發(fā)布時(shí)間：2018-06-06 01:26

  本文選題：全科醫(yī)生 + 績(jī)效考核��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:基于對(duì)全科醫(yī)生績(jī)效進(jìn)行定量化考核的目標(biāo),擬定數(shù)據(jù)收集的指標(biāo)體系框架,用大數(shù)據(jù)和信息化系統(tǒng)來(lái)解決全科醫(yī)生績(jī)效考核的問(wèn)題,為全科醫(yī)生績(jī)效考核從規(guī)劃走向現(xiàn)實(shí)架起一座橋梁,為全科醫(yī)生績(jī)效考核信息資源的有效利用提供參考。方法:通過(guò)文獻(xiàn)計(jì)量學(xué)方法分析并界定國(guó)內(nèi)全科醫(yī)生績(jī)效研究的前沿和熱點(diǎn)領(lǐng)域,為指標(biāo)框架的擬定提供指示;通過(guò)文獻(xiàn)研究,查找全科醫(yī)生績(jī)效考核指標(biāo)框架中的具體要素,初步設(shè)計(jì)了全科醫(yī)生績(jī)效考核指標(biāo)框架;采用利益相關(guān)者分析的方法對(duì)全科醫(yī)生績(jī)效考核過(guò)程中可能的參與主體進(jìn)行理論探討,并從不同的職能角度對(duì)全科醫(yī)生績(jī)效考核利益相關(guān)團(tuán)體的信息需求進(jìn)行分析;采用結(jié)構(gòu)-過(guò)程-結(jié)果三維質(zhì)量評(píng)價(jià)模式,對(duì)初步設(shè)計(jì)的全科醫(yī)生績(jī)效考核指標(biāo)框架進(jìn)行評(píng)價(jià)。結(jié)果:1.全科醫(yī)生績(jī)效研究(1)國(guó)內(nèi)全科醫(yī)生績(jī)效研究熱點(diǎn):(1)與全科醫(yī)生相關(guān)的激勵(lì)機(jī)制:簽約服務(wù)、雙向轉(zhuǎn)診、分級(jí)診療;(2)全科醫(yī)生健康管理的研究熱點(diǎn):慢性病管理、糖尿病、高血壓。(2)全科醫(yī)生相關(guān)制度包括:“全科醫(yī)生簽約制服務(wù)”制度、社區(qū)首診制和雙向轉(zhuǎn)診制度、“按人頭付費(fèi)”制度等。(3)全科醫(yī)生績(jī)效考核指標(biāo)體系框架:從醫(yī)療服務(wù)結(jié)果、醫(yī)療服務(wù)過(guò)程和醫(yī)療服務(wù)能力三個(gè)方面出發(fā),初步構(gòu)建以人群健康結(jié)果和醫(yī)療費(fèi)用為導(dǎo)向的全科醫(yī)生績(jī)效考核指標(biāo)框架,為數(shù)據(jù)倉(cāng)庫(kù)概念模型主題的確定與描述奠定了基礎(chǔ)。2.全科醫(yī)生績(jī)效考核信息需求分析全科醫(yī)生績(jī)效考核的利益相關(guān)集團(tuán)包括衛(wèi)生行政機(jī)構(gòu)、醫(yī)療衛(wèi)生專(zhuān)業(yè)機(jī)構(gòu)、醫(yī)療衛(wèi)生服務(wù)提供方和醫(yī)療衛(wèi)生服務(wù)需求方。從不同的職能角度對(duì)各利益相關(guān)團(tuán)體的信息需求進(jìn)行了具體的分析與闡述,為數(shù)據(jù)倉(cāng)庫(kù)模型中主題的確立奠定了基礎(chǔ)。3.全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)模型的研究(1)全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)概念模型的研究:(1)根據(jù)數(shù)據(jù)倉(cāng)庫(kù)的主要特征和數(shù)據(jù)組織形式,結(jié)合實(shí)際情況,界定數(shù)據(jù)倉(cāng)庫(kù)系統(tǒng)邊界,涉及三個(gè)子系統(tǒng):社區(qū)居民、醫(yī)療服務(wù)的提供者即全科醫(yī)生、全科醫(yī)生制度管理方;(2)確定了主要的主題域并對(duì)其進(jìn)行分析;(3)以“考核”主題為例,采用信息包圖完整、規(guī)范化的對(duì)主題進(jìn)行分析,建立了概念數(shù)據(jù)模型;(4)利用E-R圖表示了全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)的概念設(shè)計(jì)模型。(2)數(shù)據(jù)倉(cāng)庫(kù)邏輯模型的確定主要完成了三方面的工作:(1)分析主題,確定當(dāng)前要優(yōu)先裝載的主題,即“考核”主題;(2)對(duì)數(shù)據(jù)倉(cāng)庫(kù)中數(shù)據(jù)粒度進(jìn)行了劃分,以“考核”主題與“醫(yī)療費(fèi)用”主題為例進(jìn)行闡述,確定這兩個(gè)主題均采用雙重粒度;(3)定義關(guān)系模式,針對(duì)全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)中信息組織特點(diǎn)和概念模型的多維特性,采取星型模式和雪花模型來(lái)實(shí)現(xiàn)全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)邏輯模型設(shè)計(jì)。并以考核主題、醫(yī)療費(fèi)用主題、慢性病管理主題為例,來(lái)說(shuō)明設(shè)計(jì)中使用的維度表,事實(shí)表,以及之間的邏輯關(guān)系。(3)全科醫(yī)生績(jī)效考核物理模型的設(shè)計(jì)主要從確定數(shù)據(jù)的存儲(chǔ)結(jié)構(gòu)、索引策略、存放位置以及數(shù)據(jù)的存儲(chǔ)分配等方面進(jìn)行了分析�？偨Y(jié):本研究從全科醫(yī)生績(jī)效考核業(yè)務(wù)需求的角度出發(fā),闡述和分析了數(shù)據(jù)倉(cāng)庫(kù)模型的設(shè)計(jì)過(guò)程,通過(guò)概念模型、邏輯模型和物理模型構(gòu)建面向主題的全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)模型。該模型的建模原則和設(shè)計(jì)過(guò)程對(duì)全科醫(yī)生績(jī)效考核數(shù)據(jù)倉(cāng)庫(kù)的構(gòu)建具有較好的參考價(jià)值,同時(shí)為全科醫(yī)生績(jī)效管理決策提供一定的理論指導(dǎo)。
[Abstract]:Objective: Based on the objective of quantitative assessment of the performance of the general practitioner, the framework of the index system for data collection is drawn up to solve the problem of the performance assessment of the general practitioner with large data and information system, so as to build a bridge for the performance assessment of the general practitioner from the planning to the reality, and to make effective use of the information resources of the general practitioner's performance assessment. Provide reference. Methods: through Bibliometrics method analysis and definition of the domestic general practitioner performance research frontiers and hot areas, to provide indicators for the formulation of the index framework; through literature research, find out the specific elements in the framework of general practitioner performance assessment index, initially set up a general practitioner performance evaluation index framework; adopt benefits. The method of stakeholder analysis is a theoretical study of the possible participants in the performance assessment process of the general practitioner, and analyzes the information requirements of the general practitioner's performance assessment from different functional perspectives, and uses the structure process results three-dimensional quality evaluation model to evaluate the performance evaluation index of the preliminary general practitioner. Framework evaluation. Results: 1. general practitioner performance study (1) domestic general practitioner performance research hot spots: (1) incentive mechanism related to general practitioner: signing service, two-way referral, grading diagnosis and treatment; (2) the research hotspot of general practitioner health management: chronic disease management, diabetes, hypertension. (2) general practitioner related system including: "general practitioner" Contract system service "system, community first diagnosis system and two-way referral system," pay by person "system and so on. (3) the framework of the performance assessment index system of general practitioners: from three aspects of medical service results, medical service process and medical service ability, the performance of general practitioner based on population health results and medical expenses is preliminarily constructed. The assessment index framework provides a basis for the determination and description of the theme of the conceptual model of the data warehouse, which lays the foundation for the performance assessment of the.2. general practitioner. The stakeholder groups including the health administration, the medical and health institutions, the health service providers and the medical and health service providers. A specific analysis and exposition of the information requirements of various interest related groups is carried out, and the research on the basis of the theme of the data warehouse model has been laid on the basis of the.3. general practitioner performance assessment data warehouse model (1) the research on the concept model of the general practitioner performance assessment data warehouse: (1) according to the main features and data groups of the data warehouse Weaving, combining with the actual situation, defines the boundary of the data warehouse system, involving three subsystems: community residents, medical service providers, the general practitioner, the general practitioner system manager, and (2) determining the main subject domain and analyzing it; (3) taking the "assessment" theme as an example, using the information package complete and standardized to the subject. The concept data model is established. (4) the concept design model of the GP performance assessment data warehouse is expressed by E-R diagram. (2) the determination of the data warehouse logic model is mainly completed in three aspects: (1) to analyze the theme, to determine the topic that should be first loaded, that is, the "assessment" theme, and (2) the granularity of data in the data warehouse. In this paper, the "assessment" theme and the "medical cost" theme were illustrated for example, and the two subjects were determined to use double granularity; (3) the relationship model was defined. In view of the multidimensional characteristics of the information organization characteristics and conceptual models in the general practitioner performance assessment data warehouse, the star pattern and snowflake model were adopted to achieve the general practitioner performance. Check the logic model of the data warehouse, and take the examination topic, the medical cost theme, the chronic disease management subject as an example, to explain the dimension table, the fact table and the logical relationship between the design, (3) the design of the physical model of the general practitioner's performance assessment is mainly from the storage structure, the index strategy, the location and the number of the data. According to the analysis of the storage distribution and other aspects, this paper summarizes and analyzes the design process of the data warehouse model from the perspective of the requirements of the performance assessment of the general practitioner, and constructs the data warehouse model of the subject oriented general practitioner through the concept model, logic model and physical model. And the design process has a good reference value to the construction of the general practitioner's performance appraisal data warehouse, and provides some theoretical guidance for the general practitioner's performance management decision.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.1

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