| BackgroundAs the continuous development of social informatization and economic globalization, information technology is now being widely used in healthcare field. Many countries in the world including China have made significant progress in hospital informatization, and now many of them have commenced regional health information sharing. With the rapid development of community health services in China, the importance to improve the informatization level of community health service center (CHSC) is raising fast. But it is still on the initial stage for the CHSC to employ the information technology, we need overcome many obstacles.Making comprehensive evaluation of the diverse dimensions of the informatization system of CHSC, on one hand it can help the CHSCs to diagnose and evaluate by themselves and understand the current status of their informatization work including strength, weakness, problems and treatment, in the other hand it can help the government to find out the current situation of informatization in CHSCs and advance the policy making to promote the informatization process of them.ObjectivesThis study was aimed to develop an indicator system for evaluating the informatization level of CHSCs in Shanghai. Based on this indicator system we developed relative evaluation methods to make current status survey and comprehensive evaluation for the CHSCs in Pudong new district, Shanghai. On one hand this survey and comprehensive evaluation would provide the information of current status of informatization in CHSCs and policy commendations to the government, on the other hand it would test the validity, reliability and operability of the indicator system for the further improvement.MethodsIn this study, literature review and focus group discussion method were used to establish the initial indicator system, Delphi method was used to filter the indicators and improve the structure of the indicator system, and Analytic Hierarchy Process (AHP) method was used to calculate the weight of the indicators. According to this indicator system, we surveyed the current status of the 29 CHSC of Pudong new district by questionnaire. Based on the survey data we made the comprehensive evaluation by weighted linear complicated method. We also made the comprehensive evaluation by Topsis method and Rank Sum Ratio (RSR) method for ranking. We combined the different comprehensive evaluation results by synthetical evaluation methods in the last.Main findings1. Developed an indicator system for evaluating the informatization level of CHSC.·The indicator system included 6 dimensions,18 topics and 59 indicators. Six dimensions were IT support system, IT infrastructures, Information system development and application, Information sharing and standardization, IT security, IT benefit, the weight of them were 18.00%,18.00%,33.60%, 10.20%,12.20%,8.00%.·Reliability and Validity of the indicator system:Internal consistency was good, Cronbach's a coefficients of all dimensions are more than 0.60, some of them were even more than 0.80; Content validity was good, because this study was based on experts suggestions; Construct validity was good, Spearman correlation coefficient between the dimension and total score(0.506?0.898) were higher than which between dimensions(0.171?0.585); Discriminant validity was good, the indicator system could be used to relatively accurately distinguish different types of community health service centers. 2. Current status survey and comprehensive evaluation of informatization level of CHSC in Pudong new district.·There were large variances between different dimensions. IT support system and IT infrastructures were better than other dimensions, and Information system development and application, Information sharing and standardization were the weakest two dimensions.·The informatization level varied between CHSCs. The score of weighted linear complicated method ranged from 71.55 to 35.87,62.07% of these CHSCs were scored between 40 and 60.·There were variances between CHSCs from different area type groups. By the mean level, the urban group was the best and the rural group was lowest. When the centers were divided to three groups by K-means cluster analysis, there were groups including good, moderate and weak. Also there were variances between CHSCs from these different level groups. The mean standardized score of six dimensions of good level group were the best, and which of the weak level group were the lowest.·When compared the diverse topics, it showed that the mean standardized score of organization support, planning support, financial support, information security regulation, work efficiency improvement were higher, and that of development and application level of electronic health record (HER), informatization level of comprehensive administration, informatization level of special applications in CHSC, integration and sharing of data, information security arrangement, improvement of work flow were lower.·We made the comprehensive evaluation by weighted linear complicated method, Topsis method and Rank Sum Ratio(RSR) method for ranking. We combined the comprehensive evaluation results by synthetical evaluation methods mean rank method, Borda method, Copeland method and fuzzy Borda method, and we found that the results of different evaluation methods had high consistency. Main conclusions1. The indicator system is reliable, valid and sensitive, and it can be used to evaluate the informatization level of CHSC at larger scope.2. The evaluation results show that there are large variances between different evaluation dimensions, Information system development and application, Information sharing and standardization are the weakest two dimensions, especially we should improve the development and application level of EHR, informatization level of comprehensive administration, informatization level of special applications in CHSC, integration and sharing of data..Policy recommendations1. To promote the informatization level of CHSCs in Pudong new district, the government should develop an integrated planning, unified the information standardization in CHSC, set up guidelines and classification management.2. In the future the informatization work should focus on promoting Information system development and application, Information sharing and standardization of CHSC.3. In the future we also should continually promote IT support system, IT infrastructures, IT security, IT benefit of CHSC and strengthen the informatization work of CHSCs in rural area.Contributions of this study1. This is the first study to develop an indicator system for evaluating the informatization level of CHSC in China.2. This is the first study to carry out a comprehensive evaluation of the informatization level of CHSC in China. |
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