Evaluation Of Integrated Services For Chronic Diseases Based On Patient Perception

[Purpose]The foreign integrated service evaluation scale for patients with chronic diseases(PPIC)is introduced to conduct cross-cultural debugging and reliability and validity test,so as to form an evaluation tool for chronic disease integrated service suitable for China’s national conditions.An empirical study on the perception of patients with chronic diseases is carried out by using the chronic integrated service evaluation scale after chinesization.The current situation of chronic integrated services based on patient perception and related influencing factors are investigated and analyzed.And improvement strategies are proposed for the deficiencies of current work.Therefore,it can provide reference for promoting the rational use of chronic disease integrated service evaluation scale based on patient perception and the further promotion of chronic disease integrated service in China.[Methods]1.Literature research methodBy searching foreign language databases such as Web of Science,Pub Med,full-text databases of Chinese journals such as CNKI,wanfang,weipu and relevant authoritative websites,etc.we comprehensively collected domestic and foreign data on evaluation of chronic disease integrated services,and summarized the research progress of evaluation of chronic disease integrated services,conducted a comparative analysis of existing evaluation tools,and selected measurement tools suitable for this study.2.Expert consultation and discussion(1)Expert group discussion: experts and scholars in the fields of hospital management,health policy research and prevention and treatment of chronic diseases were invited to set up an expert group to discuss the scale after being translated into Chinese and revise the items according to the national conditions.(2)Expert consultation method: on the basis of the preliminary test and debugging of the scale,two rounds of expert consultations were conducted among 13 relevant experts to evaluate the structure and content of the Chinese version of the scale.3.Field investigation method(1)Using the method of convenient sampling,sampling was conducted in two prefecture-level cities,Wuhan City,Hubei Province and Zhongshan City,Guangdong Province,the preliminary draft of the integrated service evaluation scale for chronic diseases was used to conduct a preliminary survey of 260 patients with chronic diseases in community health service centers in the two places to test the reliability and validity of the evaluation scale.(2)With the method of typical sampling,the integrated service evaluation scale of chronic diseases was used to conduct a formal survey of 380 patients with chronic diseases in community health service centers in 9 towns and districts of Zhongshan City by combining the general data of patient questionnaires,medical experience and life attitude and orientation scale.4.Data analysis methodA database was set up with Epidata 3.1,and SPSS 21.0 were used for quantitative data analysis.(1)Descriptive statistical analysis: descriptive analysis was used to analyze the basic data of the sample included in the study and the status quo of chronic disease integrated service evaluation.(2)Item analysis and reliability and validity analysis: correlation analysis and differentiation analysis were used to screen the items,and the reliability of the scale was tested by internal consistency reliability and retest reliability,and the validity of the scale was tested by exploratory factor analysis.(3)Univariate difference analysis and correlation analysis: Univariate analysis of variance was used to explore whether there were differences in the demographic characteristics of patients’ evaluation of integrated services.The correlation between the integrated service evaluation of chronic diseases,the overall medical treatment experience and the life attitude was analyzed.(4)Multiple regression analysis: taking the score of integrated service of chronic diseases and the score of overall medical treatment experience as the dependent variables and the significantly correlated factors as the independent variables,the multiple linear regression analysis was conducted to explore the influencing factors of integration service evaluation of chronic diseases and the overall medical treatment experience.[Results]1.Localization and revision of integrated service evaluation scale for chronic diseases based on patient perceptionThe PPIC scale was sinicized in strict accordance with the steps of cross-cultural debugging of the international scale to form the integrated service evaluation scale of chronic diseases based on the perception of patients.The scale contains: clinic during the initiative and positive response,the synergistic effect of family doctor within the team,the family doctor collaborative between team and the higher medical institutions,familiar with the patient’s medical history,and treatment,self-health management guidance to patients and centered on patients with six dimensions,a total of 37 items,the Chinese version of integrated service evaluation scale for chronic diseases Cronbach’s alpha coefficient is 0.927,the Cronbach’s alpha coefficient of each dimension is between 0.804-0.899,the reliability of the retest is 0.974.After extracting data by principal component analysis and selecting the maximum variance method for rotation,a total of 6 common factors were extracted,and the cumulative variance contribution rate was 67.134%,with good reliability and validity.2.Evaluation of integrated services for chronic diseases based on patient perceptionThe empirical results showed that scale out of 126 points,the overall score of chronic disease patients was 73.90±20.60,and the scores of each dimension were as follows: dimension 1(initiative and positive response during the visit)36 points,patient score 18.81±8.39 points,dimension 2(collaboration within the family doctor team)10 points,patient score 5.89±3.10 points,dimension 3(collaboration between the family doctor team and the superior medical institution)16 points,patient score 7.25±5.10 points,dimension 4(familiar with the patient’s medical history and treatment)12 points,patient score 6.92±1.35 points,dimensions 5(guidance of self-health management for patients)36 points,patient score 21.82±7.70 points,dimension 6(patient-centered)16 points,patient score 13.21±2.06 points,the total score is above average level.3.Analysis of influencing factors of chronic disease integrated service evaluation based on patient perceptionThrough single factor analysis and multiple regression analysis,it can be seen that occupation type,economic income,type of chronic disease,payment method of medical insurance,length of service of contracted family physician team and life attitude orientation are the main influencing factors for the evaluation of chronic disease integrated service based on patient perception.And sex,fixed number of year of the illness,chronic disease integrated service evaluation of the third dimension(collaboration between the family doctor team and the superior medical institution),the fourth dimension(familiar with the patient’s medical history and treatment),the fifth dimension(guidance of self-health management for patients),and the patient’s life attitude orientation can significantly affect patients with chronic diseases treatment experience.[Conclusions]1.In this study,the integrated service evaluation scale of chronic diseases based on patient perception after chinesization has good item differentiation and discrimination,reliability and validity.It can be used as an effective evaluation tool to evaluate the integrated services of chronic diseases from the perspective of the demander.However,it is still necessary to revise the scale according to specific domestic practice and broader research,so as to improve the promotion value.2.The score of patients with chronic diseases is above average.Among them,the highest score is the sixth dimension(patient-centered),followed by the fourth dimension(familiar with the patient’s medical history and treatment),the second dimension(collaboration within the family doctor team),the third dimension(collaboration between the family doctor team and the superior medical institution),the fifth dimension(guidance of self-health management for patients),the first dimension(initiative and positive response during the visit).The main influencing factors for the evaluation of the integrated services of chronic diseases are the occupational type,economic income,type of chronic diseases,payment method of medical insurance,service years of the contracted family physician team and life attitude.In the next step,the work should be carried out based on the dimension of unsatisfactory patient scores,and meanwhile,the intervention strategy should be constructed based on the analysis results of influencing factors to promote the integrated service of chronic diseases.3.Enhance communication and enhance the synergy of inter-agency cooperation.Establish incentive mechanism to mobilize the enthusiasm of medical staff and improve the quality of service.Strengthen the guidance of patients’ self-health management by taking health as the center.Reasonably allocate human resources and increase the training of general practitioners.Establish a long-term interactive mechanism involving the community,patients and families.