| Objectives:Based on the theory of performance management and the relevant literature research,this study aims to build a community TCM preventive health service performance evaluation index system,which combines with the relevant policies,current situation and characteristics of the development of TCM preventive health services.In this study,the Data Envelopment Analysis model is used as the framework.This paper explores the status quo of service development,the gap between specific indicators and the service performance,its direction and space of improvement,and the factors affecting service performance.Finally,to summarize the reasons for the gap in the performance of community TCM preventive health services,and explore the development of targeted strategies to improve the quality of community TCM servicesMethods:(1)By using the literature analysis,this study analyzed the current situation of the community TCM preventive health services,the research progress of community health service performance evaluation,common methods and steps of index system construction,and the connotation and application scope of the Data Envelopment Analysis theory.Then to find out the shortcomings of the existing related researches,and determine the object,content,methods and research ideas of this study.(2)Adopting the Delphi Expert Consultation method,and perfecting the indicator system according to the experts'comments on the deletion and revision of the indicator system.(3)6 community health service centers(township health centers)from different administrative districts(townships)in Huzhou City,Shaoxing City and Hangzhou City,Zhejiang Province,and a total of 18 were extracted as the research objects,and we conducted the Semi-structured Interview with the heads of institutions,surveyed the residents with questionnaires.(4)By using the Factor Analysis method,we further screened the indicators of community TCM preventive health service performance evaluation index system;and compared the current situation of the community TCM preventive health services in different regions and different types of population from the perspective of supply and demand by using the Descriptive Analysis and Single Factor Analysis;evaluated the comprehensive technical efficiency,scale efficiency and pure technical efficiency of community TCM preventive health service by using the Data Envelopment Analysis method;analyzed the influencing factors of TCM preventive health service performance by using the Multiple Linear Regression Analysis.Results:Through the literature and related policy analysis,Delphi Expert Consultation method and Factor Analysis method,this study used a combination of qualitative and quantitative methods to determine a set of community TCM preventive health service performance evaluation index system that met the requirements of the Data Envelopment Analysis.1.The system evaluated the performance of community TCM preventive health services from the aspects of input and output.The input indicators included manpower input,financial input and material input.The specifics were as follows:"the number of medical staff with bachelor degree or above in the department of TCM prevention and health care of the institution","the proportion of special allocation for TCM preventive health services in government departments in the total allocation",and "the number of technical equipment for TCM preventive health service" three indicators.The output indicators were designed from three aspects:service efficiency,service efficiency and service effectiveness,included five indicators:"the ratio of the total income of TCM preventive health services accounts for the business income","the ratio of the number of outpatients in the departments of TCM prevention and health care accounts for the total number of outpatients","The ratio of traditional Chinese medicine health management services for the elderly over 65 years old","the utilization rate of residents'TCM preventive health services",and"the degree of trust of residents in community TCM preventive health services".2.The indicator system was initially applied to grassroots medical institutions in Zhejiang Province.From the perspective of the supplier,Hangzhou City had more resources for manpower,financial resources and material resources than the other two places,but the high level of doctors was relatively insufficient.The quality of full-time medical staff in Shaoxing City was high but the quantity was insufficient,there were relatively few "the number of TCM preventive health care services",and the number of "outpatients in related departments" needed to be improved,but the ratio of special income to expenditure reached 2.07,which was the highest level in the three regions.There were relatively few "specialized technical equipment" in Huzhou City,and there were some shortcomings in "the number of suitable technical service personnel for Chinese medicine practitioners"."The number of outpatients in related departments" and "the number of suitable technical service personnel for Chinese medicine practitioners" in Hangzhou City were much higher than those in the other two places.For the health management services for the elderly over 65 years old,the average service rate of the 6 communities in Shaoxing City was the highest(56.40%),and that in Hangzhou City and Huzhou City was slightly lower,41.29%and 40.00%respectively.In terms of TCM health management services for children aged 0-36 months,the average service rate of the 6 communities in Hangzhou City was the highest,reaching 66.30%,followed by Shaoxing City(59.40%)and Huzhou City(49.83%).From the perspective of the demand side,the overall awareness rate of residents'TCM preventive health services carried out by the community was 65.8%The service items that occupy the top of the utilization rate were acupuncture,massage,Chinese medicine(paste)and proprietary Chinese medicines.Residents'awareness and utilization rate of TCM health management services were very low.In terms of residents'trust,the highest score was "health care personnel",4.17 points,and the average score of the three trust evaluation items was 4.05.In terms of residents' satisfaction,the satisfaction rate of "service attitude" was the highest,with a score of 4.33 points,and the average satisfaction score of the six service evaluation items was 3.90 points3.The results of Single Factor Analysis showed that among the general demographic characteristics,the differences in the trust scores of residents with different household registration,age,education level,marital status,type of medical insurance and health self-assessment were statistically significant(P<0.05).The differences of residents'satisfaction scores of different ages,education levels and medical insurance types were statistically significant(P<0.05).Different regions have different levels of trust and satisfaction scores in all dimensions.The differences in service organization,medical staff and overall scores in the three regions of trust were statistically significant.In terms of satisfaction,the differences in service equipment,service attitudes,technology levels,service charges,service effects,and overall scores in the three regions were statistically significant.Shaoxing City scored the highest and the average scores of trust and satisfaction scores were 4.13 and 4.08 respectively.Hangzhou City ranked second with scores of 4.04 and 3.97,and Huzhou City scored lower with 3.99 and 3.91 respectively.4.The DEA analysis showed that the overall efficiency of 18 institutions is 0.922,and the overall efficiency of Huzhou City,Shaoxing City and Hangzhou City were 0.924,1.000 and 0.843,respectively.The average values of pure technical efficiency and scale efficiency were 0.987 and 0.930 respectively.There were 14 institutions that had achieved effective DEA,and 4 institutions that were not valid for DEA.The communities that failed to achieve effective DEA were shown to have reduced returns to scale.The lowest score was the DMU15 community,with a combined efficiency of 0.471.The agency only used 47.1%efficiency compared to an effective agency.5.The results of multiple linear regression analysis showed that the number of professional technical equipment and the number of outpatients in relevant departments had an impact on the overall technical efficiency and scale eff-iciency,and it was statistically significant(P<0.05).Among them,the number of professional technical equipment had a negative impact on the overall technical efficiency and scale efficiency,and the number of outpatients in relevant departments had a positive impact on the overall technical eff-iciency and scale efficiency.Conclusion:1.Based on the theory of the Data Envelopment Analysis,this study introduces the operational research methods and quantitative indicators into the performance evaluation of community TCM preventive health services,reflects the objectivity of evaluation.The combination of expert consultation method and factor analysis method ensures the scientificity of index screening.The preliminary application of the indicator system shows that the indicator system is feasible.2.According to the results of single factor analysis,the scores of trustworthiness and satisfaction evaluation of residents of the TCM preventive health services in the three cities in Zhejiang Province are 4.05±0.79 and 3.90±0.90,respectively.Residents with lower ages and higher levels of education have lower trust and satisfaction with services.The comparison between the three places shows that Shaoxing City has the highest overall score,followed by Hangzhou City.The difference in trust is mainly reflected in service organizations and medical personnel.The difference in satisfaction is mainly reflected in service equipment,service attitude,technical level,service charges and services effect.3.According to the results of DEA analysis,the efficiency of TCM preventive health care services in grassroots medical institutions in Zhejiang Province is relatively good,and the utilization eff-iciency of input resources in most communities has reached an optimal state.Shaoxing City has the highest overall eff-iciency level,followed by Huzhou City.There are 14 institutions that have achieved effective DEA,and 4 non-DEA effective institutions have excessive input in the three dimensions.The problems of insufficient output mainly focus on the outpatient volume of the TCM preventive health care service departments and the utilization rate of residents.4.According to the results of Multiple Linear Regression Analysis,the number of professional technical equipment has a negative impact on the overall technical efficiency and scale efficiency,indicating that the smaller number of professional technical equipment invested in the sample institutions surveyed,the higher the scale efficiency.In turn,the overall technical efficiency is also higher.The number of outpatients in relevant departments has a positive impact on overall technical efficiency and scale efficiency,indicating that the more outpatients in the TCM preventive health care services departments,the higher the scale efficiency,and the higher the overall technical efficiency.5.Through data analysis,this study finds that the problems existing in the current service development process are mainly reflected in:(1)there are insufficient resources in different regions;(2)Residents have low trust and satisfaction with the service environment and equipment of the institutions,and residents have lower awareness rates and utilization rates for other uncommon service types;(3)For the free service projects for the elderly over 65 years old and children aged 0-36 months,the residents'awareness and utilization are low;(4)There are still rooms for improvement in the efficiency of community TCM preventive health care services in Zhejiang Province,especially for non-effective institutions.In response to the above problems,this study has explored and formulated targeted strategies to improve the quality of community TCM services. |
PDF Full Text Request