Wang Gan, Luo Li
Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China.
School of Public Health, Fudan University, Shanghai, China.
Front Public Health. 2025 Apr 8;13:1565499. doi: 10.3389/fpubh.2025.1565499. eCollection 2025.
By studying the Technology-Organization-Environment Framework (TOE), this research explores the impact of various indicators in technology, organization, and environment on the performance of family doctor services during major public health emergencies. It aims to identify the driving paths to improve performance.
A stratified sampling of 34 community health service centers in Shanghai was conducted, using the comprehensive performance score of family doctors as the outcome variable. The Average Internet Medical Service Person-times and the Information Technology Expenditure per Thousand Population were considered as technology-related variables. The Fiscal Allocation per Thousand Population (/1,000), the Family Doctor Team Members per Thousand Population, and the Medical Social Workers and Volunteers per Thousand Population were identified as organization-related variables. The Proportion of Older Adult Population, Fiscal Allocation per Thousand Population, and the number of patient self-education organizations per thousand population were taken as environment-related variables. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was employed to conduct necessity analysis, truth table analysis, and configurational analysis of antecedent conditions, with robustness tests performed by adjusting consistency thresholds and case frequencies.
The study found that the performance of family doctor services was influenced by multiple factors, with no single decisive factor. In overall communities, five configurations, including per capita fiscal allocation and community participation, affected performance, explaining 4.2% of the variance. In central urban areas, information technology expenditure and the Proportion of Older Adult Population were core conditions, influencing 27.5% of performance paths. In non-central urban areas, core conditions such as financial support and IT covered 53.9% of data cases. The fsQCA results, which were robustly tested, begin to provide a strong basis for resource allocation and policy formulation.
This study begins to fill the gap in research on family doctor service performance during major public health emergencies, exploring the synergistic effects and causal asymmetry among multiple indicators such as technology, organization, and environment from a holistic, or configurational, perspective.
本研究通过对技术 - 组织 - 环境框架（TOE）的研究，探讨技术、组织和环境中的各项指标对重大突发公共卫生事件期间家庭医生服务绩效的影响。旨在识别提升绩效的驱动路径。
对上海34家社区卫生服务中心进行分层抽样，以家庭医生综合绩效得分作为结果变量。将互联网医疗服务人均人次和每千人口信息技术支出作为技术相关变量。将每千人口财政拨款（/1000）、每千人口家庭医生团队成员数以及每千人口医务社工和志愿者数确定为组织相关变量。将老年人口比例、每千人口财政拨款以及每千人口患者自我教育组织数量作为环境相关变量。采用模糊集定性比较分析（fsQCA）对前因条件进行必要性分析、真值表分析和组态分析，并通过调整一致性阈值和案例频率进行稳健性检验。
研究发现，家庭医生服务绩效受多种因素影响，不存在单一决定性因素。在整体社区中，包括人均财政拨款和社区参与等五种组态影响绩效，解释了4.2%的方差。在中心城区，信息技术支出和老年人口比例是核心条件，影响了27.5%的绩效路径。在非中心城区，财政支持和信息技术等核心条件覆盖了53.9%的数据案例。经过稳健性检验的fsQCA结果开始为资源配置和政策制定提供有力依据。
本研究开始填补重大突发公共卫生事件期间家庭医生服务绩效研究的空白，从整体或组态的角度探索技术、组织和环境等多个指标之间的协同效应和因果不对称性。
