| Objective:Through the investigation of both supplies and demands the health management service of 6 community health service centers in Hangzhou,to understand the demand,utilization and satisfaction and main influencing factors of community residents' health management services,to put forward the further countermeasures for the development of community health management service,and to provide references for the government and the community health service institution to carry out community health management.Methods:1.Literature research.Through the retrospective study of related concept and progress in research and practice of health management and community health management services,to lay the theoretical foundation for exploring the status and development strategies of community health management services.2.Questionnaire design and investigate.The questionnaire was designed by means of literature review,focus group discussion and expert consultation.Stratified random sampling was used to select 6 community health service centers in Hangzhou.The project was carried out by using “The questionnaire for health management centers of community health service centers in Hangzhou” to research the basic information of each health management centers' staff,belongings and services.And using “The questionnaire for customers about the utilization/demand/satisfaction of health management service” to take investigation of 410 customers who has received health management service.3.Data statistics and analysis.Using Epidata3.1 to establish database and input data;using SPSS20.0 to analyze data;using the Cronbach's ? reliability coefficient to test reliability of the questionnaire,using factor analysis and Pearson correlation coefficient to test validity of the questionnaire;using Descriptive Analysis,Rank Sum Test and Binary Logistic Regression Analysis to analyze the evaluation factor thatinfluence the community residents' satisfaction for health management services;and using TOPSIS to evaluate the pros and cons of health management service in community health service center.Results:The Supplier investigation showed that: 1.the configuration of personnel: the quantity of in-service personnel had large differences,which was between 87-132,with the largest number of medical practitioner;the education background of staffs was mainly concentrate on undergraduate and below,graduate and above accounted for less than 10% in all institutions,per million population in the proportion of general practitioners was among the 2-14 people.2.The supply of health management services:(1)The health management services in total population,usage rate of electronic health records and pass rate of health records were both above 80%,but the utilization rate of health records reached only 50%;the agencies had carried out various forms of health education,new and more frequent.(2)In the health management services for key population,the indicators of health management for children and pregnant women were more than90%,but the health management rate of the elderly wasis between 40%-70%.(3)For health management services in a group of patients with chronic hypertension,diabetes,and severe mental disease management specification rate between 7.64%-72.10%,10.09-71.9% and 57.97%-100% respectively.(4)In the health examination and evaluation services,health guidance and intervention services,the service content and methods of each organization had different emphasis.Survey on the demand side: 1.Questionnaire reliability and validity analysis.The Cronbach's coefficient of each dimension of the questionnaire were 0.83 above,the overall Cronbach's coefficient is 0.901,the reliability is good;KMO was 0.887(P<0.001),the cumulative variance of each dimension accounted for 69.659%,the validity was good;related demand dimensions and overall demand number was between 0.863~0.950,with good content validity.The Cronbach's alpha coefficient ofsatisfaction questionnaire evaluation dimensions' part was greater than 0.85,the overall Cronbach's coefficient was 0.916,the reliability was good;KMO was 0.916(P<0.001),the cumulative variance of each dimension accounted for 87.992%,the validity was good;the dimensions of satisfaction and overall satisfaction degree of correlation coefficient was between 0.764-0.939,content validity was good.2.The health condition of respondents: 13.2% of the respondents in the past two weeks had been attacked by a disease,19.6% of the respondents had at least one chronic disease,their health self-evaluation were main in general(47.3%)and good(38.5%).The average score of health management service demand and satisfaction were 3.88 and 3.63 respectively.3.The awareness and usage of health management service: 59.2% of the surveyed residents knew health record service,53.2% of the surveyed residents knew the charge doctor services;the top three health management services that residents have ever received were the health examination(72.8%),health records(35.4%)and health risk assessment services(20.4%).4.The demand of health management service: the three highest score demands were health examination,health records,disease management services.By comparing the differences of health management services in different regions,we can see that the demand for health examination and assessment services in Xiacheng District was higher than that in Jianggan District(P<0.05).The main factors affecting the health management service demand were the awareness of responsible physician services,the type of most frequently involved in health management services organization,the types of medical insurance,and the satisfaction of community health management services.5.The satisfaction of health management service: residents' 3 aspects of the most unsatisfactory were the frequency of providing service,service items,diagnosis and treatment facility.There was no significant difference in the satisfaction evaluation of health management services between Jianggan District and Xiacheng District(P>0.05).The type of most frequently involved in health management servicesorganization,the prevalence of chronic diseases and the demand for health management services were the main factors affecting the overall satisfaction of community health management services.The results of TOPSIS comprehensive evaluation showed that the satisfaction degree of community health service center D was the highest,and center A was the lowest.Conclusion:1.supplier survey conclusions.The investigation of community health service human resource allocation is not reasonable,the schooling of staffs are to be improved,health records utilization rate,the elderly health management rate and standard in patients with hypertension and diabetes management rate is still low.The agencies are providing unified and comprehensive health management services,but the traditional Chinese medicine health management services carried out still remains to perfect;there is still a gap among institutions for the content of providing physical examination service,the way of health guidance and health education.2.Consumer survey conclusion.Residents have a high demand for community health management services,but the level of awareness of health management related services and the use of health management services in addition to routine physical examination are low.Managers of community health service institutions should take effective measures to improve the satisfaction of service objects about the service content,especially the service frequency.3.Countermeasures and suggestions.The government departments should strengthen manpower support,financial support,material supply and policy support,community health service agencies should strengthen the health management with demand as guidance,adjust the service content timely,improve service attitude and quality,strengthen publicity supervision and guidance,pay attention to talent team construction,actively strengthen cooperation with the outside world,pay attention to the feedback and evaluation of residents,promote the healthy development of community health management services by the cooperation between government and community health service institutions. |
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