| Objective: The Elderly Care Departments at the community health service centers are the new pension mode combined of medical treatment and endowment for the communities in China.Its geographical position,good health care and community health care conditions and rich resources of the community are conducive to all kinds of care resources integration and optimization,thus to deeply explore the endowment patterns of our country and the formation and development of integrated type pension system has great significance and value.This study which is on the basis of the status research of Elderly Care Departments at the community health service centers in Chongqing,qualitative analysis and study,combined with the current international vigorously advocated by the ‘integration care’concept,built a set of Elderly Care Departments at the community health service centers’ endowment service evaluation index system that accords with the concept of integrated care.The evaluation index system provides more objective and comprehensive evaluation of endowment service quality standardsand promotes the development of the endowment patterns of promotion and standardization,at the same time it provides certain reference for integrated care services developments in our country.Methods: The research is divided into three parts:(1)Background research.Using the method of literature research,policy research,comparative study and so on,which specifically analyzed the concept of integrated care abroad,patterns and the meaning of improving the aging strategies every country;study the present status of domestic and foreign pension model and explore the application of the integrated care pension mode in China.(2)The present situation investigation.Using semi-structured depth interview of qualitative research methods interviewed 18 residents,12 nurses and 9 endowment caregivers in 3 different Elderly Care Departments at the community health service centers in Chongqing.It analyzed deeply the advantages and disadvantages of Elderly Care Departments at the community health service centers and the degree about theconcept of integrated care.(3)The construction of evaluation index system.Based on the literature research,policy research and qualitative interviews in the early stage,first constructed the preliminary evaluation index system framework,then using the Delphi method selected more than 30 experts from the public health,pension services and management,community health care and nursing,nursing education and other fields for consulting and revised repeatedly on the evaluation index system,eventually determined the content of the index system.And weight parameters are given by experts,and the result of generalized evaluation of the index system is obtained through weighting.Rusults:1.The interview results of the elderly who stay in the Elderly Care Department at the community health service centers.6 themes and 16 sub-themes were extracted in total.(1)safety and trust: basic medical care was guaranteed,localized elderly care was more convenient,the advantage of a public institution,prevention and handling of accidents.(2)Satisfaction and relief: reduced family burden,basic room and boarding services,emotion consolation.(3)Gratitude and understanding: gratitude towards the care takers,mutual understanding among the family,mutual understanding among the elderly.(4)Independent and adapt.(5)Complains and helplessness: separation from family life,maladjustment to life at the ECDs,disconnection with the society,low life expectancy.(6)Worries and apprehension: Deteriorated personal health,economic burden.2.The interview results of the nurses who worked in the Elderly Care Department at the community health service centers.4 themes and 9 sub-themes were extracted in total.(1)A certain lack of professional value: disagreement with the work of elderly care among the society,inadaptation of leaving the clinical nursing work.(2)Stresses and challenges which brought by the changed roles: large pressure of communication between the elderly family members,difficulty of caring elderly and low salary.(3)Professional self-identity was higher: recognition of professional development,satisfaction of private value.(4)Positive professional attitudes: strong demand of enhancing their professional quality,expectation of the of Dlderly Care Departments’ development.3.The interview results of the nursing staff who worked in the Elderly Care Department at the community health service centers.7 themes and 4 sub-themes were extracted in total.(1)Professional recognition was low: young and professional nursing staff met with social and peer’s discrimination,difficulty in recruiting nursing assistant and high draining rate.(2)Care tasks were heavy:difficulty in caring elderly,no-guarantee of rest.(3)Lack of professional training.(4)Requirement of the understanding and cooperation among the elderly family.(5)The work was relatively stable and the welfare treatment situation was relatively satisfied.(6)Sense of accomplishment brought by caring the elderly.(7)Adhere to the Elderly Care Department mode.4.Three rounds of expert consultation results of the Elderly Care Departments at the community health service centers’ elderly service evaluation index system.(1)The recovery rate of the 3 rounds of expert consultation question was 100.00%,100.00% and 93.33%,experts’ authority coefficient was 0.81~0.83.The Kendall coefficient values(W)of the first and second rounds were respectively 0.211 and 0.241(P<0.01).(2)The mean value of the indexes in the first round was 4.167 ~ 4.967,the variation coefficient(CV)was 0.037 ~ 0.268,the recognition rate was 76.67% ~ 100%.For CV> 25% of the indicators,together with the revise opinion of experts to re-modify,then deleted four three-level indicators and added a three-level indicator.The mean value of the index of the second round was 4.067 ~ 4.900,CV 0.062 ~ 0.221,the recognition rate was 73.33% ~ 100%.According to the experts’ opinions and the group discussion,then deleted two three-level indicators.The final index system covered 6 first-level indicators,17 second-level indicators,and 55 third-level indicators.(3)The consistency ratio(CR)of the 28 expert scores was no more than 0.1,indicating that the results of the expert correspondence were in good agreement.In the first-level index,the experts had the highest value of "the normative quality of service quality control"(0.208),"the rationality of the charging standard" was the second(0.207),and the "comprehensive view of the integrated care concept" was the lowest,0.128.Conclusion:1.The elderly,nurses and nursing staff are highly recognized for the Elderly Care Departments at the community health service centres,which are consistent with the concept of integrated care that is being advocated by the international community.However,there are clear lack of systematic guidance for integrated care theories and multi-level integration of resources.2.The construction of the Elderly Care Departments at the community health service centers’ evaluation index system is scientific and systematic,and the content of the evaluation index system are objective and comprehensive.It is good reflection of the latest international integrated care concept,and it not only can provide some reference for the objective evaluation of Chinese pension service industry,but also help to promote the concept of integrated pension service conception.3.At present,the elderly support service industry’s awareness of the concept of integrated care are still lacking,it may affect the future in-depth development of integrated pension care services.So it is imperative to continue to develop relevant research,and take various measures to improve the recognition of the concept of integrated care... |
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