Research On The ICCC-based Quality Improvement Mechanism Of The Community-based Prevention And Control Of Chronic Disease

ObjectiveThis study focuses on the community-based prevention and control of chronic disease. The objective is to analyze the quality improvement mechanism in China combining with present situation of community-based prevention and control of chronic disease in typical areas on the basis of Innovative Care for Chronic Conditions (ICCC) framework, and then to perfect the relevant policy recommendations.ContentsBased on the analysis of ICCC framework, to propose the key elements affecting the quality of community-based prevention and control of chronic disease. To analyze the present situation of community-based prevention and control of chronic disease in typical area on the basis of field investigation, and the relationships between key factors and the quality of community prevention and control of chronic diseases. To perfect the relevant policy recommendations.MethodsThrough literature study, summarized theory and practice about the quality improvement mechanism of community-based prevention and control of chronic disease. Through inductive analysis, proposed the key elements affecting the quality of community-based prevention and control of chronic disease on the basis of literature review and the analysis of ICCC framework. A field investigation was carried out to collect the related information of community-based prevention and control of chronic disease in the typical area, and the causal relationship diagrams were drawn to analyze the quality improvement mechanism of community-based prevention and control of chronic disease in China.Results1. Based on the analysis of ICCC, this dissertation proposed the key elements affecting the quality of community-based prevention and control of chronic disease, which included policy guarantee, infrastructure construction, incentive, collaborative service, service quality supervision, information system construction, community support and patients’participation.2. The city of Beijing, Shanghai and Chengdu gave priority to high blood pressure and diabetes in the work of community-based prevention and control of chronic disease. The work, which included identification and management of high-risk people, diagnosis, treatment, follow-up, health education and the management of health archives, was in the charge of general team of community health service centers. During the year of 2011-2013, the rates of standard management and the effective control of high blood pressure and diabetes presented a rise trend, which prompted the quality of the community-based prevention and control of chronic diseases was turning better.3. The practices of community-based prevention and control of chronic disease in the city of Beijing, Shanghai and Chengdu included:1) Made a series of policy document, concentrated in chronic disease prevention and control planning, health education and health promotion planning, law about tobacco control.2) Through the standardized construction, promoted the basic hardware construction of community health service center; Trained general practitioners through job-transfer training, standardization cultivation, establishing the training base and so on.3) Performance appraisal-based material incentive and non-material incentive were major incentives.4) Developed the general team service model to promote internal coordination; Strengthened the vertical integration of resources and the upper and lower linkage of the health system to promote external coordination.5) Conducted the quality regulation in the whole process of service delivery.6) Information system was used widely in the community-based prevention and control of chronic diseases.7) Main sources of community resources were residents’ committees, street offices, and the community volunteers.8) Promoted patients’ participation in many ways.Conclusion1. Community health human resource was the key determinant affecting the quality of community-based prevention and control of chronic disease. General practitioners had a shortage in China and the professional ability of nurses needed to be improved. The system of personnel training mechanism showed a big difference in different areas.2. Incentive promoted the quality of community-based prevention and control of chronic disease by arousing the enthusiasm of the medical staff. Performance appraisal was the major incentive, but the incentive was limited on the premise of caps.3. General team service model with clear division of responsibilities was conducive to providing collaborative services. And providing the contracting service on the basis of general team was conducive to promoting hierarchical diagnosis and treatment.4. Information system was used widely, and promoted the quality of the community-based prevention and control of chronic diseases by ensuring the other key elements.5. Community support and patients’ participation made a function, which lacked initiative slightly, and a long-term persistence mechanism needed to be established.RecommendationsThis dissertation proposed five recommendations as follows:Making the on-the-job training more systematical, and improving the professional ability of nurses. Making a breakthrough in performance caps, and improving the awarding performance wages proportion. Making it clear that general team members’ function and duty and providing the contracting service, with giving priority to patients with chronic diseases. Strengthening informatization construction. Strengthening the initiatives of community and patients, and establishing the long-term persistence mechanism.