| Objective:At present,the Chinese government is putting forward and actively implementing the mode of combining medical care with old-age care from the perspective of resource integration.However,due to various reasons,the resource integration function advocated by the combination of medical care with old-age care cannot be well implemented in chongqing.Therefore,it is urgent to learn from advanced international concepts and practices for systematic exploration."Integrated care"is a new technology and organizational model designed to establish a close relationship between the funding,administrative and/or provider-level treatment and care sectors for better coordination and collaboration.Community pension is the most important way of providing for the elderly in China.The integration of resources at the community level has important practical significance.Taking the main city of Chongqing as an example,this study developed a set of“integrated care concept emphasizing evaluation index system”to evaluate the degree of integrated care concept of different old-age care modes in urban communities in Chongqing,and to analyze its influencing factors in depth.It is intended to provide reference for improving the quality and level of community resources integration,promoting the development of community pension in chongqing,deepening the understanding of the connotation of the combination of medical and nursing care in China and accelerating the implementation of the function of the combination of medical and nursing care mode in chongqing.Methods:The research is divided into three parts:1.To construct an integrated evaluation system for the degree of performance of care.Draft the first draft of the indicator system through literature review,policy research,group discussions,and expert group review.Using the Delphi method,23 experts from 2 rounds were asked to establish an indicator system.2.Design and preliminary verification of the corresponding questionnaire:Based on 63three-level indicators,the questionnaire will be formed after discussion and revision by the group.It is convenient to take 150 community health service centers to support the elderly for pre-experiment,and further test the reliability and validity of the questionnaire through extreme group method,factor analysis method,and test reliability.3.Empirical research:A questionnaire survey was conducted on 214 elderly patients and244 elderly people living in the community who met the inclusion criteria to understand the degree of integration of the care concept in the old-age care model of the community health service center in Chongqing and the community-based care system to analyze its influence factors,in order to further the early stage of the validation of this study is to construct the evaluation index system.Results:1.Consultation results of the integrated care performance evaluation index system(1)Twenty-three questionnaires were issued to the two rounds of experts,and the effective recovery rate was 100%.The authoritative coefficient of the expert's letter was 0.829and 0.846.The W value of the first round of experts'first,second and third grade indicators was respectively For the 0.336,0.240,and 0.195,the second round of experts asked for the first,second,and third grade W values of 0.344,0.320,and 0.245,respectively.Two rounds of experts asked for W-tests were statistically significant(P<0.001).(2)The first round of experts asked for the importance of the first-level indicator value4.48~5.00,the full score rate was 52.174%-100%;the second-level indicator importance assigned value 4.43~5.00 the full rate 47.826%~100%;the third-level indicator importance assignment 3.87~5.00,the full score is 21.739%~100%.The final version of the indicator system consisted of five primary indicators,17 secondary indicators,and 63 tertiary indicators.2.Correspondence to the reliability and validity test results of the questionnaire(1)Reliability analysis results:the total questionnaire Cronbach's?coefficient is 0.955,the Cronbach's?coefficient of each dimension is 0.773~0.901;the total questionnaire is divided into the partial reliability coefficient of 0.912,and the semi-reliability coefficient of each dimension is 0.709~0.878;The reliability(r)is 0.881,and the reliability of each dimension is 0.778~0.863.(2)Validity analysis results:The results of the factor analysis showed that the Kaiser-Meyer-Olkin measure of sampling adequacy value was 0.925 and the Bartlett spherical test reached a significant level(?~2=5366.590,df=861,P<0.01).By using a principal component analysis and varimax rotation,a total of five common factors,each with an eigenvalue>1,were extracted.They generated a cumulative contribution rate of 66.782%.The 42 items of the questionnaire have a load of>0.45 and no multiple loads.The load value of each item on the corresponding factor is 0.478~0.897.The correlation coefficient between the five dimensions is 0.454~0.833,and the correlation coefficient between each dimension and the total questionnaire is 0.735~0.923.3.Empirical research results(1)Comparison of the scores of elderly and community-based elderly care for the elderly in the community health service center:the scores of the total scores and scores of the two groups of the elderly were statistically significant(P<0.001),and the community health service center The scores in the total score,each dimension and all individual items are higher than the community home pension.(2)Single factor analysis results that affect the self-assessment score of the integrated care concept of the elderly:age,marital status,education level,self-rated health status,self-care degree,and household registration type There was a statistically significant difference in the self-evaluation scores of the degree of concept(P<0.05).Community home:age,marital status,monthly income,self-rated health status,self-care level,whether or not suffering from chronic diseases is the result of single factor analysis of the self-assessment score of the integrated care concept of the community at home.(3)Multi-factor analysis results of integrated care concept embodying degree evaluation scores:The integrated care concept of the two old-age care methods reflects the scores affected by the“self-evaluation health status”factors.The type of household registration,the degree of self-care,and the marital status will affect the degree of integration of the concept of care for the old-age care.Monthly income,whether or not suffering from chronic diseases will affect the score of the concept of integrated care for the community at home.Conclusion:(1)Through two rounds of Delphi expert's letter of inquiry,the“integrated care concept embodying degree evaluation index system”was constructed.The index system includes 5first-level indicators,17 second-level indicators and 63 third-level indicators.(2)The“Integrated Care Concept Reflection Degree Questionnaire”constructed by the corresponding index system has good reliability and validity.All indicators have reached the measurement standard,and the discrimination is good.It can better distinguish the different ways of supporting the old age.The difference can provide a reference for the self-assessment and long-term development of China's integrated care and retirement model.(3)Elderly Care Departments in the community health service centres's ability to integrate care and care for the elderly is better than the home-based care. |
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