A Comprehensive Evaluation Model And Its Application On The Chronic Disease Control Priority In Community

Objective:To determine the priority intervention of chronic diseases and allocate the limited health resources in community reasonably,we establish a comprehensive evaluation model of the chronic disease control priority in community,and explore its effectiveness in a community in Guangzhou.Methods:1.Establish a comprehensive evaluation model of the chronic disease base on basic priority rating model(BPR) by analyzing literature.And setting the details of four parameters(A.B.C&D) about the model.2.A community in Guangzhou was selected for this research as an example to validate the model.(1)By analyzing the electronic health records,10 major chronic diseases with the highest prevalence rates in the community residents in 2013 were served as the object of evaluation.(2)By assessing the prevalence rates of each diseases,we got the value of A-parameter in the model.(3)By assessing the total economic loss and disability adjusted life years(DALY) of each diseases,we got the value of B-parameter in the model.(4)By assessing the degree of interventions of each diseases,we got the value of C-parameter in the model.(5)By assessing the BPR of each diseases,we got the ranking of diseases which should be controlled prior.Results:1.Analysised by single disease,the prevalence of chronic diseases top 10 during the community residents in 2013 were:hypertension diseases(49.38‰),chronic gastroenteritis(15.01‰),rheumatoid arthritis(12.30‰),diabetes mellitus(10.91‰),peptic ulcer(8.83‰), chronic bronchitis(8.71‰),cerebrovascular2.diseases(8.17‰),intervertebral disc disorders(5.06‰),ischaemic heart diseases(4.32‰),cholelithiasis and cholecystitis(4.18‰).3.DALY loss of 10 major chronic diseases were followed by cerebrovascular diseases(1146.98 years),ischaemic heart diseases(897.36 years),chronic bronchitis(514.05 years),hypertension diseases(369.31 years),diabetes mellitus(355.62years),rheumatoid arthritis(178.80 years),chronic gastroenteritis(112.70years),cholelithiasis and cholecystitis(108.58 years),peptic ulcer(53.07years),intervertebral disc disorders(39.69 years).4.Total economic loss of 10 major chronic diseases were followed by hypertension diseases(391.59 million yuan),rheumatoid arthritis(35.15 million yuan),peptic ulcer(27.48 million yuan),cerebrovascular diseases(26.16 million yuan),diabetes mellitus(24.39 million yuan),chronic gastroenteritis(22.63 million yuan),chronic bronchitis(16.74 million yuan),intervertebral disc disorders(15.89 million yuan),cholelithiasis and cholecystitis(15.46 million yuan),ischaemic heart diseases(5.90 million yuan).5.The degree of interventions of 10 major chronic diseases were followed by hypertension diseases(8.68),diabetes mellitus(8.15),rheumatoid arthritis(7.43),cerebrovascular diseases(7.41),intervertebral disc disorders(6.92),ischaemic heart diseases(5.84),chronic gastroenteritis(5.68),chronic bronchitis(5.51),cholelithiasis and cholecystitis(5.44),peptic ulcer(5.19).6.The BPR of 10 major chronic diseases were followed by hypertension diseases(75.23),diabetes mellitus(54.33),cerebrovascular diseases(51.87),rheumatoid arthritis(47.06),chronic bronchitis(34.90),ischaemic heart diseases(31.15),chronic gastroenteritis(30.29),intervertebral disc disorders(27.68),peptic ulcer(25.95),cholelithiasis and cholecystitis(23.57).Conclusions:After analyzing documents,a comprehensive evaluation model of the chronic disease base on basic priority rating model(BPR) was first established and proved feasible and effective in community.Disease control priority could be quantitativeanalyzed by basic priority rate.BPR=[(A+B)C]D/3.A-parameter in the model was described the size of the problem and involved the prevalence rates of chronic diseases;B-parameter in the model was described the seriousness of the problem and involved the total economic loss and disability adjusted life years caused by chronic diseases.C-parameter in the model was described the degree of interventions of chronic diseases,composed of three sub-criteria:economy,efficiency and receptivity;D-parameter in the model was described as PEARL including propriety,economics,acceptability,resources and legality.