| BackgroundCommunity Health Services has widely been developed in China,and the investment from government is also increasing.But the effect of community health services is poor,and the health of residents have not been effectively guaranteed,it is difficult to reflect the effect on the government investing to the community service institution.The concern and importance of medical health reform in our country are to further norm,manage,evaluate the community health services,and to improve the quality of the community health services.The Chinese government and scholars have realized that the community health service quality is lack of effective supervision and assessment,making community health services in a current developmental bottlenecks,which are important factors on their health and sustained development,so a community health service performance evaluation system is proposed to be established.At the same time,some regions have started to take chronic disease as point of cut-in to carry out exploratory practice. However,there is a lack of relevant research reports on the specific indicators of management,performance evaluation index,performance scores and so on.Therefore, the related study on performance evaluation system,the establishment of the system and its effective implementation becomes urgent and important.Because the community health services covers a wide field and involves complex work,the whole study is relatively difficult.The community management of hypertension was chosen as the best connection point in the study,through research and analysis on its work,management indicators,the expectation indicators and the actual control rates of control rate,performance indicators and assessment percentile ratio,we explored management and evaluation system for prevention and treatment of hypertension in community,and signified function on other chronic diseases,but also lay the foundation for community health service overall assessment study,fully reflected the effect of the government purchasing public health services.Of course,it is one of the important contents to build a harmonious society in China.ObjectiveThe management index,performance evaluation indicators and scores matching were analyzed and established through investigation of community workers and health administrator,which provided a theoretical basis for building evaluation system of hypertension control in the community,and promoted work implementation and development of hypertension prevention and treatment in the community.At the same time,the performance evaluation system was extended to other chronic disease and all community health services based on this example,and solving the important problems of development and reform for community health services.Methods1.Literature review methodThe related literatures were searched,particularly those with more mature practice, experience and effects in community health service management,in order to learn the current status of hypertension control and the present issues of hypertension management in the community.2.Questionnaire designingThe questionnaire was designed by ourselves according to the practical experience of the local health workers,community health services staff,particularly chronic disease management experts,and the content and requirements of hypertension prevention and cure.3.Sampling methodsA stratified cluster sampling method was adopted in this study,the 2 regions was extracted from 11 regions in zhejiang province according to existing administrative divisions,then a urban-rural binding region was extracted from the extracted two regions,and the medical staff and some administrators were surveyed in the community health services center.4.field surveyThe object was mainly to understand the performance evaluation related information of hypertension prevention and treatment in the community,the main contents included:community management projects and their work proportion,expected control objectives,the actual control rates and expected performance evaluation indicators and percentile ratio.Results1.96.5%(248)of the respondents thought that the hypertension should included in community disease control,which ranked first among 21 diseases.2.There was not significant statistical difference in the management index among categories of personnel,different organizations and regions.The chosen index is patients over 35 age in the first consultation(89.1%),construction document rate (79.3%),the follow-up rate(75.4%),the registration rate(71.6%)and awareness rate of hypertension(69.6%),detection rate(69.3%),control rate(64.2%), knowledge rate(62.6%).3.The actual control level for hypertension management indicators in the community was respectively:patients over 35 age in the first consultation 76.02%, detection rate 39.09%,the registration rate 80.28%,construction document rate 76.28%,treatment rate of hypertension 69.56%,knowledge rate 62.70%, awareness rate of hypertension 70.28%,control rate 53.75%,the follow-up rate 74.76%,health education rate 92.26%.The actual control level failed to meet the expectation control level with significant difference.4.The measurements of blood pressure,registration Files,health education and follow-up took most of workload for hypertension control,and the referral was at least in the workload.5.The performance evaluation index proportion from high to low levels was: registration files(87.5%),the measurement of hypertension(83.3%),follow-up (82.1%),health education(81.7%),periodic health examination(76.3%), treatment(75.1%)and referral(58.4%)in turn.6.The percentile ratio results of performance evaluation indicators were:the measurement of hypertension 22.24,registered files 17.49,health education 14.68, treatment 16.01,follow-up 13.31,referral 6.38,periodic health examination 10.14. There was not obvious difference of performance evaluation scores ratio between regions.Sores values of the measurement of blood pressure,registration files and health education in the community institution was higher than that of other institution respectively,The given scores of measuring blood pressure group, referral and periodic health examination was not great difference among categories of personnel,while that of registration files,health education,treatment and follow-up was different,of which,the given scores of the various index in general population was relatively high.Conclusions1.The performance evaluation system of community health service with hypertension as the first had wide public opinion.2.most of study subject among different regions,different personnel category and institution thought that 10 community-based management items of hypertension should be classified as management indicators.Of them,Ex-5 indicators were blood measurement rate for patients over 35 age in the first consultation,construction document rate,the follow-up rate,the registration rate and awareness rate of hypertension.And there was certain differences between the actual control levels and the expectation control levels for all indicators in present.3.The hypertension prevention and management performance evaluation indicatiors in the community were:Registration Files,measurement of blood pressure,follow-up, health education,periodic physical examination,treatment and referral,its former five indicatiors were basically accorded with the chosen management index.The highest proportion of achivevement scores was measuring blood pressure,while the lowest proportion was referral.
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