| BackgroundCommunity Health Service has been widely developed in China, and the investment from government is also increasing. But the effect of community health service is poor, the health of residents has not been effectively guaranteed, and it is difficult to reflect the effect of the government investing to the community service institution. The concern and importance of medical health reform in our country are to perfect norm, manage, evaluate the community health services, and to improve the quality of the community health services.The Chinese government and scholars have realized that the community health service quality is lack of effective supervision and assessment, making community health service in a current developmental bottleneck, which is important factor on the health and sustained development, so a community health service performance appraisal system is proposed to be established. Meanwhile, some regions have started to take chronic diseases as point of cut-in to carry out exploratory practice. However, there is a lack of relevant research reports on the specific indicators of management, performance appraisal indicator, performance scores and so on. Therefore, the related study on performance appraisal system, the establishment of the system and its effective implementation becomes urgent and important.Because the community health service covers a wide field and involves complex work, the whole study is relatively difficult. The community management of hypertension,diabetic and coronary heart disease were chosen as the best concerning point in the study. Through research and analysis on its work, management indicators, the expectation indicators and the actuality of control rate, performance indicators and assessment percentile ratio, we explored management and appraisal system for prevention and treatment of major diseases in community, and signified function on other chronic diseases, but also lay the foundation for community health service overall assessment study, fully reflecting the effect of the government purchasing public health service. Of course, it is on the agenda to build a harmonious society in China.ObjectiveThe management indicators, performance appraisal indicators and scores matching were analyzed and established through investigation of community workers and health administrator, which provided a theoretical basis for building appraisal system of hypertension,diabetic and coronary heart disease control in the community, and promoted work implementation and development of major chronic diseases prevention and treatment in the community. At the same time, the performance appraisal system was extended to other chronic diseases and the whole community health service based on this example, and solving the important problems of development and reform for community health services.Methods1. Literature review methodThe related literatures were searched, particularly those with more mature practice, experience and effects in community health service management, in order to learn the current status of hypertension,diabetic and coronary heart disease control and the present issues of chronic disease management in the community.2. Questionnaire designingThe questionnaire was designed by ourselves according to the practical experience of the local health workers, community health services staff, particularly chronic disease management experts, and the content and requirements of hypertension prevention and cure.3. Sampling methodsA stratified cluster sampling method was adopted in this study, the 2 regions was extracted from 11 regions in Zhejiang province and the medical staff and some administrators were surveyed in the community health services center. 4. Field surveyThe object was main to investigate the related information of performance appraisal and prevention,treatment of major chronic diseases in the community, the main contents included: community management projects and their work proportion, expected control objectives, the actual control rates and expected performance appraisal indicators and percentile ratio.Results1 Major prevention and treatment diseases in community99.6% (257) of the respondents thought that the hypertension and diabetic should be included in community disease control, which ranked first among 21 diseases; 65.5% of the respondents chosen coronary heart disease; 38.8% person chosen malignant tumor; 38.4% chosen chronic obstructive pulmonary disease.2 The management indicator of major prevention and treatment disease in community1. There were no significant statistical differences in the management indicator among categories of personnel, different organizations and regions, except that the indicator of blood pressure measurement rate for patient over 35 years old in the first consultation,construction document rate,treatment rate and follow-up rate had significant statistical differences among different regions. The chosen indicator rate: blood pressure measurement rate for patient over 35 years old in the first consultation (89.9%), the follow-up rate (70.9%), construction document rate (58.1%), the registration rate (59.7%) and awareness rate of hypertension (58.5%), detection rate (58.1%), treatment rate (68.6%), health education rate (66.3%), control rate (58.9%), knowledge rate (58.1%).2. There were no significant statistical differences in the management indicator among categories of personnel, different organizations and regions, except that the indicator of awareness rate of diabetic and health education had significant statistical differences among categories of personnel. The chosen indicators rates were as follow: construction document rate (90.5%), detection rate (83.2%), treatment rate (78.4%), the follow-up rate (77.6%), health education rate (75.9%), the registration rate (73.7%), knowledge rate (72.8%) and awareness rate of diabetic (70.3%), control rate (70.3%),3. There were no significant statistical differences in the management indicator among categories of personnel, different organizations and regions, expect that the indicator of registration rate and awareness rate of coronary heart disease had significant statistical difference among categories of personnel. The chosen indicators rates were: construction document rate (84.2%), the follow-up rate (82.0%), health education rate (78.4%), detection rate (75.2%), treatment rate (75.2%), control rate (71.6%), knowledge rate (68.0%), the registration rate (66.7%) and awareness rate of coronary heart disease (64.0%).3 The actual and expected control rate of management indicator1. The actual control level of hypertension management indicators in the community respectively were: blood pressure measurement rate for patient over 35 years old in the first consultation 74.90%, detection rate 39.20%, the registration rate 80.40%, construction document rate 78.66%, treatment rate of hypertension 73.44%, knowledge rate 69.27%, awareness rate of hypertension 74.03%, control rate 53.75%, the follow-up rate 73.71%, health education rate 71.92%. The actual control level failed to meet the expectation control level with significant differences.2. The actual control level of diabetic management indicators in the community respectively were: detection rate 67.87%, the registration rate 70.32%, construction document rate 69.92%, treatment rate 71.88%, knowledge rate 68.85%, awareness rate of diabetic 70.55%, control rate 67.20%, the follow-up rate 70.28%, health education rate 70.89%. The actual control level failed to meet the expectation control level with significant difference.3. The actual control level of coronary heart disease management indicators in the community respectively were: detection rate 67.06%, the registration rate 70.70%, construction document rate 66.06%, treatment rate 71.17%, knowledge rate 70.25%, awareness rate of coronary heart disease 70.11%, control rate 61.61%, the follow-up rate 64.70%, health education rate 66.12%. The actual control level failed to meet the expectation control level with significant difference.4 The contents of work in preventing and treating major chronic diseases incommunityThe measurements of blood pressure , registration files, health education and follow-up took most of workload for hypertension control. The measurements of blood glucose, treatment, registration files, health education and follow-up took most of workload for diabetic control. The measurements of blood pressure,blood glucose and blood lipid, registration Files, health education and follow-up took most of workload for coronary heart disease control.The referral took the least workload of the three diseases control in community.5 The performance appraisal indicator of major prevention and treatment on chronic diseases1. The performance appraisal indicator proportion of hypertension from high to lowlevels were: registration files (82.9%), follow-up (77.1%), health education (73.3%),the measurement of hypertension (72.1%), periodic health examination (69.4%), treatment (63.6%) and referral (42.6%).2. The performance appraisal indicator proportion of diabetic from high to low levelswere: registration files (88.0%), health education (82.8%), follow-up (81.9%), treatment (77.2%), the measurement of blood glucose (72.0%), periodic health examination (72.0%), and referral (50.0%) .3. The performance appraisal indicator proportion of coronary heart disease from highto low levels were: health education (84.5%),registration files (83.6%), follow-up (83.6%), the measurement of hypertension,blood glucose and blood lipid(82.8%), periodic health examination (75.3%), treatment (71.6%) and referral (53.4%).6 The percentile ratio of performance appraisal indicator1. The percentile ratio results of hypertension's performance appraisal indicator were: the measurement of hypertension 21.87, registered files 18.52, health education 16.68, treatment 16.68, follow-up 17.49, referral 8.44, periodical health examination 16.09. There were no obvious differences of performance appraisal scores ratio between regions. Scores of the measurement of blood pressure, registration files and health education in the community institution were higher than those in other institution respectively, There were no great differences in the given scores of measuring blood pressure, registered files, health education, treatment and periodic health examination among categories of personnel, while those of referral and follow-up were different, of which, the given scores of the various indicator in general population was relatively higher.2. The percentile ratio results of diabetic's performance appraisal indicator were: the measurement of blood glucose 17.16, registered files 16.48, health education 14.66, treatment 19.55, follow-up 16.59, referral 8.30, periodical health examination 10.92. There were no obvious differences in performance appraisal scores ratio among different regions and categories of personnel, except scores of registration files and health education among categories of personnel.3. The percentile ratio results of coronary heart disease's performance appraisal indicator were: the measurement of hypertension,blood glucose and blood lipid 16.90, registered files 15.80, health education 14.10, treatment 21.00, follow-up 16.60, referral 6.90, periodical health examination 10.50. There were no significant differences in performance appraisal scores among regions. The given scores of measuring blood pressure,blood glucose and blood lipid, treatment and follow-up didn't have great differences among categories of personnel, while those of registration files,health education, referral and periodical health examination were significantly different.Conclusions1 Major diseases for prevention and treatmentThe major diseased for prevention and treatment in community were: hypertension, diabetic, coronary heart disease, malignant tumor and chronic obstructive pulmonary disease. 2 The management indicator1 .Most of study subjects among different regions, different personnel categories and institutions thought that 10 community-based management items of hypertension should be classified as management indicators. Of them, Ex-5 indicators were blood measurement rate for patients over 35 ages in the first consultation, construction document rate, the follow-up rate, treatment rate and health education rate of hypertension. And there were some differences between the actual control level and the expectation control level for all indicators at present.2. Most of study subjects among different regions, different personnel categories and institutions thought that 9 community-based management items of diabetic should be classified as management indicators. Of them, Ex-5 indicators were construction document rate, detection rate, treatment rate, follow-up rate and health education rate. And there were some differences between the actual and the expectation control level for all indicators presently.3. Most of study subjects among different regions, different personnel categories and institutions thought that 9 community-based management items of coronary heart disease should be classified as management indicators. Of them, establishing file rate, follow-up rate, health education, treatment rate and detection rate. And presently there were some differences between the actual and the expectation control level of all indicators.Generally speaking, there was some consistency in selecting managerial indicator among three diseases, and establishing file rate,follow-up,treatment rate and health education rate all had obtained great acceptability.3 The performance appraisal indicator1. The hypertension prevention and management performance appraisal indicator in the community were: registration files, follow-up, health education, measurement of blood pressure, periodical physical examination, treatment and referral, and the former five indicatores were basically accorded with the chosen management indicator.2. The diabetic prevention and management performance appraisal indicator in the community were: Registration Files, health education, follow-up, treatment, measurement of blood glucose, periodical physical examinationand referral, and the former five indicatores were basically accorded with the chosen management indicator.3. The coronary heart disease prevention and management performance appraisal indicator in the community were: health education, Registration Files, follow-up, measurement of blood pressure,blood glucose and blood lipid, periodical physical examination, treatment and referral, and the former five indicatores were basically accorded with the chosen management indicator.4 The percentile ratio of performance appraisalThe highest performance appraisal proportion of hypertension scores was measuring blood presure, and that of diabetic and coronary both were treatment, while the lowest proportion was referral. The percentile ratio of performance appraisal and workload were positive correlated.
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