民族地区妇幼卫生工作绩效考核项目实施效果评估

目的:对民族地区妇幼卫生工作绩效考核项目实施效果进行评估,推动民族地区妇幼卫生工作绩效考核工作。方法:制定评估方案,成立国家级评估组,采用座谈会、现场考查、个人技术考核、个人定性访谈等方法,对项目县绩效考核项目实施效果进行现场评估。结果:通过项目实施,提高了当地对妇幼卫生绩效考核工作的认识;帮助当地掌握绩效考核标准和考核方法;项目地区绩效考核工作初见成效。结论:通过项目实施在一定程度上促进了当地政府对妇幼卫生工作的重视,加大了对妇幼卫生工作的支持力度,促进了当地妇幼卫生体系建设与发展,规范了妇幼保健服务。     

2011-2016年北京市妇幼卫生绩效考核结果分析

目的通过绩效考核结果分析,了解绩效考核效果,发现工作中的问题,不断提高政府部门对妇幼卫生工作重要性认识,促进妇幼卫生体系建设与发展。规范妇幼卫生各项服务,提高服务能力与水平,推动医药卫生体制改革相关政策的落实。方法通过听取相关部门汇报、查阅资料、问卷调查、现场查看与日常工作相结合等方式,对辖区卫生行政部门、妇幼保健机构,助产机构、基层卫生服务机构、托幼机构等部门的妇幼卫生工作,进行整体评估。结果 6年的北京市妇幼卫生绩效考核发现,大部分区县在政府保障、妇幼保健网络建设、妇幼健康状况、妇幼保健管理与服务均有不同程度提升,实现持续改进。但部分远郊区县发展相对滞后,妇幼工作有待持续改进。结论通过绩效考核,进一步推动妇幼卫生事业发展,及时发现工作中的问题,明确责任单位,督促积极整改,实现北京市妇幼卫生工作持续改进。     

山东省城区社区妇幼卫生服务效果评价

目的 :评估山东省 3个城市 6个街道社区妇幼卫生服务效果。方法 :对 6个街道内 2岁以下儿童母亲 10 0人 ,其中 4个月以内婴儿母亲全部进行定量调查 ,同时 ,采用定性调查方法召开 3个座谈会 ,将妇幼卫生各项工作指标与1997年基础调查进行比较。结果 :各级政府领导对该项目的目的、意义、工作职责非常明确 ,制定了社区服务工作计划 ,积极支持项目实施 ,参与项目活动 ,协调有关部门工作 ,使项目得以顺利执行。社区开展了多项妇幼卫生服务项目 ,促进了母乳喂养 ,提高了妇幼卫生各项工作指标。结论 :社区妇幼卫生服务效果是肯定的 ,城区是可以实施的 ,是深受群众欢迎的。     

建立基层妇幼卫生工作评估体系初步研究：———“贵州省妇 …

通过深入调查，征询专家意见，结合我省实际，制定的《贵州省基层妇幼卫生工作评估指标体系》，适用于基层县（市）、乡（镇）两级妇幼卫生工作的评估考核。评估体系由Ⅰ、Ⅱ两级指标组成，Ⅰ级指标包含：“政府、卫生主管部门”，“卫生业务部门”，“服务人群”三类，Ⅱ级指标共含９个部分。其中Ⅰ级指标的一、三类内容为县、乡两级评估时通用，第二类县、乡两级卫生业务部门，分别有不同的指标要求。全部评估指标综合专家意见分配     

以开展项目活动为抓手,推动民族地区妇幼卫生工作——贵州省从江县妇幼卫生工作调研引发的思考和建议

目的以贵州省从江县为例,了解＂西班牙＂项目实施对我国民族地区妇幼卫生工作的影响和推动作用。方法通过听取报告、访谈、现场查看以及文档资料查阅等调查研究方法,了解项目实施对当地妇幼卫生工作指标的影响。结果项目实施后,从江县住院分娩率从2009年的61.2%上升至2011年的94.8%,提高了33.6%;孕产妇死亡率由2009年的87.7/10万下降至2011年的21.5/10万;婴儿死亡率从2009年的39.3‰波动下降至2011年的10.98‰,降低了28.32‰;5岁以下死亡率从2009年的31.8‰下降至2011年的15.1‰,降低了16.7‰。妇幼卫生服务指标明显改善。同时发现三级妇幼保健网薄弱,妇幼保健服务能力建设有待提高等问题。结论通过＂西班牙＂项目实施,有效推动了民族地区妇幼卫生工作的开展。建议在政府重视和大力支持下,以项目活动为抓手,提高基层妇幼卫生服务能力为重点,进一步加强民族地区妇幼卫生工作。     

新疆克拉玛依市2013年县级妇幼卫生绩效考核评估分析

目的通过2013年克拉玛依市县级妇幼卫生绩效考核,分析全市4个区妇幼卫生工作政府保障、妇幼保健网络建设、妇幼保健管理及妇幼保健服务提供情况,为今后妇幼卫生事业发展及政府决策提供科学依据。方法依据克拉玛依市县级妇幼卫生工作绩效考核标准,从政府保障、妇幼保健网络建设、妇幼保健管理、妇幼保健服务提供、妇幼健康状况5个方面,对全市4个区的妇幼卫生工作绩效进行考核。调查涉及35家单位,采取现场查看、查阅资料、人员技术考核等方法对照考核标准进行量化打分,并对调查结果进行汇总分析。结果考核项目总分值1100分,2013年克拉玛依区872．7分、独山子区871．7分、白碱滩区828．2分、乌尔禾区724．1分。结论克拉玛依市妇幼卫生事业发展与当地社会、经济发展不相适应,各级政府投入相对不足,妇幼保健服务网络不健全,工作人员配备不足,学历偏低、年龄偏大,整体服务能力有限,供需矛盾突出,妇幼保健服务需要进一步规范。     

建立基层妇幼卫生工作评估体系初步研究——“贵州省妇幼卫生协作项目和评价体系的研究”报告之四

通过深入调查，征询专家意见，结合我省实际，制定的《贵州省基层妇幼卫生工作评估指标体系》，适用于基层县（市）、乡（镇）两级妇幼卫生工作的评估考核。评估体系由Ⅰ、Ⅱ两级指标组成，Ⅰ级指标包含：“政府、卫生主管部门”，“卫生业务部门”，“服务人群”三类，Ⅱ级指标共含９个部分。其中Ⅰ级指标的一、三类内容为县、乡两级评估时通用，第二类县、乡两级卫生业务部门，分别有不同的指标要求。全部评估指标综合专家意见分配权值，满分为１０００分。评估结果分为四等，６００分为合格，低于６００分不合格，７５０分以上为良好，９００分以上为优秀     

基于综合指数法对世行贷款项目县妇幼卫生指标的综合分析

目的通过对2000年和2006年5省107个世界银行贷款项目县妇幼卫生指标进行综合分析,为妇幼卫生状况相对较差地区的可持续性发展提供建议。方法利用综合指数法,通过象限分布图对妇幼卫生指标进行综合分析。结果妇幼卫生服务投入利用指数和健康状况指数在象限分布图中的结果表明,2000年湖南和海南的妇幼卫生状况相对较好,贵州和新疆的妇幼卫生状况相对较差,吉林居中;2006年5个省的项目县妇幼卫生状况均有较大提高,其中湖南和吉林发展稳定,海南出现波动,贵州和新疆仍有部分项目县的妇幼卫生状况有待继续提高。结论妇幼卫生服务投入利用状况及健康状况相对较差的项目县是日后工作的重点地区;根据各个项目县妇幼卫生状况特点,应开展不同的干预活动。     

辽阳市白塔区《两纲》中期评估妇幼卫生指标分析

2005年是实施《两纲》中期目标的最后一年,按照辽阳市妇女儿童工作委员会对《两纲》中期目标评估工作的要求,对白塔区2001~2005年各项妇幼卫生指标监测情况进行了评估分析,以便掌握白塔区妇幼卫生工作的发展趋势,总结经验与不足,制定今后妇幼卫生工作规划。1两纲中期评估妇幼卫生指标完成情况白塔区铁西办事处辖区有少数农村人口,妇幼保健服务始终按城市人口管理,有关农村的妇幼卫生各项指标没做单独统计。本文数据来源于2001~2005年的妇幼卫生监测资料和上报国家、省、市的统计报表。各项指标完成情况见附表。没达到中期目标的指标有:出生…     

北京市妇幼卫生社区服务模式初探

探索了北京市妇幼卫生服务模式，即实行社区卫生服务通科医师制和产妇划片分娩制度，开展围产期保健系统管理，制定妇幼卫生常规登记报告和监测报告制度，制定了各种妇幼卫生服务指标，根据掌握的信息和评估结果，不同的社区制定了不同的干预措施。通过实施干预措施，提高了医疗保健机构的社会效益和经济效益，满足了群众的不同保健需求，是新时期妇幼卫生发展的出路所在。     

2008年少数民族地区5岁以下儿童死亡状况的横断面研究

目的:了解少数民族地区5岁以下儿童健康状况的真实水平。方法:对6个少数民族地区(贵州雷山县、从江县,云南陇川县、潞西县,青海化隆县,西藏工布江达县)的5岁以下死亡儿童家庭成员(父母或其他知情者)进行问卷调查,分析这些地区真实的5岁以下儿童死亡情况。结果:6个少数民族地区的5岁以下儿童死亡平均漏报率高于50%;新生儿死亡率、婴儿死亡率和5岁以下儿童死亡率均比调查前各县通过年报系统上报的有所上升;感染性疾病(肺炎和腹泻)、出生窒息、早产或低出生体重是这些地区5岁以下儿童死亡的主要原因。结论:提高少数民族地区妇幼信息工作人员的业务能力对于掌握该地区真实的妇幼卫生状况至关重要;加强对少数民族地区基层医疗服务能力的建设,重点提高感染性疾病(肺炎和腹泻)、出生窒息、早产或低出生体重的诊治水平,对于降低少数民族地区5岁以下儿童死亡率有重要意义;提高少数民族地区家庭经济收入水平和文化教育程度,能极大地提高当地儿童患病后进行治疗的比例。     

Comparison of FIMR Programs with Other Perinatal Systems Initiatives

OBJECTIVES: While the goals of fetal and infant mortality review (FIMR) programs and other perinatal systems initiatives (PSI) are similar, our knowledge of the processes they use to meet their goals is limited. This article compares a nationwide sample of FIMR programs and PSIs with regard to their roles and involvement in performance of eight essential maternal and child health services (EMCHS) as part of a national evaluation of FIMR. METHODS: The evaluation was a cross-sectional observational study in which geographic units were sampled based on the presence or absence of a FIMR or other PSI using FIMRs as the sampling frame of reference. Telephone interviews were conducted with 74 FIMR and 62 PSI directors in the sampled communities. RESULTS: Both programs performed several of the essential MCH services. FIMRs were significantly more likely to be located in a local health department than were PSIs. The results of multiple logistic regression analyses indicate that the performance of the essential MCH services by the programs was increased when both a FIMR and a PSI were in the community. FIMR programs alone had reduced odds of performing several essential MCH services than did PSIs alone. The findings also indicate that performance of some essential MCH services was reduced for FIMR programs and PSIs located in a local health department. CONCLUSIONS: Comparisons between FIMR and other PSIs suggest that both programs are currently engaged in diverse efforts to attain their goal of improving the health and health care delivery system for pregnant women, infants, and their families. FIMR programs appear to be more circumscribed in their activities than PSIs, but the presence of both programs in a community appears to enhance the programs' performance of the essential MCH services.     

城乡一体化背景下公共卫生服务体系绩效评价指标的构建研究

摘要:目的　以城乡一体化为背景,从公共卫生投入、产出和效果三个维度构建公共卫生服务体系绩效评价指标。方法　采用专家咨询方法,经过两轮专家咨询,建立评价指标框架。结果　两轮专家咨询回收率分别为83.3%和93.3%,权威程度分别为0.557和0.709,协调系数分别为0.173和0.486（χ2＝803.654,P＜0.01）,差异具有统计学意义。确立了以投入、产出和效果为主体框架的城乡公共卫生服务体系绩效评价指标,包括一级指标3个,二级指标13个,三级指标33个,3个一级指标的权重分别为0.2080,0.5791和0.2129。结论　该指标框架的可靠性和可信性程度较高。投入指标突出了城乡公共卫生服务的政府职能,产出指标涵盖了城乡公共卫生服务的重要内容,强调了公共卫生服务过程,效果指标契合了WHO卫生系统目标的价值取向,具有很强的代表性、实用性和可操作性。     

The Relation of FIMR Programs and Other Perinatal Systems Initiatives with Maternal and Child Health Activities in the Community

OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.     

社区卫生服务风险评价指标体系研究

目的:针对社区卫生服务发展现状,开展社区卫生服务风险评价指标体系研究,确定社区卫生服务风险评价指标体系的内容和权重。方法:采用Delphi专家咨询法确定指标体系。通过第一轮专家咨询筛选指标,通过第二轮咨询,用专家咨询权数法(Delphi法)确定指标权重。结果:构建了包括5个一级指标、16个二级指标、56个三级指标在内的具有层次性的社区卫生服务风险评价指标体系,并确定了一、二、三级指标的权重值。结论:社区卫生服务风险体系建立科学合理,可用于社区卫生服务机构的风险测评。     

Primary Care Trusts involving the community: is community development the way forward?

Patient and user involvement is central to current government thinking on the NHS. More comprehensive approaches to organised community participation and community development have received less support and examples of effective and genuine participation in key areas such as primary care decision-making are rare. The initiative described in this paper was established in Newcastle upon Tyne in 1995 to promote community participation in decision-making about local health services. It has particular relevance to current concerns about addressing social exclusion and tackling health inequalities since it operates in an area of social disadvantage with a significant black and ethnic minority population (6 percent). This case study is based on an independent evaluation which used multiple research methods, including interviews, questionnaire surveys and direct observation, to assess the project's practice and impact. Describes a community development approach to public participation. An emphasis on inclusive practices has facilitated meaningful involvement of minority groups such as ethnic minority residents and those with disabilities who tend to be marginalised in public debate. Argues that the project has made a significant impact on the ways in which local health services are planned and delivered     

The Nationwide Evaluation of Fetal and Infant Mortality Review (FIMR) Programs: Development and Implementation of Recommendations and Conduct of Essential Maternal and Child Health Services by FIMR Programs

OBJECTIVE: An evaluation of fetal and infant mortality review (FIMR) programs nationwide was conducted to characterize their unique role in improving the system of perinatal health care. The aim of this paper is to examine intermediate outcomes of the FIMR, in particular the development and implementation of recommendations produced by the FIMRs and the conduct of essential MCH services by the FIMRs. METHODS: We report on 74 FIMRs whose communities were selected for the nationwide evaluation and for whom we had data from the FIMR director or comparable respondent. We focus on the recommendations of the FIMRs and the essential maternal and child health (MCH) services conducted by the FIMRs as intermediate outcomes (or outputs) and then examine how selected characteristics of the FIMR may influence these. RESULTS: FIMRs developed recommendations on a broad range of topics but there were some areas for which nearly all programs had developed recommendations. The FIMRs relied primarily on strategies related to programs and practices, with few FIMRs reporting attention to policy-oriented approaches. Implementation of recommendations was high. Factors that influenced likelihood of implementing recommendations and conduct of essential MCH services included structure of the FIMR and training received by FIMR directors and staff. CONCLUSIONS: The focus of FIMR recommendations and the likelihood of implementation vary across FIMRs as does the conduct of essential MCH services. FIMR team structure and training of the director and staff are important areas to consider in efforts to maximize the impact of FIMR.     

The MCH Certificate Program: A New Path to Graduate Education in Public Health

Objective: The purpose of the MCH Certificate Program was threefold: to develop a new educational initiative in response to national and local demands for increased MCH workforce capacity, to eliminate key financial and nonfinancial barriers to advanced MCH academic preparation, and to improve rates of recruitment and retention of students from minority communities, thus enhancing the quality of MCH services available to the region. Methods: An MCH Certificate Program, designed for clinicians (e.g., nurses, occupational therapists and nutritionists) and public health practitioners as a bridge to graduate programs in public health, combined a competency based curriculum with skills workshops, leadership seminars, mentoring, small group activities, and an interactive teaching format. Results: Students from the first two cohorts (n = 45) report an expansion of core public health knowledge (issues, policies, and strategies), enhanced self-confidence, and efficacy. Half have experienced job changes that represent increased responsibility, leadership, and professional advancement. A third are enrolled in or have completed a formal program of graduate study in MCH. Conclusions: This innovative MCH Certificate Program, now in its fourth year, is a new approach to increasing workforce capacity and a successful model of instruction for adult learners. It has the potential for adaptation to a variety of educational settings and MCH populations, and helps to expand the continuum of MCH training experiences in schools of public health.     

手术科室医师工作量考核指标体系的构建和应用

目的：构建手术科室医师工作量考核指标及权重。方法：采用文献分析法、专家咨询法选择考核指标,统计分析专家咨询结果,得出每项指标的权重。根据安徽省立医院（南区）临床医师工作量考核进行实例分析。结果：根据两轮专家咨询法,设计出含门诊量、会诊量、手术量和住院服务量四个一级指标和16个二级指标的考核体系。结论：临床医师工作量考核指标体系构建需要分科室类型和职称级别,科学的临床医师工作量考核方法有利于医院整体绩效的提升。