Study On The Quality Evaluation Index System Of Village Clinic Service In Western China's Rural Areas-

Objective: on the basis of systematic literature study,to comprehensively analyze and compare the advantages and disadvantages of existing quality evaluation systems of village clinic service along with corresponding system indexes,and apply the Delphi Method to try to establish a quality evaluation index system of village clinic medical service that is suitable for China's practical situation,scientific and comprehensive,and easy to apply and promote,aiming to effectively evaluate the medical service quality of rural clinics,identify weak links and key problems during their service process,provide ideas on improving their service capacity,and provide references for government macro regulation and control as well as reasonable health resources allocation.Method: through questionnaire survey and interview,to investigate village doctors and the current health service situation at village clinics of sampled areas;through the systematic literature review on papers related to the quality evaluation index system of village clinic health service,to analyze the current situation of studies and existing problems on this subject.On such a basis,to integrate existing indexes and form an index framework for the village clinic service quality evaluation system.To make a comprehensive evaluation and screening through the Delphi Method,and screening on the evaluation indexes is made through two rounds of expert consultation according to experts' active coefficient,degree of opinion concentration as well as degree of experts' opinion coordination,etc.To use SPSS19.0 for the statistic analysis of expert consultation results,and eventually propose a quality evaluation index system of medical service targeted at village clinics.Result: this study finds that,at present village clinics have problems such aslow village doctor quality in general,limited income;inadequate basic medicine guarantee,low patients' trust;major difficulty in achieving some public health services,low subjective initiative of village doctors.Through all-round literature retrieval,this study involves 12 papers researching the village clinic service quality evaluation system in the aspects of basic medical service,public health service and institutional functions.After comparison,it is found that different quality evaluation index systems are quite different in the number of,content and focus of indexes,yet it is hard to develop a system to cover all factors.According to the results of earlier systematic evaluation and research,the framework of the village clinic service quality evaluation system is formed,referring to and learning from other service quality evaluation systems,and the Delphi Method is used for index screening.This study makes two rounds of expert consultation in total.18 questionnaires are given out during the first round,and 17 valid ones are collected,demonstrating an expert active coefficient of 94.5%;during the second round 17 questionnaires are issued with 16 valid ones collected,demonstrating an expert active coefficient of 94.1%;the statistical analysis results show that,the value of Kendall coefficient of concordance of the second round is much higher than that of the first round,indicating that the experts' evaluation opinions towards each item are gradually reaching unanimity.Therefore the expert consultation can be ended.Eventually,6 first grade indexes,“human resources for health”,“income and expenditure”,“infrastructure”,“medical service quality”,“public health service quality” and “relevant health service quality”,and 36 second grade indexes including “number of village doctors per thousand people”,“ratio of qualified prescription writing”,“number of patients each year”,and“housing area for service”,are brought into the system.Conclusion: it is found through the study that,village clinics can not fully satisfy and safeguard basic health services for rural residents.Therefore,it is urgent to use a standardized and practical village clinic health service system to evaluate the health service quality of village clinics.Through the comparison among all indexes of the current village clinic service quality evaluation system,it is found that the quality evaluation index system of village clinic service still needs to be normalized and unified.Through the comprehensive evaluation and screening of all indexes withinthe village clinic service quality evaluation system using the Delphi Method for two rounds,an all-round and normalized village clinic service quality evaluation system has been formed,which provides a theoretical basis for future quality evaluations of village clinic service and the scientific development of relevant policies to improve village clinic service quality.