Research On The Development Of An Evaluation Indicator System For Health Service Capacity Of Village Clinics In Western Areas Of China

Research PurposesThis research is to use qualitative and quantitative methods to develop ancomprehensive and scientific evaluation indicator system with high validity,reliability anddifferentiation for evaluating health service capacity of village clinics in western areas ofchina,which is suitable for the current development situation of health services of villageclinics in western areas and easy to carry out and spread,and thereby provide reference andbasis for strengthening scientific,standardized and normalized administration of healthservices of village clinics for health administrative departments and organizations.Research MethodsIn this study,literature review and analysis,personal interview,group discussion,fieldinvestigation and Delphi method were used to develop the indicator system,and fuzzymathematical method was used to calculate the weight of the indicators.Factor analysis,cluster analysis and ANOVA analysis were adopted to test the validity,reliability anddifferentiation of indicator system.Comprehensive Indicator Method,Weighted Topsismethod,Grey Relation Analysis Method and Projection Pursuit Method were applied toevaluate the service capacity of the village clinics. Research Contents(1) To establish the basic framework of the research by reviewing the relevant theoryand methods of the health evaluation as well as some of relevant researches.(2) To determine the basic health service items and contents of the village clinics byusing Delphi method and literature review.(3) To understand the current status of the village clinics in western areas of China,andto find the existing problems and bring forward the suggestions by carrying out the filedinvestigation.(4) To select the indicators by using experts discussion and Delphi method and tocalculate the weight of indicators by using fuzzy mathematical evaluation method(5) to evaluate the service capacity of the village clinics by using ComprehensiveIndicator Method,Weighted Topsis method,Grey Relation Analysis Method and ProjectionPursuit Method and to verify the stability of indicators and operability of the evaluationindicators system by calculating Kendall's coefficient of concordance.(6) to test the validity,reliability and differentiation of indicator system by selecting themethods of Factor analysis,cluster analysis and ANOVA analysis.(7) To develop the standard evaluation indicator system and form the operationalevaluation handbook.Research Results(1)An evaluation indicator system for health service capacity of village clinics in Chinais to be developed in four aspects of service conditions,public health services capability,basic medical services capability and non-medical services capability respectively,by meansof experts consultation,key informant interviews,etc.Meanwhile,each category ofindicator is to be classified into 3 classes according to its levels.(2)In class 1 evaluation indicators,3 class 2 indicators (equipment and facilities,humanresources,financial resources) and 9 class 3 indicators under class 2 indicators are included in service conditions;4 class 2 indicators (maternal and children health care,healtheducation,disease control,assistant work) and 22 class 3 indicators under class 2 indicatorsare included in public health services;3 class 2 indicators (diagnosis and treatment ofcommon diseases,emergency treatment,standard services) and 4 class 3 indicators (exampass rate of knowledge on diagnosis and treatment of common diseases andfrequently-occurring diseases,exam pass rate of knowledge on common acute diseases,rateof standard writing of prescriptions,the percentage of basic drugs to prescription drugs) areincluded in basic medical services;2 class 2 indicators (reactivity,the degree of satisfaction)and 2 class 3 indicators (reactivity of community residents,the degree of satisfaction ofcommunity residents and village committees) are included in non-medical servicescapability.(3)The weighting of each class of indicators is determined by experts consultation andFuzzy comprehensive judgment method.The weighting of class 1 indicators is 0.2433,0.4008,0.2617 and 0.0942 respectively.The weighting of class 2 indicators is0.100417,0.095000,0.047917,0.054615,0.145769,0.077308,0.081667,0.046667,0.116667,0.060833,0.084167,0.046667 and 0.047500 respectively.(4)Factor analysis to each two classes of evaluation indicators is made to test thestructural validity of the indicator system.The factor analysis of the second class indicatorsof Service Conditions showed that totally three common factors were extracted,theaccumulative variance reached 76.355%.The common factor 1 (F1) is mainly influenced byvariable"Number of village doctors per 1,000 population","Rate of holders of PracticingCertificate for Village Doctors","Rate of village doctors participated in trainings within twoyears"and"Exam pass rate of village doctors"and it could be named as Human Resources;F2 is mainly influenced by variable"Area of buildings for business","Arrangement ofbuildings for business","Rate of basic equipment equipped"and"Quantity and category ofdrugs"and it could be named as Equipment and Facilities;F3 influenced by variable"Amount of funds invested in village clinics by higher authorities"and it could be named as Financial Resources.The results of factor analysis are accordant with the expected resultsand it shows the indicator system has good validity.(5)The internal reliability of indicators is reflected by calculation of Cronbach'scoefficient a.The standard value of Cronbach's coefficient a for class 2 indicators is 0.8193;the standard value of Cronbach's coefficient a for class 3 indicators is 0.9179.The values ofa for class 2 and class 3 indicators are all larger than 0.7,indicating higher reliability ofindicators.(6)According to the cluster analysis,it is appropriate to divide the 8 evaluated districtsinto 3 groups,and the ANOVA analysis showed that the differences among the three groupsand between every two groups are statistical significant (P＜0.05) ,the differentiation of theindicators is good.(7)The results of evaluation showing relevant convergence of different evaluationmethods (coefficient of concordance w=0.5982,x2=16.7500,p=0.01) indicate that theseevaluation indicators can be used for health service capacity evaluation of village clinics andthe evaluation indicator system is relatively stable.Conclusions(1)The service items and contents of the village clinics should base on the preventivehealth service and carry out the basic medical health service for the rural residents to meettheir health service demands.(2)The evaluation indicator system has relatively reasonable structure as well asintegral and complete contents in evaluation.(3)The results are relatively reliable as evaluation indices are screened with Delphiexpert consultation method.(4)On the basis of judgment by experts,the weighting of indicators is calculated withFuzzy judgment method to ensure scientific,accurate and reasonable calculation results.(5)The indicator system has good validity,reliability and differentiation and it issuitable for evaluating the village clinics. (6)The results of different comprehensive evaluation methods shows the evaluationindicator system has good stability and operability,and also indicates that the evaluationindicator system developed can be used for evaluation of health service capacity of villageclinics.