| BackgroundAs a public health problem diabetes, hypertension, coronary heart disease has become a serious threat for Chinese people. International Diabetes Federation estimates that diabetes prevalence of our country is about 39.8 million in 2007 and will reach 59.3 million in 2025. Chinese residents Nutrition and Health Survey in 2002 indicated more than 23 million of people suffering from diabetes in China. About 90,000 people died of diabetes every year. the Ministry of Health data shows that diabetes prevalence rate of our country in the past 20 years has increased by 4 times. Through Chinese residents Nutrition and Health Survey in 2002,the results of the third national health servce,it is estimated that diabetes led to the loss of life expectancy in the city for the 0.21-year-old and in rural areas for the 0.08-year-old, the National Total for the 0.15 years of age by calculations of go cause of death in life expectancy. diabetes caused about 1.3 million life years lost of potential years of life. It caused about 10.7 billion yuan direct economic burden by diabetes, accounting for 1.88% of China's total health expenditure in 2002. it is predicted the number of Chinese diabetes will be the second in the world during 2000-2030(only after India).Globally, diabetes accounts for the fifth cause of death. The excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2% of all deaths. Increasing infections including tuberculosis are the main causes of morbidity and mortality. Domestic and international experience has shown that the most effective way to cure and prevent diabetes is the general control in the community. It needs system and mechanism to be ensured. This study is to explore diabetes management indicators' system in the community based on diabetes. It can meet the needs of management and development in the current health service Agencies of community ,it can provide a viable path to induce chronic disease management and community health service agencies to develop out of the predicament.ObjectiveThrough literature reviewing,consulting experts and brainstorming the community prevention and treatment of diabetes management indicators questionnaire was designed. The 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 diabetes control in the community, and promoted work implementation and development of diabetes prevention and treatment in the community. At the same time, the performance appraisal 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.MethodsA. Literature review methodRetrieval and access to domestic and foreign literature, particularly those with more mature practice, experience and effects in community health service management, in order to learn the current status of diabetes control and the present issues of diabetes management in the community.B. Questionnaire designing In this study, the questionnaire was designed according to local health workers and community health services in the actual situation, especially in chronic disease management experts, practical experience and the requirements of the community focusing on prevention and treatment of diabetes and other chronic diseases, as well as the use of brainstorming focusing on more than intelligence.C. Sampling methodsConvenience sampling and stratified cluster sampling method was adopted in this study, the 4 regions was extracted from 11 regions in Zhejiang province according to existing administrative divisions, then four different county was extracted from the extracted four regions by Convenience sampling,and 2-3 CHS was extracted by stratified cluster sampling method . the medical staff and some administrators were surveyed in the community health services center.D. field surveyLearn the major diabetes prevention and treatment of community-related information management indicators. Include: community management projects and their work proportion, expected control objectives, the actual control rates and expected performance appraisal indicators and percentile ratio.ResultsA. Major prevention and treatment diseases in community97.0%(488),96.6%(486) of the respondents thought that the hypertension,diabetes should included in community disease control, which Separately ranked first,second among 21 diseases. 70.4% of respondents chosen coronary hearty desease; 38.8% of respondents chosen malignant tumor ;29.8% of respondents chosen chronic obstructive pulmonary disease.B. The management indieator of major prevention and treatment for diatetes in communityThere was not significant statistical difference in the management index among sex,occupation,speciality,age,graduate time except that the indicator of detection rate had significant statistical differencse among categories of personnel and education,the registration rate among categories of education and technical post. The chosen indicators rates were construction document rate (90.2%),detection rate(85.1%),follow-up rate (81.2%),the registration rate(78.9%),treatment rate (74.1%),health education rate (70.9%),control rate (58.4%),knowledge rate (58.0%),awareness rate of diatetes (56.5%).C. The actual and expected control rate of Community-based prevention and treatment of diabetes disease management indicatorsThe actual control level of diabetic management indicators in the community respeetively were detection rate59.19%, the registration rate 67.70%, construction document rate 73.30%,treament rate 71.55%,knowledge rate 68.27%,awareness rate of diatetes 71.39%, control rate 65.85%, follow-up rate 69.94%, health education rate 70.82%.The expected control level of diabetic management indicators in the community respeetively were detection rate80.07%, the registration rate89.37 %, construction document rate92.93 %,treament rate94.89 %,knowledge rate91.02 %,awareness rate of diatetes88.20 %, control rate87.81 %, follow-up rate91.12%, health education rate92.64 %.D. the contents of work in preventing and treating diatetes in communityHealth education, follow-up, treatment, periodic physical examination accounted for the main contents of the work of diabetes control, and the referral and periodic health examination were at least contents of work.E. The performance appraisal indicator of prevention and treatment on diabetesThe performance appraisal indicator proportion of diabetic from high to low levels were : the registration and construction document rate93.7%, follow-up rate91.4%, health education rate 90.6%, the measurement of blood glucose78.2%, periodic health examination61.7%, referral rate 39.5%. the measurement of blood glucose,treatment,referral, periodic health examination were significant statistical difference in the performance appraisal indicator among difference regions; registered files among categories of personnel and the measurement of blood glucose,treatment,follow-up among different organizations were significant statistical too.F. The percentile ratio of performance appraisal indicatorThe percentile ratio results of diabetie' performance appraisal indicator were: follow- up 20.95,registered files 20.88,health edueation20.65,treatment 17.97, the measurement of blood glucose 17.50,periodic health examination 12.95,referral5.83.G. The main referral indicators selectionDiabetic main referral indicators selection were complicated by severe infection450 (89.5%), acute renal failure 448 (89.1%), diabetic ketoacidosis 444 (88.3%), non-ketotic diabetic coma 441 (74.1%), blood sugar difficult Controled 361 (71.8%), lower extremity ulcers occured or feeling receded 323 (64.2), patients and family members strongly urge 296 (58.8%), decreased visual acuity occurred 250 (49.7%), water and electrolyte acid-base disorders 228 (45.3%), low blood sugar reaction 132 (26.3%).ConclusionsA. Major diseases for Prevention and treatmentThe major diseases for prevention and treatment in community were:hypertension,diatetes, coronary heart disease, malignant tumor and chronic obstructive pulmonary desease.B,the management indicatormost of respondents among different regions, different personnel category and institution thought that 9 community-based management items of diabetes should be classified as management indicators. Of them, Ex-5 indicators were construction document rate, detection rate ,the follow-up rate, the registration rate and treament rate of diabetes. And there was certain differences between the actual control levels and the expectation control levels for all indicators in present.C,The performance appraisal indicatorThe diabetic prevention and management performance appraisal indicatiors in the community were: registration Files, follow-up, health education, treatment ,measurement of blood glucose, periodic physical examination, and referral, its former five indicatiors were basically accorded with the chosen management indicator.D,The percentile ratio of performance appraisalThe highest performance appraisal proportion of diabetes scores was health education, while the lowest proportion was referral.E,the main referral indicators of community-based diabetes prevention and treatment are complicated by severe infection, acute renal failure, diabetic ketoacidosis, nonketotic diabetic coma, blood glucose is difficult to control.
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