| With the in-depth development of the medical system reforms in China, the health gatekeeper system has gained top priority in medical reforms. It is one of the key issues in further deepening the community health service reforms to explore the ways to best demonstrate the role of community health services, which make an essential link in urban health system, as a health gatekeeper to enable local residents to enjoy the continuous, whole-process and effective healthcare. The implementation of the general practitioner system is critical to the health gatekeeper system. However, general practitioners as a new service model remain in a stage of exploration with no reference to any set models available and, therefore, have to be developed and perfected through constant trials. In Changning District, a pilot district of community health service reforms launched in China, the development and perfection of community health services have gone through such three stages as structural construction, mechanism construction and exploration of the connotation of general practitioner service model. The comprehensive supporting reforms of the community health services in the district that establish a teamwork model involving general practitioners have laid a good foundation for exploration of a general practitioner system facing families.The scientific performance assessment of the general practitioner system will not only inspire medical professionals’ initiatives to the fullest extent, but also effectively urge the community health service centers to transform their service modes, improve service functions and enhance service qualities and ultimately put community health into full play as a health gatekeeper. Given the fact that China is still going through a stage of exploring general practitioner performance assessment indicator system and that there are neither uniform assessment indicators nor tools available, this research is designed to establish and tentatively operate general practitioner performance assessment indicator system in a chosen district. And it is expected that the scientific basis shall thereby be offered to help perfect the general practitioner system, optimize the health resources and improve the environment for and approaches of rendering medical services in China.Method:Having learnt about the current status of the general practitioner system both at home and abroad, and based on the literature studies, an initial framework was built first of all for Changning District general practitioner assessment indicator system. Then the specific assessment indicators in the framework got modified and perfected, with the various indicator weights thereby generated, through Delphi expert consultations. Finally, the established assessment indicator system was verified in terms of the operability on site of 10 selected community health centers in Changning District.An Access 2007 database is created for all data collected and the data are entered by two persons and the statistical analysis of the data is conducted using SPSS 18.0.Results1. Establishment of Changning District general practitioner assessment indicator systemSixty experts, who are engaged in such specialties as health administration, clinical medicine and public health and who have an average career life of no less than 10 years, have been invited to participate in the Delphi Expert Consultations under this research. The two rounds of the experts’ positive coefficients are 95% and 97.5%. 87.5% of the experts share a judgment coefficient of 0.8 and up and the obtained experts’ authoritative coefficient is 89.95%. The assessment weights of performance dimensions in terms of the indicators’ necessity, feasibility, stability and sensibility are 0.44,0.32,0.16 and 0.08. The experts’ coordination coefficient of the second round is 0.42, with the significance test less than 0.05.The assessment indicators have been set up in terms of management, performance and effect according to the screening principles and the final decisions made by the experts through discussions. From top going downward, there are 7 level-I indicators including Internet-based data management, execution of agreements, basic medical services, health management, agreement execution and medical services, satisfaction degree and medical expense,17 level-II indicators as well as 29 level-Ⅲ indicators.2. Application of Changning District general practitioner assessment indicator system According to the survey data, during Mar 2013 to Dec 2013. all of the community health centers in Changning District have conducted surveys of and built files for the inhabitants living in the respective communities. The files take records of local population, number of inhabitants, number of the key households and the key health problems etc. In this research, the average of the following quantitative indicators is lower than 50%:the number of inhabitants having signed agreements/total number of household inhabitants in the communities (20.32%), the number of household inhabitants with valid agreements signed/total number of household inhabitants in the communities (9.92%), the number of household inhabitants with valid agreements signed/total number of household inhabitants with agreements signed (45.54%) and the rate of initial seeking of medical treatment among the inhabitants having signed agreements (46.20%), The number of weekly appointments with clinic activities per weekly outpatient service (4.02%). The average of some other indicators exceeds 80%: the number of households having been set up with the household health files/total number of the households in the communities (89.29%) and the rate of standardized management of chronic diseases (89.83%). In addition, such three indicators as the patients suffering from chronic diseases under actual control/the patients suffering from chronic diseases who should be put under control, the times of actual follow-up visits to the patients suffering from chronic diseases/the times of follow-up visits that should be paid to the patients suffering from chronic diseases and the rate of initial seeking of medical treatment among the subjects of the "joint actions of four medical resources" have attained 100%.Having weighted and summed up, the 10 community health centers in Changning District have earned an average score of 60.46, with limited scoring gaps existing between the communities, of which the highest score is 65.33 and the lowest 57.13. Such three communities as Jiangsu, Tianshan and Chengqiao have ranked as the top three, while Xianxia Community has the lowest score. Of the various indicators, the overall signing rate of agreements (3.97), outpatients’appointment rate (1.7) and the number of household inhabitants with valid agreements signed/total number of household inhabitants in the communities (1.44) appear to have considerable gaps if compared with the full-score indicators.ConclusionThe Changning District general practitioner assessment indicator system, which was established during the research, has proved to have remarkable practical value and to properly cover the highlights of the work relating to general practitioners as it’s rendered clear goals to the community health services in a rational and scientific way. Therefore, the objectives of this research have been achieved.Judging through the actual application of the assessment indicators, we can see that the community health service centers in Changning District share a similar level of performance as they’ve basically established the working criteria for general practitioners, despite certain room for further improvement. In general, the communities properly accomplish their jobs in terms of familiarity with local inhabitants’ basic information, outpatient services and management of chronic diseases etc. However, the jobs relating to the overall agreement-executions, valid agreement executions and outpatient appointments etc. have not yet been fulfilled sufficiently. |
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