Differences of Community Health Service Quality Evaluation in China and Abroad：a Systematic Review
In China, the assessment of community health services has been increasingly valued as the development of such services advances, but relevant research is still at the exploratory stage. Therefore, establishing a community health service quality evaluation system suitable for China's national conditions is critical to domestic development of such services.
To perform a review of studies about community health service quality evaluation in China and abroad to identify the similarities and differences in terms of assessment perspectives and contents between them, providing theoretic evidence for further implementation of such evaluations in China.
Studies regarding community health service quality evaluation were systematically searched in databases of China National Knowledge Infrastructure, CQVIP, Wanfang and PubMed from inception to October 15, 2020. Two researchers performed literature screening, data extraction, and comparative analysis of community health service quality evaluation at home and abroad by assessment perspectives and contents, separately. Descriptive analysis was used to analyze the comparative results.
In total, 62 articles in English, and 16 articles in Chinese were included, among which 10 in English and 7 in Chinese evaluated the quality of community health services in terms of the major factors of features of community health services (first contact, humanization, accessibility, continuity, coordination and comprehensiveness) . The top 3 highlights of these 10 foreign articles were coordination (7/10) , humanization (6/10) and accessibility (5/10) , while those of 7 domestic articles were humanization (6/7) , comprehensiveness (4/7) and accessibility (4/7) . Fifty-two articles in English and 9 articles in Chinese assessed the quality of specific community health services, and these foreign articles mostly focused on the management of chronic diseases〔type 2 diabetes (12/52) , cardiovascular and cerebrovascular diseases (11/52) , hypertension (7/52) , respiratory diseases (7/52) , chronic kidney disease (5/52) 〕, followed by the use of antibiotics (5/52) , cancer screening (5/52) , medication safety (5/52) , child health care (5/52) and geriatric care (5/52) , while domestic articles mostly focused on the management of chronic diseases〔type 2 diabetes (3/9) , hypertension (3/9) 〕, and maternal health management (3/9) .
The quality of community health services is increasingly valued by relevant academic circles. Compared to foreign studies, domestic studies are far less concerned about first contact and coordination, and the assessed specific services in which are not complete, with no quality assessment of diagnosis and treatment of common diseases and frequently-occurring diseases. It is suggested to address the above-mentioned issues to promote the community health service quality evaluation, and improve the depth and breadth of relevant research, thereby the community health service quality evaluation system could be improved constantly.
Exploration of Primary General Medical Care Quality Management：a Case Study of Shanghai General Practice Clinical Quality Control Center
The general medical care quality management system plays an essential and key role in assuring the quality of general medical care and patient safety in primary care settings. There are no unified criteria and methods for assessing the primary general medical care quality, and rare relevant quality improvement research and practical explorations in China.We reviewed the primary general medical care quality management nationwide, and highlighted the problems, then particularly detailed the three-year (2018—2020) implementation status and achievements of Shanghai, in which the primary general medical care quality was managed by Shanghai General Practice Clinical Quality Control Center (hereinafter referred to as Quality Control Center) in an exploratory way. And the management actions taken by the quality control center were as follows: defining the organizational objectives and tasks; developing the organizational framework and allocating workers; establishing municipal-and district-level organizational networks and operational systems for primary general medical care quality control; developing the inspection indicators for assuring primary general medical care quality; conducting an annual investigation of the general medical care in each of the primary care settings in Shanghai, and providing targeted guidance as well as supervision. The actions of the Quality Control Center provide strong support for quality improvement and safety assurance of primary general medical care. And the practical explorations of the Quality Control Center could be a reference for improving primary general medical care quality management nationwide. To improve the primary general medical care quality management at the naitonal level, which is still in its early phase, we put forward four recommendations: improving the development of the organization system, developing a scientific system for assessing the primary general medical care quality, comprehensively and dynamically carrying out quality controlsupervision regarding primary general medical care, and strengthening the quality controlsupervision.
Quality of General Medical Care in Community Health Centers in 2019—2020：Overview and Problems Analysis
Strengtheningclinical quality control and supervision is one of the effective ways to ensure medical quality. Supervising the quality of general medical care in primary care settings in the local region could contribute to the systematical assessment of general medical care quality and identification of relevantproblems in such settings.
To analyze the supervision of quality of general medical care in Shanghai's primary care settings conducted in 2019 and 2020, and based on this, to give targeted, rational recommendations on the identified problems in quality management of general medical care.
The quality of general medical care in a cluster sample of community health centers (CHCs) of Shanghai was supervised in 2019 and 2020 by relevant experts from Shanghai's municipal and district general practice quality control departments using the Clinical Quality Control and Supervision Standards for General Medical Care in Shanghai's Community Health Centers (hereinafter referred to as CQCSS) developed by Shanghai General Practice Clinical Quality Control Center. In May 2021, the supervision results of the two years were analyzed using descriptive analysis, then compared, and the identified problems were summarized and analyzed.
Two hundred and forty-three CHCs were involved in the 2019 supervision, and 244 were involved in the 2020 supervision. The average total CQCSS score for 2019 was (87.32±5.97) points, and that for 2020 was (86.67±5.36) points. Compared to the results in 2019, the scores of first-level indicators of basic conditions (99.93% vs 99.80%) , staffing and determining job responsibilities of general practitioners (GPs) (93.44% vs 91.90%) , diagnosis and treatment ability of GPs (85.82% vs 85.72%) , chronic disease management ability of GPs (81.07% vs 80.95%) and scientific research and teaching levels (29.99% vs 28.87%) increased in 2020. The problems mentioned were mainly distributed in five aspects: staffing〔176 (22.03%) 〕, GPs' clinical management ability〔154 (19.27%) 〕, quality of inpatient medical records〔92 (11.51%) 〕, quality of home sickbed patients' medical records〔91 (11.39%) 〕, allocation of facilities〔91 (11.39%) 〕. In terms of the mentioned frequency, the top five problems were: ineligible senior GPs to registered GPs ratio〔84 (10.51%) 〕, poor scientific research〔84 (10.51%) 〕, less than 3.5 GPs per 1 000 residents〔61 (7.63%) 〕, unsatisfactory clinical skills〔40 (5.01%) 〕, and insufficient number of home sickbeds〔36 (4.51%) 〕.
These two years of quality control supervision has initially promoted the quality improvementof general medical care in CHCs. To further improve it, it is suggested to take actions to deepen the core essence of general medical care quality management, improve the diagnosis and treatment ability of GPs, as well as their teaching and research ability.
