| With the development of social and economic rapidly, the residents’ health needsbecome more diversified. There’re higher demands on our health service system. Inorder to meet the health needs of the residents better and to achieve the goal of Healthfor All, the CPC Central Committee, the State Council issued the Decision on HealthReform and Development in1997. It is proposed to develop community healthservices, and a health service network will be founded with rational function. Inrecent years, community health which is developed quickly, has been graduallyrecognized by the residents, provided basic public health and medical health servicesfor people. Community health nursing is an important part of community healthservices. It will be the basic link for achieve universal primary health care in China.The community health nurses make full use of community health resources forindividuals, families and populations to provide health services, especially in primarycare.This study was designed on the basis of system theory, incentive theory andbehavioral science theory. After the analysis of the literature and the advice fromextensive experts, the evaluation system of urban community performance has beenestablished. According to the characteristics of community health nursingperformance evaluation system indicators and evaluation purposes, appropriate dataenvelopment analysis model is selected for further study. A range of communityhealth service centers will be evaluated by the established index system. Then, put thedata into the model for performance evaluation. Analysis the impact factors whichaffected the performance of the urban community health nursing, and the applicationof qualitative research methods for further study on the existing problems ofcommunity health nursing management. After the analysis of the empirical results,countermeasures to enhance our urban community health nursing performance theproposed.With the rapid social and economic development, the residents’ health needs more diversified, higher demands on our health service system. In order to better meetthe health needs of the residents, the goal of health for all, the countries shouldactively develop community health services, and gradually form a rational function,and health service network to facilitate the masses. In recent years, the cause ofcommunity health development, has been gradually recognized by the residents, andassumed the functions of the grass-roots public health and health services provided.Community nursing as an important part of community health services to achieveuniversal access to primary health care goals a basic link. The community nursesmake full use of community resources for individuals, families and groups to providehealth services, especially in primary care has played an important role.This study was designed on the base of system theory, incentive theory andbehavioral science theory. Scientific methods are used to get the advice fromextensive experts to establish urban community performance evaluation systemsuitable for China.According to the characteristics of the community nursing performanceevaluation system indicators and the evaluation purposes, appropriate dataenvelopment analysis models were selected for study. A range of community healthservice centers were selected for performance evaluation by the system. Collecteddata were put into the DEA model for analyzing. Impact factors affecting theperformance of the urban community nursing would be found. Meanwhile, theexisting problems would be revealed by the application of qualitative researchmethods. The countermeasures would be proposed for enhancing our urbancommunity nursing performance.According to the literature review and the Delphi method, urban communityperformance evaluation system is established. The research object is communitynursing of urban community health service centers in9cities of Jilin Province.Technical efficiency, pure technical efficiency and scale efficiency are evaluated byCCR model and the BBC model of DEA. Descriptive analysis, multiple linearregression analysis, Kruskal-Wallis test, Jonckheere-Terpstra test and Mann-WhitneyU test are used for study. Qualitative research method is used to uncover the problemsfor the community nursing management.After research, indicators for community nursing performance measurementsystem is established and divided into inputs and outputs. Inputs include the four dimensions of the human resources, material resources, financial resources andmanagement. The seven items of the inputs are the number of community nurses,community nurses training, the expenditure of community health service, relatedexpenses of community nurses, the environmental conditions of the community healthservice centers, community health policy and community health informationmanagement. The9indicators are the number of nurses per thousand population, theproportion of community nurses training, the expenditure for public health andpharmaceutical, government financial assistance, the average wage and performanceallowance of community nurses, training expenditures for community nurses,business space, the implementation of the supporting community health policy andhealth information technology application. The outputs include3dimensions ofpublic health services, medical services and satisfaction. The10items of outputs arehealth records, health education, maternal and child health, mental illnessmanagement, planning immunization, elderly care, health management for patientswith chronic diseases, infectious disease management, general outpatient, two-wayreferral and residents’ satisfaction for nursing job. The14indicators are health recordscreating rate, the number of health education, newborn visiting rate, the number ofchildren management which aged0to6, number of maternal management, thenumber of psychiatric management, the rate of vaccination, the rate of elderly healthmanagement, health management of patients with hypertension, health managementof patients with diabetes, the number of the management patients with infectiousdiseases, the number of outpatient (general), the number of transferring consultation,and residents satisfaction for nursing work.According to the results from2010to2012, the investment increased year byyear for urban community health nursing in Jilin Province. By2012, in urbancommunities Jilin Province, the number of community nurses per thousand populationis0.239±0.195, community nurses training rate is71.5±35.2%, governmentfinancial assistance is379.934±571.591million RMB, expenditures for public healthand pharmaceutical reached454.538±8,061,770RMB. The difference of urbancommunity nursing indicators is still various, especially in expenditure for publichealth and pharmaceutical, government financial assistance, management expenses,the number of health education, the number of infectious diseases patientsmanagement, the number of transferring consultation and satisfaction whose coefficient of variation is more than1.5, and the dispersion degree is significantlyhigher than other indicators. Also found that the coefficient of variation is less than0.5in the proportion of community nurses training, community nurses average wageand performance allowance, health records creating rate and the preventivevaccination rate.According to the comparison and analysis from2010to2012, communitynursing performance is rising in urban cities of Jilin Province. With the guidance ofnational policy, urban community nursing performance of Jilin Province continueimproving.After multiple regression analysis of technical efficiency, pure technicalefficiency and scale efficiency, in input resources, the management expenses is themain factors for technical efficiency and pure technical efficiency; while communitynurses average wage and performance allowance is the main factor for the scaleefficiency. In output services, the number of maternal health management persons andthe number of hypertensive management patients have a greater impact on technicalefficiency and pure technical efficiency; while preventive vaccination rate and healthrecords creating rate have a greater impact on the scale efficiency.During qualitative research, it is found that the lack of community nursingservices criteria made difficulties for the rational calculation of nursing workload. Forthe various community nurses abilities, it is seemed to unfair that different levels ofnurses were evaluated by the same standards. Performance appraisal mechanisms isinadequate. Although social recognition of community health services continue to beenhance, some residents wouldn’t like to work together with community healthworkers which coursed limited development of community health service. Lack ofcommunity health nurses is one of the reason for difficulty completement incommunity health nursing.Based on the findings, suggestions are proposed. For human resources, theproportion of community nurses should be increased to ensure the human resourcesmeeting the residents’ needs. Strict access system should be set up to improve thecommunity nurses ability and community nursing services. The establishment of CoreCompetency Standards for community nurses will improve community nursingperformance management and organizational effectiveness. For financial resources,more measurement should be taken in making full use of government financial support, the development of the financial audit system and standardizing the use offunds.In the end, to improve the performance of community nursing, various factorsshould be considered. With the establishment of a wide range of community nursingservices specification and improve the community nursing performance constantly,effective commuty health services would be deliveried for all the residents. |
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