市级妇幼保健院绩效评估指标体系研究

目的:探讨建立科学、合理的市级妇幼保健院评估指标体系。方法:采用专家咨询法、离散趋势法、相关系数法、因子分析法和聚类分析法从妇幼保健公共卫生服务、医疗保健质量、工作效率、社会效益、经济效益、发展潜力六个方面筛选指标。结果:筛选出六大类共27个指标建立指标体系。结论:指标的筛选是客观而科学的。     

云南省卫生资源区域分类指标研究

目的 筛选适合于云南省卫生资源优化配置的区域分类指标。用这些指标将云南省16个地州市进行适当分类。方法 采用专家咨询打分法，离散趋势法，主成分分析法和聚类分析法进行分析。结果 从50多个影响因素中筛选出对区域分类有代表性好，灵敏度高，独立性强，具有实用性的7个指标。用这7个分类指标对云南省16个地州市1999年资料进行系统聚类，将云南省16个地州市分成五类地区。结论 这种区域分类与云南省实际区域是相同的，云南省区域分类指标研究结果为云南省区域分类和区域卫生资源配置标准的制定提供了科学依据。     

Delphi法筛选四川省实用新农合统计指标的应用

[目的]应用德尔菲法(Delphi)初步筛选出一套实用性、代表性好的新农合统计指标体系,使其能正确反映新农合工作开展的情况,以便有针对性地采取措施,促进新农合的发展。[方法]通过两轮德尔菲专家咨询法筛选出新农合的核心指标。[结果]两轮专家咨询的积极系数均为100%、权威程度(0.860和0.837)和协调系数(0.30和0.57)均较高。经过两轮德尔菲专家咨询筛选出指标29个。[结论]初步确立了四川省实用新农合核心统计指标。     

城市社区卫生服务质量的综合评价指标体系的创建

目的探讨基于调查问卷原始资料创建评价指标的合理性,并利用优劣解距离法(TOPSIS)与秩和比法(RSR)结合方式对潍坊市社区卫生服务质量进行综合评价,为政府决策部门评价社区卫生服务质量提供依据。方法对潍坊市15个社区卫生服务机构及其管辖的居民进行问卷调查并量化创立评价指标,利用聚类和主成分分析法筛选并构建评价指标体系,应用TOPSIS和RSR结合进行综合评价。结果在调查资料的基础上建立了50个量化指标,筛选出9项用于综合评价,TOPSIS法将1～15个社区卫生服务机构排出优劣顺序;RSR将社区卫生服务机构分成上等机构3家,中等机构10家,下等机构2家。结论基于调查问卷资料创建评价指标并用多元统计方法筛选建立指标体系有较好的适用性;TOPSIS法和RSR法结合使评价方法优势互补,评价结果更加准确、客观,亦为政府决策部门提供了简捷明了的评价依据。     

疾病预防控制统计指标评价

目的 构建实用性及操作性强的疾病预防控制统计指标体系.方法 采用德尔菲专家咨询法对指标的实用性、代表性进行评价,利用问卷调查法对指标的操作性进行评价,利用制定的筛选原则对指标进行实用性与操作性筛选.结果 筛选出实用性及操作性较强的疾病预防控制统计指标75个,两轮专家咨询的积极系数分别为93.75％和83.87％,操作性指标的积极系数为100.00％.3大类指标:传染病类、血吸虫病类、健康教育类专家权威程度第1轮分别为0.72、0.69、0.74;第2轮分别为0.76、0.74、0.77;协调系数第1轮专家咨询三大类指标实用性分别为0.23、0.16、0.37,代表性分别为0.22、0.17、0.37;第2轮实用性分别为0.41、0.46、0.23,代表性分别为0.35、0.40、0.19,除健康教育类指标外,协调系数第2轮均高于第1轮(P＜0.05).结论 筛选出的实用性疾病预防控制统计指标体系较为实用、可靠,可用于评价疾病预防控制工作.     

实用性医疗服务统计指标评价

目的:为更好地实施医院管理,构建实用性及操作性强的医疗服务统计指标体系。方法:利用德尔菲专家咨询法对指标的实用性、代表性进行评价,利用问卷调查法对指标的操作性进行评价,利用制定的筛选原则对指标进行实用性与操作性筛选。结果:筛选出实用性及操作性较强的医疗服务统计指标体系50个,两轮专家咨询的积极系数分别为83.3%和75.0%,权威程度分别为0.85和0.88;协调系数第一轮专家咨询实用性为0.234、代表性为0.217,第二轮实用性为0.432、代表性为0.374,第二轮均高于第一轮(P<0.05)。结论筛选出的实用性医疗服务统计指标体系较为可靠,可用于评价医疗服务,加强医院管理。     

国家卫生统计与专题调查样本地区的实验设计——社会经济多变量综合因子作为分层抽样的标识

本次研究旨在通过分层整群随机抽样抽取一个经济而有效的国家卫生统计和专题调查的地区样本。采用人口普查分地区社会经济、文化教育和健康等多个指标的资料,用主成分因子分析法确定抽样分层的标识,在此基础上用K-MEANS聚类分析法对总体聚类分层;采用分层整群随机抽样技术抽取多组不同样本容量的样本,分别计算出每个样本各变量的统计量;通过各样本变量的统计量对代表总体参数精确度的比较和各样本变量的统计量与总体参数分布拟合度检验确定最佳样本容量和样本地区。结果表明,抽取60个县(市)可以代表全国,至少90个县(市)可以代表全国不同类型地区。     

构建进口特殊膳食用食品风险评估指标体系的研究

目的:构建进口特殊膳食用食品风险评估的指标体系并确定其权重值。方法:应用头脑风暴法、经验分析法列出指标,再进行指标分类,收集专家意见,最终确定评估指标体系和指标评判内容,并运用层次分析法计算各指标权重值。结果:对进口特殊膳食用食品的评估指标体系可分为五个一类指标和二十五个二类指标,其中一类指标的权重排序为:实验室检验结果(0.469)、标签(0.201)、配料(0.201)、基础资料(0.086)、安全性证明资料(0.043)。结论:对进口特殊膳食用食品风险评估指标体系采用层次分析的方法是科学的,它能够比较客观、合理地评价进口特殊膳食用食品的安全现状,对评价、判断口岸进口特殊膳食用食品的风险状态具有一定的参考价值。     

青少年艾滋病健康教育效果评价指标体系研究

目的:建立青少年艾滋病健康教育效果评价指标体系,为评价青少年艾滋病健康教育效果提供技术支持。方法:运用文献分析法和专家咨询法进行指标的筛选,应用层次分析法计算各级指标的权重。结果:构建了青少年艾滋病健康教育效果评价指标体系并确立了各级指标的权重。两轮咨询专家积极系数分别为93.3%和96.7%;专家权威程度系数为0.763;一级指标的专家意见协调系数大多达到了0.2以上。结论:在青少年艾滋病健康教育效果评价指标体系研究中,专家咨询法和层次分析法是科学和可行的方法。     

《中国卫生统计》杂志1989年第6卷分类目录索引

【指比较配对诊断试验的统计方法 .....................··、.·····……陈平雁等6(4),19筛选试验评价指标的再理解相对数在卫生统计中的误用标】(梁海华)二’6(2)巧8对统计量cPd名称与计算方法的商榷 (胡克震)6(4):59 (韩景源呼振海)6(妇,:53谈两个有关同类指标的比较…     

职业卫生管理综合评价指标的筛选

目的筛选探讨我国地区性职业卫生管理综合评价指标体系。方法以卫生部2003年职业卫生调研资料为基础，以我国《职业病防治法》为依据．设立职业卫生管理综合评价备选指标并进行数理统计学筛选验证。结果确立反映职业卫生领域8个方面的13项综合评价指标。结论入选指标符合重要、确定、可获得、可比、敏感和特异性原则，经验证代表性较好．可用于进一步综合评价研究。     

国内外健康统计指标数据元分类比较

国家层面的健康统计指标,是描述一个国家居民健康状况与医疗服务水平的核心指标,各国根据其卫生状况和管理重点有各自的指标分类框架和指标内容。我国已建立完善的统计调查制度和卫生统计指标网络直报系统,并逐步走向国际化,特别是卫生统计指标数据元标准化工作。军队人员是一个特殊群体,其健康统计既有一般人员健康统计的共性,又有其特殊属性,需要建立一套反映军队人员这一特定群体的健康统计指标。本文通过对国内外健康统计指标分类进行归纳与比较,为促进我国和军队卫生统计指标标准化和完善指标体系打下基础。     

Cost-benefit analysis of Helicobacter pylori screening

BACKGROUND: Helicobacter pylori screening may markedly reduce mortality and morbidity in the decades ahead. AIMS: This study explores the costs and benefits of population-based H. pylori screening in terms of health care cost taking into account all relevant H. pylori-related diseases. MATERIAL AND METHODS: The computer-based decision analysis compared two strategies: (1) screen for H. pylori and treat those individuals who test positive, and (2) do not screen for H. pylori, and test and treat H. pylori only if related clinical symptoms appear. The model estimated the discounted H. pylori-related accumulative health care costs from screening age to death in both strategies. The baseline case estimates cost-benefit for screenees aged 15-45 years. The main outcome measure is the incremental health care cost per case in the screening compared with the no-screening alternative. The probability estimates were obtained from the Finnish Vammala H. pylori screen and treat project, including 5288 subjects in the years 1996-1998, published studies, national statistics and hospitals' internal accounts. RESULTS: The incremental cost per case was 26 US dollars in the screening compared with the no-screening alternative. It was lowest in the group aged 45 years, where H. pylori screening showed cost savings per case. CONCLUSIONS: H. pylori screening is more favourable in the older age cohorts. The estimated cost per screenee can be considered to be very acceptable if the current pathophysiological evidence on the potential effects of H. pylori eradication are confirmed in the future. However, there is uncertainty about the possible negative effect of eradicating H. pylori infection on gastro-esophageal reflux disease and esophageal adenocarcinoma. This could change the balance of benefits against risks of eradicating H. pylori infection.     

Hearing and vision screening program for school-aged children

BACKGROUND: Hearing and vision screening programs for school-aged children are common, yet little is known about their impact. OBJECTIVE: To evaluate Michigan's screening program, in which local health department (LHD) staff screen school-aged children using standardized protocols. METHODS: This project was completed in three phases: interviews with officials and screening technicians from ten LHDs, audit of LHD records regarding outcomes of screening during the 2000-2001 school year, and telephone interviews with randomly selected parents of children with an abnormal screen. RESULTS: Variations in LHD program implementation pertained to methods for tracking outcomes, screening of older children, parental notification of screening results, and availability of follow-up hearing clinics. According to LHD records, documentation of follow-up examination after an abnormal screen was low (hearing 27%, vision 25%). In contrast, most parents reported follow-up (74% hearing, 76% vision), and many reported that this resulted in treatment (50% hearing, 74% vision). In logistic regression modeling, the odds of follow-up after hearing or vision screening according to parents was not associated with income, health insurance status, or race/ethnicity. For hearing screening, the odds of follow-up decreased with school grade (p <0.001); however, the proportion who received treatment did not vary by grade. For vision screening, follow-up did not vary by grade, but the proportion who received treatment increased with grade (p =0.05). CONCLUSIONS: According to parent reports, most children had follow-up after an abnormal screen, and the majority of these children received treatment. Screening school-aged children for sensory impairment appears to be an important public health function.     

德尔菲法在“营养教育效果综合评价问卷”制定中的应用

目的通过德尔菲法筛选"营养教育效果综合评价问卷"的指标,为营养教育效果综合评价体系提供可靠的测量工具。方法选取27名营养、食品、健康教育、统计、疾控领域的知名专家对"营养教育效果综合评价问卷"实施两轮德尔菲法评价。根据评价结果,对综合评价问卷中的相关内容进行适当的修改和完善。结果第一轮德尔菲评价,专家权威程度为0.82,协调系数为0.22(P0.05),提示综合评价问卷在某些部分专家意见存在不一致性,有待调整和修改;第二轮德尔菲评价,专家权威程度为0.83,协调系数为0.62(P0.05),各部分重要性得分最低为3.92±0.78,最高为4.59±0.67,变异系数在0.15～0.21之间,说明专家对综合评价问卷的内容给予肯定,具有较为一致的评价。结论经过两轮德尔菲专家评价,"营养教育效果综合评价问卷"的内容得到了修改和完善,其指标具有较高的专家认可程度和一致性。     

不同发育阶段儿童视屏时间与执行功能的关联

探讨不同发育阶段儿童视屏时间与执行功能(executive function,EF)的相关性,为促进儿童身心健康提供参考.方法 方便整群抽取安徽省蚌埠市2所小学一~二年级儿童,共收集完整父母问卷1 269份,调查儿童幼儿期(0~3岁)、学龄前期(3~6岁)及学龄期学习日与周末视屏时间;采用《学龄儿童执行功能行为评定量表—父母版》(BRIEF-P)评价儿童执行功能指标:行为管理指数(BRI)、元认知功能指数(MI)和总执行功能复合分(GEC),同时开展体格发育检查,计算体质量指数(body mass index,BMI).采用多因素Logistic回归分析不同发育阶段视屏时间与EF各指标的关联.结果 父母报告幼儿期与学龄前期平均视屏时间1~<2 h/d的比例分别为13.1%和24.5%,≥2 h/d的比例分别为4.3%和8.4%.学龄期学习日与周末视屏时间≥2 h/d的报告率分别为15.6%和74.2%.多元Logistic回归分析显示,在幼儿期,相对于无视屏暴露组,视屏时间为<0.5,0.5~<1,1~<2,≥2 h/d组儿童BRI T得分增高(OR值分别为1.880,1.894,2.125,3.110,P值均<0.05);视屏时间为0.5~<1和≥2 h/d组儿童GEC T得分升高(OR值分别为1.776,2.344,P值均<0.05).在学龄前期,相对于视屏时间<0.5 h/d组,视屏时间0.5~<1,1~<2,≥2 h/d组儿童BRI T得分升高(OR值分别为1.828,2.304,2.293,P值均<0.05);视屏时间1~<2 h/d组儿童MI T得分增加(OR=2.036,P<0.05);视屏时间0.5~<1,1~<2,≥2 h/d组儿童GEC T得分升高(OR值分别为1.640,2.304和2.109,P值均<0.05).学龄期视屏时间对EF各指标影响均无统计学意义.结论 学龄期儿童周末视屏时间≥2 h/d普遍存在,幼儿期和学龄前期视屏时间超过0.5 h/d与行为管理、元认知和总执行功能降低密切相关.     

小康社会“健康素质指数”研究及实证分析

目的构建与我国全面建设小康社会相适应、操作简便的健康素质评价的理论与方法,建立科学、直观的“健康素质指数（HQI）”模型,用于衡量小康社会建设中健康素质提高的程度,预测小康社会的发展进程。方法广泛收集有关反映健康素质的相关指标,用DELPHI法进行筛选,得到四个核心指标,通过数学与统计学方法计算“健康素质指数”,并在东、中、西部分别选取五个省进行HQI的实证分析。结果在东部五省中,HQI基本在80以上;中部五省中,HQI基本在60左右;西部五省的HQI基本平稳在50左右。经F检验,我国东、中、西部不同区域间2005年健康素质指数差异有统计学意义（F=28．39,P〈0．05）。结论HQI研究为统计部门以及政府宏观决策提供了一个科学、综合、敏感、直观的评价指数,能较好地反映一个国家或地区的健康素质水平。     

Blood‐based screening for bowel cancer may not resolve suboptimal screening participation in Australia

Objective: Emerging blood‐based screening technologies for bowel cancer may improve screening participation compared to at‐home stool sampling. This study assessed the impact of different screening delivery scenarios with increasing health system interactions on sampling preferences and likelihood of screening participation. Methods: N=1,561 persons aged 45 to 74 years completed a behavioural survey measuring demographics, readiness to screen, overall collection method preference, and proposed participation in stool and blood methods across four screening scenarios differing in terms of the number of required health system interactions. Results: Overall, respondents preferred a blood test (79.6%) compared to a stool test (20.4%). However, increasing health system interactions had a strong impact on the likelihood of participating in either sampling method (p<0.001). Moreover, likelihood of participating in each of the four blood‐screening scenarios was significantly lower than the current at‐home stool sampling approach (all p<0.001). Conclusions: Blood‐based screening methods require increased contact with the health system but these interactions have negative impact on screening likelihood. All blood‐based scenarios showed lower screening likelihood ratings than the current at‐home FIT approach. Thus, blood‐based screening may not resolve suboptimal screening participation rates in Australia.     

Longitudinal analysis of factors associated with participation in community-based mass screening for the frail elderly in need of care

PURPOSE: To examine factors associated with participation in a community based comprehensive health check to screen frail elderly before they become in need of long-term care. METHODS: All residents aged 70 years and over living in Kusatsu, Gumma prefecture were surveyed for their sociodemographics, and physical, mental and social functioning through in-person interview in the years 2001 and 2003. In the following years--in 2002 and 2004, respectively--mass screenings were conducted to detect early signs of need for care among the elderly. Using the baseline interview information as explanatory variables, we performed multiple logistic regression analysis in order to examine the social determinants of participation in the mass-screening. RESULTS: For the first mass-screening, having high blood pressure and poor subjective health decreased the likelihood of attending the screening by 34% and 65% respectively. In contrast, one point increases in IADL, mobility and social-role score increased the probability of attendance by 27%, 26% and 26% respectively. After the screening was re-conducted, the factors influencing attendance appeared to have changed. With a third mass-screening, while the IADL and mobility score still had significant effects, elderly having excellent subjective health were less likely to go by some 48%. It was also found that not having visual impairment had a significantly positive effect on attendance. CONCLUSION: If local government conducts community-based mass screening aiming to screen the frail elderly in need of care, it is likely that there are high risk elderly among the non-participants. It is very important to follow up those non-participants using an attendance roll and provide appropriate advice. It is also worth discussing mass screening that focuses more on health promotion than on "screening" itself.