Research On The Theory System Of Service Quality Evaluation Of Village Clinic In Western China

Objective: On the basis of systematic literature research,the existing rural health service quality assessment theory system and theoretical system are analysed comprehensively and compared,which enable to explore and establish a theoretical system of western rural health service quality assessment,that is scientific,comprehensive,feasible,and accessible,that conforms to China's actual conditions.It will promot eeffectively assessment and supervision of service quality in village clinic,and provide a reference for the government's macro regulation and rational allocation of health resources.Methods: Through a systematic literature review of relevant literature on the rural health service quality evaluation theoretical system,the current research status and existing problems of the rural health service quality evaluation theoretical system are analyzed;next,use systematic reviewmethods to analyze and compare these theoretical systems to form the basic framework of the theory system of rural health service evaluation;then,Delphi method is adopted to comprehensively evaluate and screen the system framework,so that the opinions of experts are basically the same,and the results of the consultation of the two rounds of experts are statistically analyzed according to the indicators such as positive coefficient and authoritative coefficient via SPSS 22.0.Finally,a theoretical system suitable for evaluation of service quality in western rural health clinics is formed.Results: 1.Bibliometric analysis of rural health service quality evaluation system: A total of44 studies were included,published from 1989 to 2017,including 23 cross-sectional studies,18 reviews,2 randomized trials and 1 randomized controlled trial,of which 15 were published in SCI journals(34.2%),6 in periodicals(13.6%),18 in ordinary journals(40.9%),and 5 asacademic papers(11.4%);research contents included public health,medical service,and medical insurance;the scope of use was mainly targeted at village clinics,township health centers,and communities;the theoretical models involved included: 10 mechanisms(12studies,27.3%),11 systems(12,27.3%),and 13 methods(15,34.1%).2.Systematic review results of rural health service quality assessment theoretical system: 23 studies were included in the study,published from 2001 to 2017;11 studies(47.8%)were published in SCI journals;other studies were published in generaljournals;correspondence author's countries were mainly concentrated in China(11 articles,47.8%),Australia(3 articles,13.0%),USA(2 articles,8.7%),UK(2 articles,8.7%)and Mexico,Indonesia,Bangladesh,Sweden,South Africa and other countries;11 studies(47.8%)were rated as medium quality,and others as high quality;research topics and institutions involved public health,maternal and child health care,clinical services,primary health care services,and township health centers;12 studies(52.2%)researched on theoretical models,11 studies(47.8%)investigated or applied 9 different tools and methods,and 4 papers(17.4%)applied the theoretical model.3.The optimization and reconstruction of service system of rural health services in western China: according to the results of previous literature reviews,a total of 27 basic frameworks for system entries were proposed.19 questionnaires were distributed in the first round and 18 valid questionnaires were returned,which meant thepositivecoefficient was 94.7%.Then 17 questionnaires were allocated in the second round.In this case,all of them were recovered and the positive coefficient was 100%.The statistical analysis results showed that the Kendall coefficient of the second round was higher than the first one,indicating that the evaluations of the various theoretical systems by experts were gradually converged.Finally,three theoretical models including "Tripartite Comprehensive Assessment Model","Donabedian Model Joint Continuous Quality Improvement Model(CQI)",and "Elmore Primary Health Care Service Evaluation Model(EPHS)",six kinds of tools and methods including "Johns Hopkins of the United States.The University's basic medical service quality assessment scale(PCAT),SERVQUAL and one framework were included to reconstruct the theoretical system of service quality evaluation in village clinic in western China.Conclusion: Comparing and analyzing the content of the current rural health service quality assessment theoretical system,it was found that the existing theoretical system lacked standardization and unity of systematicness,pertinence and applicability.Based on the systematic review and the two-round Delphi method,the basic framework of the theory system of rural health service evaluation was selected,optimized and supplemented,and the theory system of service quality assessment in village clinics applicable to rural areas in the west was reconstructed,which was comprehensiveand scientific.This provided a theoretical basis for the effective assessment and supervision of the service quality of rural health clinics in the future,and needed to be tested with further application.