October 2013, Volume 16, No.28 Abstracts

 Present Situation and Development Trend of Community Health Service Institution Setting and Human Resource Allocation Standards

YE Qiang,ZONG Wen-hong,FU Xiao-ting,et al.Zhabei District Health Bureau,Shanghai 200070China 

Abstract Through contrasting and analyzing the differences of documents of the community health service institution setting and human resources allocation standards formulated by the Central Committee and 7 Provinces and Cities of Shanghai, Chongqing, Guangdong, Zhejiang, Jiangsu, Gansu, and Xinjiang, we explore the existing major problems in formulating the community health service institution setting and human resources allocation standards and put forth the development trend.

Key words Community health servicesHealth agenciesInstitution settingHuman resource allocation standard

Establishment of Assessment Index System for Community Health Emergency Plan

CUI Na,SUN Jing,WANG Ya-dong,et al.Divison of Medical Affairs in Beijing Northern Hospital, China North Industries Group Corporation, Beijing 100089, China 

Abstract Objective To establish a set of index system suitable for evaluating the health emergency plan at the community level.

Methods Specialists were selected according to the purpose of research and Delphi method was applied to form the sketch of index system.

Results According to the criteria totally 32 experts were selected, with 31 in the first round and 28 in the second. The retrieval rates of the two rounds of consultation inventory were 96.9% and 90.3% respectively; the authority coefficients of the two rounds of consultation were 0.75 and 0.77 respectively. After twice consultation, the harmonious coefficients of all index in each grade were improved obviously, being all≥0.40,and the difference was of statistic significance (P0.05).According to the advice and criteria of the experts, the index construction and assessment system conforming to the requirements was set up, including 3 first-level indicators,13 secondary indicators and 47 tertiary indicators.

Conclusion An assessment index system for the community health emergency plan has been basically established, which provides a basis for the evaluation of community plan.

Key words Community health; Health emergency; Assessment index system; Delphi method

Evaluation on Collaborative Services under Medical Group Model by Patients in Community Health Service Centers

ZHANG Lu,YANG Ren-yongQIAN Dong-fu.School of Health Policy and Management, Nanjing Medical University, Nanjing 210029,China 

Abstract Objective To analyze the cognitive evaluation of collaborative services under medical group model of community and hospital in Zhenjiang City by patients from community health service centers (CHSCs),so as to provide evidence basis for local medical service collaboration.

Methods A random sampling was used to choose 3 CHSCs from Jiangbin Group and 3 from Rehabilitation Group 2,and 2 from Rehabilitation Group 1 with a close collaboration. A self-designed questionnaire survey was conducted on the patients with hypertension and diabetes mellitus visited in the sample CHSCs, and 841 questionnaires were put out and all the retrieved (100.0%) were eligible.

Results The awareness rate of collaborative services by patients was lower, only 12.7%.Some 61.5% of the patients held that the information exchange between doctors from hospitals and CHSCs was bad, and only 22.2% believed that they could get service from medical staff from hospitals in CHSCs. The patients from Rehabilitation Group 1 with a close collaboration had the highest awareness rate, highest evaluation on the continuity of collaborative service and information exchange, and highest belief in possibility to get the service in CHSCs by doctors from hospitals, as compared with the patients from Rehabilitation Group 2 and from Jiangbin Group (P0.05).

Conclusion The patients have lower awareness on the collaborative service and a lower evaluation on the information exchange and continuity of service.Majority of the patients hold that there is no way to get the service and drugs given by doctors from hospitals in CHSCs.It is suggested to promote the popularity of collaborative service,enhance the supporting strength on collaboration between hospital and CHSC,potentiate the information construction,and establish continual medical service system.

Key words Community health service centers;Hospitals;Medical group;Collaborative service

Factor Analysis on the Satisfaction of Personnel with Community Health Centers in Shanghai

MAI Shu-peng,ZHANG Jian,FU Xiao-ting,et al.Health Research and Information Center of Zhabei District,Shanghai 200072,China 

Abstract Objective To analyze the influencing factors of personnel with community health centers in Shanghai.

Methods A total of 420 community health personnel were chosen to fill in a self-designed questionnaire.

Results According to factors analysis,the top 3 factors with the most impact were post,promotion,and payment.The satisfaction degree among personnel with intermediate and senior professional title was lower than that of those with junior title.The contract personnel showed higher satisfaction degree than those on regular payroll.Public health personnel and general practitioners who participated in the family doctor system had relatively low satisfaction degree.

Conclusion Related government sectors should try to improve the satisfaction of community health personnel based on the abovementioned influencing factors.

Key words SatisfactionCommunity health servicesFactor analysis

Performance Management of Community Health Service in Guangming New District,Shenzhen

WU Yun-hui,HAO Xiao-ning,QIU De-xing,et al.Community Health Service Management Center of Guangming New District People′s Hospital,Shenzhen 518106,China 

Abstract Objective To evaluate the situation of performance management of community health service (CHS),and to analyze the problems so as to provide reference for developing the CHS performance management system.

Methods A total of 6 community health service units in Guangming New District in Shenzhen were chosen through stratified cluster sampling. The condition of these health service units was collected and analyzed. Seven hundred and twenty patients chose randomly at the community health service units were interviewed, and another 116 patients with chronic diseases were interviewed via telephone.

Results In the 6 community health units, the prescriptions of two antibiotics and more took up 13.0% of the total prescriptions, the proportion of the prescriptions of steroids was 9.5%,the proportion of intravenous infusion was 34.0%,about 97.3% drugs prescribed in these units were the essential drugs, and 97.1% prescriptions were qualified. In 2010,the rate of planed immunization records was 100.0%,of which 97.6% received all the five vaccines. About 84.3% pregnant women and 83.3% hypertension patients received standard health management services. Approximately 83.1% patients felt satisfied with the services in the units, and 96.6% patients with chronic disease were satisfied with the doctors′ attitudes. For 91.4% residents, it only took less than 20 minutes to get to the community health units.

Conclusion The structure of the performance management of CHS and the performance evaluation system have already been established to some extent. Health services provided by community health units are safe, effective, and satisfactory. Over 80% of the residents are satisfied with the health services. But there are still certain gaps between the situation and the reform target of our country, and the performance evaluation system needs to be refined. It is necessary to deepen the reform and improve the whole performance of the CHS system.

Key words Community health services;Performance management;Performance evaluation

Cognition and Appraisal on Internal Performance Evaluation by Personnel at Rural Community Health Service Centers in Wujiang City

QIAN Dong-fu, CHEN QiangZHOU Ya-fu, et al.Medical College of Nanjing Medical University, Nanjing 210029,China 

Abstract Objective To understand the cognition on internal performance management by Personnel at Rural Community Health Service CentersRCHSCs in Wujiang City.

Methods The questionnaire survey and In-depth Interview were conducted.Frequency comparisonchi-square testetc.were used to analyze the data.

Results For job evaluationthe ratio of irrational degree perceived by respondents on comparison between different jobs was 14.1%44/312.There were 64.9%203/313 of respondents who thought merit pay should account for more than 40% of gross wages.The top 2 of main obstacles for implementing internal performance evaluation were respectively:"it is complex and lack of comparability between different jobs""lack of scientific and reasonable index for job performance evaluation",and corresponding rates were 69.5%219/315,49.2%155/315 respectively.

Conclusion To strengthen the cohesion and coordination between internal and external performance evaluationTo increase appropriately the merit pay percentage in gross wagesTo establish a reasonable division of labor and job performance evaluation systemTo promote efficiency of performance evaluation by computer information construction.

Key words Rural community health service centersTownship health centersInternal performance evaluationCognition

The Development of Medical Treatment Adherence Scale for the End-stage Renal Disease Patients with Maintenance Hemodialysis

ZHANG YanHUANG Jin.The Second Xiangya Hospital of Central South UniversityChangsha 410011China 

Abstract Objective To develop a specific medical treatment adherence scale for the end-stage renal diseaseESRD client with maintenance hemodialysis,which is suitable for application under the cultural background in China.

Methods The scale was developed based on the definition of adherence. The scale contained four subscales: dietary adherence, fluid intake adherence, medication adherence and dialysis regimen adherence.Related literature had been extensively reviewed, related instruments developed both at home and abroad already had been referred, suggestions from experts had been considered, and some patients had been interviewed before the initial items were formed. The items were analyzed and screened with six item analysis methods, and the reliability and validity of the items were examined.

Results A medical treatment adherence scale for the ESRD patients with maintenance hemodialysis was developed,including 23 items in 4 dimensions:dietary adherence 8 items,fluid intake adherence 6 items,medication adherence 5 items and dialysis regimen adherence4 items.The Cronbach′α coefficient of the whole scale was 0.877,and those of the four subscales were 0.819,0.838,0.792,0.815 respectively.The split reliability of the whole scale was 0.881,and those of the four subscales were 0.784,0.846,0.851,and 0.881,respectively.The test-retest reliability of the whole scale was 0.943,and those of the four subscales were 0.887,0.894,0.787,and 0.895,respectively.Content Validity IndexCVIwas 0.877.Totally 4 factors were developed by exploratory factor analysis and the cumulative variance accounted for is about 55.524%.

Conclusion The specific medical treatment adherence scale for the ESRD patients with maintenance hemodialysis was basically developed,every assessment index meets the general requirements for scale development.So it is can be used for measurement of this kind of patients′ adherence,however,it needs to be further improved in practice.

Key words End-stage renal diseaseMaintenance hemodialysisAdherenceScale

Clinical Application of Vascular Endothelial Growth Factor in Diagnosis and Condition Assessment of Acute Exacerbation in Elderly Patients with Chronic Obstructive Pulmonary Disease

ZHANG JieMA JinZHANG Yinget al.Department of Geriatricsthe First People′s Hospital of HefeiHefei 360001China 

Abstract Objective To investigate the value of the vascular endothelial growth factor (VEGF) to diagnosis,condition assessment,effect monitoring and prognosis judgment of patients with acute exacerbation of chronic obstructive pulmonary disease AECOPD in the elder.

Methods From October 2011 to October 2012,thirty COPD patients as the stable stage (COPD group),thirty AECOPD patients with purulent sputhum (AE-1 group) and thirty with no purulent sputum (AE-2 group),as well as thirty healthy persons (control group) were enrolled.The parameters of VEGF,serum procalcitoin (PCT),high-sensitivity C-reactive protein (hs-CRP),white blood cell (WBC),and neutrophil percentage (N) were measured within 24 hours after admission for all the subjects.The above indicators were measured again at the 8th day since the admission for the patients of the two acute groups.The scores of Acute Physiology and Chronic Health Evaluation Ⅲ (APACHE Ⅲ) were record for the AECOPD patients within 24 h after admission and at 8th days since admission for assessment of the disease condition.

Results (1) At the 1th day,the VEGF level was higher in the two AE groups than in the COPD group,and higher in the COPD group than in the control group (P0.05).(2) The sensitivity of VEGF index was 88.3% and its specificity was 60.0%,and its Youden′s index was the highest among the indicators.At the 1th day the VEGF value was (233±74) in the AE-1 group,being significantly higher than (194±66) in the AE-2 group (P0.05).(3) The VEGF values of the AE-1 and AE-2 groups were all higher at the 1th day than at the 8th day (P0.05).(4) The VEGF level was positively correlated with APACHE III score both at the 1th day (r=0.743) and at 8th day (r=0.574).

Conclusion (1) The serum VEGF is a good indicator for diagnosis of AECOPD,its differentiating effect to the sensitivity and specificity of bacterial infection is higher than those of PCT,hs-CRP,WBC,and N.(2) The serum VEGF can serve as a monitor for the effect of anti-infection.(3) The serum VEGF can be a important index for reflecting the severity of the disease and its prognosis.

Key words Pulmonary diseasechronic obstructiveInfection;Vascular endothelial growth factorDiagnosisCondition assessmentEffect monitoringPrognosis


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