Research On The Evaluation Of The Implementation Effect Of Hierarchical Healthcare Of Urban Primary Health Care Institutions In Wuhan City

[Purpose]The purpose of this study is to evaluate the implementation effect of hierarchical healthcare of urban primary health care institutions.The "result chain" theoretical model and the combined evaluation method are used to construct the evaluation index system to evaluate the effect of hierarchical healthcare in urban primary health care institutions.On this basis,comprehensive evaluation methods are used to evaluate the implementation process and effect of hierarchical healthcare of urban primary health care institutions.In addition,the cognition and evaluation of hierarchical healthcare by urban grassroots medical staff is analyzed.In order to discover the obstacles to hierarchical healthcare of urban primary health care institutions in Wuhan,and put forward policy recommendations.[Methods](1)Literature research: Using literature analysis method to study domestic and foreign literatures,policy documents and quantitative data such as health annual report to summarize the current status of hierarchical healthcare in Wuhan and the realization of the key role of urban primary health care institutions in the hierarchical healthcare system,and determine the evaluation framework and comprehensive evaluation methods for hierarchical healthcare of urban primary health care institutions.(2)Empirical research: This study adopts multi-stage stratified proportional random sampling method to extract 35 primary health care institutions from 4 sample areas in Wuhan.Using the collection of existing data,regional questionnaire,institutional questionnaires,medical personnel questionnaires and semi-structured interviews of the insiders to collect the qualitative and quantitative data needed for the study.(3)Expert consultation: In this study,15 experts engaged in hierarchical healthcare administration and study are selected for expert consultation to establish the final framework of the evaluation index system for the effect of hierarchical healthcare of urban primary health care institutions.(4)Entropy weight method: In order to reduce the subjectivity of expert opinions,the entropy weight method is used to determine the weight of each index in the evaluation index system for the effect of hierarchical healthcare of urban primary health care institutions.(5)Descriptive statistical analysis: Sorting the collected data.Descriptive statistical analysis methods are used in the analysis of support situation and various work developments of hierarchical healthcare.Descriptive analysis and univariate analysis methods are used in the analysis of medical staff's cognition and evaluation of hierarchical healthcare.(6)Comprehensive evaluation: TOPSIS method,RSR method and the weighted fuzzy combination of both methods are used to evaluate the implementation effect of the hierarchical healthcare of urban primary health care institutions in Wuhan city.[Results](1)Index system construction results: This study uses the method of combined empowerment to construct an evaluation index system for the implementation effect of the hierarchical healthcare of urban primary health care institutions,including 4 first-level indicators,11 second-level indicators,and 20 third-level indicators.The weights of the firstlevel indicators are: input(0.5081),activity(0.3882),output(0.0726),and result(0.0312).(2)Main results of the comprehensive evaluation: Since the implementation of hierarchical healthcare,the allocation of primary health care resources in Wuhan has been optimized,the basic medical and health service capabilities have been improved,and the hierarchical healthcare related work continued to advance.In addition,the comprehensive evaluation results of three methods are consistent: that is,from 2015(the year before the reform)to 2018(two years after the reform),the comprehensive evaluation scores are getting higher and higher,indicating that the comprehensive effect of hierarchical healthcare of urban primary health care institutions in each sample district of Wuhan is improving year by year.(3)Cognitive and evaluation analysis results of urban grassrootsm edical staff: The 2308 medical staff questionnaires collected were analyzed,and it was found that the respondents in the central city are more likely to accept the first-level consultation in primary health care institutions and have higher evaluation of the ability of these institutions.Relevant trainings for medical guidelines or norms need to be strengthened;female,retired personnel,medical staff with a working life of 5 years or less,and an average monthly income of 4,000 yuan or less in the past three months have a higher overall evaluation of the effect of hierarchical healthcare of urban primary health care institutions.[Conclusions](1)Hierarchical healthcare plays an important role in improving the ability of urban primary health care services.Since the implementation of hierarchical healthcare in Wuhan,the number of primary health care institutions and personnel have been continuously optimized,and the standardization rate of primary health care institutions has increased.It also has participated in the construction of close medical alliances,providing telemedicine services,and establishing classified medical information systems from nothing.(2)An efficient hierarchical healthcare service system of Wuhan has not yet been formed.First,the orderly medical treatment pattern has not yet formed.The crowding effect of hospitals on the source of medical care in primary health care institutions is still significant;Second,the two-way referral mechanism is still not perfect.The core interests of the referral agencies are urgently needed to be solved;Third,insufficient resource allocation and insufficient utilization of primary healthcare institutions;Fourth,insufficient allocation of grassroots health human resources and lack of perfect performance appraisal and compensation mechanism;Fifth,medical alliance construction,medical insurance and medical policies are not significant for hierarchical healthcare of primary health care institutions.(3)It is recommended to establish a primary diagnosis system for grassroots diseases and strengthen the first consultation at the grassroots level.Focusing on the construction of talent team and innovative service model as the core to improve the level of primary medical capability.Establishing a synergy mechanism between the medical insurance and the medical alliance to balance the interests of both referrals.Strengthening the grassroots financial compensation mechanism,medical insurance system,drug policy and other relevant policies to promote the overall synergy of hierarchical healthcare of primary health care institutions.Through the joint efforts of all parties to enhance the trust of patients to primary health care institutions,and actively guide patients to have sevice in these institutions.