中文摘要：

目的构建社区卫生服务质量提升工程制约因素的多级递阶结构模型,识别各制约因素间的逻辑关联及传导环路,为提升我国社区卫生服务质量提供合理化建议。方法采用文献研究法和专家核检法,总结归纳出当前社区卫生服务质量提升工程的17类制约因素。采用解释结构模型法,分析因素间的层级关系及传导环路,并得到直观的层次结构图示。结果我国社区卫生服务质量提升工程的17类制约因素存在＂四阶梯结构＂和＂两条传导路径＂。结局因素为＂医生服务品质＂和＂服务供给平台＂,最深层的内驱要素是＂社区领导力＂和＂政府职能建设＂,二者通过＂自我成长＂与＂外部规制＂两条传导环路,共同影响社区卫生服务质量的整体提升。结论社区卫生服务质量提升工程依赖于＂自我成长＂与＂外部规制＂两轨制的建设路径,并以＂社区领导力＂和＂政府职能建设＂为双核驱动的始发原点,通过健全信息网络、夯实全科医学教育、关注医生保障制度、充盈社区基本资源配置的四大战略,发挥＂个体-组织＂契合协同联动作用,最终实现＂品质服务-优质平台＂的双向产出。

英文摘要：

Objective To build a multi-level structure model of restraining factors for quality improvement project of community health services and identify the role relationship and conductive loops between all factors.Additionally,some relevant coping strategies have been provided,too.Methods Based on the literature research and expert nuclear inspection method,17 categories of factors restraining the quality improvement project of community health services were collected.Ultimately,a visual hierarchical structure chart was developed based on the analysis of the hierarchy relationship between various restraining factors and the conductive loops by using the interpretive structural modeling method.Results A 4-step structure and two conductive pathways are presented in the chart of 17 categories of factors restraining the quality improvement project of community health services in China.The directly ending factors of quality improvement project of community health services are ＂ service quality＂ and ＂ service supply platform＂.The internal core drivers are ＂ community leadership＂ and ＂ government functions＂,which potentially exert an influence on the quality improvement project of community health services mainly through two pathways：internal self-growth and external regulation.Conclusion The development of quality improvement project of community health services relies on ＂ self-growth ＂,and ＂ external regulation ＂,these two construction pathways.And ＂ community leadership＂,and ＂ government functions ＂,are regarded as the dual drive starting point.By four strategies,perfecting information network,strengthening the general practice education,focusing on the system of safeguarding the rights and interests of doctors,sufficing the basically needed community health resources,to develop the effect of double conjunction of individual-organization for collaborative linkage,to realize the bidirectional output of ＂ quality service-high quality platform＂,so as to promote the quality improvement p