Study On The Demand Attribute And Optimization Countermeasures Of Medical Care Combined With Community Based-home Care Service

Objective:Taking the rural elderly as the research object,this paper uses KANO model to attribute classification and prioritization for medical care combined with community based-home care service,analyzes the differences of elderly people’s demand attributes for medical care combined with community based-home care service,accurately grasps the rural elderly people’s cognition and focus on the demand for medical care combined with community based-home care service,and improves the accuracy of supply and demand.On this basis,giving suggestions to optimize the resource allocation of medical care combined with community based-home care service,and to improve the quality of rural community home-based care services.Methods:In order to build the theoretical basis of the research,we have read and analyzed a large number of literatures and policy documents to learn the research progress of medical care combined with community based-home care service in China and abroad.The questionnaire was formed through expert consultation,group discussion and project analysis.Based on KANO model,the author analyzes the elderly’s cognition of the needs of the medical care combined with community based-home care service and the difference of the elderly on the demand attributes by using the two-dimensional attribute classification,Better-Worse coefficient analysis and two-dimensional matrix analysis.Then,the priority of the demand for medical care combined with community based-home care service and integration was carried out by TOPSIS analysis.SPSS22.0 was used to describe the general data of the elderly.The R×C chi square test(Fisher exact probability method was used when the R×C chi square test was unaccepted)was used to analyze the difference of the cognitive attributes of the elderly in different age groups of medical care and community home-based elderly care service.The difference was statistically significant when P < 0.05.Results:(1)26 items were incorporated in the questionnaire,the Cronbach’s α coefficient was0.95,and the half reliability was 0.89.I-CVI is between 0.80-1.00 and S-CVI/Ave is 0.99.(2)The distribution of KANO attribute of rural elderly medical care combined with community home-based elderly care service demand items: Among the 26 items,there were 7 items belonging to Must-be Quality,2 items belonging to One-dimensional Quality,10 items belonging to Attractive Quality and 7 items belonging to Indifferent Quality;(3)The difference analysis of the cognitive needs of the elderly in different ages is that 15 of the 26 requirements have statistical significance;(4)The results showed that the top three factors of the improvement of satisfaction were daily life care(0.86),chatting with each other(0.83),rehabilitation nursing and training(0.77),emergency rescue(0.84),chronic disease management(0.80),diagnosis and treatment services(0.78),and health check reminder(0.78);(5)The priority of elderly medical care combined with community based-home care service needs: Must-be Quality: diagnosis and treatment service >health check reminder >drug use guidance >chronic disease management > physical examination service >establish health records>psychological consultation and guidance;One-dimensional Quality:emergency assistance > daily life care;Attractive Quality: visiting at home>chatting with each other >leisure and entertainment > traditional Chinese medicine diagnosis and treatment > family doctor > rehabilitation nursing and training > interest study class >health consultation >life and living instruction> health management.There are Indifferent Quality:two-way referral>acupuncture and physical therapy> health care service and guidance of traditional Chinese medicine>Lifestyle evaluation>fitness guidance>health education>caregiver guidance.Conclusion:From the perspective of demand,the study identified 26 items of the demand for home-based elderly care service in the community through literature review,expert consultation,pre-investigation and project analysis.Through questionnaire survey,the items’ attributes were classified,the better worse coefficients were calculated and the demands’ characteristics were analyzed by using KANO model.Then,we analyzed the demand attribute difference of different ages in elderly people.At last,we prioritize the requirements of each attribute level by combined using of TOPSIS method and KANO model,and the analyzing conclusions were described as follows:(1)The initial questionnaire of the demand for home-based elderly care service in the community was constructed through literature review,expert consultation,group discussion and reference books.Finally,26 items were obtained after the initial questionnaire was deleted through pre-investigation and project analysis.The reliability and validity of the questionnaire are tested by the survey data,which shows that it has good reliability and validity.(2)KANO model can accurately identify and classify the types of demand attributes of elderly medical care combined with community home-based elderly care services.(3)The cognitive characteristics of the elderly in different ages are different in the demand attributes of the community home-based elderly care service.(4)Through the Better-Worse coefficient analysis,we can understand the influence of demand items on improving or reducing satisfaction,and find out the key needs that affect the satisfaction of medical care combined with community home-based elderly care services.(5)KANO model combined with TOPSIS analysis can clarify the priority of items in each attribute,and provide reference for supply priority when multiple requirements cannot be met at the same time.