目的：

了解我国预防接种门诊的服务能力现状，发现预防接种门诊服务工作中存在的问题和不足。并通过初步建立一套适用于评价预防接种服务能力的指标体系，评价预防接种门诊的服务能力情况，为卫生健康主管部门对预防接种门诊的服务能力评价以及为预防接种门诊改善服务质量、提高服务能力提供参考依据。

方法：

本研究主要基于问卷调查的数据，通过对数据的描述性分析和对比分析，了解36个预防接种门诊的门诊服务能力现状；并基于政策文件要求、国内外文献研究内容、专家咨询的建议初步确定评价指标体系，而后运用熵权法计算各指标权重、应用TOPSIS法和RSR秩和比法对36个预防接种门诊的服务能力进行综合评价。

结果：

1. 36个预防接种门诊的服务能力现状：服务半径及服务周期等可及性方面有待更进一步提高，东部地区门诊面积、冰箱容积等基础设施建设配置相对不足，预约取号、接种通知等便利性服务设施配备率不高。门诊量较大的地区门诊配比较低，人员构成相对单一，工作人员总体满意度不高，存在有流失风险。工作人员的薪酬待遇及对执业环境的感知影响工作人员的满意度，有待进一步改善。免疫规划疫苗接种率普遍较高（总体接种率均超过95%），但接种及时率存在地区差异，东部省份和城市地区的接种及时率较高。儿童家长对预防接种服务的满意度总体较高，但在服务可及性上略低，接种通知服务、服务等待时间、健教宣传活动等影响服务体验和满意度。

2. 评价指标体系及权重：本研究从门诊建设与投入、预防接种规范化管理、服务产出与效果3个维度确定预防接种门诊服务能力的指标评价体系，共有3个一级指标13个二级指标。熵权结果显示，权重较高的指标基本都是冰箱总容积、接种台个数、门诊面积等结构性指标，权重较低的多为工作人员满意度、DTP3及时接种率和规范化操作达标率等过程和结果指标。

3. 综合服务能力评价：经TOPSIS法对36个门诊服务能力进行综合评价，评价结果显示，服务能力最好的为GD5，最差为LN2，城乡之间的总体排名差距较小；RSR法分档后发现，服务能力位于好、中、差的门诊数量分别为10个、12个、14个，服务能力好的门诊比例为27.78%，提示我国基层预防接种门诊的服务能力整体不高，仍有较大上升空间。

建议：

1.完善预防接种门诊服务能力评价体系，加强预防接种服务工作指导

2.增强预防接种门诊建设，优化预防接种服务流程

3.加强基层门诊人员队伍建设，提高薪酬待遇，完善激励机制

4.进一步保障预防接种服务产出和效果，规范预防接种服务工作

5.推动地区间门诊的预防接种服务经验交流

Objective：

Find out the current status of the service capacity of our vaccination clinics and identify the problems and deficiencies in the work of vaccination clinics. And by initially establishing a set of indicators system applicable to the evaluation of vaccination service capacity, the service capacity of vaccination clinics will be evaluated, providing a reference basis for the evaluation of service capacity of vaccination clinics by health and health authorities as well as for improving service quality and service capacity of vaccination clinics.

Methods：

Based mainly on questionnaire data, this study was conducted to understand the current status of clinic service capacity of 36 vaccination clinics through descriptive analysis and quantitative comparative analysis of the data. The evaluation index system was initially constructed based on the requirements of policy documents, research content of domestic and foreign literature and expert consultation recommendations, and the entropy weighting method was applied to calculate the weights of each index, and the TOPSIS method and  Rank sum ratio (RSR) method were applied to comprehensively evaluate the service capacity of 36 vaccination clinics.

Results：

1.Current situation of service capacity of 36 vaccination clinics: The accessibility of services in terms of radius and service cycle needs to be further improved, and the allocation of infrastructure construction such as outpatient area and refrigerator volume in the eastern region is relatively insufficient, the rate of convenient service facilities such as appointment pick-up and vaccination notification is not well equipped. Outpatient clinics in areas with higher volumes are less allocated, staff composition is relatively homogeneous, overall staff satisfaction is low and there is a risk of turnover. The staff's salary and perception of the practice environment affect the staff's satisfaction, and need further improvement. The immunization program vaccination rates are generally high (all above 95% overall), but there are regional differences in vaccination timeliness rates, with higher rates in the eastern provinces and urban areas. Parents of children were on the whole satisfied with the vaccination service, but slightly less satisfied with the accessibility of the service, with the vaccination notification service, waiting time for the service and health education and promotion activities affecting the service experience and satisfaction.

2. Evaluation index system and weight: This study constructs an index evaluation system of vaccination outpatient service capacity from 3 dimensions: Outpatient construction and investment, service quality and effect, standardized management of vaccination and the effect of immunization planning, with a total of 3 primary indicators and 13 secondary indicators. The entropy weighting results show that the indicators with higher weights are basically structural indicators such as total refrigerator volume, number of vaccination tables and clinic area, while the indicators with lower weights are mostly process and outcome indicators such as staff satisfaction, DTP3 timely vaccination rate and standardised practice compliance rate.

3. Comprehensive service capability evaluation:Through the comprehensive evaluation of outpatient service capability by TOPSIS method, the results show that the best service capability is GD5 and the worst is LN2, and the overall ranking gap between urban and rural areas is small. According to the RSR method, the number of outpatients with good, medium and poor service capacity is 10, 12 and 14 respectively, and the proportion of outpatients with good service capacity is 27.78%, suggesting that the service capacity of grass-roots vaccination outpatients in China still has great room for improvement.

Recommendations: 

1. Improving the evaluation system for the service capacity of vaccination clinics and strengthening the guidance of vaccination prevention services.

2. Enhance the construction of preventive vaccination clinics and optimize the flow of preventive vaccination services.

3. Building up the workforce of primary outpatient clinics, improving their remuneration and incentive mechanisms.

4. Further guarantee the output and effectiveness of preventive vaccination services and standardise the work of preventive vaccination services.

5. Promotion of an exchange of experiences in vaccination services among district clinics.