| Research PurposesSince performance assessment of health service has been advocated by world health organization (WHO) in the year 2000, the ideas and methods have been highly paid more attention by the countries around the world. As one of branches of health system, community health service (CHS) has being developed rapidly, a scientific evaluation on this system will be helpful for us to find the problems and promote its further development.This study was aimed to use qualitative and quantitative methods to establish an indicator system with highly practicability, validity, reliability and differentiation for evaluating performance of CHS to improve the degree of management of CHS in terms of standardization and scientificity. In the meantime, the methods, manners and the models of synthetical evaluation were also explored in this study to provide some of basis in methodology for evaluation practice. This study has important practical significance in promoting sustainable development of CHS and providing theoretical and methodological basis for policy making.Research MethodsIn this study, literature searching, expert discussion and Delphi method were used to establish the indicator system, and fuzzy mathematical method was used to calculate the weight of the indicators. The synthetical evaluation methods of indicator, rapid assessment methods and indirect evaluation manners were also explored by utilizing field survey data. Factor analysis, Cronbach's alpha coefficient, cluster analysis and ANOVA analysis were employed to test the validity, reliability anddifferentiation of indicator system. Lastly, accumulative synthtical grading evaluation , Topsis method and Rank Sum Ratio (RSR) method were applied to evaluate the performance of CHS synthetically at more than 10 districts in Hubei province, meanwhile, four combination methods, namely average method, Borda method, Copeland method and fuzzy Borda method, were used to combine the results of the four synthetical evaluation, and the consistency and rationality were also explored.ContentsIn this study, the administration district in city was seen as evaluation object, and the performance was evaluated from the third side perspectives. The contents include: (1) reviewing system theory, performance and performance assessment theory, CHS theory and some of relevant researches and establishing the basic framework of indicator system; (2) by using experts discussion and Delphi method to filter the indicators and calculate the weight of indicators by using fuzzy mathematical evaluation method; (3) through Shenzhen field survey, applying and exploring some of methods for indicator evaluation like equity, satisfaction and responsiveness, those methods include Lorenz Curve, Gini coefficient, Topsis method and fuzzy synthetical evaluation and etc.;(4) through the field activities in Hubei province, Chongqing and Guizhou province, the methods of rapid evaluation and indirect evaluation manners such as LQAS, patient imitation and heading off; (5) validity, reliability and differentiation were tested by using mathematical statistical methods; (6) exploring the application of some of synthetical evaluation methods such as accumulative synthetical grading, Topsis and RSR in CHS performance assessment; (7) combining the results of four synthetical evaluation and discussing the consistency and rationality of the results of combination.Resultsthe results of this study are as follows: (1) having constructed a hierachical indicator system composed of three groups, namely supporting, service process and performance, including three first class indicators, 16 second ones and 56 third ones. The supporting group is composed of policy support, financial input, organization andnetwork construction and health personnel and etc. service process group is composed of six functions of CHS, namely medical service, prevention, health care, health education, rehabilitation and family planning; the performance group is composed of the indicators of efficiency, benefits, service utilization, health improving, equity, satisfaction and responsiveness and etc.; (2) having confirmed the weight of the indicators of three classes. The weight of three indicators of the first class are 0.3396737, 0.336193 and 0.32417 respectively; the weight of 16 second class indicators are 0.082637, 0.086619, 0.083327, 0.087053, 0.060558, 0.059508, 0.055785, 0.058028, 0.052899, 0.049415, 0.053786, 0.05649, 0.055146, 0.053182, 0.052968, 0.052597 respectively. (3) the factor analysis of the second class indicators showed that totally three common factors were extracted, the accumulative variance reached 78.556% and initial eigenvalues of these three common factors are bigger than 1. The common factor 1 (F1) is mainly influenced by variable 8,11,12,13,15 andl6 , it could be named as the achievement and effectiveness of CHS; F2 is mainly influenced by variable 5,6,7,9,10 and 14, named as service process and quality; F3 influenced by variable 1,2,3 and 4, and named as supporting and network construction. The results of factor analysis are accordant with the expected. On the whole, the indicator system has good validity. (4) Cronbach's alpha coefficient of the second class indicators is 0.919 ( F = 92.154, P = 0.0000) and the third class is 0.959 ( F = 31.238, P = 0.0000) , it was showed that the reliability of the indicators is very good. (5) according to the cluster analysis, it is appropriate to divide the 12 districts into 3 groups, and the ANOVA analysis showed that the differences among the three groups and between every two groups are statistical significant ( P<0.05 ) , the differentiation of the indicators is good. (6) it was found by analyzing the difference of the scores of the second class indicators among the three groups that policy supporting, financial input, organization and network construction, health personnel, community rehabilitation, family planning, benefits, satisfaction and responsiveness are the key factors influencing the performance of CHS in the 12 districts. (7) the results of field surveys showed that Lorenz Curve and Gini coefficient could be used to evaluate the equity of resource allocation, and it is reliable to use Topsis method and fuzzymathematical method to evaluate the satisfaction and responsiveness; (8) some of qualitative and quantitative methods (LQAS) could be used for the rapid evaluation of some indicators, it has the characters of rapidness and convenience;(9) the field activity of CHS evaluation on national level showed that the manners of indirect evaluation was important and effective for us to find the problems and acquire the details, direct and indrect manners can make up for each other to assure the truth of the information; (10) three evaluation models, namely accumulative synthetical grading method, Topsis method and RSR method had highly consistency, the Spearman rank correlation coefficients were 0.9371 and 0.8531 respectively. (11) it was found by combining evaluation results that the four combination results have highly consistency, the Kendall coefficient is W~a = 0.994 ( P = 0.000 ). Compared with the separate evaluation, the combination result is much reasonable.ConclusionsBased on the results of the research, the conclusions and recommendations could be put forward. (1) the scope covered by the indicator system is broad, and the whole system is valid and realiable; (2) the method for filtering indicators is reasonable; (3) the method of confirming the weight of indicators is scientific, and the result is relatively accurate; (4) the organic integration of quantitative and qualitative methods is the direction of indicator system research in the future; (5) the results from, different synthetical evaluation models are basically consistent, the combination evaluation of the results has reduced the error lowest and the combination results are realiable and reasonable; (6) the method chosen for evaluation is depended on the practical situation and conditions; (7) CHS performance is influenced by lots of factors, the stronger the ability of all aspects, especially the key factors, the better the performance; (8) based on the research results, the importance, maneuverability, sensitivity, validity and reliability of the indicators could be summarized.
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