| BackgroundChina's aging process is accelerating,the prevalence of chronic diseases is rising rapidly,medical costs are rising sharply,and individuals,society and the government are overburdened.National Basic Public Health Service Standards?The "Healthy China 2030" Planning Outline mentioned health management many times.Health management has become an important strategy and key path to achieve national health and build a healthy China.The Guidelines on Promoting the Construction and Development of Medical Consortium pointed out that a variety of organizational modes of medical associations should be gradually formed to realize the transformation of development mode from disease-centered to health-centered.The "Healthy Guangxi 2030" Plan also put forward the task of developing health management and building a health promotion system.The final completion of these two tasks is undoubtedly inseparable from the platform structure or implementation carrier of the medicalassociation,especially the close medical association.Under the new situation,Especially under the background of speeding up the construction and development of the medical association,how can the tertiary general hospitals play a leading role in evaluating their own health management service capability,improving the level of health management service,innovating the health management service mode,and jointly building the linkage mechanism of health management? How can the medical institutions at different levels focus on the practice circle of health management under the framework of the close medical association? It is an important issue for us to make some achievements.Objective1.This study untangle the practice of health management in tertiary general hospitals and the development of Medical Consortium in China.We try to provide theoretical basis and practical reference by establishing the evaluation index system for health management service capacity of tertiary general public hospitals.2.This research construct the evaluation index system of health management service capacity under the framework of the Medical Association by investigating and evaluating the status quo of health management services and linkage in Guangxi tertiary general hospitals.It is a effective intietives to provide index system and empirical data for evaluating hospital health management service capacity.3.This paper analyses the strengths,weaknesses and opportunities and threats of health management services in Guangxi's tertiary general hospitals under the framework of medical Consorium,and puts forward countermeasures andsuggestions for improving the health management service system of the tertiary general hospitals,so as to provide decision-making reference for promoting the tertiary general hospitals and their member units in the medical association to enhance their health management service capabilities,optimize the health management service mode and jointly build the health management linkage mechanism.It also provides decision-making reference for promoting tertiary general hospitals and their member units in the Medical Consortium to enhance the health management service capacity,optimize the health management service mode,and jointly build the health management linkage mechanism.Methods1.Literature research method: To search and collect relevant documents,government documents,laws,regulations and provisions of the Health Management and Medical Association at home and abroad,refine the theories,models,experiences and methods that can be used for reference in this study,and establish the theoretical framework of the Health Management Service and Medical Association.2.Delphi expert consultation method: Based on the results of literature research,after clarifying the relevant theoretical framework of health management services and medical association,the evaluation index system is preliminarily designed.After 2 rounds of expert consultation,the evaluation indicators of health management service capacity were screened,and expert opinions were gradually unified to form an evaluation index system.3.Questionnaire survey method: the questionnaire was designed according to the evaluation index system,The cross-sectional survey(health management service provider)was conducted among 31 members of the health managementcommittee of Guangxi Hospital Association.The physical examination population conducts basic health literacy level,self-health management ability and health management service satisfaction survey(health management service demander).Understand the status quo of hospital health management service capabilities and analyze its characteristics,and discuss the main problems and the reasons for the related results.4.Expert interview method: On the basis of expert consultation and questionnaire survey,taking advantage of the opportunity of the annual meeting of the Health Management Committee of Guangxi Hospital Association to further carry out expert interviews with the heads of the health management departments of hospitals,to understand the current situation of the development of health management institutions,health management services and linkages in three-level general public hospitals in Guangxi,and to seek advice and suggestions.5.Comprehensive evaluation method: Based on the field survey data,the method of combining weighted Close-value method with Rank sum ratio(RSR)method and nested method is adopted to evaluate the health management service ability of three-level general public hospitals in Guangxi comprehensively.The weak link of the health management service ability of hospitals is analyzed systematically by radar chart method.6.SWOT analysis method: Based on the above research results,this paper lists and comprehensively analyses the opportunities and challenges,advantages and disadvantages of hospital health management service in a matrix way,clarifies the role of hospital in health management,and puts forward SO,WO,ST and WT strategies and Countermeasures to improve hospital health management service capacity by using strategy matching method.7.Statistical analysis method: Analytic hierarchy process(AHP)is used to calculate the weight of each index in the evaluation index system;internal reliability and structural validity are used to evaluate the reliability and validity of the evaluation index system;EPI Data Management Software is used to collect and input the data in the questionnaire,establish the database initially,and import the relevant data into SPSS software for various statistical analysis and processing.It mainly includes descriptive analysis and inferential analysis.Results1.Evaluation index system of health management service capacity of Guangxi tertiary general hospital under the framework of Medical ConsoriumThe comprehensive index system is established for evaluating the health management service capacity of Guangxi tertiary comprehensive hospital under the framework of hospital united system by Delphi expert consultation method and analytic hierarchy process.,which is included2 levels,4 first-level indicators and 34 secondary indicators.The arithmetic mean of the expert authority coefficient of the two-level consultation of the two rounds of Delphi method is0.865 and 0.869,and the degree of expert authority is high.The coordination coefficient is 0.282 and 0.348 respectively.The second round is larger than the first round.The expert opinions gradually become consistent,and the expected effect of the convergence of expert advice is better.The five judgment matrices constructed by AHP method,the consistency ratios CI and CR of single sort and total sort are less than 0.10,the judgment matrix has satisfactory consistency,no adjustment is needed,the relative weight of each index and the combined weight data are accurate,and the result is credible.The representativeness,authority and consistency of experts are significant,objective,scientific and practical.The system covers health management service input,service process,service output,service effect and other aspects,and solves the problem of no evaluation index system in public hospital health management service capability.2.Health Management Service Ability of Three-level General Hospitals in Guangxi provinceTwo organizations violated the regulations to carry out health checkups.There is a wide gap between the volume of health examination service,annual medical examination income and per capita medical examination expenses increase year by year.Nearly one-third of the institutions did not have a sound management system for people and property,and 35.5% of health management(physical examination)institutions were not established quality control system.And nearly 40% of the organizations still do not conduct consultations or questionnaires.The service projects of health physical examination are uneven,and the independent development capacity is not strong.The sharing with hospitals is more common.Individual institutions have not carried out basic general examinations and physical examinations.About half of the agency medical examination reports did not include disease risk assessment and chronic disease risk assessment.38.7% of the institutions failed to conduct a comprehensive analysis and assessment of the health status and the risk of future illness or death.64.5% of the institutions failed to conduct graded intervention and follow-up of chronically ill patients,and 67.7% of institutions failed to provide early screening,health guidance and intervention for high-risk groups.After the inspection,the coverage of the service is not wide,and the follow-up items are limited,6.4% of institutions still only stay in the initial stage of healthtesting,and only a physical examination or "only check".22.5% of the institutions have extended to the stage of health tracking,However,the overall emphasis on health physical examination,contempt for health management.35.1% of the physical examinations were only 2 to 3 years or even longer,only11.1% of the population often measured their heart rate and blood pressure,and30% of the people often observed their own situation to conduct a rough health check.10.1% of the respondents often carry drugs with them when they are on a business trip or travel.5.4% of the respondents never wear seat belts.The correct rate of 9 basic knowledge awareness rates of respondents is not high.The basic health literacy level of the respondents is low.The average satisfaction rate of health management services is 89.16%,and the level of satisfaction between different institutions was not much different.1.The representativeness,authority and consistency of experts are significant,objective,scientific and practical.The system covers health management service input,service process,service output,service effect and other aspects,and solves the problem of no evaluation index system in public hospital health management service capability.The health management personnel and other professional technicians closely related to health management services have insufficient human resource allocation.The assessment and reward and punishment mechanisms for health management work have not been established.The collection and mastery of the health status of the medical examiner is not comprehensive enough,which affects the accuracy of the subsequent health assessment and the effect of health intervention.The level of informatization and intelligence of health checkups is low,which affects the satisfaction of health management services to some extent.There is very little linkage between health management in hospitals and medical associations,information interconnection is difficult to achieve,healthmanagement concepts and disease management services of clinical staff are poor,and health management services lack innovation.The overall health status of the physical examination population in Guangxi tertiary general hospital is not optimistic.3.Comprehensive evaluation of health management service capacity of Three-level General Hospitals in Guangxi provinceThe comprehensive evaluation results of the combination of weighted close value method,rank sum ratio method and "radar map" show that four Hospitals are in excellent position.Five hospitals are located in the differential,and the remaining hospitals are mid-range.The LZ2 Hospital ranked first in all indicators was significantly better than the NN8 hospital.The NN8 hospital is not ideal in the performance evaluation indicators of health management service capabilities,resulting in the final ranking of comprehensive evaluation of service capabilities.In the third file,the process and effect indicators are little difference.The main difference lies in the input and output indicators.The service ability is in the "excellent" file,the overall performance is relatively good,the input,process,output,and performance indicators are better than the other two.However,there are some indicators in some hospitals that are not well developed and the indicators are not performing well.The main indicators of good general performance are: health management(physical examination)institutions comply with the Provisional Regulations on Health Physical Examination Management,apply information system to carry out appointment and referral services in the medical association,and carry out health knowledge education.The main indicators of poor performance are:health check-up or medical service information of health management objects are safely interconnected within the consortium,and health management isincluded in hospital performance appraisal.4.Service model of health management of Three-level General Hospitals in Guangxi provinceThe health management service model of most organizations still stays in the health check-up health management service mode(specialized health check-up service mode)with health check-up(re-examination of light management),plus the overall health of the health check-up population of the tertiary general hospital.The situation is not optimistic,the basic health literacy level is low,self-health management awareness and ability are poor,and the health management of Guangxi three-level integrated public hospitals has a long way to go.Conclusions1.The three-level comprehensive public hospital demonstration leads the health management service with its unique advantages,in the context of great health,development opportunities are ushered in.however,due to the long-term disease-centered development model of public hospitals and the resulting operational inertia and path dependence,the implementation of health management in Guangxi tertiary public hospitals is also Faced with no small challenges and many obstacles.2.Governments at all levels,as organizers of public hospitals,should give full play to the role of “doing a good job in health management top-level design and establishing a health management operation mechanism”,and promulgating the“Interim Provisions on Health Management Services for Medical Institutions” as soon as possible;health,medical care,development and reform The relevantministries and commissions,such as finance,human society,education,and insurance supervision,should take the initiative to formulate the role of“developing health management supporting policies and strengthening health management coordination guidance”.3.The three-level general hospitals should innovate and demonstrate the“integration under the medical joint framework”.The new model of health management service with “type,all-round,individualized and wide coverage”realizes the goal of full-service,intelligent management,information sharing,various duties,shared responsibility,linkage,benefit sharing and integrated operation.The new mechanism of health management linkage under the framework of the establishment of the medical and medical association,"institutions,personnel,information,services,prevention and control";provincial teaching research hospitals,county,secondary,urban hospitals,Chinese medicine hospitals,specialized hospitals,community health service centers,township hospitals and other medical institutions at all levels must be based on their own functions Features play in Nationwide Health Collaborative Management. |
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