Study On Performance Assessment Indicator System Of Community Health Service Centers In Shanghai

[Purposes]This study was aimed to, using qualitative and quantative methods, establish an indicator system with highly practicability, validity, reliability, and differentiation for evaluating performance of CHS centers in Shanghai, with the purpose to improve the degree of management of CHS in term of standardization and seientifieity. Meanwhile, the methods, manners, and the models of synthetical evaluation were also explored in this study, to provide some of information for decision-making and to give good suggestions for the establishment and/or improvement of performance assessment system in the future.Based on the aforementioned objective, we selected ten CHS centers in Shanghai as research samples and subsequent survey was proceeded. The following questions were always kept in mind that:firstly, develop a performance assessment indicator system that is suit for CHS centers in Shanghai; secondly, use the indicator system developed to describe and evaluate the performance of the ten sample hospitals; thirdly, verify the reasonability, practicability, and operability of the indicator system as well as the evaluation methods adopted, thus, provide a good reference for start up a performance assessment project in Shanghai.[Methods]In this study, a combination of literature review, focus group discussion, key stakeholder interviews, Delphi method and structured questionnaire were used to obtain abundant qualitative and quantitative data. Descriptive statistical analysis were conducted first, followed by several complicated but beneficial methods including fuzzy mathematical method, weighted synthetical score method, Topsis method, RSR method. Data were collected, summarized, induced, and analyzed to make the final indicator system, and the seientifieity, reliability, practicability of this system were tested.[Results]1) The performance assessment indicator system of community health service centers in Shanghai was formed, Including 4 first-Level indicators,9 second-level indicators and 26 third-level indicators. This system involves medical service, public health, traditional Chinese medicine, organization operation, general practitioner, chronic disease management as well as degree of satisfaction.2) The overall performance of community health service institutions is good, but efforts are still needed for providing much more services for some key populations, controlling the medical expense and improving efficiency. The lack of human resources is the one of key influencing factors that restrict the development of community health service institutions in Shanghai.3) The performance scores of ten sample hospitals were measured and evaluated against our indicator system. Synthetical score method, Topsis method, RSR method were used to verify the reliability, validity, and differentiation of the indicator system and the results tended to be consistent with the fact, so this indicator system could be used in practice and would contribute to the establishment of CHS performance assessment system in Shanghai.4) Regional difference in the community health service exists in Shanghai and the community health service centers located in remote regions shared a lower performance compared with those in urban districts, taking into account the fact that community health service performance is related to the resource investment from the government.([Conclusions]Following the research results, we could conduct a few conclusions and suggestions as well: 1) the indicator system formed by this study covered most important aspects that should be taken into consideration and its validity and reliability were satisfied and met the requirement; 2) not only the methods for selecting indicators were reasonable, but also the method for identifying the weight of each indicator was scientific, as well, the results were relatively accurate; 3) the results produced by different evaluation methods were of basic consistency, but combining these results together seemed to be more reliable and was recommended strongly; 4) all indicator systems, not only ours, should not stand still, but be justified appropriately and improved continually according to specific conditions; 5) to enhance the total performance of CHS centers in Shanghai, the allocation of health resources should be optimized and the problem of inadequate health human resources be resolved as soon as possible, moreover, personnel policy and health funding must be raised and increased for remote regions in order to help CHS centers there develop sustainably.