ESTABLISHMENT AND APPLICATION OF EVALUATION INDEX SYSTEM FOR HIERARCHIC HEALTHCARE OF TRADITIONAL CHINESE MEDICINE BASED ON THE DONABEDIAN QUALITY EVALUATION MODEL

Zhiheng Zhou*, Zhijie Huang, Zeling Zhu and Jiaji Wang

ABSTRACT

Objective: To construct the evaluation tool of Traditional Chinese Medicine(TCM) hierarchic healthcare effect in primary medical institutions based on the Donabedian quality evaluation model, and to apply the developed tools to evaluate the effect of grassroots TCM hierarchic healthcare in Guangdong Province, China. Methods: The literature analysis, expert consultation and field investigation were applied to construct the evaluation model and evaluation index system based on Donabedian quality evaluation model. Through empirical research, we evaluated the effect of TCM hierarchic healthcare in Guangdong Province, south of China, insufficient and main influencing factors, and proposed management strategies. Results: The evaluation index system for hierarchic healthcare of TCM was built, which included three level 1 index (structure, process, result), 7 secondary 2 indicators (resource allocation of traditional Chinese medicine, grading work mechanism, hierarchical healthcare implementation, TCM diagnosis recognition, resource utilization of Chinese medicine, Chinese medicine service revenue, service satisfaction) and 20 level 3 indicators. The assessment found that the total number of TCM medical institutions in Guangdong province was 24,000, with 149,000 employees in TCM medical and health institutions, accounting for 12.7% of the province's total. Among primary medical institutions, 99.7% of community health service centers, 97.8% of community health service stations and 95.2% of village clinics provided TCM services, forming a "15-minute service circle" for community-level TCM. The government have invested a total of RMB 3.5385 billion to support the development of TCM. Most institutions have established implementation plans for the construction of a tiered diagnosis and treatment system, a two-way referral system, and a system for urgent and slow treatment.80.67% of the institutions have strengthened the development of at least 6 TCM technologies, and 39.33 % have applied more than 15 appropriate TCM technologies. In 2023, medical institutions in Guangdong province will provide 231 million TCM outpatient services, and promoted more than 40 TCM appropriate technologies in 10 categories. The workload per doctor in township health centers received 10.1 patients per day, while doctors in community health service centers received 20.3 patients per day. Conclusion: This study constructed a TCM hierarchic healthcare effect in primary medical institutions based on the Donabedian quality evaluation model. The evaluation results indicate that that the primary medical institutions in southern China basically have the ability of TCM services, and have formed a mechanism of hierarchic healthcare, but the implementation effect of hierarchic healthcare needs to be improved. Local health administrative departments should further improve the implementation of TCM hierarchic healthcare, so as to improve the efficiency and effect of TCM hierarchic healthcare.

Keywords: Traditional Chinese medicine, hierarchic healthcare, Donabedian model, effect evaluation.