【作者】 刘聪；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 目的以中心乡镇卫生院的功能为基础,界定中心乡镇卫生院的绩效和绩效维度,确定绩效指标和权重,从而构建绩效评价的指标体系,在此基础上以绩效指数为核心建立中心乡镇卫生院的绩效综合评价模型。方法1.文献研究法查阅国内外关于绩效理论、绩效评价、卫生系统绩效评价、医院绩效评价和乡镇卫生院评价等文献资料。2.德尔菲法通过制定的问卷对专家进行咨询,以确定中心乡镇卫生院的绩效指标。3.层次分析法利用层次分析法的思想,建立各维度指标的判断矩阵,以确定中心乡镇卫生院各绩效指标的权重。4.问卷调查法利用设计的问卷收集各样本中心乡镇卫生院的绩效指标数据。5.统计学方法利用Microsoft Office Excel2003建立数据库,并进行绩效指标值的标化和绩效指数的计算。利用SPSS11.5进行统计分析,分别采用了描述性统计分析、非参数检验、信度分析、相关分析等统计学方法。结果1.中心乡镇卫生院的功能包括基本医疗、公共卫生、管理职能。其中基本医疗则包括中医和西医相结合的基本的临床医疗服务;公共卫生包括预防、康复、保健、计划生育技术指导、健康教育等;而管理职能则包括辖区内公共卫生管理以及村级卫生组织的技术指导和村医的培训等。2.中心乡镇卫生院的绩效是在可获得资源条件下,其机构功能的实现程度。功能是界定绩效的基础,绩效对功能发挥具有引导作用。绩效维度包括效率、效果、质量,以三个绩效维度为坐标轴,绩效呈三维立体结构。绩效维度、测量和指标,绩效评价的方式、方法和工具,以及评价的主体、客体和绩效环境构成了绩效评价体系。3.中心乡镇卫生院绩效综合评价的指标体系分三层。第一层即总体绩效;第二层是效率、效果、质量三个绩效维度;第三层是绩效指标,其中效率维度包含关于产出/投入的3个指标,效果维度包含关于服务结果的3个指标,质量维度则分为技术质量与非技术质量等共6个指标。4.中心乡镇卫生院绩效综合评价模型是关于绩效指数的函数。利用绩效指数的函数公式可以计算绩效指数,反映中心乡镇卫生院的总体绩效水平,绩效指数的函数模型则可以显示绩效结构,反映中心乡镇卫生院的绩效特征。5.评价结果显示各样本卫生院的绩效指数值不同,绩效结构也存在差异。对模型进行信度和效度分析,其中总体克朗巴赫α系数为0.6249,信度适中可以接受,而绩效指数与准测比较的Kendall’s等级相关系数为0.778(p<0.01),比较理想。结论1.中心乡镇卫生院的绩效是在可获得资源条件下,机构功能的实现程度。其绩效维度包括效率、效果、质量。2.中心乡镇卫生院绩效综合评价的模型具有较好的信度和效度,能够比较有效和可靠地评价乡镇卫生院的绩效。3.中心乡镇卫生院绩效综合评价的模型可以同时反映机构的总体绩效水平和机构的绩效结构特征。4.中心乡镇卫生院的实际绩效结构可以分为三种类型,即效率型、效果型、质量型。5.中心乡镇卫生院的理想绩效具有两个基本特征,即具有高的绩效指数值,同时各绩效维度均衡。理想绩效的均衡模型是一个三维的正方体。更多还原

【Abstract】 Objective:Define the performance and dimensions of central township health centers on the basis of its function. Determine the performance indicators with weights, and construct the indicator system of performance assessment. Then, establish the comprehensive assessment model of the performance of central township health centers with performance index as core.Methods:1. Document study. Consult domestic and foreign literature about the performance theory, performance assessment, health system performance assessment, hospital performance assessment and township health centers assessment and so on.2. Delphi method. To determine the performance indicators of central township health centers consult the experts by Delphi inquiry.3. AHP. To determine the indicators weights of the central township health centers construct pairwise comparison matrices of indicators in each dimensions by Analytic Hierarchical Process.4. Questionnaire survey. Collected data of performance indicators in the central township health centers which as samples by Questionnaire.5. Statistics method. Establishment database and compute the value of standardized indicators and performance index by Microsoft Office Excel2003. Descriptive Statistics, Nonparametric test, Reliability analysis, Correlation analysis are applied by SPSS11.5.Results:1. The function of central township health centers combines fundamental medical care, public health, management. Fundamental medical care refers to basic clinical services of integrated traditional Chinese and western medicine. Public health refers to prevention, rehabilitation, care, family planning, health education. Management refers to public health management, technology instruction to village hygiene organization, hygiene personnel training and so on.2. The performance of central township health centers is defined as function attainment relative to resource availability. The function is the basis of defining performance, and the performance has strong guidance for the function display. The performance dimensions including efficiency, effectiveness, quality, taking them as coordinates, the organization performance assumes the three dimensional spatial structure. Performance dimensions, measures, indicators, and the ways, methods and tools of performance assessment, as well as the appraisal subjective, the objective and the performance environment constituted the performance assessment system.3. The indicator system of central township health centers divides three layers. The first layer is overall performance. The second layer is dimension, combing efficiency, effectiveness, quality. The third layer is performance indicator, which three output-input indicators are involved in efficiency, three outcome indicators are involved in effectiveness, six technology quality and non-technology quality indicators are involved in quality.4. The comprehensive assessment model of central township health centers performance is a function of performance index. The value of performance index reflecting the overall performance level is computed by its function formula, and the function model of performance index reflecting the performance characteristics will reveal the performance structure.5. The results of performance assessment showed that the township health centers were different in performance index and performance structure. Then, carried on the reliability and validity analysis to the model, and the value of Cronbach’sαcoefficient was 0.6249, the value of the Kendall’s coefficient was 0.778(p<0.01).Conclusion:1. The performance of central township health centers is the function attainment relative to resource availability. The performance dimensions including efficiency, effectiveness and quality.2. The reliability and validity of the comprehensive assessment model of central township health centers performance are better, so the model could assess the performance of township health centers reliably and validly.3. The comprehensive assessment model of central township health centers performance could simultaneously reflect the overall performance level and the performance structure characteristic.4. The central township health centers actual performance structure could divide into three kinds of types, which are the types of efficiency, effect, quality.5. The high value of performance index and the equilibrium of performance dimensions are two basic characteristics of ideal performance of central township health centers. The equilibrium model of ideal performance is a three dimensional cube.更多还原