通讯作者: 李建涛, sxmuljt@126.com

DOI：10.12201/bmr.202507.00046

From “Single Soldier” to “Team”: a Longitudinal Single-case Study of the Dynamic Evolution of the Rural Family Doctor Contracting Service Model

• 摘要：目的：探讨农村地区家庭医生签约服务模式的发展脉络与演进机制,为相关部门持续优化家庭医生签约服务政策提供参考。方法：基于理论抽样原则,选取列为国家基层卫生健康综合试验区之一的S省J市作为案例研究对象,通过现场访谈等方式搜集一手资料,并纳入二手资料,导入NVivo11软件对其进行程序化扎根编码。结果：基于三级编码,梳理出71个初始概念、24个副范畴以及9个主范畴,经选择性编码形成核心范畴,农村地区家庭医生签约服务历经乡村医生个体签约、团队签约以及县域医共体下的团队签约三个阶段,其演进条件依次经历了签约形式化、服务能力化、效能协同化,制度三要素适配行动依次呈现制度脱嵌下的差序执行、结构嵌入下的协同阻滞与系统耦合下的协同执行,基于此逐步实现家庭医生政策责任制度化奠基、能力结构化跃升与利益共同体深化。结论：农村地区家庭医生签约服务模式演进机制体现为政治情境、社会情境、政策情境条件下的动态性适配,基于制度三要素差异化进阶逐步实现责任、能力、利益三要素闭环。

  关键词： 家庭医生签约服务; 动态演进; 纵向案例研究; 扎根理论; 农村地区

   

  Abstract: Objective: To explore the development lineage and evolution mechanism of the family doctor contracting service model in rural areas, and to provide reference for the relevant departments to continuously optimize the family doctor contracting service policy. Methods: Based on the principle of theoretical sampling, City J of Province S, which is listed as one of the National Comprehensive Primary Health Care Pilot Zones, was selected as a case study, and primary data were collected through on-site interviews and secondary data were included, and imported into the NVivo11 software to programmatically grounded-code them. Results: Based on the three-level coding, 71 initial concepts, 24 sub-categories and 9 main categories are sorted out, and the core categories are formed by selective coding. The contracting service of family doctors in rural areas has gone through three stages, namely individual contracting by rural doctors, team contracting, and team contracting under the county medical community, and the conditions of its evolution have gone through the contracting formality, the service capability, and the synergism of effectiveness in turn, and the action of system adaptation of the three elements has shown poor execution under system disembedding, synergistic blockage under structural embedding, and synergistic execution under system coupling. The three elements of the system are adapted to the action in order of poor order of implementation under the system de-embedding, synergistic blockage under the structural embedding, and synergistic implementation under the system coupling, based on which the institutionalization of the policy responsibility of the family doctor is gradually realized, the ability to structurally jump up, and the community of interest is deepened. Conclusion: The mechanism for the evolution of the contracted service model of family doctors in rural areas is reflected in the dynamic adaptation of the conditions of the political, social, and policy contexts, and the gradual realization of the closed loop of responsibility, capacity, and benefits based on the differentiated progression of the three elements of the system.

  Key words: Family doctor contracting service；Dynamic evolution；Longitudinal case study；Grounded theory；Rural areas; ; ; ; 

  提交时间：2025-07-14

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-05-03	bmr.202507.00046V1	下载

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