兰州大学学报(医学版)

目的 评价2023年兰州市城关区社区卫生服务机构基本公共卫生服务质量，为促进社区服务提质增效、均等化发展提供参考。方法 基于16项评价指标(V₁～V₁₆)，采用熵权法、逼近理想解排序(TOPSIS)法、秩和比(RSR)法及其模糊联合法综合评价100家社区卫生服务机构的基本公共卫生服务质量。结果 各种评价方法所得服务质量排名前3位的社区均为X₅₅、X₂₁、X₁₅；采用熵权TOPSIS法、0.5C_i+0.5RSR及0.9C_i+0.1RSR模糊联合法所得排名后3位的社区均为X₈₅、X₅₉、X₂₂；而采用RSR法和0.1C_i+0.9RSR模糊联合法所得排名后3位的社区均为X₂₂、X₅₉、X₈₅，以上方法排序结果虽不完全相同，但总体趋势一致。多元线性回归结果显示，16项评价指标对C_i均有显著影响(P<0.01)。其中，0～6岁儿童眼保健和视力检查覆盖率、2型糖尿病患者基层规范管理服务率、产后访视率的正向影响显著；严重精神障碍患者规范管理率、健康档案使用率、预防接种建证率的影响程度较低。结论 熵权TOPSIS法和RSR法模糊联合能够有效评价社区卫生服务质量。兰州市城关区社区卫生服务机构间基本公共卫生服务质量发展不均衡，重点人群的实施效果是影响服务质量的关键因素。

Objective To evaluate the basic public health service quality of community health service institutions in Chengguan District of Lanzhou City in 2023, and to provide reference for promoting the development of community quality, efficiency and equality. Methods Based on 16 evaluation indexes(V₁-V₁₆), the basic public health service quality of 100 community health service institutions was comprehensively evaluated via the entropy weight method, technique for order preference by similarity to ideal solution(TOPSIS) method, rank sum ratio(RSR) method and fuzzy combination method. Results The top three communities of service quality obtained by various evaluation methods were X₅₅, X₂₁ and X₁₅. The last three communities obtained by the entropy weight TOPSIS method, 0.5 C_i+0.5 RSR and 0.9 C_i+0.1 RSR fuzzy combination method were X₈₅, X₅₉ and X₂₂. The last three communities obtained by RSR method and 0.1 C_i+0.9 RSR fuzzy combination method were X₂₂, X₅₉ and X₈₅. Although the ranking results of the above methods were not exactly the same, the overall trend was consistent. Multiple linear regression results showed that 16 evaluation indexes had significant effects on C_i values(P<0.01). Among them, the coverage rate of eye care and vision examination for children aged 0-6 years, the rate of grass-roots standardized management services for patients with type 2 diabetes, and the rate of postpartum visits had a significant positive impact; the impact of standardized management rate, health record utilization rate and vaccination certification rate on patients with severe mental disorders was relatively small. Conclusions The fuzzy combination of TOPSIS method and RSR method can better evaluate the quality of community health service institutions. The quality of community health service institutions in Chengguan District of Lanzhou City is not balanced, and the implementation effect for key populations is a key factor affecting the quality of basic public health services.