Status Analysis And Evaluation Indicators Research Of Health Service Quality In Some Rural Area In China

Objective:By investigation and analysis on the supply and demand of rural health services, found the main problems of health care quality and evaluation, combined with international experience, analyzed the current situation and core impact factors of rural area healthcare institutions, established and completed health service quality standards and evaluation methods which fit for rural area health services, developed daily evaluation tools, and proposec strategies to improve health care quality measures.Method:Main methods include:literature review, typical investigation, satisfaction survey, expert advice and peer-reviewed and so on. Implementing site investigation in Huining, Gaolan of Gansu, Yushe, Zezhou of Shanxi, Gaoyou, Haimen of Jiangsu. By mean, median, dispersion, logistic regression model and gap evaluation of service quality to analyze the main factors for rural area healthcare quality.Result:Through this research, structure, process and outcome issue of the rural primary health care quality is outstanding, the status of rural primary health care quality is difficult to meet rural residents'growing health care needs and demands. The health service quality issues of township hospitals main feature:First, lack of internal quality management system, lack of a strong commitment and support of institutional leadership to quality management, lack of full-time or part-time personnel engaged in quality management, and the lack of the necessary theory and skills of these staff, lack of necessary quality control requirements; Secondly, external quality control monitoring system and expertise in quality management are limited, with the decentralization of quality management and monitoring, so division of labor can not form an external monitoring system; The third, effective quality evaluation activities couldn't be found; Fourth, the shortage of a workable system of quality assessment, uncertainty of quality indicators, lack of quality standards and the poverty of evaluation methods; Fifth, the lack of supporting conditions for quality management activities undertaking, such as management conditions, information conditions and capacity conditions. The quality of village clinics is even more obvious. The uncertainties of policies of construction and development among village clinics and personnel are source problems. Village clinics are short of motivation and conditions to carry out health services management. Village clinics also lack of external quality control monitoring system, effective quality evaluation activities, workable quality evaluation system and supporting conditions for quality management activities undertaking, the extent of the problems which compared to township hospital are even worse.This study constructed 6 factors as a healthcare satisfaction survey, including environment and facilities, service attitude, healthcare procedure, complaints management, medical expenses and healthcare ethics. Using a way combing of qualitative and quantitative analysis, a random sample of 1147 outpatients and 605 inpatients in six samples Counties were implemented satisfaction survey, in order to explore status of healthcare quality satisfaction among patients, and to provide informations to to find the key dimensions of healthcare quality.Key indicators screening of rural healthcare quality evaluation literature review, several rounds of arguments of different experts. First, the indicator database was set up through the analysis of literature and existing evaluation tools, and the indicators which commonly used in the sample counties were found through field surveys, while listening to the grassroots experts'comments to select key indicators, and finally the initial key indicators were formatted by the research group experts judging on these indicators. After a number of experts judgement, the final number of indicators evaluation system included:18 quality indicators of township hospitals healthcare, with 7 additional indicators,14 public health quality indicators; 8 village clinics healthcare quality indicators,and 7 public health quality indicators.Conclusion:Enhancing quality of primary health services in rural areas must be based on realistic, pragmatic and gradual manner. Improvement activities to healthcare quality of primary health institutions in rural area must be based on a reality of China's rural grass-roots health organizations. Operability of indicators is a prerequisite to implementing the entire rural healthcare quality evaluation. Commonly used indicators are basic of quality indicators. Graduallly expanding the scope of indicators by the improvement of service development and management level, the progressive development is an important strategy to enchance healthcare quality in rural area. Practical and realistic should be the first principles health services quality improvement in rural areas. The key point of healthcare quality improvement in rural area is effective implementation.Developing assessment tool of the rural health service quality is only an instructional tool to improve the rural health services quality, whether it can play an active role in the grass-roots organization relying on attention to implement.Enhancing dynamic of different level administrative departments, township hospitals and village clinics continued to improve healthcare quality, innovating ideas, establishing a set of improvement mechanisms fitting for China's rural health services quality;Enhancing the education of healthcare quality, raising operational capacity of medical personnel improving the management skills of health service managers;Effectively promoting primary evaluation system of rural healthcare quality,and formatting a long-term working mechanism of internal and external evaluation.