研究目的：

本研究以区或县为研究对象，主要利用文献研究法来明确居家社区医养结合服务能力基本内涵，结合德尔菲法构建居家社区医养结合服务能力评价指标体系框架、确定具体评价指标，并通过专家咨询对所构建的能力评价指标体系进行权重的确定和效度的检验，为“十四五”时期进一步评价和提升居家社区医养结合服务能力、推进居家社区医养结合服务体系建设提供决策支持。

研究内容：

一是明确居家社区医养结合服务能力的基本内涵；二是构建居家社区医养结合服务能力评价指标体系框架；三是确定居家社区医养结合服务能力具体评价指标；四是确定居家社区医养结合服务能力评价指标权重；五是进行居家社区医养结合服务能力评价指标的效度检验。

研究方法：

本研究主要利用文献研究法来明确居家社区医养结合服务能力基本内涵，结合德尔菲法构建居家社区医养结合服务能力评价指标体系框架、确定具体评价指标，并通过专家咨询对所构建的能力评价指标体系进行权重的确定和效度检验。

研究结果：

明确了居家社区医养结合服务能力的基本内涵：以区或县为单位，辖区内与居家社区医养结合服务提供相关的主体，通过整合资源、规范管理秩序、优化服务流程等多种手段，为居家社区养老老年人提供有效医养服务的能力。具体而言，居家社区医养结合服务能力包括医疗卫生服务能力、养老服务能力和医养结合服务保障能力三个主要的方面，医养结合服务保障能力包括领导治理、人才能力、资金能力、设施设备能力、信息化能力等。

构建了居家社区医养结合服务能力评价指标体系：包括投入、过程和结果3个一级指标；组织管理、人力资源投入、资金投入、机构建设、信息化，医疗和护理服务、基本公共卫生服务和养老服务，可及性、质量和满意度11个二级指标和36个三级指标。

确定了居家社区医养结合服务能力评价指标权重：3个一级指标中，权重由大到小依次为过程、投入、结果指标；11个二级指标中，组合权重居前五位的指标依次是医疗和护理服务、养老服务、质量、可及性、基本公共卫生服务；36个三级指标中，组合权重居前五位的指标依次是服务可及性、管理人群血压控制率、管理人群血糖控制率、药物可及性、照护服务。

进行了居家社区医养结合服务能力评价指标的效度检验：内容效度：98%指标的值均在0.78及以上，98%指标的值均在0.74以上，表明整体上评价指标的内容效度较好；值为1，表明平均水平的内容效度较优。

研究结论：

本研究基于系统论、健康老龄化理念和能力评价理论来构建指标体系框架，从投入、过程和结果三个方面对居家社区医养结合服务能力进行全过程的评价，在具体指标选取上遵循全面性、代表性、可行性等原则，采用可靠性、专业性强的德尔菲法进行指标筛选和权重确定，并利用专家咨询情况进行指标的效度检验，通过定性和定量研究方法联合使用，最终得到一套合理、实用的居家社区医养结合服务能力评价指标体系。

建议：

注重动态调整居家社区医养结合服务能力评价指标体系；注重提升居家社区医疗和护理服务能力及服务可及性；注重加强居家社区医养结合服务能力评价和监督。

Objective:

This study takes the district or county as the research object, mainly uses the literature research method to clarify the basic connotation of the ability of combining medical care and elderly care services in home communities, constructs the evaluation index system framework of combining medical care and elderly care service capacity in home communities in combination with Delphi method, determines the specific evaluation indicators, and determines the weight and validity of the constructed capacity evaluation index system through expert consultation, so as to provide decision-making support for further evaluating and improving the capacity of combining medical care and elderly care services in home communities and promoting the construction of combining medical care and elderly care service systems in home communities during the 14th Five-Year Plan period.

Contents:

First, clarify the basic connotation of the ability of combining medical care and elderly care services in home-based communities; The second is to build an index system framework for the evaluation of the ability of combining medical care and elderly care services in home-based communities; The third is to determine the specific evaluation indicators of the ability of combining medical care and elderly care services in home-based communities; The fourth is to determine the weight of the evaluation index of the ability of combining medical care and elderly care services in the home community; The fifth is to test the validity of the evaluation index of the ability of combining medical care and elderly care services in the home community.

Methods:

This study mainly uses the literature research method to clarify the basic connotation of the ability of combining medical care and elderly care services in the home community, combines the Delphi method to construct the evaluation index system framework of the combining medical care and elderly care service capacity of the home community, determines the specific evaluation indicators, and determines the weight and validity of the constructed capacity evaluation index system through expert consultation.

Results:

Clarify the basic connotation of the ability of combining medical care and elderly care services in home communities: with the district or county as the unit, the entities related to the provision of combining medical care and elderly care services in the home community within the jurisdiction provide effective medical care and elderly care services for the elderly in the home community through integrating resources, standardizing management order, optimizing service processes and other means. Specifically, the combining medical care and elderly care service capacity of the home community includes three main aspects: medical and health service capacity, elderly care service capacity and medical and nursing service guarantee ability, and the integrated medical and nursing care service guarantee capacity includes leadership governance, talent ability, financial ability, facility and equipment capacity, and information ability.

Construct an evaluation index system for the ability of combining medical care and elderly care services in home-based communities: including three first-level indicators of input, process and outcome; Organization management, human resource investment, capital investment, institutional construction, informatization, medical and nursing services, basic public health services and elderly care services, accessibility, quality and satisfaction 11 secondary indicators and 36 third-level indicators.

The weights of evaluation indicators of combining medical care and elderly care service capacity in home-based communities were determined: among the three first-level indicators, the weights were process, input and outcome indicators in descending order; Among the 11 secondary indicators, the top five indicators with the highest combined weight are medical and nursing services, elderly care services, quality, accessibility, and basic public health services. Among the 36 tertiary indicators, the top five indicators with the highest combined weight were service accessibility, blood pressure control rate in the management population, blood glucose control rate in the managed population, drug accessibility, and care services

The validity test of the evaluation index of the ability of home community medical and nursing care service was carried out: the content validity: the I-CVI value of 98% of the indicators was 0.78 and above, and the Kappa value of 98% of the indicators was above 0.74, indicating that the content validity of the evaluation index was good overall; the S-CVI value was 1, indicating that the average content validity was better.

Conclusion:

This study builds the framework of the index system based on the system theory, healthy aging concept and ability evaluation theory, evaluates the whole process of the ability of combining medical care and elderly care services in the home community from the three aspects of input, process and results, follows the principles of comprehensiveness, representativeness and feasibility in the selection of specific indicators, adopts the Delphi method with strong reliability and professionalism for index screening and weight determination, and uses expert consultation to test the validity of indicators. Through the combined use of qualitative and quantitative research methods, a reasonable and practical evaluation index system of combining medical care and elderly care services in home communities was finally obtained.

Recommendations:

Pay attention to the dynamic adjustment of the evaluation index system of combining medical care and elderly care services in home communities; Focus on improving the capacity and accessibility of medical and nursing services in home-based communities; Pay attention to strengthening the evaluation and supervision of the ability of combining medical care and elderly care services in home communities.