关键词: 家庭医生签约服务, 服务质量改进, 就诊对应率, 卫生保健改革

Abstract: With the deepening of the comprehensive reform of community health services in Shanghai，the number of residents signing medical contracts with family doctors has continued to expand，but the problems of imperfect supporting measures and residents signing contracts without visiting still exist.Establishing a long-term and stable service relationship between contracted residents and family doctors is the basis for the practice of family doctor services.On the basis of consolidating the existing contract-signing rate of residents，the Pujin Community Health Service Center in Minhang District of Shanghai had shifted the focus of contracted family doctor service to provide the effective service，in order to explore the reform methods of family doctor service to improve the corresponding visiting rate of contracted residents.The main methods included carrying out the "three optimizations and two extensions" model（optimizing the shift arrangement of general practitioners，the publicity model，and outpatient registration and visiting queue system；extending the telephone consultation service hours and working-day noon service hours and opening the weekend clinics）；implementing the "two more policy" for drug supply after residents signed contracts（signed residents were issued a larger number of drug types and quantities for outpatient visits）；implementing the service of long prescription and extending its advantages；promoting the reform of performance and evaluation mechanism to widen the performance gap between contracted residents and non-contracted residents receiving outpatient consultation from family doctors；and issuing quality briefings to conduct appraisal feedback in the form of rectification notice.After one year of the reform（as of June 2019），the rates of consulting the contracted family doctor，visiting the contracted family doctor for outpatient services，and extending period of prescriptions by the contracted family doctor reached 38.53%，31.99% and 87.03%，respectively，which increased by 30.54，26.98 and 60.02 percentage points compared with the beginning of the reform（July 2018）.At the same time，the resource utilization of family doctor services，the awareness rate of family doctor services，and satisfaction degree of residents also improved to a certain extent.The purpose of this article is to introduce the reform methods，the effect and further work priorities of Pujin Community Health Service Center，in order to provide references for other areas to improve the effectiveness of contracted family doctor services.

Key words: Contracted family doctor services, Service quality improvement, Corresponding visiting rate, Health care reform