UHPP项目成都和沈阳实施效果评价

利用访谈、小组座谈和家庭入户调查资料,对成都和沈阳中英城市卫生服务与贫困医疗救助项目实施情况进行了评价。UHPP项目通过社区卫生服务机制建设、人员培训和医疗救助等活动的开展,促进了社区卫生服务建设,提高了城市贫困人群卫生服务利用,降低了贫困人群医疗经济负担,探索了以社区为基础的城市医疗救助机制,为全国发展社区卫生服务和开展医疗救助提供了经验。     

贫困农民医疗救助实施效果评价;

目的:评价武陟县贫困农民医疗救助的实施效果。方法:通过医疗救助覆盖率、基金筹集和使用情况以及救助对象受益情况等,比较中国农村卫生发展项目(卫Ⅺ)实施前后武陟县医疗救助实施情况。结果:从2006年到2010年,医疗救助覆盖率从2.70%增加到4.17%,基金总量从89.25万元增加到559.30万元,救助对象人均救助额从54.57元增加到206.03元。次均住院救助费用从2007年的1 360.51元下降到2010年的895.74元。结论:贫困农民医疗救助的可及性和公平性得到改善,但医疗救助保障水平还较低,应建立多元化的筹资机制,逐步提高医疗救助保障水平。     

城市贫困人群医疗救助效果评价及影响因素分析

目的 了解A、B、C、D、E、F等6试点城市贫困人群医疗救助实施效果,并探讨影响城市医疗救助的因素.方法 用分层抽样的方法对1116名贫困市民进行入户调查.结果 救助前后相比,市民就诊率、就诊次数、就医机构、患病采取的处理方式、应住院未住院5个方面的差别有统计学意义(P＜0.05);人均医疗支出、两周家人患病次数、对救助政策知晓程度、门诊起付线高低、救助是否方便、家人健康状况是影响市民利用医疗救助的主要因素(P＜0.05).结论 尽快完善城市医疗救助制度,提高城市贫困人群卫生服务的可及性.     

城市贫困居民住院医疗救助利用影响因素研究

目的:探索城市贫困居民住院医疗救助利用的影响因素,促进医疗救助服务利用。方法:以6个城市1053户贫困居民入户调查数据为基础,综合运用卡方检验和非条件Logistical回归分析住院医疗救助利用的影响因素。结果:受访居民自述健康状况、月人均医疗支出、救助政策知晓程度、住院救助病种范围和住院救助起付标准等因素对住院医疗救助的利用具有显著性影响。结论:贫困居民对住院医疗救助的利用既受到医疗救助相关政策的直接限制,又受到医疗服务利用相关影响因素的影响。取消住院医疗救助病种范围限制和起付线,加强救助政策宣传将有助于贫困居民对住院医疗救助的利用。     

特困家庭医疗救助对贫困家庭就医行为的影响分析

通过对重庆黔江区210户扶贫户和163户非扶贫户的入户调查资料的比较研究,分析了卫Ⅵ项目特困家庭医疗救助对贫困家庭就医的影响,得出了特困医疗救助可以提高贫困家庭对妇幼卫生服务的利用率、有效控制不合理的卫生费用、减少妇幼卫生领域的不公平现象等结论,总结了黔江区卫Ⅵ项目特困家庭医疗救助工作的经验和教训,提出了利用财政转移手段建立特困医疗救助等建议.     

城市医疗救助家庭健康改善影响因素的调查与多元分析

目的 探讨城市医疗救助家庭健康改善的主要影响因素,为城市医疗救助制度长效机制的发挥提供依据.方法 采用多阶段抽样方法 ,利用全国6个试点城市1116户贫困家庭的调查资料.用因子分析法找公因子,然后对公因子进行逐步Logistic回归分析确定主要影响因子.结果 影响城市贫困家庭健康改善的主要因素依次是医疗救助实施因子、医疗救助需求因子、家庭健康因子、医疗救助政策知晓因子和家庭经济状况因子等.结论 城市贫困家庭健康状况不容乐观.我们应该针对5个公因子包含的因素,做好医疗救助工作,保障贫困居民健康改善取得更快进展.     

特困家庭医疗救助对贫困家庭就医行为的影响分析

通过对重庆黔江区210户扶贫户和163户非扶贫户的人户调查资料的比较研究,分析了卫Ⅵ项目特困家庭医疗救助对贫困家庭就医的影响,得出了特困医疗救助可以提高贫困家庭对妇幼卫生服务的利用率、有效控制不合理的卫生费用、减少妇幼卫生领域的不公平现象等结论,总结了黔江区卫VI项目特困家庭医疗救助工作的经验和教训,提出了利用财政转移手段建立特困医疗救助等建议。     

医疗救助试点城市贫困人群疾病经济风险分析

目的 了解试点城市不同贫困人群的疾病经济风险,为完善城市贫困人群医疗救助政策提供科学依据.方法 利用多阶段抽样方法调查了1 116户城市贫困市民,对调查资料进行疾病家庭经济风险和特定人群疾病经济风险测量分析.结果 有240户家庭属于疾病经济高风险家庭:75岁以上的人群和月收入在200元以下的人群疾病经济风险度最高.结论 75岁以上的老人和月收入在200元以下的人群是城市医疗救助的重点对象.     

社区卫生服务在城市医疗救助中的作用分析

分析社区卫生服务在城市医疗救助中的作用、责任和需要的外部环境，对于探索城市卫生服务和贫困医疗救助新的机制与模式，制定和完善项目市贫困医疗救助方案有重要意义。     

沈阳中英城市贫困人群医疗救助项目的作用和影响

2003年8月1日中英城市社区卫生服务与贫困救助项目（UHPP）在沈阳市铁西区、和平区实施，其中医疗救助项目资金，在3个资助年内为每年金额200万，来自UHPP项目DfID专项资金和当地政府的配套资金．专门用于对当地的贫困人群进行医疗救助。沈阳的中英UHPP项目的医疗救助，主要针对沈阳市铁西、和平两区有明确界定和认定的人均收入为220元低保人群进行医疗救助。下面我们以铁西区为例．分析中英城市贫困人群医疗救助项目的作用与影响。     

关于项目评价有关理论问题的思考

该对项目评价的目的、定义、分类、设计等理论问题进行探讨,特别对其中的“项目”的定义、划分及理论进行了比较详细的阐述。作结合项目评价的实践提出：项目评价的设计模型要根据实际情况而定;项目评价研究与其他研究最大的区别在于研究的目的,而非研究方法。评价不仅要掌握项目评价的技术方法,而且要充分了解项目的目的、背景、内涵和项目理论。     

The dissemination of a smoking cessation program to 23 antenatal clinics: the predictors of initial program adoption by managers

Objective: To investigate whether the method of dissemination, antenatal clinic practice norms for smoking intervention and subjective evaluation of the attributes of a new smoking cessation program are associated with a nurse unit manager's initial decision to adopt the new program.
Method: Twenty-three hospital clinics were randomly allocated to two groups which received the program either by simple or intensive dissemination methods. Simple dissemination involved a mailout of the 'Fresh Start' program and intensive dissemination involved a mailout which was enhanced by personal contact with midwifery facilitators who provided support and training for the program. It was hypothesised that intensive dissemination would improve program adoption compared to simple dissemination. It was also hypothesised that managers' perceptions of the program and clinic smoking intervention practice norms would predict program adoption. A hierarchical regression analysis was used to examine the association between these variables and the adoption of program components.
Results: The results indicated that the method of dissemination and the managers' perceptions of the program are significant predictors of program adoption.
Conclusions: Although clinic practice norm for smoking cessation education is not a significant predictor of program adoption, it appears to mediate managers' perceptions of the program.     

The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation-the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation-the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that "build in" adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.     

The impact of including incentives and competition in a workplace smoking cessation program on quit rates.

PURPOSE: To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. DESIGN: A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksite. SETTING: The study was conducted from 1990 to 1991 at three aerospace industry worksites in California. SUBJECTS: All employees who were current, regular tobacco users were eligible to participate in the program offered at their site. INTERVENTION: The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program. MEASURES: Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period. RESULTS: The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent-programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs. CONCLUSIONS: Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.     

THE EFFECTIVENESS OF A PRECEPTORSHIP MODEL IN POSTGRADUATE EDUCATION FOR RURAL NURSES

ABSTRACT: This retrospective study was designed to evaluate the effectiveness of a preceptor program in meeting the needs of first-year graduate nurses employed in a large rural hospital. In particular, this project aimed to assess whether the program leads to improvement in the clinical skills of the graduate over the 12-month period of the program: the suitability of the program to meet the graduates' needs; and the perceptions of nursing unit managers, preceptors and enrolled nurses regarding the program. Questionnaires were designed and distributed to the above categories of nurses, as well as graduates. Results indicated that the graduates considered the program to be excellent and that it met their needs to a high degree, while the clinical nurses rated the program, between adequate and good. The paper will define the strengths and limitations of the program and the effect on recruitment and retention of nurses in a rural area.     

Subjective outcome evaluation of the Project P.A.T.H.S.: findings based on different datasets

A total of 216 schools participated in the Project P.A.T.H.S. in the 2008/2009 school year. After completion of the Tier 1 Program, subjective outcome evaluation data were collected from 3274 program implementers. Based on the consolidated data with schools as units, results showed that participants had positive perceptions of the program, implementers and benefits of the program. More than four-fifths of the implementers regarded the program as helpful to the program participants. Multiple regression analysis revealed that perceived qualities of the program and the program implementers predicted perceived effectiveness of the program. Grade differences were not significant, except in the perception of the program for the Secondary 1 and Secondary 3 programs. The present study provides additional support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.     

Optimal investment in HIV prevention programs: more is not always better

This paper develops a mathematical/economic framework to address the following question: Given a particular population, a specific HIV prevention program, and a fixed amount of funds that could be invested in the program, how much money should be invested? We consider the impact of investment in a prevention program on the HIV sufficient contact rate (defined via production functions that describe the change in the sufficient contact rate as a function of expenditure on a prevention program), and the impact of changes in the sufficient contact rate on the spread of HIV (via an epidemic model). In general, the cost per HIV infection averted is not constant as the level of investment changes, so the fact that some investment in a program is cost effective does not mean that more investment in the program is cost effective. Our framework provides a formal means for determining how the cost per infection averted changes with the level of expenditure. We can use this information as follows: When the program has decreasing marginal cost per infection averted (which occurs, for example, with a growing epidemic and a prevention program with increasing returns to scale), it is optimal either to spend nothing on the program or to spend the entire budget. When the program has increasing marginal cost per infection averted (which occurs, for example, with a shrinking epidemic and a prevention program with decreasing returns to scale), it may be optimal to spend some but not all of the budget. The amount that should be spent depends on both the rate of disease spread and the production function for the prevention program. We illustrate our ideas with two examples: that of a needle exchange program, and that of a methadone maintenance program.     

数据包络分析模型在艾滋病母婴传播评价中应用

目的以预防艾滋病母婴传播项目为例,探索数据包络分析方法在公共卫生项目技术效率评价中的应用。方法采用包含不可控因素的数据包络分析(DEA)模型,以县为单位,测算85个项目县预防艾滋病母婴传播项目人类免疫缺陷病毒(HIV)检测工作的技术效率和规模效率。结果85个预防艾滋病母婴传播项目县(HIV)检测工作的纯技术效率值平均为0.590,纯技术效率值为1的项目县共有11个,效率值最小为0.160,部分项目县属于技术效率较低的情况。85个项目县的规模效率值平均为0.884,规模效率值为1的项目县有6个,规模效率值最小为0.147,绝大多数项目县规模效率值0.8。结论包含不可控因素的DEA模型很好地解决了不可控因素对生产过程产生的影响及各决策单元(DMU)不可比的问题,消除了DEA在公共卫生应用领域的阻碍,可指导公共卫生项目管理尤其是绩效评价。