Study On Service Capacity Evaluation Of County Level Maternal And Children's Healthcare(MCH)Institutes That Had Department System Reformed

Objective To understand the current situation,distribution differences and changing trend of the county level maternal and child health care(MCH)institutes that had department system reformed.At the same time,explore to establish a set of county level maternal and child health care service capacity evaluation index system suitable for the department system reformed,and comprehensive evaluation of the service capabilities of the institutions currently undergoing reformMethods 1.Using the monitoring data of MCH institutes to conduct a descriptive analysis of the resource allocation,operation and service provision of the county level MCH institutes that had department system reformd,and conducts a longitudinal comparative analysis between institutions to understand the trend of changes in the reformed institutions2.In this study,the evaluation indexes of service capacity of MCH institutes are selected and weighted by combining subjective and objective methods to form the final evaluation index system.In the selection of indicators,a preliminary evaluation indicator system was established through expert consultation,and then mathematical indicators such as correlation coefficient method,cluster analysis,principal components and factor analysis methods were used to further select indicators.In index weighting,the subjective weight of the index was determined by expert scoring,and the objective weight of the index was determined by the CRITIC method,and the final weight of the index was determined by the combination of the two.The weighted TOPSIS method and the weighted rank sum ratio method were used to rank the service capabilities of institutions that had department system reformed,and finally the two results were combined to obtain a comprehensive organization ranking,and the ranking results of individual provinces were verfied by experts.Results 1.Analysis of the status quo of county level MCH institutes reformed in the country:(1)In 2018,there were 2699 county level MCH institutes in the country,of which 295 county level MCH institutes met the reforme standars of this study.In terms of institutional resources and operating conditions,the average number of health technicians in reformed institutions was 163,among them,the department of maternal health accounted for the largest proportion(26.4%),followed by the department of child health(22.2%);The average area of purchase and construction business of reformed institutions was 9062m2,and the average number of equipment units with more than ten thousand yuan was 139;The average business income of the reformed MCH institutes was 31.73 million yuan,of which the department of maternal health business income accounted for more,followed by the department of child health.In terms of service provision,the average number of outpatients per year in reformed institutions was 94876,of which the child health department accounts for a large proportion(38.6%);The average number of discharged patients per year was 4208,of which the pregnancy and birth health department accounts for more(42.6%);The average number of live births in the reformed institutions was 1636,accounting for 29.4%of live births in midwifery institutions in the jurisdiction.(2)The analysis results of longitudinal changes from 2015 to 2018 show that the reformed institutions maintain a growth trend in terms of resources and operating conditions or service provision;The absolute number of each indicator is that the eastern region is better than the central and western regions,and the average annual growth rate of each indicator is that the western region higher than the eastern and central regions.2.Construction and evaluation of the service ability evaluation system of MCH institutes reformed in county level:(1)Firstly,based on the theoretical framework of"structure-process-outcome" and "input,service provision and health outcome" and refer to relevant literature,a candidate index library including 4 types of first-level indicators,14 types of second-level indicators and 69 third-level indicators was established.Then,based on the alternative indicators,design a correspondence table and consult with 16 experts.By summarizing the opinions of the experts,the number and content of the first-level indicators and the second-level indicators in the alternative indicators were unchanged,and the third-level indicators were adjusted to 62,and preliminary evaluation Index system was formed.Based on the data collected by the national maternal and child health care institutions,the indicators were screened objectively,Finally,the service ability evaluation index system of MCH institutes reformed in county level was formed,which included 3 first-level indicators,12 second-level indicators and 40 third-level indicators.The first-level indicators mainly include resource allocation,service provision and result output,and the second-level indicators include human resources,financial resources,material resources,information resources,general services,maternal health services,child health services,pregnancy and birth health services,districts maternal and child health services,service efficiency,quality improvement and economic benefits.(2)The final weight of the indicator was calculated through the combination of expert scoring and the CRITIC method.The results show that the weight of indicators such as health technicians,the number of equipment units above ten thousand yuan,the actual open bed day,and the annual growth rate of business income of the four major health departments were relatively large.(3)From the comprehensive evaluation results,the weighted TOPS IS method and the weighted rank sum ratio method Spearman rank correlation coefficient was 0.733(P<0.001),the results of the two comprehensive evaluation methods were consistent,and the combination was sorted on this basis.The results show that the top ranking institutions in the east account for more than the central and western regions,indicating that the eastern region's institutional service capacity was better than the central and western regions.(4)The comprehensive ranking results of hebei,shandong,hunan and sichuan were verified by experts.The results showed that the Kappa coefficients of hebei,shandong,hunan and sichuan were 0.367,0.550,0.727 and 0.543,respectively.The expert ranking results were moderately consistent with the theoretical ranking results of this study.Conclusions 1.The department system reformed MCH institutions of county level have a good development trend,but there were still differences among regions.The data analysis results from 2015 to 2018 show that the department system reformed MCH institutions have grown in terms of resource allocation and service capacity.The average annual growth rate of various indicators in the western region was higher than that in the central and eastern regions,but the absolute still lower than central and eastern regions.2.This study was based on the national monitoring system of MCH institutions,based on the characteristics of the department system reformd institutions,using a combination of subjective and objective methods,from the aspects of resource allocation,service provision and result output,scientifically constructed the evaluation of the service capacity of department system reformd institutions index system.By means of combination ranking,this paper sorts the MCH institutions that were currently undergoing the department system reformd,which was conducive to the comprehensive evaluation of the service capacity of MCH institutions by the health administrative departments at all levels.