农村公共卫生绩效评价框架研究

目的 建立农村公共卫生绩效评价框架,为改善我国农村区域公共卫生绩效提供参考依据.方法 通过文献研究、理论推导和Delphi法,构建农村公共卫生绩效评价框架,并通过Kendall协调系数W检验、卡方检验,对专家咨询结果进行相应的检验分析.结果 构建的农村公共卫生绩效评价框架包含4个概念模块、10个绩效目标和28个绩效评价指标;专家积极系数为0.889,4个概念模块的专家权威程度均值在0.681～0.715之间,指标必要性、敏感性和可操作性的Kendall W一致性系数分别为0.167,0.209和0.185,P值均＜0.01.结论 构建的农村公共卫生绩效评价框架具有一定的应用价值.开展农村公共卫生绩效评价要注重科学性和适用性.     

新西兰新的卫生系统绩效评估方法

2014年12月,新西兰卫生部公布了一项新的评估新西兰卫生系统绩效的框架。该措施有两个主要目的,一是增强对纳锐人的责任感,二是通过"整体系统"绩效评估方法来提升卫生系统各部门的绩效。这一新的框架,被称为"整体绩效与激励框架(IPIF)",因需要应运而生。新西兰需要一个绩效管理框架来反应作为一个整体的卫生系统的状况,从而促进初级和二级卫生服务提供者向着共同的目标努力,并综合地方社区的各种需求。IPIF评估指标有两个水平:一是系统指标,测量全国水平,二是地区指标,反映地区卫生机构情况。第一年,IPIF仅应用系统指标测量,并仅评估初级卫生保健服务绩效。随着时间推移,IPIF一定会不断发展,并逐步覆盖卫生系统较大的范围。IPIF在改善卫生系统绩效方面的成功关键取决于卫生部门员工能密切参与绩效评估过程的意愿。     

浅析疾控机构绩效评估过程及对存在问题的思考

目的浅析疾控机构绩效评估中存在的问题,为更好的开展绩效评估工作提供依据。方法综述绩效评估工作产生的背景、目的、标准框架及实施过程。结果结合绩效评估实施过程,浅析存在的问题,进行对策思考。结论科学设计疾控机构内部评估指标,及时改进评估中发现的问题,探索建立适合基层疾控机构履行公共卫生职能及内部绩效评估新机制,提高疾控机构的服务能力和水平。     

天津市基本公共卫生服务项目预算绩效管理现状、问题及对策

从绩效目标设置、绩效运行监控、绩效评价及绩效管理结果应用等方面,对天津市基本公共卫生服务项目现状进行综合分析,发现存在的问题并分析成因,提出提高基本公共卫生服务项目预算绩效管理水平的建议:建立事前绩效评估机制、合理调整绩效目标、改善绩效运行监控方式、科学开展绩效评价、强化绩效管理结果应用。     

儿童卫生绩效评估指标体系框架的构建

文章系统回顾和总结了国外卫生绩效评估相关的理论模型,以及儿童卫生绩效评估的研究实践,并结合我国儿童卫生工作现状,初步提出了儿童卫生绩效评估指标体系框架。该框架包括儿童卫生投入、产出、结果 3个部分,内容涉及政策制定与落实、资源配置、系统管理、保健服务提供、疾病筛查与干预、服务监管、知晓与满意度、生存状况、营养水平和患病情况等10个方面。     

中国公共卫生服务体系绩效评价

公共卫生服务体系是卫生系统的有机组成部分,具有成本低、效益好的优点,优先发展公共卫生是中国卫生事业发展的必然选择.当今循证决策日益重要,了解公共卫生服务实施情况及成效如何非常必要[1].致力于公共卫生服务绩效的改善,需要统一的测量工具针对公共卫生实践和人群健康结果,发现公共卫生服务体系中存在的主要问题,并对问题做出判断,找出存在的原因,从而为完善体系建设、制定相关政策提供决策依据[2].因此,本研究对中国公共卫生服务体系绩效评价情况进行研究,旨在构建适合中国国情的公共卫生服务体系绩效评价指标框架,以期对公共卫生服务体系绩效做出客观、公正的评价.     

公共卫生服务体系绩效评价指标框架研究

依据WHO卫生系统概念框架,基于"投入—产出—结果"的结构模型,积极借鉴以往的研究成果和国家基本公共卫生服务项目规范以及疾病预防控制区域绩效评估指标,经过两轮专家咨询,初步构建了公共卫生服务体系绩效评价指标框架,共包括一级指标3个,二级指标12个,三级指标25个,为下一步建立完善的公共卫生服务体系绩效考核方案奠定了基础。     

公共卫生决策数据元概念框架的研究

目的建立公共卫生决策数据元（指标）概念框架,确定框架的维度、子维度及其关联关系。方法应用文献分析法和概念分析法确定概念框架的结构、维度和子维度。概念框架是建立在健康影响因素模型的基础上,总体框架遵循科学性、实用性、关联性、系统性和可扩展性的5个原则。维度和子维度的确定依照概念化、目标化、独立性和数目不宜过多的4个原则。维度间的关系则根据公共卫生的特点和公共卫生理论确定。结果提出了健康结果、非医学健康因素、公共卫生系统绩效、公共卫生系统资源、社区特征和保障体系5个维度和20个子维度组成的概念模型,并说明了维度间的相互关系。健康结果维度包括健康状态、人体功能和死亡3个子维度;非医学健康因素的4个子维度是健康行为、生活和工作条件、个人资源和环境因素;公共卫生系统的绩效包括有效性、可及性、效率、安全性和反应性;公共卫生资源包括机构资源、人力资源、财政资源、设施资源和信息资源;社区特征和保障体系维度由社区特征、公共卫生政策法规和保障体系组成。结论作为对公共卫生系统的抽象,概念框架全面地反映了公共卫生系统的组成和复杂的公共卫生过程。可指导公共卫生系统指标体系、乃至公共卫生信息系统的建立。概念框架与以结构、过程、条件和结果所组成的卫生服务质量评价模型相吻合。     

深圳市公共卫生服务质量整体评估与疾病预防控制绩效评估的比较分析

公共卫生服务质量评估和疾病预防控制绩效评估都是根据公共卫生的职能和目标,从结构、过程、结果等方面对公共卫生系统和机构进行测评,但在研究定位、评估指标、满意度评估等方面存在差异。质量评估侧重于公共卫生服务的过程考核,较为适合当地实际;绩效评估是经过严密设计和科学论证的指标体系,具有很强的理论性和指导性。     

户籍医生责任制在社区卫生服务工作中的绩效评估探讨

本文探讨了户籍医生责任制下,社区卫生服务工作的绩效评估机制.通过专家小组讨论的形式确定了绩效评估的主体、原则和具体的考核指标.从公共卫生服务指标、效果指标、效率指标及质量指标,来评价户籍医生的工作,引导其注重社会效益,注重公共卫生服务,关注服务的效果及效率,从而实现社区卫生服务的功能.     

A conceptual framework to measure performance of the public health system

OBJECTIVES: This article describes a unifying conceptual framework for the public health system as a way to facilitate the measurement of public health system performance. METHODS: A conceptual framework for the public health system was developed on the basis of the work of Donabedian and a conceptual model previously developed by Bernard Turnock and Arden Handler. RESULTS: The conceptual framework consists of 5 components that can be considered in relationship to each other: macro context, mission, structural capacity, processes, and outcomes. Although the availability of measures for each of these components varies, the framework can be used to examine the performance of public health systems as well as that of agencies and programs. CONCLUSIONS: A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public health system performance.     

农村公共卫生绩效反馈控制系统模型的构建与验证

目的:构建农村公共卫生绩效反馈控制系统模型并进行验证;方法:设计验证量表,对农村公共卫生管理者进行调查,通过信度、效度分析、隶属度分析以及典型相关分析,对模型进行验证。结果:模型具有较高的信度,具有一定的收敛效度,区别效度不够理想,各题项的隶属度介于0.19～0.52之间,各构成要素之间及其与系统之间具有正相关关系。结论:该模型提供了一个研究农村公共卫生绩效控制与改进的分析框架。     

Linking accreditation and public health outcomes: a logic model approach.

Emerging public health standards, performance assessment tools, and accreditation models hold significant promise for defining and standardizing public health practice, yet the lack of empirical research on their relationship to outcomes represents a serious barrier to adoption. Given the growing interest and momentum related to public health agency assessment and accreditation efforts, there is increasing need for evidence that performance standards and associated accreditation programs are effective means for moving public health systems toward the ultimate goal of population and community health improvement. This article provides an overview of accreditation in health and other industries, and its relationship to outcomes. We examine lessons that might have meaningful public health translations, as well as influences in and on public health that pose challenges for research and evaluation in this area. Finally, we propose a logic model framework to help depict the ways in which we can begin to explore the impact accreditation has on various levels of outcomes. This logic model is intended to guide the development of measures and to serve as a tool to help convey the breadth and depth of research needed to link accreditation to health outcomes.     

某市社区卫生服务工作质量评估及改善建议

质量是社区卫生服务工作的生命。通过对湖南省某市社区卫生服务工作质量进行评估,发现城市社区卫生服务在加速发展的同时,存在机构设置规划不科学,经费拨付依据不充分,基本医疗服务不规范且费用偏高,基本药物制度试点效果不明显,部分机构服务质量低、态度差等问题。提出进一步完善社区卫生服务工作绩效考核指标和考核方法,实施公立医院“名医进社区”工程,全方位监管以有效规避社区卫生服务工作的道德风险,是提高社区卫生服务工作质量的必由之路。     

Content and criterion validity evaluation of National Public Health Performance Standards measurement instruments

OBJECTIVE: The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states. This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument. METHODS: Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a model standard for each indicator. Content validity of each model standard in the local instrument was addressed by community partners along the following dimensions: the importance of each standard as a measure of the associated Essential Service, its completeness as a measure, and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance in that service. Content validity of the state instrument was evaluated in a group interview of health department staff members from three states. Criterion validity of the local instrument was assessed for a sample of eight public health departments in Florida and six in New York by examining documentary evidence for selected responses. Criterion validity was also evaluated for a sample of Florida local public health departments and one Hawaii public health department by comparing state health department staffs' judgments of performance against the instrument score. RESULTS: Criterion validity was upheld for a summary performance score on the local instrument, but was not upheld for performance judgments on individual Essential Services. The NPHPSP standards based on the Essential Services have validity for measuring local public health system performance, according to community partners. The model standards are valid measures of state performance, according to state public health departments in three states. CONCLUSIONS: Within the scope of the validity evaluations completed, the NPHPSP state and local performance assessment instruments were found to be valid measures of public health performance.     

对WHO卫生系统绩效公平性评价的几点疑问

文章从理论框架、内容到结论等方面对《2 0 0 0年世界卫生报告》中卫生系统绩效的公平性评价提出不同意见 ,认为 WHO制定的评价框架并没有真实反映出卫生系统的公平性 ,数据来源有限 ,可信度较差 ,存在较大偏倚 ,结论并没有比较出各国卫生系统的公平性差异 ,整个评价体系在理论上存在一定的缺陷。建议在确定和测量公平性评价指标方面还需要做更深入的研究     

妇幼保健机构综合绩效评价指标体系构建

目的 探索构建妇幼保健机构综合绩效评价指标体系,为妇幼保健机构绩效管理提供思路和依据.方法 采用文献回顾、专家论证法、Delphi专家咨询法、离散趋势法、相关分析法、主成分分析与因子分析法和聚类分析法等建立指标体系,采用专家评分法和CRITIC法主客观权衡计算指标权重系数,并对指标体系的一致性信度及内部结构效度进行检验.结果 根据绩效评价指标体系框架,设定医疗保健工作质量、医疗保健工作效率、公共卫生服务质量和效率、社会效益、经济效益、发展潜力6大类一级指标.结论 通过科学研究,可以建立一套科学合理的适用于我国不同级别妇幼保健机构的综合绩效评价指标体系.     

The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR): translating theory into research

Innovative and effective health promotion interventions targeted on older adults within a public health framework will be increasingly important as the US population ages dramatically. The benefits of healthier lifestyles for older adults include increased functional ability and improved quality of life. The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) Project is a multibehavioral health promotion intervention for community-dwelling older adults focusing on increasing exercise and fruit and vegetable consumption. Intervention materials are stage-tailored for each individual, and include manuals, newsletters, expert system assessments and reports, and telephone coaching. The primary purpose of the SENIOR Project is to investigate the relative effectiveness of a multiple-behavior intervention-based on a single theoretical framework-compared to single-behavior interventions. The secondary purposes are to investigate the intervention's effects on both functional ability and general health outcomes, and how older adults move along a continuum of changing health behaviors. The Transtheoretical Model of Health Behavior Change, the conceptual framework for the SENIOR Project, was chosen for the following reasons: performance potential with older adults, individual tailoring on a stage basis, technological features, and interdisciplinary research base and community partnership.