Research On The Evaluation Of The Effect Of The Medical-Prevention Fusion Model Of Chronic Hypertension Based On Value-based Medicine

[Purpose] Comprehensive analysis of the severe challenges brought by hypertension in China,from the perspective of value medicine,understand the important role of the integrated management model of medical treatment and prevention in solving the problem of "separation of medical treatment and prevention" in the prevention and treatment of basic hypertension in China.The purpose of this study is to build a four-dimensional medical service model for patients,service teams,organizations,and the external environment in value medicine through a method of literature research,expert consultation,and empirical analysis.Indicator system.Through empirical research,we analyze the implementation effect and existing problems of the management model of hypertensive medical prevention and treatment in China,and put forward related policy recommendations to help improve the management of hypertensive medical prevention and integration in China.[Methods]1.Data collection method: collect relevant data through literature research method;use personal in-depth interview method to improve the construction of indicator system framework;use expert consultation method to modify and improve indicator system and determine the weight of each indicator.Using empirical research methods to understand the current status of integrated management of hypertension and medical prevention in Enshi Prefecture(Xianfeng County,Lichuan City)and Wuhan City(Qiaokou District,Huangpi District)of Hubei Province,a total of 899 patients with hypertension were surveyed in 12 institutions.2.Data sorting method: For data collected by literature research and empirical research,use Epidata3.0,Excel 2016,SPSS19.0 and other statistical software for data entry,sorting and analysis,and carry out comparative analysis through comprehensive scoring method and weighted RSR method.3.Data analysis method: use expert consultation method and analytic hierarchy process to determine the index weight,analyze the collected data through SPSS19.0,and carry out comparative analysis through comprehensive scoring method and weighted RSR method.[Results]1.Based on the 4-dimensional value medical service evaluation framework constructed by William,this study establishes an evaluation framework for the management of hypertension medical and prevention integration based on "patients,service teams,organizations,and the external environment",in which patients include satisfaction and Health promotion has two sub-dimensions.The service team includes two sub-dimensions of service capability and disease management.The organization includes two sub-dimensions of capital investment and organizational management.The indicator system has 4 dimensions,7 primary indicators,and 20 secondary indicators.2.Two rounds of expert consultations were attended by 16 experts.The degree of cooperation between the experts is very high,and the positive coefficient of the experts is 100%.The overall judgment coefficient Ca of the index system is 0.890,the familiarity of the experts is 0.840,and the expert authority coefficient is 0.865.The coefficients of variation are all below 0.2;the weights of the four dimensions are 38.70%,25.68%,20.37%,and 15.25%,respectively.3.Empirical research found that the comprehensive scores of the 12 institutions were 91.07,84.63,73.28,65.27,69.96,79.38,77.43,75.39,82.37,88.04,85.27,74.52,of which 3 institutions with a score of 85 or higher accounted for 25.0%,9 below 85 points,accounting for 75.0%.Institutions with a score of 85 or better have better results,as reflected in the establishment of multi-level and multi-agency efforts to improve the prevention and control system,the establishment of an efficient prevention and control team,and the implementation of the performance evaluation of medical and prevention integration.Institutions below 85 points are not performing well,mainly because the prevention and control system lacks a top-level design,the medical-prevention integration prevention and control system is mostly inside the health system,and there is no coordination at all levels of society,as well as the shortage of control staff,village doctors are not connected.[Conclusions and suggestions]1.From the perspective of value medicine,this study builds an evaluation index system consisting of 7 primary indicators and 20 secondary indicators from four perspectives: "patient,service team,organization,and external environment".In addition,this study also builds a comprehensive evaluation model through a comprehensive scoring method.2.The results obtained by the comprehensive scoring method and the weighted RSR method are the same,reflecting the strong operability of the evaluation index system and comprehensive evaluation model established in this study.The integration of hypertension medical prevention and prevention management in the pilot institutions is at a relatively low level.This study proposes to optimize the management of hypertension medical prevention and prevention from the aspects of improving the toplevel design,promoting extensive participation among all levels of society,changing misconceptions,increasing financial investment,improving the technical level of medical staff,and optimizing incentive mechanisms.