| Background:With the industrialization, urbanization and aging population, our lifestyle changes, and this leads to the obvious changes in human disease spectrum. Rapid growth of cerebrovascular disease, diabetes, cancer and other chronic diseases are also found in our residents. According to " Major findings of the fourth national health services survey in the People's Republic of China ", residents surveyed suffering from chronic disease rose to 20.0%, increasing 4.9 percentage in comparison to that of 2003. Hence the estimation that cases of chronic diseases nationwide totals to 2.6 million, with the annual increase of 10 million over the past decade. Among them, cases of hypertension and diabetes increased by 2 times, heart disease and cancer by nearly 1-fold; chronic disease lasting two weeks increased from 39% to 61% in the past decade, and 80.9% died from chronic disease, while 10 years ago,73.8% died from those diseases. Chronic infectious diseases in Shenzhen in 2008 reported an increase of 127% than in 2004; 224.95 of 10 million citizens are found to be suffering from the chronic diseases, which is far higher than that of the national average (53.87/10 million); 13% citizens are suffering from hypertension, with victims of 1.3 million (according to the city's 10 million population). It is worse with hypertension, diabetes and other chronic diseases. These chronic diseases not only cause physical injury, psychological trauma in the victims, and become the heavy burden of their families and the community, influencing their quality of life, but also become a major public health problem for their being great health hazard to residents.In recent years, with the health system reform in depth, Shenzhen agencies for preventing chronic diseases improved their service in disease prevention and control mechanisms, financial investment, job performance and service quality, though left a lot to be done in coping with the fast deterioration of the chronic disease outburst, in meeting resident's growing needs for healthiness. Thus those agencies need breakthroughs in their service and self development.Objectives:To launch the Service Quality Evaluation in public health agencies, is not only an important means to enhance their serving capability, improve their serving quality, but also an effective method to perfect the public health system, to optimize the allocation of resources, to improve the equalization of public health services and to assist the supervision of the management. In 2009, "the CPC Central Committee State Council Views on Deepening the Reform of Medical and Health System" also clearly stated the requirements of "strengthening the public health service system, improving public health services, improving operating efficiency, service level and service quality". The purposes of this study are:1. Constructing Shenzhen Municipal Chronic Diseases Service Quality Evaluation Index System.2. Constructing Shenzhen Municipal Chronic Diseases Service Quality of Integrated Evaluation Model.3. Studying on service quality of Shenzhen chronic disease prevention and control institutions.Methods:Public health management approaches are applied in this study. Service Quality Evaluation Index System and Evaluation Model is established, based on the functions and core business of the chronic disease prevention and control institutions in Shenzhen City, combined with the existing conditions and its own characteristics, including the qualitative and quantitative research method, obeying the principles of "integrated, typical, scientific, and effective". Literature review, field research, expert interviews and group discussions were applied to establish the first draft index system; target screening and weight design are conducted among more than 30 public health experts consulted in two rounds, in which 35 experts in the first round and 31 experts in the second round. The age, profession, education, job title, geographic distribution of the experts gained consideration and a good combination. The criteria for the indicator evaluation derived from the national health departments'related business rules; 6 district-level chronic disease prevention and control institutions in Shenzhen are subject to the empirical study, who are investigated by the combination of questionnaire survey and field evaluation; the results of the empirical study are analyzed comparatively by using comprehensive score, weighted RSR method and the weighted TOPSIS method; A database is established by using Epidata3.0, and the data are analyzed by SPSS 15.0, SAS9.0 etc.Results:In this study, based on the Donabedian Theory of health services evaluation, a conceptual framework of quality assessment is established with "basis, process and service outcome" as its main part. The "basis" includes 3 dimensions of policy guarantee, system guarantee and the ability guarantee; the "Process" includes 6 dimensions of monitoring network, disease monitoring, health surveys, behavior intervention, health education and work supervision; the "service outcome" includes 3 dimensions of health promotion state, disease control efficacy and satisfaction. A comprehensive evaluation model is established on the basis of comprehensive scores received from the Index System which includes 3 level one indicators,12 level two indicators,80 level 3 indicators.In 2 rounds of expert consultation, including 35 experts in the first round and 31 in the second, positive coefficients were 88.6% and 96.8% respectively, indicating experts'high level of cooperation; all indicators' expert judgments coefficient, familiarity coefficient and authority degree coefficient are above 0.8, with the variation coefficient of below 0.2; experts coordination coefficients in level one, level two, level three indicators were respectively 0.7613,0.7587 and 0.5661, statistically significant at the level ofα= 0.05. In 2 rounds of expert consultation, the mean "importance" of all the indicators are 8.391 and 8.533 separately, with the variation of below 0.2, showing good concentration; 3 level one indicators weights 0.198,0.408 and 0.394. It is found in the empirical study that the overall service levels of the 6 chronic disease prevention and control agencies are good, with the integrated score of 913.9,880.7,849.5, 804.4,762.9,698.9 respectively, and the order from best to worst is:H1, H2, H3, H4, H5, H6; the correlation coefficients of the 3 evaluation methods are 0.994 and 0.999 (P<0.01).Conclusions:1. It is the first in building quality evaluation index system of Shenzhen chronic disease prevention and control institutions. Concise and highlighting, the index system covers the basic functions of the chronic disease prevention and control institutions and their main business; with the reasonable target weight, being scientific and practical, it is currently the most complete and systematic service quality evaluation index system of chronic disease prevention and control agencies.2. It is the first in building evaluations of comprehensive scores based on a comprehensive evaluation model. Specific criteria and scoring methods are developed in indicators of 3 levels; operating scales for each indicator are developed, clarifying the evaluation factors and rating rules; the evaluation formula of integrated score received by the subjects are also proposed, hence a operative model.3. It is found in the empirical study that chronic disease prevention and control institutions in Shenzhen can provide good services overall and they can be classified into 3:upper, middle and lower. H1 belongs to the upper class, and the other five are middle, leaving no one to the lower class. According to their service quality, the six district-level chronic disease prevention and control institutions can be ordered from upper class to lower class as following:H1, H2, H3, H4, H5, H6; and 3 kinds of assessment methods were consistent.
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