Comprehensive Evaluation On TCM Service Capability Of County-Level Hospitals Of Traditional Chinese Medicine In Shandong Province

ObjectivesThe overall objective of this study is to evaluate the TCM service capability of county-level TCM hospitals in Shandong Province by constructing the TCM service capability evaluation index system of county-level TCM hospitals,and analyze its main influencing factors,so as to put forward policy suggestions for improving the service capability of county-level TCM hospitals.The specific research purposes include:(1)constructing the evaluation method of TCM service capacity of county-level TCM hospitals;(2)To evaluate the service ability of county-level TCM hospitals in Shandong Province;(3)Reveal the influencing factors of TCM service ability in county-level TCM hospitals;(4)Put forward suggestions to promote the development of TCM service capacity in county-level TCM hospitals.MethodsThis study takes 98 county-level public TCM hospitals in Shandong Province from 2015 to 2017 as the research object.The data comes from the annual report database of traditional Chinese medicine hospitals in Shandong Province,which collects the relevant data of traditional Chinese medicine hospitals.This study extracts the relevant data of county-level traditional Chinese medicine hospitals for collation and analysis.In the part of evaluation model construction,firstly,based on the results of literature analysis and policy document analysis of health service ability at home and abroad,an evaluation index pool of TCM service ability is constructed;Six panel members were selected to organize two panel discussions and formulate the expert consultation table for the evaluation index system of traditional Chinese medicine service capacity of county-level traditional Chinese medicine hospitals.Then,18 experts were selected to carry out two rounds of expert consultation,and the evaluation index system of TCM service ability of county-level TCM hospitals was determined;The expert scoring method and entropy weight method are combined to determine the index weight;Finally,through literature analysis,combined with pest and competitive environment analysis,an index pool of influencing factors of TCM service ability is constructed,and through correlation analysis,the indicators are preliminarily screened.In the empirical research,firstly,descriptive analysis is used to analyze the current situation of the structure indicators,process indicators and outcome indicators of the sample county-level TCM hospitals;Then,the min max standardization method is used to standardize the data,so as to obtain the comprehensive evaluation results;The scale of county-level TCM hospitals in Shandong Province was divided by K-means cluster analysis;Using ANOVA,t-test,repeated measurement ANOVA and so on to carry out stratified significance test;Finally,using multiple linear regression analysis to explore the influencing factors of TCM service ability.Results(1)The three first level indicators of the evaluation index system of TCM service capacity of county-level TCM hospitals include structure,process and results;There are 9 secondary indicators,including human resources,material resources,financial resources,rational drug use,fairness,outpatient TCM service ability,inpatient TCM service ability,TCM characteristic service provision and service efficiency;There are 33 tertiary indicators.After testing,the index system has good reliability and validity.Among them,the Cronbach a coefficient of the overall index system is 0.958,and the scale level content validity index s-cvi/ave is 0.97.(2)Comprehensive evaluation of TCM service ability in County TCM hospitals.In 2017,the ratio of practicing(Assistant)doctors in TCM category to practicing(Assistant)doctors and the ratio of Chinese medicine practitioners to pharmacists were 43.7%and 52.8%respectively,which failed to meet the minimum requirement that the ratio of practicing doctors in TCM category and the ratio of Chinese medicine practitioners should not be less than 60%as proposed by the State Administration of traditional Chinese medicine in the notice on giving play to the advantages of traditional Chinese medicine and strengthening the staffing of traditional Chinese medicine hospitals in 2009.The proportion of TCM medical income to medical income has decreased year by year.From 2015 to 2017,the proportion of prescriptions of Chinese medicine prepared pieces in outpatient clinics of county-level Chinese medicine hospitals in Shandong Province and the utilization rate of Chinese medicine prepared pieces in discharged patients showed a slight upward trend.From 2015 to 2017,the annual growth rate of the number of people treated with traditional Chinese medicine such as acupuncture,massage and outpatient Chinese medicine non drug therapy exceeded 10%..(3)Analysis of hierarchical results of comprehensive evaluation of TCM service ability in County TCM hospitals.The difference of TCM service ability between different cities was mainly from the result index.With the increase of income level,the comprehensive ability of high-income areas was the strongest.The results of ANOVA showed that the trend development level had no significant effect on TCM service ability of county-level TCM hospitals.Regional stratification,the eastern region county-level Chinese medicine hospital service ability is the strongest,followed by the central region and the western region.The results of ANOVA showed that there were significant differences in TCM service ability among different regions.The level of hospitals is divided into three grades:Grade A hospitals have the strongest TCM service ability,which are grade Ⅲ B,grade Ⅱ A,grade Ⅱundetermined and grade Ⅱ B.The results of ANOVA showed that there were significant differences in TCM service ability among different levels of hospitals.The results of independent sample t-test showed that there was no significant difference in TCM service ability between county-level TCM hospitals with or without TCM preparation room and hospital clinical information system.Scale stratification,large-scale,medium-sized,medium-sized,small-scale,small-scale county-level TCM service capacity decreased in turn.ANOVA results showed that there were significant differences in TCM service capacity among different scale county-level TCM hospitals.Policy stratification:the TCM service capacity of county-level TCM hospitals with policy support increased more than that of the group without policy support from 2015 to 2017.Spearman correlation test results show that policy support has a positive impact on the TCM service ability of county-level TCM hospitals.(4)Analysis of influencing factors of TCM service ability in County TCM hospitals.The influencing factors of TCM service ability are ranked from large to small as follows:the proportion of TCM characteristic service treatment in the city,the number of medical insurance participants,the per capita medical expenses of inpatients,and the ratio of outpatient number in county and district.The influencing factors of the structural indicators were the proportion of patients with TCM characteristic services occupying the city and the per capita medical expenses of inpatients.Conclusions and policy implicationsThe main conclusions of this study are as follows:(1)the TCM service capacity of county-level hospitals of TCM continues to improve,and the growth mainly comes from the outcome indicators,among which the outpatient service capacity of TCM grows the most.(2)At present,there are some problems in county-level TCM hospitals,such as unreasonable pricing of TCM diagnosis and treatment projects and insufficient financial subsidies,which lead to the emergence of TCM hospitals pay more attention to revenue in the process of operation in order to survive,rather than play the advantages of TCM service characteristics.There are some phenomena such as "TCM hospital’s inpatient service mainly depends on Western medicine","TCM Westernization".(3)The higher the level,the larger the scale,the stronger the TCM service ability.(4)The implementation of the work plan of comprehensively improving the comprehensive ability of county hospitals has played a good role in promoting the service ability of TCM at county level in Shandong Province,and the policy support plays a good guiding role in the development of TCM.(5)The influence factors of structure index,process index and result index are different.The influencing factors indicate that the competition is the main factor affecting the service ability of TCM.This study proposes the following policy recommendations:(1)the state should continue to promote the policy preference for TCM hospitals and TCM,and at the same time,take effective measures to ensure the implementation of the policy,and ensure the implementation of the fiscal preferential policy for TCM by governments at all levels.(2)We should integrate the service ability of TCM into the performance evaluation of county-level hospitals of TCM,vigorously develop the characteristic advantages of TCM,strengthen the introduction and cultivation of talents of TCM,and enhance the service ability of TCM hospitals,so as to ensure the development of the core competitiveness of TCM hospitals and realize the sustainable and healthy development of TCM hospitals.(3)The development of TCM service ability in county-level TCM hospitals needs multi department cooperation.We should cooperate with the price department to improve the price formation mechanism of TCM,and work with the medical insurance department to formulate the medical insurance policy in favor of TCM.