Quality Assessment of Reproductive Health Centers in Chongqing, China
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概要
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Background Whether or not a health system was performing well became a subject of public debate and a hot academic issue. Efforts to improve the quality of reproductive health services in Reproductive Health Centers (RHCs) have come into practice over the past seven years in Chongqing city. Activities were implemented focusing on capacity building and performance standardization as instructed by national guidelines. However, there is currently no measurement system for evaluating the performance of reproductive healthcare. Therefore, a quality assessment system is needed to identify the performance of reproductive healthcare.Objective The objectives of this study were two-fold: first, to devise an assessment system according to the framework of a structure-process-outcomes model; second, to evaluate quality of healthcare in five RHCs using this assessment system and existing data to indicate the direction for further activities.Methods Formulation of the assessment system was based on the Structure-Process-Outcomes Model by Donabedian. Ten criteria and 20 indicators were selected as the contents of assessment based on the national guidelines and considering the importance of the contents and availability of data. The structure part included human resources, infrastructure and equipment. The process consisted of consultation, diagnosis, treatment, infection control and medical records. Outcomes involved adverse events and satisfaction. Five RHCs were evaluated using the new assessment system.Results The results for human resources, infrastructure, equipment, consultation, diagnosis, treatment, infection control, medical records, adverse events, satisfaction and total score were, respectively, as follows: the scores for RHC-A were 6, 8, 9, 10, 9, 10, 6, 8, 10, 6 and 82; for RHC-B 9, 6, 9, 10, 9, 10, 9, 7, 10, 8 and 87; for RHC-C 10, 6, 8, 10, 10, 10, 6, 10, 10, 8 and 88; for RHC-D 9, 7, 8, 10, 10, 10, 7, 7, 10, 8 and 86; and for RHC-E 9, 7, 9, 10, 10, 10, 6, 10, 10, 8 and 89, respectively. The average scores for structure, process, outcomes and total scores of the five RHCs were 24, 44.8, 17.6 and 86.4, respectively.Conclusion An assessment system was established in this study, constructed employing ten items and 20 key indicators. The items included human resources, infrastructure, equipment, consultation, diagnosis, treatment, infection control, medical records, adverse events and satisfaction. The results of evaluating five RHCs revealed consultation, diagnosis, treatment and adverse events to be the common strong points of reproductive healthcare in RHCs; equipment and medical records were the second strongest points in the five RHCs. The aforementioned items are needed to maintain good performance. Human resources, infrastructure, infection control and satisfaction showed large gaps among the five RHCs and require priority improvements.
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