Effect Evaluation On Health Management Community Health Services Based On A Two-Stage Grey Clustering Mode

Background: Health management is an activity aimed at preventing and controlling disease,reducing medical expenses and improving life quality.Community health service is an important part of community construction.Combining health management with community health service provides a good management and service platform for the community residents,which is of great significance in promoting community medical treatment,preventing diseases and keeping health.We conducted a cross-sectional survey to explore the level of community health services in the comprehensive development of health management in Huangpi District of Wuhan city.Objective: The aims of our study were:(1)To reveal the overall development and identify the problem of community health service in Huangpi District,Wuhan via evaluating the level of its status quo.(2)To explore risk factors for the utilization of community health service among residents by analyzing a cross-sectional survey,and provide targeted reference for the formulation of health policy.(3)To understand the needs of community health service among residents by surveying their satisfactions with health service,and explore more scientific,comprehensive and satisfactory community health service.Methods:(1)Studies related community health service between 1998 and 2018 were retrieved using the CNKI electronic database.The research area,publishing dynamics,corresponding institutions,names of journal and authors were recorded and analyzed by knowledge mapping and Visualization analysis based on Cite Space software.(2)A census survey was conducted to evaluate the level of community health service among all the health service institutions in Huangpi District,Wuhan.Six primary indicators and 21 secondary indicators were selected to structure the indicator system of community health service,based on data from 19 community health service institutions.Community health service in Huangpi District of Wuhan was divided into four grads of excellent,good,normal and poor by an improved center point mixed trigonometric whitening weight function.The gray scale clustering coefficients of 19 community health service institutions were calculated with the comprehensive measure decision model to determine the level of service in each community.(3)A multistage stratified cluster random sampling and Probability Proportionate to Size Sampling were adopted to collect sociodemographic factors,health related behavior,health literacy,health status,community health service,and residents' satisfaction among 2475 residents in 10 communities.Logistic regression was adopted to explore the risk factors of community health service utilization,and Structural equation model was used to evaluate residents' satisfaction in four selected communities.Results:(1)A total of 2871 research articles were selected in this study.Studies on community health services has experienced a dramatic increase overall and showed a tortuous trend since 2006.The publishing institution was also mainly concentrated in the eastern areas and decrease from eastern to the western areas.Meanwhile,publications related community health service was still focused on the field of public health and preventive medicine.While the high-quality literature on clinical medicine was quite limited.(2)There were two community health service institutions in the category of poor,3 in normal,4 in good and the remaining 10 in excellent in the first stage of gray clustering analysis.After a comprehensive measure of the second stage of the decision-making,the number of community health service institutions in weak,normal,good,and excellent were changed to 1,3,6 and 9.(3)Results from the Logistic analysis showed that,age,education level,occupation,household per capita monthly income,source of income and medical insurance were the factors that affect community health services.The structural equation model of community residents' satisfaction was built in “health literacy-health behavior-health status-community health service – satisfaction of residents”.The KMO value was 0.875,indicating that the model fitted well.The results showed that health literacy,health behavior and community health service level had direct effects on satisfaction of residents.And health literacy,health status had indirect effects on satisfaction.Conclusions:(1)Community health services research mainly focused on the current situation and development trend,utilization and evaluation research of urban and rural community health service,service capacity analysis in grass-roots community health service institutions,satisfaction and influencing factors of community health service,health resources allocation of community health service institutions,health management in the role of community health services,community health service centers and two-way referral hospital system,evaluation index system of community health services,etc.These researches represent the frontier of community health service research and are the main development direction in the future.(2)The overall level of the community health service is in average and relatively excellent class,while it is poor in some town hospitals.For some weak grey class institutions,it is necessary to enhance the management to make some transition from weak class to strong class.(3)The government should strengthen the investment and supervision,increase the allocation of talents,and improve the quality and service level of medical staff in community health service institutions.Interventions should be conducted to improve residents' satisfaction by improving health literacy,changing health related behaviors,and improving health conditions.