Page 75 - 2022-25-中国全科医学

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【Abstract】 Background In March 2020，the Shanghai Municipal Health Commission proposed that fever alertness
clinics should be set up in primary healthcare institutions（community health service centers）to deal with multi-site sporadic
outbreaks by the principle of local emergency disposal combined with standardized and regular outbreak control. Objective
To explore and construct a comprehensive and standardized evaluation index system for the operation of fever alertness clinics.
Methods Two rounds of semi-structured in-depth interviews were conducted with 10 staff from three fever alertness clinics in
downtown，suburban，and peri urban locations of Shanghai，respectively，using a purposive sampling method from January to
April 2021. Raw data were obtained，interview materials were collated with the aid of the ROST CM6 software，and paradigm
analyses were conducted using the Charmaz constructing grounded theory. Using a purposive sampling method，12 experts familiar
with the operating characteristics of fever alertness clinics（fever alertness clinics managers，researchers from universities，
scholars from related associations，health development institutes，etc.）were invited as consulting objects to answer the
correspondence questionnaire for 2 rounds from May to June 2021，and the weighting of indicators at each level was determined
by hierarchical analysis to check the logical consistency of indicators at all levels，the evaluation index system of operation of fever
alertness clinics was finally formed. Results The evaluation index system for operation of fever alertness clinics，which was
constructed based on the grounded theory，consisted of 5 primary indicators，13 secondary indicators and 29 tertiary indicators.
The effective recoveries rate of the two rounds of expert consultation questionnaires was 100.0%，the expert authority coefficient
2
2
of the two rounds was all 0.81，Kendall's W coefficients were 0.265（χ =163.768，P<0.001）and 0.320（χ =130.323，
P<0.001），respectively. The final developed evaluation index system for operation of fever alertness clinics consisted of 5 primary
indexes（functions and responsibilities，consulting room setting requirements，staffing，workflow and work specifications），
13 secondary indexes and 25 tertiary indexes. The weights of the five primary indexes were 0.033 7，0.056 4，0.392 6，0.377 8
and 0.139 5，respectively. The consistency ratio（CR）of indicators at all levels was 0.056 5、0.032 5、0.042 4（<0.100 0）.
Conclusion The application of grounded theory to the construction of evaluation index system for fever alertness clinics is highly
operable，and the constructed evaluation index system has a certain scientific validity and application value. Follow up with the
policy iterations，the evaluation index system can be further supplemented and improved with the aid of grounded theory.
【Key words】 Fever alertness clinics；Grounded theory；Constructivism；Evaluation index system；Construction；
Community health services

2020-03-22，上海市卫生健康委提出，在全市已有 1 对象与方法
117 家发热门诊的基础上，增加建设 182 家社区卫生服 1.1 基于扎根理论初步构建发热哨点诊室运行评价指
务中心发热哨点诊室，以进一步加强发热患者筛查、登 标体系
记和随访工作，减轻综合医院发热门诊的负担，充分发 1.1.1 研究对象 考虑到上海市中心城区、郊区、城郊
挥发热哨点诊室在疫情防控中的“哨兵”作用 ［1］ 。随 结合地区发热哨点诊室在覆盖的人口数、目标定位、功
着上海市社区卫生服务中心发热哨点诊室建设工作的深 能划分等方面存在差异，本研究分别从上海市中心城区、
入开展，四川省、山东省、浙江省、广西壮族自治区、 郊区、城郊结合地区选取 1 家发热哨点诊室作为样本来
河南省、北京市等省份亦着手组织开展发热哨点诊室建 源地。于 2021 年 1—4 月，采用目的性抽样法，选取来
设工作 ［2］ 。目前，国内尚未建立健全发热哨点诊室运 自上述 3 家发热哨点诊室且参与发热哨点诊室运行的工
行评价指标体系，对于发热哨点诊室的运行质量缺乏统 作人员作为研究对象。纳入标准：（1）具有丰富接诊
一的考核、评价标准。发热哨点诊室运行评价指标体系 经验的一线医务人员或发热哨点诊室运行管理人员；（2）
的构建有助于保障发热哨点诊室安全、稳定运行，同时 熟练掌握新型冠状病毒肺炎的诊断标准、治疗原则、防
也是促进发热哨点诊室充分发挥职能的有力“抓手”。 护标准等；（3）知情同意，并自愿参加本次研究。样
本研究采用扎根理论研究方法，直接从实际观察入手， 本量的确定以理论饱和为标准，即访谈对象所提供的资
从原始资料中归纳经验概括，从而初步确立各级发热哨 料不能进一步揭示类属的属性和维度、无法产生新的理
点诊室运行评价指标。在此基础上，通过专家函询法遴 论见解时，停止抽样。
选评价指标，借由层析分析法确定各级指标权重、检验 1.1.2 研究方法
各级指标逻辑一致性，最终构建了一套发热哨点诊室运 1.1.2.1 方法学的确立 本研究采用建构主义扎根理论
行评价指标体系，旨在为基层卫生政策的制定、发热哨 的范式收集和分析资料 ［6］ 。建构主义扎根理论认为，
点诊室运行效果的客观评价、发热哨点诊室服务水平的 现实是一种相对主义的现实，是在特定的社会和情境中
提升奠定一定的基础 ［3-5］ 。 建构的，而建构过程取决于研究者与受访者间的互动。