Quality Assessment Of Community Chronic Disease Case Management For The Elderly In Chengdu City

Purposes: To find out the actuality of community chronic disease case management in Chengdu city by investigating the elderly who received the management and the CHC who offered the service; to demonstrate the effect of community chronic disease case management by comparing the resource invested in health and its health outcome between the aged patients who received the service and who not; to make reasonable suggestions on subsequent development of the service.Methods: According to different economic status, 374 aged patients with hypertension and 68 aged patients with diabetes and 73 with both hypertension and diabetes were sampled purposely for questionnaire survey from Yanshikou community, Dongguang community, Yulin community and so on; 11 CHC from Jinjiang district and 9 CHC from Wuhou district were visited and part of UHPP project evaluation data were utilized to find out the actuality of community chronic disease case management in Chengdu city.Results: Construct appraisement. (1) The community chronic disease case management which these 20 CHC offered had respectively covered 11.2% and 15.1% of potential hypertension and diabetes patients before April of 2006.Most CHC are supposed to improve work efficiency in future. (2) The composing of workers' education background and technical post title were unreasonable, and only 71.0% have accepted relevant operation training. (3) Workers were not familiar with management software and did not make most use of it. (4) The cost of CHC was not compensated in time, which would affect its sustainable development.Process appraisement (1) Workers made health records for every patient, of which only 55.3%～99.7% were fully recorded. (2) Most patients have not received long-term management. Almost everyone knew there was a health record set up for him, but other services were not to be such extent. Outcome appraisement (1) Even including labor costs and overhead expenses of CHC, each hypertension patient who received management consumed 2.6 Yuan per month less than those who did not received the service. (2) Those who received management were more likely to comply with the physician's orders. Among those who accepted management, 90.2% of hypertension patients and 84.8% of diabetes patients had taken medicine every day, and 93.1% of hypertension patients and 84.8% of diabetes patients had been regularly detected; while among those who did not received management, only 78.6% of hypertension patients and 65.3% of diabetes patients had taken medicine every day, and 73.5% of hypertension patients and 80.8% of diabetes patients had been regularly detected. (3) Those who received management had achieved more positive health outcome than those who not. 57.9% of the former persons had safe blood pressure, higher than that of the latter ones (42.2%). (4) Those who received management had achieved higher score on quality of life and longer active expected life than those who not. The former persons with hypertension received a score of 0.797 on average, which was higher than that of the latter ones with the same disease (0.782). Among the diabetes patients, those who received management made a score of 0.799 on average, higher than that of those who did not receive management (0.740). In terms of active expected life, those who received management enjoyed 0.9 years more than those who not. (5) It is found out that the longer the time they received management, the higher probability the patients control their blood pressure within safe range, according to multivariate analysis of blood pressure controlling rate.Conclusions: Generally speaking, each CHC had offered corresponding services according to the management scheme, which satisfied most patients. Meanwhile, the number of the staff would be increased and the structure of the staff would be improved, in order to adapt to the following work. The management had reduced the resource-consuming for those hypertension patients receiving the management even including the cost of CHC. The controlling rate of blood pressure had largely increased for the patients with hypertension. And the patients who received management were more apt to comply with the physicians' orders and received more positive health outcome. It's found out that their health would be improved more in the future.