Study On Performance Management Of COPD Community Prevention And Treatment

ObjectivesThrough investigating the basic conditions of staff of community health institutions in Zhejiang province and these staff's cognition degree of all indexes about performance management of COPD community prevention and treatment, this thesis analyses the basic conditions of performance management of COPD community prevention and treatment, establishes the basic indexes of community COPD prevention and treatment management and performance appraisal, discusses and improves the effective ways to evaluate community COPD prevention and treatment performance, aiming for enhancing the service quality of COPD community prevention and treatment team, and providing beneficial references to performance appraisal of community prevention and treatment of COPD and other chronic non-infectious diseases.MethodsA. Literature review methodAccess to relevant documents and information, learn from the community at home and abroad COPD performance management and personal performance appraisal experience and practices, understanding of COPD and the current status of community-based prevention and treatment of community COPD management and performance appraisal to performance problems. B. Questionnaire designingAccording to local health workers, community health services, chronic disease management and the practical experience of experts in the request of the Government of COPD prevention and treatment of content and requirements, from the management of chronic diseases has extensive experience in the Chinese Center for Disease Control and Prevention expert guidance to design the questionnaire.C. Sampling methodsThis issue using stratified cluster sampling method, in Zhejiang Province to 11 randomly selected municipal cities of Hangzhou, Ningbo city, and the two cities were randomly selected from the Jianggan District and Yinzhou District, its affiliated community health service agencies and other health-related line agencies staff, community health managers and a total of 258 expert group, such as the survey questionnaire.D. Field surveyThrough face-to-face survey methodology at the scene, the main understanding of community prevention and treatment of COPD, Zhejiang, the basic situation and the performance of the management of COPD community awareness related indicators.E. Statistical methodsMean, standard deviation, proportion and frenquency table were used to reflect the population characteristics of objects. ANOVA and Rank Sum test were used to analyse the differences in cognition of COPD, cognition of control diseases,management indications of COPD, expected control objectives, actual controlling objectives, workload of COPD preventing and performance assessment, referral indications between different objects. Multiple logistic regression was used to analyse the impact of job titles, duties, whether to accept the training of general practitioners to these indications.ResultsA. The basic situation of Community health workersSurvey is not very different from male to female ratio of staff, 31-40 year-old age-based,post-secondary education and above accounted for 82.2 percent of the staff, the more clinical medicine, accounting for 55.4%, to engage in the number of general practice 45 people (17.4%), engaged in the prevention of health care staff is also the relative proportions of relatively small (43 people, or 16.7%), 55.4 percent have graduated from the survey of more than one time, the majority of the titles for junior staff (accounting for 54.3% ), more front-line staff, accounting for 52.3%, there are 156 general practitioners who have received training (60.5%).B. Major prevention and treatment diseases in communityThere are 99 communities that COPD should be listed as one of the five major disease control (38.4%), ranked fifth., The former four for high blood pressure, diabetes, coronary heart disease, malignant tumor. Scores on the performance of COPD mainly concentrated in the score 10-20 points, with an average score of (29.6±29.1), select the number of 80-100 points, 13 were significantly lower than most other diseases. COPD in different regions of the focus of control should be included in community awareness of the disease were significantly different.C. The actual and expected control rate of Community-based prevention and treatment of diabetes disease management indicatorsNeed to be included in the survey that targets community-based management evaluation followed by the top five high to low rates of health education (88.8%), treatment rate (86.8%), follow-up rate (85.7%), archiving rate (85.3%), detection rate (82.6%). Different socio-demographic characteristics of survey indicators for the first five indicators included in community-based management evaluation were not significantly different. Different sections of the survey are included in the registration rate for community management of COPD awareness evaluation indicators were significantly different, in different regions of staff awareness of COPD and control community-based management is incorporated into the evaluation of COPD awareness indicators were significantly different. Management indicators and expectations of the actual gap between the level of control in more than 20% of the control file the rate of the highest levels of expectations, and the largest gap between the rate of actual control. Detection rate in different regions of the actual control rate, registration rate, the rate of actual control and archiving of the rate of assessment of the actual control rate were significantly different, different positions on the treatment rate of the survey expect the control objectives, COPD awareness expect to control targets, expect the rate of health education Control Objectives for the assessment were significantly different, different sections of the survey of health education on the rate of assessment of the actual control rate were significantly different.D. The performance appraisal indicator of prevention and treatment on COPDThe performance appraisal indicator proportion of COPD from high to low levels were : health education98.4%, periodic physical examination 89.1%, registration file88.4%, the treatment 86.4%, follow-up 86%, measuring lung capacity / function of 77.1%, referral 67.4 %. Performance scores of the indicators are as follows: treatment 35.82, follow-up33.26, Health Education31.99, Measuring vital capacity / function 28.79, Periodic health examination28.64, registration file 26.45, referral23.10.E. The referral indicators selectionReferral indications for the choice of all proportion in more than 80%.ConclusionsA. Community health service personnel's expertise and personnel structure need to further improve, Strengthening the training of professional knowledge and good talents is the premise of COPD prevention and control performance management of community.B. Study the management of the majority of nine indicators that should be incorporated into community-based management evaluation indicators of COPD, in which the health education rate, treatment rates, follow-up rate and detection rate file out the top five, but the control rate and awareness rate in the management of COPD should be of great importance. Actual control of the indicators of control objectives and expectations of the rate of more than 20% of the prevalence of the gap, the gap between the rate of which the largest file to reflect the current file system of COPD prevention and treatment communities to be perfect.C. Registration file, health education, treatment, follow-up, referral, periodic health examination, including treatment and health education the proportion of the workload of the two home, referral of the lowest proportion of the workload. From the measurement of lung capacity / function of the relatively low percentage proportion of the workload, the current staff should pay attention to the diagnosis of COPD understanding and knowledge of community health service centers of the construction of hardware.D. COPD prevention and treatment choice of performance evaluation indicators for the proportion of high to low as follows: health education, periodic health examination, registration file, treatment, follow-up, measure lung capacity / function, referral, evaluation indicators and management options are basically the same as the top five. Treatment, follow-up, health education, higher achievement scores, referral lowest score of each performance and workload are related to each other.E. COPD indications for referral were complicated by severe pneumonia, complicated by ARDS, complicated by heart failure, complicated by respiratory failure, complicated by severe infections, complicated spontaneous pneumothorax, water, electrolyte and acid-base imbalance strongly urge patients and their families.F. The methods of improve COPD community prevention and control performance assessment: the purpose of a clear positioning assessment, performance assessment organizations to develop goals and objectives; performance evaluation results should be timely feedback to the examination and exchange of persons; performance appraisal indicators for assessing the design fully into account the differences between objects, Guided by the principle of people-oriented, in accordance with the work, nature of work and work to develop different performance appraisal program; the standardized assessment process; examination results should be the material and spiritual basis for incentives.