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Comparison of Primary Care Services among Six Cities in Pearl River Delta, China.

机译：中国珠江三角洲六座城市的初级保健服务比较。

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摘要

Backgrounds: China's current healthcare reform has an overall goal towards re-strengthening primary care. Establishment and expansion of primary care network based on community health centres (CHCs) in urban areas has been prioritized. Due to various socio-economic status of local population and policy context across urban areas in mainland China, primary care is delivered by three main organisational models: government-owned CHCs, hospital-owned CHCs, and privately-owned CHCs with each model being adopted in various localities. This PhD study focuses on studying the process of primary care provided under different CHC models in the six cities of Pearl River Delta (PRD) and it is part of a larger study entitled "A Study of Comparing Primary Care Services among Six Cities in the Pearl River Delta" funded by Bauhinia Foundation Research Centre, in which other co-investigators have studied the structure and outcome of the primary care.;Objectives: This PhD study aims to use the Primary Care Assessment Tool (PCAT) within Donabedian's framework of structure, process and outcome to measure and compare the quality attributes of primary care from patient's perspective under different CHC models in the six cities of PRD where each city has different responses to the national policy for delivering primary care services.;Methods: A comprehensive literature search was conducted to review the utilization of PCAT both globally and locally. The PCAT - Adult Edition (short version) was translated into Mandarin Chinese following an internationally recognized procedure and was cross-culturally adapted into Chinese context. The reliability and validity of the PCAT instrument were evaluated through test-retest approach, exploratory factor analysis, and internal consistency reliability analysis. Multistage cluster sampling method was adopted to select CHCs in the six cities of PRD. All interviews were conducted on-site by trained interviewers. Statistical analysis including multiple linear regression and multivariate analysis of covariance were used to assess and compare the quality attributes of primary care (PCAT scores) provided by different organisational models of CHCs in the six cities of PRD.;Results: The Mandarin Chinese version of PCAT-AE (short version) contains nine primary care scales with good construct validity. Cronbach's alpha within all the nine primary care scales achieved moderate to high internal consistency reliability. A total number of 3,360 adult primary care service users were surveyed on-site at CHCs with an overall response rate of 86.1%. Descriptive city-by-city analysis based on the PCAT scores was conducted to depict primary care process in each of the six cities. Primary care service users under government-owned CHC model reported receiving better primary care experiences than those under privately-owned CHC model and hospital-owned CHC model, largely because of the greater achievements in first contact utilization and better score in the coordination domain (information system).;Conclusions: The Mandarin Chinese version of PCAT-AE (short version) was found to be reliable and valid as a measure of primary care in mainland China from patients' perspective. The study suggested that the government-owned CHCs had better quality attributes than other organisational models, and offered a direction for quality improvement in the five domains of primary care.
机译：背景：中国目前的医疗改革的总体目标是重新加强初级保健。在城市地区优先建立和扩大基于社区保健中心的初级保健网络。由于中国大陆各地城市人口的社会经济状况和政策背景各异，初级保健由三种主要的组织模式提供：政府拥有的社区卫生中心，医院拥有的社区卫生中心和私人拥有的社区卫生中心，每种模式都被采用在各个地方。该博士研究的重点是研究珠江三角洲（PRD）六个城市在不同CHC模式下提供的初级保健过程，它是一项较大的研究的一部分，该研究名为“珠三角六座城市之间的初级保健服务比较研究” “河三角洲”由紫荆基金会研究中心资助，其他合作者在其中研究了初级保健的结构和结果。；目标：本博士研究旨在在Donabedian的结构框架内使用初级保健评估工具（PCAT），过程和结果，从珠三角六个城市的不同CHC模式下，从患者的角度衡量和比较初级保健的质量属性，每个城市对提供初级保健服务的国家政策都有不同的反应。进行了审查PCAT在全球和本地的使用情况。 PCAT-成人版（简短版）按照国际认可的程序翻译成普通话，并且跨文化适应了中国语境。通过重新测试方法，探索性因素分析和内部一致性可靠性分析来评估PCAT仪器的可靠性和有效性。采用多阶段整群抽样的方法来选择珠三角六个城市的社区卫生中心。所有采访均由训练有素的访问员在现场进行。统计分析包括多元线性回归和协方差的多元分析，用于评估和比较珠三角六市不同社区卫生服务中心组织模式提供的初级保健的质量属性（PCAT评分）；结果：PCAT的中文版本-AE（简短版本）包含九种具有良好结构效度的初级保健量表。在所有九个初级保健量表中，克朗巴赫的alpha值均达到了中度到高度的内部一致性可靠性。在社区卫生服务中心对3360名成人初级保健服务用户进行了现场调查，总答复率为86.1％。进行了基于PCAT评分的描述性城市分析，以描述六个城市中每个城市的初级保健过程。与私有CHC模式和医院CHC模式相比，政府拥有的CHC模式下的初级保健服务用户报告获得了更好的初级保健体验，这主要是因为首次接触者取得了更大的成就，并且在协调领域得分更高（信息结论：从患者的角度来看，普通话版本的PCAT-AE（简短版本）被认为是衡量中国大陆初级保健水平的可靠和有效方法。该研究表明，政府拥有的社区卫生服务中心比其他组织模式具有更好的质量属性，并为改善初级保健五个领域的质量提供了方向。

著录项

  • 作者

    Wang, Haoxiang.;

  • 作者单位

    The Chinese University of Hong Kong (Hong Kong).;

  • 授予单位 The Chinese University of Hong Kong (Hong Kong).;
  • 学科 Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 296 p.
  • 总页数 296
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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