Research On The Performance Evaluation Index System Of County Medical Institutions Under The Background Of Healthcare System Reform

Background: Since China began to deepen the medical and healthcare system reform and clearly put forward to strengthen the performance evaluation of public hospitals from 2003, in order to timely find problems and correct it, timely adjust the direction of policy, reasonably distribute medical resources, strengthen the supervision of the key aspects of the medical service and provide secure, effective, high-quality, cheap and convenient medical service for the people, to establish a scientific, standardized and effective performance evaluation index system of county medical institutions to timely evaluate the present situation and the key point of management of county medical institutions has been an urgently solved problem. Therefore, it is necessary to combine the functions of county medical institutions and health care reform strategy with the related theories and methods to establish a set of performance evaluation index to evaluate the reality of county medical institutions in order to continuously adjust and improve the mechanism of the management and supervision, and constantly improve their own performance to guarantee their sustainable development.Objective: Based on literature review and the related theory research, this study will build the conceptual framework of county medical institutions and explain the definition of dimension; it will put forward the first draft of the performance evaluation index system of county medical institutions under the background of healthcare system reform through expert discussion; By consulting the experts and mathematical statistics analysis, it will select performance evaluation indexes for county medical institutions in line with China’s national conditions, and set the index weight coefficient.Methods: It provides the theoretical support for developing research programmes and constructing performance evaluation index system of county medical institutions by means of literature review; The indexes are screened and the performance evaluation index system is constructed by means of expert consultation and mathematical statistics analysis; The index weight coefficient is set by using the Analytic Hierarchy Process(AHP). The survey data are double entered into Epidata3.1 to construct data base. The statistical data are analyzed by using SPSS16.0.Results:(1) Based on Parson’s theory of social behavior system and combined with the domestic common dimensions of performance evaluation index system, we adjusted the PATH model and constructed the conceptual framework, including two transverse dimensions(patient-centered and public welfare-oriented) and four vertical dimensions(medical quality and safety, efficiency and benefit, staff and development), and carried out the definition of dimension.(2) Through the literature research and expert discussion, we put forward the draft of index system, including 6 first grade indexes, 26 second grade indexes and 137 third grade indexes.(3) The results about the first round of expert consultation: The positive coefficient of experts is 100%, the coefficients of the 19 experts are above 0.7, significant test of the Kendall coefficient of concordance is P<0.01, and evaluation results of experts are consistent. We identified 6 first grade indexes, 22 second indexes and 90 third indexes after the first round of expert consultation.(4) The results about the second round of expert consultation: The positive coefficient of experts is 100%, the coefficients of the 19 experts are above 0.7, significant test of the Kendall coefficient of concordance is P<0.01, and evaluation results of experts are consistent. We finally identified 6 first grade indexes, 21 second indexes and 70 third indexes.(5) The results about the third round of expert consultation: This round of expert consultation issued 19 questionnaires, 15 valid questionnaires were recovered, the effective recovery rate was 78.95%; It showed that the vast majority of judgement matrixes’ random consistency ration(CR) was less than 0.1 by using Analytic hierarchy process(AHP) to calculate. It means that the judgement matrixes have satisfactory consistency, and their weight coefficients are logical and can be used.Discussions:(1) This study has sufficient theoretical basis and it is consistent with domestic counterparts in the aspect of the dimension of design process. And all of these ensure the scientific and systematic dimension of the index system.(2) This study adopted a three-grade index system, which could effectively avoid the level of complexity of index tree, operational security index system. And it ensured the operability of index system.(3) The established indexes have strategic orientation, systematization and representative.(4) The selected experts have higher authority and representation in the process of expert consultation. Two rounds of expert consultation received the better positive coefficients and authority coefficients of experts and experts’ advice were more consistent. Therefore, all of these ensured the reliability of expert consultation and the quality of the research. However, this study only used subjective method to screen indexes, and the research group needs to conduct empirical research on the index system in the next step and further examines the structure validity and the acceptance in the process of practical application.(5) The advantage of using AHP to calculate the index weight is obvious.Conclusion: Through three-round of expert consultation, we identified a set of performance evaluation index system of county medical institutions under essential medicines system by basing on the Parson’s behavior theory of social system of PATH model and using methods of literature review, expert consultation, mathematical statistics analysis and Analytic Hierarchy Process(AHP). This index system is patient-centered, public welfare-oriented and taking the continuous quality improvement as the goal. And it ultimately involved 6 first grade indexes, 21 second grade indexes and 70 third grade indexes.