| 1. IntroductionCommunity health service, a grass-root service for meeting the fundamental basic health care needs of residents, is the basis of urban public health and the basic medical service system. It is critical to realize the goal of "everyone enjoys fundamental health care services", to reduce disparity of society, promote social justice, safeguard social stability and building a harmonious society.Currently, China's community health service network does not well organized and most community health service centers are short of funds and qualified health staff, resulting in poor confidence and reliability from the public. The contradiction of "difficult to find a competent doctor and cannot afford health care" is still very prominent.National policy requires medical schools and large hospitals participate actively in community health services in order to rapidly develop community health services. There are more than 280 medical schools and about 1000 affiliated hospitals with high reputation, prestigious experts, well-developed faculty, high-tech equipment and a large number of scientific studies. These should be an important power to promote quality of community health services, but their role has not yet brought into full play. There are many medical universities and their affiliated hospitals, including large municipal hospitals involving in community health services. However effect varies tremendously. There is still no a perfect model. Moreover, lack of a scientific evaluative index system has impaired efficiency, effectiveness of the entire work, lowered enthusiasm of those who joined the work. This also resulted in unscientific decision-making and over subjective supervision of government.Application of epidemiological methods to model involvement of medical schools and their affiliated hospitals in community health services and to formulate evaluation index system is able to collect health information, appreciate finished work, evaluation and supervision of health services. This will help improve scientific quality of decision-making, reasonableness of intervention, accuracy of management and effectiveness of services.So far, there has not been a systematic relevant study on this issue, only one or two experience reports and individual expert's appeal.2. Objectives2.1 The purpose of this study is to systematically analyze different models in which medical schools and their affiliated hospitals join community health services and to work out a major way for medical schools and their affiliated hospitals to participate in community health services.2.2 To set up a scientific, effective and practical evaluation index system evaluating effect of medical school and its affiliated hospitals participating in community health services in a real time fashion. It will attract government's attention, enhance guidance and intervention.3. SubjectsFirstly, developmental models of community health services in main developed countries; Secondly, models of some domestic medical schools and affiliated hospitals, including large municipal hospitals that do not affiliate any medical school, participating in community health services; Thirdly, 130 community health service centers sanctioned by Guangzhou Health Bureau.4. Methods4.1 A model for promoting quality of community health services by medical school and its affiliated hospitals4.1.1 Design of questionnaireIt was designed based on both quantitative and qualitative research methods.4.1.2 Investigative MethodA survey was conducted among leaders, senior doctors and nurses in community health service centers around Guangzhou. In addition to the survey, expert consult, interactive discussion with staff of the centers, intensive interview with main stake-holders, were also added.4.1.3 Data collection and analysisDate collected by questionnaire was subject to statistical analysis with excel 2003 Software.4.2 Evaluation Index System4.2.1 Establishment of evaluation indexThe evaluation team was composed of staff in the Office of Hospital Management Southern Medical University, the Third Affiliated Hospital and the forth-year undergraduate interns of health services management program. After reviewing relevant literature, evaluative index were formulated on the basis of consulting a panel of 30 independent experts in three rounds.4.2.2 Weight Determination via Saaty's MethodUsing pair wise comparisons via Saaty's method, experts determined relative weights of I-level indicators. In accordance with the AHP method, each expert's I level indicator weight was worked out. The arithmetic average of the weights represents the expert group's general view. In determining the secondary and tertiary index weight, a questionnaire survey and evaluation of the relative importance of the internal indicators was employed via Saaty's method and AHP method.5. Results5.1 A model for getting involved in the campaign of community health promotion by medical university-affiliated hospitals was formulated.The first is to produce more general practitioners through recruiting more medical students specialized in primary care; the second is to set up an intimately cooperative network between community health centers and medical university affiliated hospital; the third is to make staff who work in community health centers well educated make good use of educational resources in medical universities; the forth is to get staff who work in community health services well trained; the fifth is to provide community patients with convenient double-way referral services; the sixth is to promote health education through building up an information-sharing infrastructure; the seventh is to improve quality of community health services of medical students through academic medical education getting closely integrated with community health services.5.2 An index system evaluating effect of the model was formulatedThe system includes 4 I-level, 13 II-level and 27 III-level indicators, evaluating effect of the model from the following aspects: personnel training, technology, competencies and satisfaction. Weight value of each indicator at all levels was also defined.
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