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Article(id=1241771804071625581, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406300, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718726400000, receivedDateStr=2024-06-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991069094, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991069094, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991069094, creator=13701087609, updateTime=1773991069094, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3730, endPage=3735, ext={EN=ArticleExt(id=1241771805862593408, articleId=1241771804071625581, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the evaluation index system of medical service capacity in county general hospitals based on analytic hierarchy process, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To establish an evaluation index system of medical service capacity in county hospitals, so as to provide a reference basis for further evaluating the overall medical service strength of county-level hospitals.

Methods

Experts were invited to evaluate the relative importance of indicators at all levels of medical service capacity, and the weights of the dimensions of the indicators system were determined using analytic hierarchy process.

Results

A total of 35 experts were invited to consult letter inquiries, and the recovery rate of the questionnaire was 94.43%. The CR of first-level indicators judgment matrix was 0.0223, and the CR of the second-level index judgment matrix under the three dimensions of structure, process and outcome were 0.0000,0.0741and 0.0052, all less than 0.1. Finally, the evaluation index system included 3 first-level indicators, 10 second-level indicators and 23 third-level indicators. The highest weight of the first-level indicators was the result(0.4570). Among the combined weights there were 11 indicators that exceeded the average weight of 0.0435 (1/23).

Conclusion

The evaluation index system of county hospitals based on analytic hierarchy process is objective and reliable, which can provide reference for health administrative departments at all levels and county hospitals to carry out medical service ability evaluation and ability improvement according to the actual situation.

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目的

构建县级医院医疗服务能力评价指标体系，为进一步评价县级医院的整体医疗服务实力提供参考依据。

方法

邀请专家对医疗服务能力各级指标的相对重要性进行评价，运用层次分析法确定各层指标的权重。

结果

共邀请35专家进行函询，问卷回收率94.43%，一级指标判断矩阵的一致性比率为0.022 3，结构、过程、结果3项指标下的二级指标判断矩阵的一致性比率分别为0.000 0、0.074 1、0.005 2，均小于0.1，最终确定评价指标体系包括3项一级指标，10项二级指标，23项三级指标。一级指标中所占权重最大的为结果（0.457 0），在组合权重中，超过平均权重0.043 5（1/23）的指标有11项。

结论

基于层次分析法构建的县级医院医疗服务能力评价指标体系客观、可靠，可为各级卫生行政部门、县级医院结合实际开展医疗服务能力评价与能力提升提供借鉴和参考。

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张远妮，E-mail：
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陈秀彦（1992—），女，硕士，统计师，研究方向：医院管理、政策研究

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陈秀彦（1992—），女，硕士，统计师，研究方向：医院管理、政策研究

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陈秀彦（1992—），女，硕士，统计师，研究方向：医院管理、政策研究

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Modern Preventive Medicine, 2018, 45(6): 1052-1055, 1067. （in Chinese), articleTitle=Research on evaluation index system of regional medical center based on analytic hierarchy process, refAbstract=null), Reference(id=1241771825240277752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, doi=null, pmid=null, pmcid=null, year=2023, volume=16, issue=2, pageStart=16, pageEnd=21, url=null, language=null, rfNumber=[15], rfOrder=27, authorNames=王欣媛, 徐佳苗, 刘健, journalName=中国卫生政策研究, refType=null, unstructuredReference=王欣媛，徐佳苗，刘健，等．基于层次分析法的区域医疗中心评价指标体系构建研究[J]．中国卫生政策研究，2023，16（2）：16-21．, articleTitle=基于层次分析法的区域医疗中心评价指标体系构建研究, refAbstract=null), Reference(id=1241771825387078399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, doi=null, pmid=null, pmcid=null, year=2023, volume=16, issue=2, pageStart=16, pageEnd=21, url=null, language=null, rfNumber=[15], rfOrder=28, authorNames=Wang XY, Xu JM, Liu J, journalName=Chinese Journal of Health Policy, refType=null, unstructuredReference=Wang XY, Xu JM, Liu J, et al. 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Chinese Journal of Health Policy, 2023, 16(2): 16-21.（in Chinese), articleTitle=Research on construction of evaluation index system of regional medical center based on analytic hierarchy process, refAbstract=null)], funds=[Fund(id=1241771820181946914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, awardId=C2022086, language=CN, fundingSource=2022年度广东省医学科研基金项目(C2022086), fundOrder=null, country=null), Fund(id=1241771820303581737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, awardId=2024-WJZD-05, language=CN, fundingSource=广东省卫生经济学会2024年科研课题立项项目(2024-WJZD-05), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241771810400829487, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, xref=1., ext=[AuthorCompanyExt(id=1241771810413412401, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, companyId=1241771810400829487, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, China), AuthorCompanyExt(id=1241771810417606706, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, companyId=1241771810400829487, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南方医科大学第三附属医院，广东 广州 510630)]), AuthorCompany(id=1241771810551824446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, xref=2., ext=[AuthorCompanyExt(id=1241771810556018751, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, companyId=1241771810551824446, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南方医科大学南方医院)])], figs=[ArticleFig(id=1241771816390295898, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Fig.1, caption=Evaluation index system framework of medical service capacity in county general hospitals, figureFileSmall=p/1ReXQEoQOtNEUZGMxiIw==, figureFileBig=evqUCcd2/HpmYzeDbHn5zg==, tableContent=null), ArticleFig(id=1241771816503542117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=图1, caption=县级医院医疗服务能力评价指标体系框架, figureFileSmall=p/1ReXQEoQOtNEUZGMxiIw==, figureFileBig=evqUCcd2/HpmYzeDbHn5zg==, tableContent=null), ArticleFig(id=1241771816780366206, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 1, caption=

Relative importance rank table ofSaaty

, figureFileSmall=null, figureFileBig=null, tableContent=
尺度表示含义
1因素i与因素j比较，前者与后者同等重要
3因素i与因素j比较，前者比后者稍微重要
5因素i与因素j比较，前者比后者明显重要
7因素i与因素j比较，前者比后者强烈重要
9因素i与因素j比较，前者比后者极端重要
2,4,6,8表述上述相邻判断之间的中间状态
倒数若因素i与因素j比较的重要性之比为αij，当前者不如后者重要时，则以表示
), ArticleFig(id=1241771816906195334, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表1, caption=

Saaty相对重要性等级表

, figureFileSmall=null, figureFileBig=null, tableContent=
尺度表示含义
1因素i与因素j比较，前者与后者同等重要
3因素i与因素j比较，前者比后者稍微重要
5因素i与因素j比较，前者比后者明显重要
7因素i与因素j比较，前者比后者强烈重要
9因素i与因素j比较，前者比后者极端重要
2,4,6,8表述上述相邻判断之间的中间状态
倒数若因素i与因素j比较的重要性之比为αij，当前者不如后者重要时，则以表示
), ArticleFig(id=1241771817044607376, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 2, caption=

Table of average random consistency index

, figureFileSmall=null, figureFileBig=null, tableContent=
矩阵阶数n12345678910
RI000.520.891.121.261.361.411.461.49
), ArticleFig(id=1241771817166242204, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表2, caption=

平均随机一致性指标表

, figureFileSmall=null, figureFileBig=null, tableContent=
矩阵阶数n12345678910
RI000.520.891.121.261.361.411.461.49
), ArticleFig(id=1241771817287877032, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 3, caption=

Judgment matrix of first-level indicators

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一级指标结构过程结果wi
结构1.000 00.954 30.459 70.244 6
过程1.047 91.000 00.760 40.298 4
结果2.175 41.315 11.000 00.457 0
CR=0.022 3
), ArticleFig(id=1241771817413706164, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表3, caption=

一级指标判断矩阵表

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一级指标结构过程结果wi
结构1.000 00.954 30.459 70.244 6
过程1.047 91.000 00.760 40.298 4
结果2.175 41.315 11.000 00.457 0
CR=0.022 3
), ArticleFig(id=1241771817526952381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 4, caption=

Judgment matrix of second-level indicators under the structure dimension

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二级指标资源配置科室设置wi
资源配置1.000 01.084 50.520 3
科室设置0.922 11.000 00.479 7
CR=0.000 0
), ArticleFig(id=1241771819091427789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表4, caption=

结构指标下二级指标判断矩阵表

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二级指标资源配置科室设置wi
资源配置1.000 01.084 50.520 3
科室设置0.922 11.000 00.479 7
CR=0.000 0
), ArticleFig(id=1241771819221451225, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 5, caption=

Judgment matrix of second-level indicators under the process dimension

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二级指标服务能力运行效率运营效率诊疗能力wi
服务能力1.000 01.404 31.378 60.953 70.286 9
运行效率0.712 11.000 01.861 82.397 60.321 1
运营效率0.725 40.537 11.000 01.845 70.218 9
诊疗能力1.048 60.417 10.541 81.000 00.173 1
CR=0.074 1
), ArticleFig(id=1241771819364057575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表5, caption=

过程指标下二级指标判断矩阵表

, figureFileSmall=null, figureFileBig=null, tableContent=
二级指标服务能力运行效率运营效率诊疗能力wi
服务能力1.000 01.404 31.378 60.953 70.286 9
运行效率0.712 11.000 01.861 82.397 60.321 1
运营效率0.725 40.537 11.000 01.845 70.218 9
诊疗能力1.048 60.417 10.541 81.000 00.173 1
CR=0.074 1
), ArticleFig(id=1241771819536024056, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 6, caption=

Judgment matrix of second-level indicators under the outcome dimension

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二级指标诊疗量质量安全患者负担患者满意度wi
诊疗量1.000 00.451 51.176 60.962 40.200 3
质量安全2.215 01.000 02.263 21.65550.402 7
患者负担0.849 90.441 91.000 00.998 60.185 6
患者满意度1.039 00.604 11.001 41.000 00.211 4
CR=0.005 2
), ArticleFig(id=1241771819783488004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表6, caption=

结果指标下二级指标判断矩阵表

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二级指标诊疗量质量安全患者负担患者满意度wi
诊疗量1.000 00.451 51.176 60.962 40.200 3
质量安全2.215 01.000 02.263 21.65550.402 7
患者负担0.849 90.441 91.000 00.998 60.185 6
患者满意度1.039 00.604 11.001 41.000 00.211 4
CR=0.005 2
), ArticleFig(id=1241771819896734221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=EN, label=Table 7, caption=

Evaluation index systemand weight of medical service capacity in county general hospitals

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一级指标权重二级指标权重组合权重三级指标权重组合权重
结构0.244 6资源配置0.520 30.127 3实际开放床位数0.280 20.035 7
执业(助理)医师数0.324 70.041 3
注册护士数0.266 50.033 9
万元以上设备数0.128 60.016 4
科室设置0.479 70.117 3一级科室设置率0.407 40.047 8
二级科室设置率0.592 60.069 5
过程0.298 4服务能力0.286 90.085 6基本标准符合率0.552 00.047 3
推荐标准符合率0.448 00.038 4
诊疗能力0.173 10.051 7DRG组数0.506 80.026 2
病例组合指数0.493 20.025 5
运营效率0.218 90.065 3医疗服务收入占比0.488 20.031 9
人员支出占比0.511 80.033 4
运行效率0.321 10.095 8平均住院日0.486 90.046 7
床位使用率0.513 10.049 2
结果0.457 0诊疗量0.200 30.091 5总诊疗人次数0.275 70.025 2
出院人数0.200 10.018 3
手术人数0.524 20.048 0
质量安全0.402 70.184 0手术并发症发生率0.291 30.053 6
低风险组病例死亡率0.708 70.130 4
患者负担0.185 60.084 8次均门诊费用0.447 30.037 9
次均住院费用0.552 70.046 9
患者满意度0.211 40.096 6门诊患者满意度0.544 60.052 6
住院患者满意度0.455 40.044 0
), ArticleFig(id=1241771820009980441, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771804071625581, language=CN, label=表7, caption=

县级医院医疗服务评价指标体系及权重值

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标权重二级指标权重组合权重三级指标权重组合权重
结构0.244 6资源配置0.520 30.127 3实际开放床位数0.280 20.035 7
执业(助理)医师数0.324 70.041 3
注册护士数0.266 50.033 9
万元以上设备数0.128 60.016 4
科室设置0.479 70.117 3一级科室设置率0.407 40.047 8
二级科室设置率0.592 60.069 5
过程0.298 4服务能力0.286 90.085 6基本标准符合率0.552 00.047 3
推荐标准符合率0.448 00.038 4
诊疗能力0.173 10.051 7DRG组数0.506 80.026 2
病例组合指数0.493 20.025 5
运营效率0.218 90.065 3医疗服务收入占比0.488 20.031 9
人员支出占比0.511 80.033 4
运行效率0.321 10.095 8平均住院日0.486 90.046 7
床位使用率0.513 10.049 2
结果0.457 0诊疗量0.200 30.091 5总诊疗人次数0.275 70.025 2
出院人数0.200 10.018 3
手术人数0.524 20.048 0
质量安全0.402 70.184 0手术并发症发生率0.291 30.053 6
低风险组病例死亡率0.708 70.130 4
患者负担0.185 60.084 8次均门诊费用0.447 30.037 9
次均住院费用0.552 70.046 9
患者满意度0.211 40.096 6门诊患者满意度0.544 60.052 6
住院患者满意度0.455 40.044 0
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基于层次分析法的县级综合医院医疗服务能力评价指标体系研究
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陈秀彦 1 , 张远妮 2 , 关小倩 1 , 黎洁 1 , 孙林敏 1
现代预防医学 | 基层卫生服务 2024,51(20): 3730-3735
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现代预防医学 | 基层卫生服务 2024, 51(20): 3730-3735
基于层次分析法的县级综合医院医疗服务能力评价指标体系研究
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陈秀彦1, 张远妮2 , 关小倩1, 黎洁1, 孙林敏1
作者信息
  • 1.南方医科大学第三附属医院，广东 广州 510630
  • 2.南方医科大学南方医院

    • 陈秀彦（1992—），女，硕士，统计师，研究方向：医院管理、政策研究

通讯作者:

张远妮，E-mail：
Research on the evaluation index system of medical service capacity in county general hospitals based on analytic hierarchy process
Xiu-yan CHEN1, Yuan-ni ZHANG2 , Xiao-qian GUAN1, Jie LI1, Lin-min SUN1
Affiliations
  • The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202406300
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摘要
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目的

构建县级医院医疗服务能力评价指标体系，为进一步评价县级医院的整体医疗服务实力提供参考依据。

方法

邀请专家对医疗服务能力各级指标的相对重要性进行评价，运用层次分析法确定各层指标的权重。

结果

共邀请35专家进行函询，问卷回收率94.43%，一级指标判断矩阵的一致性比率为0.022 3，结构、过程、结果3项指标下的二级指标判断矩阵的一致性比率分别为0.000 0、0.074 1、0.005 2，均小于0.1，最终确定评价指标体系包括3项一级指标，10项二级指标，23项三级指标。一级指标中所占权重最大的为结果（0.457 0），在组合权重中，超过平均权重0.043 5（1/23）的指标有11项。

结论

基于层次分析法构建的县级医院医疗服务能力评价指标体系客观、可靠，可为各级卫生行政部门、县级医院结合实际开展医疗服务能力评价与能力提升提供借鉴和参考。

层次分析法  /  县级综合医院  /  医疗服务能力  /  评价指标  /  权重
Objective

To establish an evaluation index system of medical service capacity in county hospitals, so as to provide a reference basis for further evaluating the overall medical service strength of county-level hospitals.

Methods

Experts were invited to evaluate the relative importance of indicators at all levels of medical service capacity, and the weights of the dimensions of the indicators system were determined using analytic hierarchy process.

Results

A total of 35 experts were invited to consult letter inquiries, and the recovery rate of the questionnaire was 94.43%. The CR of first-level indicators judgment matrix was 0.0223, and the CR of the second-level index judgment matrix under the three dimensions of structure, process and outcome were 0.0000,0.0741and 0.0052, all less than 0.1. Finally, the evaluation index system included 3 first-level indicators, 10 second-level indicators and 23 third-level indicators. The highest weight of the first-level indicators was the result(0.4570). Among the combined weights there were 11 indicators that exceeded the average weight of 0.0435 (1/23).

Conclusion

The evaluation index system of county hospitals based on analytic hierarchy process is objective and reliable, which can provide reference for health administrative departments at all levels and county hospitals to carry out medical service ability evaluation and ability improvement according to the actual situation.

Analytic hierarchy process(AHP)  /  County general hospitals  /  Medical service capacity  /  Evaluation index  /  Weight
陈秀彦, 张远妮, 关小倩, 黎洁, 孙林敏. 基于层次分析法的县级综合医院医疗服务能力评价指标体系研究. 现代预防医学, 2024 , 51 (20) : 3730 -3735 . DOI: 10.20043/j.cnki.MPM.202406300
Xiu-yan CHEN, Yuan-ni ZHANG, Xiao-qian GUAN, Jie LI, Lin-min SUN. Research on the evaluation index system of medical service capacity in county general hospitals based on analytic hierarchy process[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3730 -3735 . DOI: 10.20043/j.cnki.MPM.202406300
正文
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县级综合医院（以下简称“县级医院”）是县域内的医疗中心和农村三级医疗卫生服务网络的龙头，是构建公立医院高质量发展体系的重要基石[1]。为落实县级医院在县域医疗服务体系中的龙头作用和城乡医疗服务体系中的桥梁纽带作用，进入高质量发展新阶段以来，国家卫生健康委等部门在县级公立医院综合改革相关政策基础上，陆续印发《“千县工程”县医院综合能力提升工作方案（2021—2025年）》《关于进一步健全机制推动城市医疗资源向县级医院和城乡基层下沉的通知》等文件，大力推动县级医院综合管理能力和医疗服务能力持续提升，为实现大病不出县打下坚实基础[2]。
提高医疗服务能力是县级医院实现高质量发展的重要任务，也是做好县域居民健康“守门人”的核心要求，但因现有的县级医院服务能力评估（以下简称“能力评估”）和公立医院绩效考核体系（以下简称“绩效考核”）评价出发点和侧重面不同，目前仍缺乏一个客观、全面地对县级医院医疗服务能力进行评价的指标体系；此外，现有的县级医院能力评价研究主要集中于综合能力评价，针对于医疗服务能力评价的研究尚少[3-6]。基于此，本研究将借鉴“能力评估”和“绩效考核”评价内容和指标内涵，构建适用于县级医院医疗服务能力的评价指标体系，旨在为县级医院高质量发展相关政策实施跟踪评估提供参考依据，助推县级医院高质量发展和县域医疗服务能力整体提升。
1　对象与方法
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1.1　研究对象
本研究以广东省县级医院为例，开展县级医院医疗服务能力评价指标体系研究，重点围绕评价指标体系层次结构的构建和各层次指标权重的确定。
1.2　研究方法
1.2.1　建立层次结构模型
本研究通过文献分析法系统性回顾县级医院相关政策、现行评估体系和既往研究进展，基于“结构-过程-结果（Structure-Process-Outcome，SPO）”模型，借鉴“能力评估”和“绩效考核”重点监测指标，结合专家咨询结果，构建县级医院医疗服务能力指标评价体系[5, 7-9]。运用层次分析法（Analytic hierarchy process，AHP）构建总目标层为县级医院医疗服务能力评价体系，准则层为结构、过程、结果3项一级评价指标和10项二级指标，方案层为23项三级指标的层次结构模型[10]。具体如图1所示。
1.2.2　构建两两比较判断矩阵
由来自于卫生行政部门和医院的专家组成专家组，依据Saaty相对重要性等级表对各级评价指标进行重要性评分，即通过对同层次对总目标层影响的各个因素之间进行两两比较，每次取两个因素i和j，用αij来表示因素i和j的重要性比值，得到两两判断矩阵A=（αij）n×n，其中1≤i，j≤n。Saaty相对重要性等级表见表1。
1.2.3　进行一致性检验
计算各级指标权重，并进行一致性检验，当一致性比率（CR）<0.1时通过一致性检验，具体步骤如下：①在两两比较矩阵的基础上，将判断矩阵按列作归一化处理：；②将判断矩阵按行进行求和运算：；③对判断矩阵做归一化处理：；④计算判断矩阵最大特征根：；⑤计算一致性指标：；⑥计算一致性比率：，RI为平均随机一致性指标，1-10阶矩阵的RI取值见表2[11-12]。
1.2.4　确定指标权重
根据层次单排序的权重值，计算总排序权重情况，将一级指标、二级指标和三级指标权重系数相乘，得出三级指标组合权重，最终确定县级医院医疗服务能力评价指标体系中各项指标权重情况。
1.3　统计分析
本研究采用Microsoft Excel 2021软件建立数据库，运用Yaahp 12.9软件群决策方法对专家组的判断矩阵计算各指标权重，并进行层次结构一致性检验。
2　结果
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2.1　专家基本情况
分别邀请35位专家进行函询。回收问卷33份，回收率94.43%，有效问卷33份，有效率100%。33位专家中，从事卫生行政部门管理者共11人（33.33%），医院管理者14人（42.43%）、临床医生8人（22.24%），在卫生行政部门管理者中，行政职级为处级以上和正科级的分别为5名（45.45%）和6名（54.55%），在医院管理者和临床医师中，正高职称和副高职称分别为9名（40.9%）和13名（59.1%），工作年限均在10年以上。
2.2　权重分析结果
2.2.1　一级指标权重
根据群决策结果，33位专家的判断矩阵的CR为0.022 3，满足CR<0.1，表明其特征向量wi可作为指标权重予以采信，得到结构、过程、结果三项一级指标的权重分别为0.244 6、0.298 4、0.457 0，具体情况详见表3。
2.2.2　二级指标权重
经群决策集结计算，各一级指标下二级指标的判断矩阵的一致性检验结果均满足CR<0.1。在结构指标下，权重最大的二级指标为资源配置，权重最小的为科室设置，对应权重分别为0.520 3和0.479 7，CR为0.000 0，具体情况见表4。
在过程指标下，权重从大到小依次为运行效率、服务能力、运营效率、诊疗能力，对应权重分别为0.321 1、0.286 9、0.218 9、0.173 1，CR为0.074 1，具体情况见表5。
在结果指标下，权重从大到小依次为质量安全、患者满意度、诊疗量、患者负担，对应权重分别为0.402 7、0.211 4、0.200 3、0.185 6，CR为0.005 2，具体情况见表6。
2.2.3　指标组合权重
与一、二级指标计算过程一致，33位专家的赋值结果经群决策集结计算和一致性检验后，得到23项三级指标权重。将每项二级指标与其隶属的一级指标，三级指标与其隶属的一、二级指标权重系数相乘，分别得到二级指标和三级指标的组合权重，最终确定县级医院医疗服务能力评价指标体系中各项指标权重情况，具体见表7。
3　讨论
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3.1　评价指标体系的科学性和可靠性分析
在指标选择方面，本研究评价指标主要来源于目前县级医院参与的由国家卫生健康委组织开展的“能力评估”、“绩效考核”等评价体系，经过多年应用和不断优化，相关指标内涵、统计口径和数据结果均具有科学性和准确性，同时在充分文献调查和咨询专家意见的基础上，应用“结构-过程-结果”模型进行评价指标筛选、确定，该评价指标体系能客观、全面反映县医院医疗服务能力情况。
在研究方法方面，县级医院医疗服务能力评价指标体系是一个具有多层次、多指标的复杂系统，各层次、各指标对总目标的相对重要性各不相同，如何科学确定各指标在整个医疗服务评价体系中的重要程度是本研究的关键问题。层次分析法是美国运筹学家萨蒂（Saaty T）等人于20世纪70年代初提出的多准则决策方法，是一种能将半定性、半定量问题转化为定量问题的有效途径，适用于难以完全用定量进行分析的复杂问题，目前已经广泛应用在解决赋权问题、规划问题和排序问题等多种场景[13]。本研究将层次分析法应用于县级医院医疗服务能力评价指标体系构建，能有效避免主观权重确定方法中的随意性和模糊性[14]。
在调查结果方面，层次分析法通过对决策者的经验判断进行量化，从而为决策者提供定量形式的依据，因依赖于决策者的经验判断，为充分考虑政策制定部门和执行部门的意见，本研究选取的33位专家中，33.33%是在卫生行政部门负责县级医院能力建设的工作人员，67.67%是县级医院的医院管理者和临床医生，所有专家工作年限均在10年以上，专家的专业知识和实践经验均有较好的代表性。在分析工具上，本研究借助专门用于层次分析法辅助软件Yaahp 12.9群决策功能，将33位专家的赋分情况进行集结计算，得出县级医院医疗服务能力评价指标体系权重，经统计检验，各层次指标的CR都小于0.1，均通过一致性检验，因此，本研究得出的评价指标权重相对科学、准确。
3.2　评价指标体系的权重分析
在3项一级指标中，结构、过程、结果分别反映县级医院医疗服务的投入、运行和产出，其中结果指标（0.457 0）权重最大，说明结果是衡量县级医院医疗服务能力的重点和核心。结果包含4项二级指标，其中质量安全（0.402 7）权重占比最高，表明优质的医疗质量安全是县级医院吸引患者、留住患者和满意患者的核心产出因素。过程包括4项二级指标，其中所占权重最高的是运行效率（0.321 1），表明高效的医疗资源利用效率是县级医院优秀医疗服务能力运行过程的重要体现；所占权重第二的是服务能力（0.286 9），表明县级医院掌握的医疗技术覆盖程度是其医疗服务能力的基础反映。结构包括2项二级指标，其中资源配置（0.520 3）是所占权重最高的指标，表明县级医院配备的床位、人力、设备等医疗资源是医疗服务开展的前提和基础。
在本研究设置的23项三级指标中，超过平均权重0.043 5（1/23=0.043 5）的指标有11项，其中，结构指标有2项，分别是二级科室设置率（组合权重为0.069 5）和一级科室设置率（组合权重为0.047 8），这两项指标均属于二级指标科室设置，指标来源为“服务能力评估”中的临床科室和医技科室设置要求，表明设置齐全的业务科室是县级医院提供优质医疗服务的重要基础；过程指标有3项，分别是床位使用率（组合权重为0.049 2）、基本标准符合率（组合权重为0.047 3）、平均住院日（组合权重为0.046 7），床位使用率和平均住院日均属于二级指标运行效率，基本标准符合率属于二级指标服务能力，表明医疗资源的利用效能是县级医院医疗服务能力水平的重要体现，而相对于危急重症与疑难病的诊疗能力，县级医院医疗技术水平能满足县域内常见病、多发病诊疗是其医疗服务能力的重要内容，这与其功能定位相一致；结果指标有6项，分别是低风险组病例死亡率（组合权重为0.130 4）、手术并发症发生率（组合权重为0.053 6）、门诊患者满意度（组合权重为0.052 6）、手术人数（组合权重为0.048 0）、次均住院费用（组合权重为0.046 9）、住院患者满意度（组合权重为0.044 0），低风险组病例死亡率和手术并发症发生率属于二级指标质量安全，门诊患者满意度和住院患者满意度属于二级指标患者满意度，手术人数属于二级指标诊疗量，次均住院费用属于二级指标患者负担，表明质量安全和患者满意度作为重要医疗服务产出，是衡量县级医院医疗服务能力的核心指标；手术是治疗外科疾病的重要手段，因此手术患者收治情况反映着县级医院的技术能力和水平；住院治疗是县级医院为患者提供医疗服务的主要内容，在同等技术难度水平下，患者所负担的住院费用越低反映的是该医院的医疗服务能力越强。总体来看，高权重指标主要集中在质量安全、科室设置、患者满意度和运行效率4项二级指标，提示在评价县级医院医疗服务能力整体情况中，这4项指标有着重要的地位和作用。
3.3　评价指标体系的应用价值分析
2018年起，国家卫生健康委启动县级医院医疗服务能力评估工作，并按照医院等级分别于2019年和2020年纳入三级、二级医院公立医院绩效考核，目前已形成较为可靠的县级医院服务评价体系。但从评价的出发点和侧重面来看，前者主要为了评价县级医院提供医疗服务的能力，包括科室设置、设施设备、医疗技术等情况，更侧重于评价提供服务的基础结构和过程，后者主要为了评价公立医院综合服务能力，包括医疗质量、运营效率、持续发展和满意度评价等方面，更侧重于应用客观性的结果类指标情况反映医疗服务能力。但目前，二者并未有机结合形成一个完整的“结构-过程-结果”的评价体系，此外，因“绩效考核”按照医院等级纳入评价，无法将不同等级的县医院进行横向比较。因此，本研究基于“结构-过程-结果”模型，整合“服务能力评估”和“绩效考核”重点评价指标，经过专家咨询和应用层次分析法确定指标权重，形成县级医院医疗服务能力评价指标体系，但各项指标是否具有稳定性、代表性和区分度，在实际评价中是否需要引入相关因素进行校正等情况，仍需要进一步开展实证研究进行检验[15]。同时，可通过实证研究结果为在高质量发展背景下县级医院提升医疗服务能力提供有力指引，同时为推动县级医院高质量发展相关政策制定和评价提供一定的参考依据。
基金
收起
  • 2022年度广东省医学科研基金项目(C2022086)
  • 广东省卫生经济学会2024年科研课题立项项目(2024-WJZD-05)
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202406300
  • 接收时间：2024-06-19
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-06-19
基金
2022年度广东省医学科研基金项目(C2022086)
广东省卫生经济学会2024年科研课题立项项目(2024-WJZD-05)
作者信息
    1.南方医科大学第三附属医院，广东 广州 510630
    2.南方医科大学南方医院

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