The Study Of Conceptual Framework Of Public Health Service Evaluation And Indicator System

Background: The rapid social and economical development and increasing sense of health protection have made people care more about their health problem and public health. The government, community, and society know about public health service and the quality of public health services, and it requires an indicator system comprised of inherently connected indicators to evaluate the quality of public health correctly and comprehensively. The indicator system is more than just a collection of indicators. It should be able to measure its distinct components of the system and also provides information about how the individual components work together to produce the overall effect. In other words, the whole of the information provided by a system of indicators is greater than the sum of its parts. After many years of public health research and practice, we have compiled a set of indicators and developed an indicator system to reflect public health service. However, most of indicator systems in the public health field were built based upon the tasks and components of public health department. These indicator systems do not have solid conceptual framework.The development of the conceptual framework for public health service will help to build indicator system which is well-structured and evenly distributed. At the same time the conceptual framework will provide a scientific classification method for indicator and make it easy to explain the indicator. The conceptual framework can help to generate systematic and comprehensive information, which can be used to formulate public health policy. It is found that the same indicator sometimes has many different definitions. The lack of standardization for indicator make it difficult for data exchange and data integration and also affect the development of public health policy, therefore, the study of indicator metadata have been emphasized much. Objectives: To explore the theory and method of developing conceptual framework for public health service, to establish the conceptual framework of public health service and to define the structure and components of the framework and the relationships among them. To build indicator system of public health service based upon the framework. To establish the methods of defining the metadata of indicator and indicator system.Methods: The initial conceptual framework was constructed on the basis of the results of literatures review and concept analyses. The development of conceptual framework is based upon health determinant model and the theory of healthcare quality evaluation. The initial framework has been modified based upon the suggestions given by experts during the expert meeting to validate the framework. Some domains and sub domains were removed and some domain and sub domains are redefined. The modified framework was evaluated by public health information conference attendee and experts and scholars in public health area via a questionnaire survey.The initial indicator questionnaire was drafted according to the newly created conceptual framework and the selecting criteria of indicators are followed. The two-round Delphi survey was conducted to establish the indicator system for public health service. The data from analysis report of national health services survey in 2003 was analyzed according to the framework. The abstracted 31 indicators were utilized to understand the complicated relationships between and within domains (or sub domains)Results: A conceptual framework consisting of four domains and 15 sub-domains is developed. The 4 domains are health status, non-medical health determinants, provision of public health service, and the supporting system. The health outcome includes three sub-domains of wellbeing, health status, functional status, and death; Non-medicine health determinants domain consists of health behavior, biological and genetic factors, social and economic factors and physical environmental factors; public health domain includes two dimensions. Vertical domain is made up of effectiveness, timeliness, safety, accessibility, continuity, responsibility, appropriateness, and efficiency; and horizontal domains includes disease prevention and control, health education, Children and maternity care and health protection. The supporting system has three sub-domains. They are resource assurance, mechanism assurance and regulation and policy assurance. The complicated relationship between these domains is also described. The notion of equity spans all dimensions of the framework, and can apply equally to any construct or dimension. Therefore equity is not included as a fifth dimension of the Health Indicators Conceptual framework, but is presented as a crosscutting element of the framework that applies to each of the four dimensions.The structure and components of the conceptual framework were highly recognized by public health information conference attendee and experts in public health fields. Twenty-Four (26) experts and scholars working in public health area were selected to participate in two-round Delphi questionnaire survey. The active coefficients of first and second round are 0.71 and 0.94, respectively. The final indicator system has 62 indicators. The results of Kendall's W test shows the higher concordance in both rounds of consultation.The comparisons of health indicators abstracted from health service report support that there are tremendous differences between the urban population and rural population. The disparities of health indicators exist in areas of different income and different education level.By analyzing the relationships among the 31 indicators abstracted from the National health service reports 2003, it is found that the indicators are closely correlated. The regression analysis indicates that the social economic status influences health outcomes, non-medicine health determinants and health services.The indicator is a special data element generated by other data elements. The description method has been developed to metadata of public health indicator. The study of metadata of indictor is the process of indicator standardization.Conclusions: The conceptual framework of public health service evaluation was first developed after extensive literature review and expert consultation and its domain and sub-domains are described thoroughly.This framework has been validated by public health information personnel and experts in the public health field. The conceptual framework plays an important role in directing establishment of indicator system and guiding the data analysis. The description method of public health indicator will improve the standardization of public health indictors.