对2019年~ 2022年间渝中区全科医疗质控工作的资料进行整理、回顾和分析，以期为优化我区的全科质控、提升社区卫生全科医疗能力、为我区基层全科医学的发展提供指引。

2019年渝中区卫生健康委成立渝中区全科医疗质量控制中心（简称"全科质控中心"），将"全科质控中心"挂靠在基层社区卫生机构（渝中区上清寺街道社区卫生服务中心），牵头成立渝中区全科医疗质量控制专委会，设置组织架构，配置相关人员，建立全科医疗质量控制管理网格体系，以"组织架构-质控过程-质控结果-持续改进"为全科质控模型，在2019年~ 2022年间分别制定《渝中区社区卫生服务中心全科医疗质量控制考核细则》三个阶段性的质控指标体系，"由面及点"每年对11个社区卫生服务中心递进式开展全科医疗质控工作等。

渝中区从无到有地建立了全科医疗质控体系，工作从面上"大范围"质控进阶到门诊日志"小靶点"；工作进程分三个阶段，第一阶段（2019年）质控自查阶段，自查平均分82.5分，<80分占比27.27%；第二阶段（2020年）质控基础阶段，以核心制度建立执行为主，11家中心均>80分，合格率均为100%；第三阶段（2022年和2021年）质控靶点阶段，门诊日志合格率平均为80.45%，同比提升18%（150/177），合格率≥80%[占72.72%（8家）]，同比提升14.3%（7/8），其中4家中心门诊日志合格率为100%[占36.4%（4/11）]；合格率≤80%[占27.3%（3家）]。主诉和现病赋分考核平均分22.13分处于C等次，A等次占18.19%（2/11），偏少；B等次占36.37%（4/11），C等次占比18.18%（2/11）；D等次占比27.27%（3/11）中2/3属于民营资本运营。可见，进阶式全科医疗质控促进了全科医疗整体能力提升，风险意识逐步提高；但部分机构重视度仍不够，门诊日志书写存在薄弱环节，全科医生的依法执业律法意识和安全意识较差，存在较大的医疗风险和安全隐患，民营机构和公立机构存在较大差距。全科医疗门诊日志赋分考核差异性分析结果显示，现病史得分差异有统计学意义（P<0.05）。

渝中区社区卫生递进式的全科医疗质控工作初显成效，走在了重庆市基层卫生前列，全科医疗质控中形成了"整合式"质控体系、"痛点式"质控管理、"交叉式"质控督导、"驻点式"质控培训的全科质控特色，提升渝中区社区卫生全科医疗的协同力、品牌力、影响力、竞争力，对渝中区社区卫生全科医疗质量水平、全科医疗诊疗能力提升、全科诊疗规范性提供有力的支撑，有较好的借鉴意义。

This study collated, reviewed, and analyzed the data of general medical practice quality control in Yuzhong District from 2019 to 2022, with a view to optimizing the district’s quality control of general practice, improving the community healthcare capabilities in general medicine, and providing guidance for the development of grassroots general practice in the region.

In 2019, the Yuzhong District Health Committee established the Yuzhong District General Medical Quality Control Center (hereinafter referred to as "General Medical Quality Control Center" ). The "General Medical Quality Control Center" was affiliated to a primary community health institution (the Yuzhong District Shangqingsi Street Community Health Service Center) and took the lead in establishing the Yuzhong District General Medical Quality Control Committee, setting up the organizational structure, assigning the relevant personnel, and establishing a general medical quality control management grid system. Adopting a general medical quality control model of "organization structure-quality control process-quality control results-continuous improvement" , the center developed the three-stage quality control index system of "General Medical quality Control Assessment Rules of Yuzhong District Community Health Service Center" from 2019 to 2022. Progressing "from macro-level to micro-level" , it conducted gradual, progressive general practice quality control work annually across all 11 community health service centers.

Yuzhong District established a general medical quality control system from the ground up, transitioning from "broad-based" quality control to targeted assessments of outpatient medical records. The The initiative was implemented in three stages. The first stage (2019) was the quality control self-inspection stage, with an average score of 82.5,with 27.27% (3/11) of centers scoring <80. The second stage (2020) is the basic stage of quality control, focusing on the establishment and implementation of the core system, with 11 centers scoring more than 80 points and a pass rate being 100%. In the third stage (2022 and 2021) quality control target stage, the average pass rate of outpatient medical records was 80.45%, marking an increase of 18% (150/177), and 72.72% (8/11) of centers achieved a ≥ 80% pass rate, reflecting a 14.3% increase (7/8). The qualified rate of outpatientmedical records in 4 centers was 100% [36.4% (4/11)], while the qualified rate remained ≤80% in 3 centers (27.3%). The average score of main complaint and current disease assessment was 22.13 points (grade C), with grade A accounting for 18.19% (2/11), grade B 36.37% (4/11), grade C 18.18% (2/11), and grade D 27.27% (3/11), two-thirds of which were privately operated institutions. It can be seen that the advanced quality control of general practice promoted the improvement of the overall ability of general practice and the gradual improvement of risk awareness. However, persistent challenges included inconsistent focus among some institutions; weaknesses in outpatient documentation; insufficient legal and safety awareness among general practitioners, leading to higher medical risks and security vulnerabilities; and significant performance gaps between private and public institutions. Statistical analysis of the score assessment of general medical outpatient medical records showed that there was a statistical difference in HZ score (P<0.05).

The progressive quality control system for general practice in Yuzhong District’s community health centers has yielded preliminary successes, positioning the district as a leader in primary healthcare in Chongqing. The general practice quality control initiative has developed distinctive features, including: an "integrated" quality control system, "pain point-targeted" quality control management, "cross-type" quality control supervision, and "on-site resident" quality control training. These efforts have strengthened the synergy, branding, influence, and competitiveness of community-based general practice services in Yuzhong District. Moreover, they provide robust support for enhancing the quality of community general practice care, improving general practice clinical capabilities, and standardizing general diagnosis and treatment practices. This model holds significant reference value for primary healthcare quality improvement initiatives.