frequency of the index，consider eliminating and modifying the index according to the boundary value，finally calculate the weight，and use the Kendall coordination coefficient to evaluate the consistency of expert opinions. Results：The degree of authority and familiarity of the 40 consultants in the evaluation of integrated medical and nursing services was 0.889 and 0.73. The mean values of the two items were more than 0.7. The Kendall coordination coefficient of the three-level indicators：the first round was 0.397（χ2=4.678，P=0.001），the second round is 0.477（χ2=3.154，P=0.000. In the first round of consultation，11 indicators to be eliminated，such as “the number of equipment that can provide medical care integration services in medical institutions”，were selected. After further discussion，6 indicators，such as “residents’own expense payment level”，were finally eliminated，and a service evaluation index system composed of 4 primary indicators，9 secondary indicators and 39 tertiary indicators was finally formed. Conclusion：This study constructs the service performance evaluation index system of integrated medical care and elderly care institutions，which has good theoretical framework basis and practical operability，and can provide basis for the evaluation of integrated medical care and elderly care services.
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基金项目:上海市普陀区卫生健康委卫生管理类课题（2020PTGL12） 上海市普陀区卫生健康委卫生管理类课题（2020PTGL12）
引用文本：
华志佳,刘轶蕾*,周春艳,李笑飞.医养结合服务评价指标体系构建的Delphi法研究△[J].江苏卫生事业管理,2022,33(6):703-707.
HUA Zhijia,LIU Yilei*,ZHOU Chunyan,LI Xiaofei.Delphi Method Research on the Construction of Performance Evaluation System of Integrated Medical and Nursing Services△[J].Jiangsu Health System Management,2022,33(6):703-707.
华志佳,刘轶蕾*,周春艳,李笑飞.医养结合服务评价指标体系构建的Delphi法研究△[J].江苏卫生事业管理,2022,33(6):703-707.
HUA Zhijia,LIU Yilei*,ZHOU Chunyan,LI Xiaofei.Delphi Method Research on the Construction of Performance Evaluation System of Integrated Medical and Nursing Services△[J].Jiangsu Health System Management,2022,33(6):703-707.
