Demands And Utilization Of Community Health Services On The Elderly In Changsha-Household Survey And Research On The Basic Data Set Of CHS

Part One Research on the Health Status and Demands and Utilization of the Elderly Residents in Changsha for Community Health ServicesObjectives: We carried out an investigate on population structure, health status and the needs and wishes of the demand for community health services to community residents of the elderly living in Changsha, analyzed the impact factors of utilization of community services and understood the accessibility of the community health services under the guidance of the 'minimum data set of community health service for older people in urban' project, one program of the national natural science foundation. To explore developmental direction and models on community health services which shift to the demand-oriented and to provide baseline data and policy basis for the elderly in Changsha. To provide field study data and statistical basis for establishing information and data sets of the urban elderly community health services.Methods: Subjects were selected by a multistage cluster sampling from five districts in Changsha city, Hunan Province in China. The baseline data of community-based was obtained by mean of a cross-section. (a) The health status and needs of community health services of the elderly in Changsha, including two-week prevalence, the prevalence of chronic disease, quality of life, health care; (b) Actual status of Utilization of community health services. (c) The wishes of demand of the elderly to community health services. The methods of descriptive analysis, comparative analysis, analysis of covariance and logistic regression analysis were used to process survey data.Results: We used indoor face-to-face interview and collected data of 630 elderly residents. The random sample came from 6 communities in Changsha city. There are 602 effective questionnaires and the efficiency rate was 95.6%. The sexual rate was 41.2% for male and 58.8% for female. The results indicated that the two-week prevalence was 52.0%, the two-week non- hospitalizing rate was 46.0%, and self- hospitalized rate of patients was 51.4%. There were 48.6% patients hadn't taken any medical measure because of economy. The prevalence of chronic disease was 56.3% in sick elderly residents, while 100.8% in case load. There were 54.9% elderly residents suffer from two or three chronic diseases. 70.9% elderly could gain shortest distance of tenement from the health service center in one kilometer around their living-site. 8.3% residents gained medical health care knowledge from consultation doctors. The Comprehensive utilization rate of elderly community health service was 40.4%, and 11.0% elderly residents were uncared-for. The result of analysis of covariance indicated that there was close relation between chronic disease and scores of all dimension of SF-36. The univariate analysis indicated the main causes of limited elderly community health service were incomprehension of community health service, incomplete function of service station and absence of medical insurance. The multivariate analysis indicated earning and awareness degree with community health service were impact factors of community health service utilization in elderly people. There were some limitations in evaluation of the health status of the elderly residents and demands of health service, using two-week prevalence and prevalence of chronic disease: (a) In logistic step-wise regression analysis of two-week prevalence and prevalence of chronic disease, goodness-of-fit of logistic models (R~2) were less than 10%, and the results were disrelat 'suffering disease' came from subjective psychology, not clinic meaning, which could easily cause 'ceiling effect', (c) In the health service survey, 'having specific diagnosed chronic disease' lied on possibility of health service accessibility and availability, diagnosed time, diagnosed name and diagnosed organization about half-past-year 'specific diagnosis' lied on memory of elderly residents. The prevalence of chronic disease was affected by memory of elderly people and the utilization.Conclusions: (a) The utilization rate of health service of elderly residents in Changsha was lower than some other cities. The two-week prevalence and prevalence of chronic disease were relatively high, and there were great potential demands of health service in Changsha. Although, the possibility of health service accessibility and availability was good, the hospitalizing rate, awareness degree with community health service and utilization rate of health service was low. Comparing with high need and demand for community health services, the utilization rate of community health services of elderly residents living in Changsha was lower. (b) The result indicated the analysis of health status and utilization rate of health service in the elderly people was different to general population. Increasing age could deteriorate the health of people, while status of demography, sociology and economics could affect the health of elderly residents less than the general population. On the other hand, awareness degree with community health service, chronic disease and physical training were main impact factors of body health of elderly people. Physical training had pivotal effect on body and mental health of elderly residents, which indicated physical training and social doings were important indicators of mental health of elderly people. (c) The two-week prevalence and prevalence of chronic disease of the elderly residents reflected their health status, but also the possibility of accessibility and availability. As general-used health indicator, the scores of SF-36 dimensions directly reflected the quality of life and psychology. Scores of SF-36 dimensions should be an indicator of demands of health service, like two-week prevalence, graveness degree of disease and prevalence of chronic disease. The results indicated chronic disease and physical training were the most important impact factor of scores of SF-36 dimensions, which approved the validity of scores of SF-36 dimensions as indicator of health status of the elderly residents. (d) To make up the information blank of cross-sectional study of community health service of the elderly residents, and obtain continuous data about community health service of the elderly resident record, it was necessarily to analyze the basic data set of community health service on the elderly. In cross-sectional study, two-week prevalence dose not mean the prevalence of clinic diagnosed disease, and there weren't diagnosis and treatment records and criterions. Part Two The Basic Data Set of Community Health Service on the Elderly in UrbanObjectives: To enhance the level of scientific management of all levels health administrative departments and allocate rationally health resources and accommodate effectively the relationship between supply and demand of the elderly community health services, improve services quality and reduce medical costs. To gather the elderly health and health services information from a variety of health services records by mean of Electronic Health Records System and reduce unnecessary surveys among households and provide basic data sets and data collection standards for real-time collection and analysis of data of elderly community health services and information.Methods: (a) The existing data sets of elderly community health service were collected and cleaned up to form data entity and to establish the framework of data sets of the elderly community health services by defining model and evaluating data sets and determining the content of framework. (b) The data sets were standardized. (c) Thebasic data sets of administrant information under the framework of the data sets of the elderly community health services were established.Results: (a) The elderly community health service data sets framework (EHDSF) was raised for the first time. The framework was composed of a 3×3 crossed matrix including participants and context. The source of information of related data sets among framework data sets was the recodes of residents' health. Participants were divided into three levels: individuals, populations and organizations. The context was divided into management, services and evaluation. (b) We combined the ' The recodes of residents' health in Hunan (tumor patients special table),' and established standardized methods of data element of the elderly community health services in urban. (c) Sixteen basic data sets of individual managementing information were defined, which were respectively individual identification, population and biological characteristics, physical characteristics, labor characteristics, living and behavioral characteristics, social characteristics, educational characteristics, living and the environmental characteristics, cultural characteristics, social security characteristics, legal characteristics, health status, social status, economic status, health knowledge and role characteristics. (d) Fifteen basic data sets of population management information and one basic data set of administrant information of organization were defined.Conclusions: (a) The authorities of health and administration may establish a corresponding information networks when a comprehensive social health service system was established for elderly and the information of electronic health recodes was utilized to analyze and provide related information of community health services on the elderly by mean of analyzing real-time data and utilizing information-based technology to drive and promote the modernization of surveillance, evaluation and management of the elderly community health services. (b) Disunity of the content and format of data sets and incompatibility of definitions and codes of data had caused large obstacles for the exchange and sharing of data and resulted in repetitive of data collection (repetitive inspection), which not only hindered utilization of these data again, moreover induced a decline in service quality and a increase in medical costs. (c)All health records of the elderly were saved dispersedly in electronic health records system. Our study had put forward a data entity under EHDSF, which covered the elderly community health services in all aspects in urban, so that existing data sets could be understood one another by different users. Stepwise standardization had been carried out for different data sets which need to exchange and share data element. (d) A standardized method of data element in urban elderly community health services had been established after combining 'The recodes of residents' health in Hunan (tumor patient special table)'. At the same time the stability and scalability of database had been guaranteed by means of fields of standardized data sets. (e) Our study raised 32 basic data sets of the urban elderly administrant information of community health services, unified data standard, reduced the waste of resources, laid the foundation for one-off data collection of the urban elderly community health services and had a better practical value.