A Study On The Influencing Factors Of Chronic Disease Management Services

Objective:To summarize and extract the influencing factors of chronic disease health management services,construct an analytical framework of influencing factors of chronic disease health management services,and take Changxing County in Zhejiang Province as a case study to systematically analyze its chronic disease health management measures,in order to provide reference for further improving chronic disease health management work in China.Methods:1.Using literature research method to retrieve and screen relevant literature on influencing factors of health management services,and using grounded theory to extract and form a set of influencing factors of chronic disease health management services.2.From the three aspects of demand factors,supply factors and governance factors,an analytical framework of influencing factors of chronic disease health management services is constructed.And 15 experts in the field of health policy were consulted to improve the conceptual norms and hierarchical relationships of each influencing factor,and finally formed the analytical framework of influencing factors of chronic disease health management services in this study.3.Analyzing Changxing County as a typical case study,firstly,according to the above-mentioned influencing factor analysis framework,data were collected from official policy documents,relevant literature,authoritative news reports and other sources to systematically sort out the specific policy measures of Changxing County’s chronic disease health management services;secondly,through purposive sampling method,semi-structured personal in-depth interviews were conducted with 16 policy makers,medical staff and patients related to chronic disease health management services in Changxing County,to understand what measures Changxing County has taken for each influencing factor in the previous influencing factor framework,and further explore the actual role and influence mechanism of each influencing factor.Results:This study extracted the influencing factors of chronic disease health management services and constructed an analytical framework of influencing factors of chronic disease health management services,which includes 3 categories(demand factors,supply factors and governance factors),9 main categories(primary health personnel,service provision mode,infrastructure,etc.),18 influencing factors(coverage range,personnel number,information construction,supervision and assessment,collaboration and integration,etc.).The framework was evaluated and modified by expert consultation method.The expert opinions mainly focused on three aspects:deleting duplicate or supplementing missing items,standardizing language expression,merging or splitting vague items.Changxing County has taken a series of effective measures in carrying out free physical examination screening,group-based provision of grid-based health management,information platform construction,normalized training of primary health personnel and so on,which have improved the quality and efficiency of chronic disease health management services and realized the full-process closed-loop management of "two chronic diseases".But there still some challenges in normalizing special fund guarantee,improving performance appraisal and incentive mechanism.Cconclusion:This study found that providing high-quality and efficient chronic disease health management services should take into account and focus on the influencing factors from three aspects:demand factors,supply factors and governance factors.Among them,demand factors determine the cognition and utilization of residents and patients for services;supply factors such as personnel,facilities and service modes directly affect the content,quality and effect of services;governance factors such as government attention degree,fund guarantee and supervision incentive mechanism affect the actual effect and efficiency of services.It is suggested that targeted intervention measures should be taken according to the needs and characteristics of different groups for weak links and key groups;digital information construction should be strengthened to form a closed loop of health management;existing resources should be coordinated and integrated to give play to the advantages of medical consortiums;group-based provision of grid-based health management services;fund guarantee mechanism and performance appraisal incentive mechanism should be improved.This study provides theoretical basis and practical reference for improving the quality,effect and efficiency of chronic disease health management services.