Development Of Standard Evaluation Indicators For The Prevention And Treatment Of Birth Defect In China And Its Application

Objective: This study aims to establish a standardized evaluation index system for birth defect prevention and control that is suitable for China’s national conditions,and to evaluate the standardization degree of birth defect prevention and control in Hunan Province.Methods: Based on the theory of health service quality assessment and the National Program for Comprehensive Prevention and Control of Birth Defects,a standardized evaluation index system and comprehensive evaluation models for birth defect prevention and control was established by literature review,focus group discussion and expert consultation.Based on the above index system,a total of 123 districts/counties of14 municipalities in Hunan province were investigated to analysis the standardization status of birth defect prevention and control in the whole province.The comprehensive scoring method was used to evaluate the overall and three dimensions(support evaluation,process evaluation,and effect evaluation)of birth defect prevention and control in each district and county.Proportions,arithmetic means(or medians)and standard deviations(interquartile range)were conducted to describe indicators.Results: Based on previous research and discussions of the research group,an initial index system consisting of 3 primary indicators,19 secondary indicators and 59 tertiary indicators was proposed.Subsequently,the initial index system was modified and improved through several rounds of expert consultation and discussions of research group,and the final standardized evaluation index system of birth defects was formulated.The final evaluation index system includes 3 primary indicators,23 secondary indicators,and 100 tertiary indicators.The positive coefficient of experts in the three rounds of expert consultation was 100%,100% and 75%,respectively.The average authority coefficient of experts was 0.93.Due to the large number of second-and third-level indicators,most experts agreed to assign equal weights to the internal weights of these two levels of indicators.Out of 10 points,the average scores of experts on the degree of agreement were 6.80 points(SD=2.18)and 7.20 points(SD=2.11),respectively.Since different experts differ greatly in their judgment of the weight of first-level indicators(Kendall coordination coefficient=0.183),and no consensus could be reached,the research group decided to use equal weight.Therefore,the group decided to assign weight to the first-level indicators by equal weight method.The evaluation results of the current situation of birth defects prevention and control in Hunan Province in 2019 showed that the median composite score of birth defects prevention and control of 123 districts and counties in Hunan Province was 84.48(the maximum score is 100,interquartile range=10.13)for the remaining 97 indicators after excluding 3 indicators whose values could not be judged from a professional perspective as superior or inferior.The median composite score of the support evaluation dimension was 82.35(interquartile range=26.47);the median composite score of the process evaluation dimension was 89.13(interquartile range=6.66);and the median composite score of the effect evaluation dimension was 87.46(interquartile range=8.17).Conclusion: Based on the theory of health service quality assessment and the National Program for Comprehensive Prevention and Control of Birth Defects,a standardized index system and comprehensive evaluation model for birth defect prevention and control in China was established through rigorous research procedures.The index system can be used to evaluate the standardization degree of birth defects prevention and control in different regions.In 2019,the overall score of the standardization of birth defects prevention and control in Hunan Province was higher,but the score of some indicators in Hunan province was still far from the national target.There were great differences in the overall score and the comprehensive score of all dimensions among different cities and different districts/counties.The government should take measures to improve indicators with low scores and narrow the gap between different cities and districts/counties.