A Study Of Evaluation Of Integrated Health And Social Care Services In The Corps From The Perspective Of Medical Alliance And The Influence Mechanism Of Its Supply And Demand Matching On Service Effectiveness

[Purpose]The purpose of this study is to construct an evaluation tool for integrated health and social care services of regional medical alliance for the Xinjiang Production and Construction Corps(XPCC),identify relevant evidence of relevant experiences and weaknesses through empirical evaluation,investigate the influence mechanism of service supply and demand matching and service effectiveness,and propose targeted strategies for optimizing health and social care integration services in the XPCC's regional medical alliance.[Methods](1)The theoretical model of integrated health and social care service of regional medical alliance was constructed by literature research method and content analysis method,and the evaluation tool of regional medical alliance health and social care integration services of the XPCC was constructed by systematic review method,expert consultation method and hierarchical analysis method.(2)Data collection:1)Using the method of typical sampling,the questionnaire survey was conducted on the health status,health and social needs and other related contents of 292 elderly people in three persion institutions in Shihezi City of the XPCC and Zhuhai City of Guangdong Province respectively,as well as the geriatric medical service provided by two tertiary hospitals and one secondary hospital within the medical alliance of the above cities respectively.2)According to the population number of the XPCC at the end of the year,the sample regions were determined by the stratified sampling method,and three representative longitudinal close medical alliances formed by division-level hospitals and regiment-level medical and health institutions were selected.A questionnaire survey was conducted on integrated health and social care service of regional medical alliance from three parties:medical alliance institutions,staff and hospitalized and homebound elderly.We collected questionnaires from 3 division-level hospitals and 46 regiment-level medical and health institutions,2376 valid questionnaires for staff members,905 valid questionnaires for hospitalized elderly and 1043 valid questionnaires for home-based elderly.(3)Main analysis methods:1)The regional differences in the health and elderly care needs of the elderly were analyze by ordered logistic regression analysis,and the validity of the model was tested by likelihood ratio;thetest was used for comparative analysis of geriatric medical service capacity.2)The hierarchical analysis method was used to determine the weights of evaluation index of health and social care integration in the XPCC'regional medical alliance;the content validity indices of index entries and measurement levels were used to verify the validity of the evaluation tool;the reliability of the measurement tool was verified with the Cronbach coefficient.3)Validation factor analysis was used to test the discriminant validity of the matching variables of supply and demand of integrated health and social care services and the explanatory variable;Pearson correlation analysis was applied to analyze the interrelationship between the matching variables and the explanatory variables.A polynomial regression analysis was used to construct a quadratic polynomial regression equation between the supply and demand of integrated health and social care,and the coefficient of determination was used to judge the fitting effect of the model,and Origin was used to draw a three-dimensional response surface graph for response surface analysis,in order to deeply explore the influence effect of integrated health and social care service supply and demand on the effect of integrated health and social care service.[Results]The main study results include:(1)A theoretical framework for the supply of integrated health and social care service in regional medical alliance focuses on the health of the elderly and divides health and social care service integration of the regional medical alliance into micro,meso and macro systems from the inside out.The micro system is the integrated care of primary institutions and support systems from social and family for the elderly.The meso system is the service connection and integration of the institutions in integrated health and social care service,including three aspects of service synergy,service extension and social participation.The macro system is governance and supervision and development and improvement of service system.The macro system provides support for resource integration of regional medical alliance of the meso system through policy integration.And through the promotion of meso-system,it indirectly acts on primary institutions and the elderly's social and family system in the micro-system,so as to improve the health level of the elderly in an all-round way.(2)The comparative analysis of health and elderly care needs and geriatric medicine service capacity of the elderly in different economic development regions found:1)the health and social care needs of the elderly with equivalent chronic diseases in the XPCC sample cities were significantly lower than those of the elderly in economically developed cities(OR=0.468,95%CI:0.238-0.918);2)the interaction of the number of chronic diseases and self-rated health status had a weaker positive effect on the health and social care needs of the elderly in the XPCC sample city(OR=1.390,95%CI:0.980-1.972)than in the economically developed cities(OR=1.523,95%CI:1.092-2.123);3)the geriatric medicine service capacity in the XPCC sample city was relatively high,mainly in the form of relatively high the number of geriatric and related specialized departments,beds and human resources(p<0.05);4)the ratio between outpatient visits and inpatient visits in the city's tertiary hospitals was significantly better than that in that of economically developed sample city(3.0:1 vs.18.8:1).(3)The construction of health and social care service evaluation index system regional medical alliance of the XPCC was constructed,including 6 primary indicators,25secondary indicators and 48 tertiary indicators.The primary indicators are governance and supervision,service system construction,service synergy,service extension and social participation,service provision,and service effectiveness.The results of content validity analysis of the indicator system show that the content efficiency of each indicator is good(I-CVI of each indicator entry is?0.78,and K values are>0.74),and the content validity of the indicator system is good(S-CVI₁>0.8,S-CVI₂>0.9).(4)The main results of the evaluation study of integrated health and social care services of the XPCC's regional medical alliance:in the governance and supervision dimension,the overall level of the sample regional medical alliances were low(S=0.462);the service system construction dimension was slightly different,with the medical alliance in region B being slightly higher than the medical alliance in region A and the medical alliance in region C(0.3239 vs 0.3164,0.2846);in the service synergy dimension,region C was higher than region A and B(0.0716 vs 0.0587,0.0651);in the service extension dimension,region A was significantly ahead of region B and C(0.4665 vs 0.4180,0.4052);in the service provision dimension,region B was significantly higher than region C and A(0.5958 vs.0.5294,0.4350);the service effect dimension was higher for the medical alliance in Region C than for the medical alliances in Region B and Region A(0.6431 vs.0.5035,0.2782).(5)The results of the polynomial regression analysis of the effect of integrated health and social care services in the XPCC'regional medical alliance:1)The slope of the consistency curve of supply and demand for integrated health and social care services for the hospitalized elderly was positive and significant(a₁=0.592,P<0.001),and the slope of it's inconsistency curve was a positive and significant(a₃=0.542,P<0.001).2)The slope of the consistency curve of supply and demand for integrated health and social care services for the elderly at home was positive and significant(a₁=0.269,P<0.01),and the curvature was positive and significant(a₂=0.210,P<0.01);the slope of it's inconsistency curve was positive and significant(a₃=0.569,P<0.001).3)Comparing the slope of the consistent curve of supply and demand for health and social services between the low doctor allocation group and the high doctor allocation group,the later was positive and significant(a₁=0.649,P<0.01).Comparing the curvature,the low doctor allocation group was positive and significant(a₂=0.307,P<0.001).Comparing the slope of it's inconsistent curve,the high doctor allocation group was positive and significant(a₃=0.584,P<0.01)than the low doctor allocation group(a₃=0.739,P<0.001).4)Comparing the slope of the consistent curve between the multidisciplinary team group and the non-multidisciplinary team group,the non-multidisciplinary team group was positively significant(a₁=0.499,P<0.01);comparing the curvature,the multidisciplinary team group was positively significant(a₂=0.467,P<0.01).Inconsistent curve slope comparison was positively significant in the multidisciplinary team group(a₃=0.825,P<0.01)than in the non-multidisciplinary team group(a₃=0.525,P<0.001).[Conclusions]The main findings are as follows.(1)The evaluation tool of the health and social care services of the XPCC'regional medical alliance includes six primary indicators,namely governance and supervision,service system construction,service synergy,service extension and social participation,service provision and service effectiveness,25 secondary indicators and 48 tertiary indicators.The evaluation found that the evaluation results of each sample regional medical alliance were close in governance and supervision,service system construction,and standardized services of the service synergy dimension.However,significant differences were found on resource allocation,two-way referral,telemedicine services,and special training,multidisciplinary service teams and caregiver support,service provision and service effectiveness.(2)The satisfaction level of hospitalized and home-bound elderly people increased with the increase of supply and demand matching of integrated health and social care services in the regional medical alliance of XPCC.The satisfaction level of integrated health and social care services with"low demand and high supply"was significantly better than that of"high demand and low supply".The high allocation of human resources in regimental-level medical and health institutions of the regional medical alliance could improve the positive effect of the consistency level of supply and demand of integrated health and social services on the satisfaction of elderly people at home;the formation of multidisciplinary service teams by the divisional-level hospitals and regimental-level medical and health institutions could improve the effectiveness of health and social care services integration in cooperation between regimental-level medical and health institutions and elderly families.[Innovation and Shortcoming]Innovations:(1)The study constructs a theoretical framework of the integrated health and social care service model of cooperation between primary health care institutions and elderly families in regional medical alliance,providing new ideas for enriching the service model of health and social care integration.(2)An evaluation tool of integrated health and social care service of XPCC's regional medical alliance was constructed,and the effectiveness of the tool was verified,which provided a new method for effectively evaluating the current status of health and social care integration services in the XCPP's regional health alliance.(3)the polynomial regression techniques was used to analyze the influence mechanisms of different types of supply-demand matching on service effectiveness,and try to select the appropriate indicators from macro and meso system to analyze the moderating effects on the relationship between service supply-demand matching and service effectiveness,so as to provide reference for identifying the problems of health and social care integration service development and proposing targeted improvement strategies.Shortcomings:(1)This study analyzed the geriatric service capacity of public hospitals in different economic development regions,lacking baseline comparison of the service capacity of primary institutions,which did not fully grasp the overall status of geriatric service capacity.(2)In the follow-up study,an in-depth analysis for matching the contracted service content of family physicians with the specific service needs of their contracted older adults is needed.