A study on regional comprehensive performance evaluation indicator system of rational use of drugs

The current research presents the design of a 4-degree-3-level performance evaluation indicator system of rational use of drugs for health care institutions accord with the Balanced Score Card (BSC) method. Financial index, patient index, professional process index, and development and blazing new trials index are adopted in the light of scientific, guiding, operable and generalizable principles. The index weight is based on the analytic hierarchy process, and comprehensive performance evaluation indicators are calculated by a linear integrated weighting method. Its practical application in 21 state-run health care institutions in Ningbo, from 2008 to 2012, has arrived at the finding that the comprehensive performance evaluation indicator system offers a scientific, practical and effective performance management quantification and is thus worth popularizing.


Introduction
How to promote the level of medical staffs' rational use of drugs is the key link in the application of essential medicine system.Most of the previous researchers at home and abroad focus more on rational use of drugs or performance and quality evaluation on a certain level [1][2][3][4], while it is obviously insufficient in the respect of representation and completion with the abolishment of drugdependent medical policies.In order to standardize the supervision mechanism of rational use of drugs for health care institutions, it is meaningful to research so as to construct an integrative performance evaluation indicator model which can generalize and reflect the numerous elements and influential factors of rational use of drugs under the background of new medical reform.The current research presents the design of a regional comprehensive performance evaluation indicator system of rational use of drugs accord with the Balanced Score Card (BSC) method.

Subjects and methords 2.1 Subjects
21 state-run health care institutions in a certain city, China, have been chosen as subjects.Institutions' original data from 2008 to 2012 has been collected with a method of field investigation and used to calculate the actual value of evaluation indicators after proper statistical treatments.The average value of the actual data from 2008 to 2012 has been calculated to be the evaluation indicator for each health care institution.

Choice of evaluation indicators
Based on the Balanced Score Card (BSC) method, financial index, patient index, professional process index, and development and blazing new trials index have been adopted to the performance evaluation indicator system of rational use of drugs in the light of people-oriented, sustainable, policy-type, guiding, safe, operable and generalizable principles.

Calculation and standardization of evaluation indicators
(1) Calculate the index value of valuation indicator.
(2) Identify the properties of the indicators: the indicators were divided into three types: Positive Index (the higher was the better), Negative Index (the lower was the better), Neutral Index ( target the value around or on a moderate level).
(3) Calculate the standardized value: relatively process the indicator values according to the linear interpolation method [5] so as to get the standardized value.

Define the indicator weight
The Analytic Hierarchy Process (AHP) [6] was adopted to define the weight of the screening indicators on each level.

Build a mathematical model of performance evaluation indicator system of rational use of drugs
The linear comprehensive weighted index method [6] was adopted to build a mathematical model of performance evaluation indicator system of rational use of drugs.The computation formulas are as follows: ) ¦ In the above formula, Z(A i ) stands for the comprehensive index value of the performance evaluation indicator system of rational use of drugs for each health care institution.E(A i ) stands for the benchmark index of the performance evaluation indicator system for each health care institution.U(Ai) stands for the realization degree of the comprehensive index value of the performance evaluation indicator system for each health care institution.A i refers to the comprehensive evaluation indicator value of different levels.i refers to the number of health care institutions to be evaluated.j refers to the indicators of performance evaluation on each level.Z ij equals the target value (standardized value) from Ai to Z j .W j is the weight value of Z j on different levels, thus, . The regional comprehensive performance evaluation on rational use of drugs in a certain department or health care institution can thus be made as well as ranked according to the value of Z.A higher Z means a better performance management on rational use of drugs.

Data processing
The research is statistically processed with the software SPSS 16.0 for Windows.

Evaluation indicator system
The research group has put forward 103 preselected group indexes, after being screened, 36 of which have been ascertained as indexes on the infrastructure layer.Financial index, patient index, professional process index, and development and blazing new trials index have been adopted as the four dimensions, meanwhile, 4 first level index, 12 second level index and 36 third level index have been adopted as the three levels of the performance evaluation indicator system of rational use of drugs in health care institutions (Table 1).There are 8 financial indexes, 12 patient indexes, 11 professional process indexes, and 5 development and blazing new trials indexes respectively.17 positive indexes, 4 neutral indexes and 15 negative indexes have been set up according to the index attribute as well.

Actual application of the comprehensive performance indicator system of rational use of drugs in health care institutions from 2008 to 2012 in a Chinese city
The average composite performance index of rational use of drugs among 21 health care institutions from 2008 to 2012 in a Chinese city was 61.15.The average index of the U Institution was the highest 72.11 in 2012, while in the year 2009, that of the K Institution was merely 44.26 as the lowest.Judging from the average index from 2008 to 2012, the T Institution, scoring 66.84, achieved the highest composite performance index of rational use of drugs, while the B Institution only accounted for 50.23.The top three were the T Institution, the Q Institution and the E Institution in proper sequence with scores 66.84, 66.48 and 65.38 respectively.The last three were the B Institution, the K Institution and L Institution with scores 50.23, 52.15 and 55.93 in file (Table 2).

Discussion
In China, National Essential Drug System (NEDS) is an important and difficult part of the new health care reform.set up and manage an effective NEDS, a scientific and effective performance evaluation system of rational use of drugs is much needed.The research integrates experts' suggestions with the current practice of rational use of drugs in health care institutions, so as to set up a representative, guiding, practical, independent and sensitive indicator system.What's more, its practical application in 21 state-run health care institutions from 2008 to 2012 in a Chinese city, has arrived at findings accord with the operational state, which has further revealed the correctness, effects, reliability and scientific nature of the evaluation findings.Thus, being repeatable and feasible, the performance indicator system has been proven a practical and effective performance management quantization tool which is worth of populating.However, under the background of new national health care reform, it is a huge systematic project to set up a performance evaluation system of rational use of drugs for health care institutions.The various levels of health care institutions and their unique developmental characteristics have directly led to the complexity and difficulty in setting up a performance evaluation system of rational use of drugs.Despite the fact that the current research have managed to choose fewer but better indicators in an objective and overall way, we believe there are significant improvements still to be made.Abundant, repeated investigations and applications wait to be planned and then carried out step by step.Aimed at an ambition of digitalization of performance evaluation indicator system of rational use of drugs, the construction of residents' electronic health files (HER) should be progressively refined, so as to make the evaluation system a valid method in measuring the management effects of health care institutions' performance evaluation of rational use of drugs.

).Table 1 .
Comprehensive performance evaluation indicator system of rational use of drugs and its weight based on BSC

Table 2 .
Results of the performance evaluation of rational use of drugs in health care institutions from 2008 to 2012 in a Chinese city