| Background:Since the implementation opinions of comprehensive reform of county-level public hospitals were fully implemented in 2015,and it was clearly proposed to establish a public hospital salary system in line with the medical industry,it is of great significance to build a scientific and reasonable salary system to mobilize the enthusiasm and initiative of medical staff and to reflect the labor value of medical staff.However,at present,medical personnel are not properly paid for their time and effort and risk and pressure in providing medical services.At present,no matter from the medical service pricing or the salary of medical staff,it does not accurately and truthfully reflect the labor value of doctors,resulting in low mood of doctors and slack work.The salary is related to the workload of doctors,but there are few researches on the workload of doctors.Therefore,combining with the functional positioning of county-level medical institutions and relevant theoretical knowledge,a set of doctors'workload indicator system reflecting labor value is constructed,and the relative value table of medical service items is established to provide a basis for calculating doctors'workload,rationalizing the medical service price and improving the salary system.Objective:A scientific and systematic indicator system of doctors'workload was established,and on the basis of the indicator system,the relative value table of 10surgical projects in general surgery was developed,and then the workload of surgeons in12 county-level public hospitals was calculated.Methods:On the basis of the index system formed by the preliminary literature review and expert group discussion,Delphi expert consultation method is used to determine the doctor workload index system through two rounds of expert consultation;Analytic Hierarchy Process is used to determine the weight coefficients of the first and second level indicators through the third round of expert consultation;The questionnaire survey and Magnitude Estimation were used to conduct field empirical research.The survey data are double entered into Epidata3.1 to construct the doctor workload database.The statistical data are analyzed by using SPSS16.0.Results:?1?The first draft of surgeon workload index system based on RBRVS was set up.Through literature review and expert group discussion held in the early stage of the research group,we put forward the preliminary draft of doctor workload index system,including 4 first grade indexes and 27 second grade indexes.?2?The index system of surgeon workload based on RBRVS was established.After one round of expert consultation,we identified 4 first grade indicators and 24 second grade indicators according to the statistical results and expert opinions;after two rounds of expert consultation,combined with expert opinions,we finally identified 4 first grade indicators and 21 second grade indicators;after three rounds of statistical analysis of expert consultation,the weight coefficient of each indicator is determined.First levelpressure=0.2369Weights of the second level index set by expert grading methodThe positive coefficient of experts is 100%,the authoritative coefficient is more than 0.7,the significance test of Kendall coefficients of concordance is P<0.01,and evaluation results of experts are consistent.?3?The doctor workload of 10 general surgery projects in 12 county-level public hospitals was calculated.First,through the collection of data of 50 diseases before operation in 10 county-level public hospitals in Anhui Province in 2018,then sorting out and summarizing the data,and after the discussion of the expert group,we determined 1benchmark project and 11 measured projects of the surgery.By using the method of Magnitude Estimation,12 medical service projects were evaluated and assigned,and the relative evaluation table of doctor workload of 12 operation projects was obtained.In order to improve the integrity and quality of the data,10 surgical projects were selected,and the doctor workload of 12 county-level public hospitals was calculated by using the formula TW=T?×M?×S?×R?,combined with the number of cases.Discussions:?1?This study has sufficient theoretical basis.The index system of doctor workload is scientific,systematic and representative,which can reflect the labor value of medical personnel.Expert consultation received the better positive coefficients and authority coefficients of experts and experts'advice were more consistent.Therefore,all of these ensured the reliability of expert consultation and the quality of the research.?2?The choice of the measured projects is representative,which can reflect the difficulty difference between different surgical projects and better reflect the technical level of doctors in this study.Through the Magnitude Estimation method,the establishment of the relative value table of 10 Surgical projects,with the 2012 edition of the“Guidelines for the National Health Service Project Price”,service project in the project time,basic human,technical difficulty and risk assignment size is consistent.And then the doctor workload of 12 county-level public hospitals is calculated,which is consistent with the actual situation of the surgical work of the interviewed surgeons.In the later stage,CPI will be introduced to adjust the economic level of each region,and the physician fees of each hospital will be calculated based on the number of doctors'workload and unit price.Conclusion:Through three-round of expert consultation,we identified a set of doctor workload index system in line with county-level public hospitals by basing on RBRVS model and using methods of literature review,expert discussion,expert consultation and Analytic Hierarchy Process?AHP?.This index system provides an evaluation basis for the later research on the relative value of medical services and the estimation of the workload of surgeons.In the later stage,the scope of medical service projects will be expanded to lay a foundation for the future reasonable pricing of medical services and doctor compensation system. |
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