Comprehensive evaluation of the implementation of close-type county medical alliance in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method.

Background: To improve the capacity of county medical and health services, China encourages all localities to pilot the close-type county medical alliance. In Shandong Province, medical alliances have been piloted in 47 counties, ranking first in the country. The objective of this study is to comprehensively evaluate the implementation of close-type county medical alliance in Shandong Province, identify the differences between different county regions, and analyze the reasons, so as to provide a reference for the construction of a new county medical and health service system with clear goals, powers and responsibilities, and division of labor.

Methods: The implementation of the close-type county medical alliance was comprehensively evaluated in 47 national pilot counties in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method. Variance analysis was used for comparison of the comprehensive evaluation results.

Results: The weight coefficient of evaluation indicators was highest for information interconnection, at 18.06%, and lowest for orderly referral of patients, at 3.64%. There was no difference in results of the comprehensive evaluation of entropy weight TOPSIS method and non-integer rank sum ratio method. Comprehensively order the implementation status of each pilot county according to the relative paste progress, 13 counties Y₅, Y₁₁, Y₁₄, Y₁₆, Y₂₀, Y₂₅, Y₂₆, Y₂₇, Y₂₈, Y₃₂, Y₃₃, Y₄₀ and Y₄₂ were ranked highest, whereas county Y₃₇ was ranked lowest. Non-integer rank sum ratio method graded counties into three grades: excellent, good and average. Kruskal-Wallis nonparametric test showed that the difference between the grades was statistically significant (H[Formula: see text]37.099, p[Formula: see text]0.001). Variance analysis based on comprehensive evaluation results showed that implementation status was not correlated with the county economic development level, the level of health resources input and the medical service ability of the lead hospital.

Conclusions: Our findings indicated that the implementation of the close-type county medical alliance is significantly different between pilot counties, with a marked differentiation within the same urban area. Therefore, effective measures are recommended to reduce this gap, including promoting informatization empowerment of the county medical community, strengthening government responsibility and improving policy effectiveness.