DEA在公共卫生项目目标管理中的应用

通过介绍数据包络分析（DEA）的基本原理及其与目标管理的内在联系，公共卫生项目投入和产出的特殊性及其在DEA模型中的处理方法．探讨了DEA在公共卫生项目目标管理中的应用。     

样本地区农村公共卫生项目服务目标群体及其完成程度分析

目的明确我国农村公共卫生项目服务目标群体,分析样本地区项目服务目标群体的完成程度,为测算单位项目成本和投入标准奠定基础。方法综合运用文献归纳分析和专家咨询法完成服务目标群体界定,通过查阅常规报表资料和机构调查数据明确服务目标群体数量和频率要求和标准。结果研究界定了我国农村公共卫生59类项目的服务对象、单位服务对象的数量和频率要求。研究表明,样本地区的农村公共卫生项目完成程度均低于100.0%,较高的上海市样本县仅达到87.2%,最低的青海省样本县仅为70.0%。结论切实提高农村地区公共卫生服务项目的完成程度,尤其是西部地区,提高广大农村居民的公共卫生服务的可及性,显得尤为迫切。     

End-of-Life Care Issues: A Personal,Economic, Public Policy,and Public Health Crisis

Advance directive documents are free, legal, and readily available, yet too few Americans have completed one. Initiating discussions about death is challenging, but progress in medical technology, which leads to increasingly complex medical care choices, makes this imperative.Advance directives help manage decision-making during medical crises and end-of-life care. They allow personalized care according to individual values and a likely reduction in end-of-life health care costs.We argue that advance directives should be part of the public health policy agenda and health reform.IS END-OF-LIFE CARE A MATTER of personal values, economics, public policy, or a looming public health crisis? Actually, it is all of these. But when we consider the population’s demographic shift to older adults, which is associated with chronic illness and multiple comorbidities, the enormous health care costs consumed in end-of-life care, and complex ethical issues, it is time for the public health community to put this issue squarely on its agenda. Increasing the rate of completion of advance directives is a key step, and specific policy strategies can be identified to accomplish this objective.Advance directives were created by federal and state law to ensure autonomy of patients who eventually become unable to make decisions for themselves.1,2 Advance directives are free, legal, and straightforward forms that can be completed in a few minutes. Typically, advance directives address several areas regarding end-of-life care when a person becomes unable to make medical decisions for himself or herself. First, a person defines the amount and kind of care he or she might receive under various medical circumstances. Second, a person designates a health care agent to make medical decisions when the person can no longer do so. Third, advance directives may also address other end-of-life care issues including organ donation, whole body donation to medical schools, funeral and burial arrangements, legacy recordings for posterity, and—in 3 states (Oregon, Washington, and Montana)—assisted dying.     

Integration of Primary Health Care and Public Health During a Public Health Emergency

We have provided a detailed evaluation of how collaboration between an Ontario public health unit and its primary care providers facilitated an optimal response to the 2009 H1N1 influenza pandemic.Family health teams (integrated, interdisciplinary teams that provide a range of care options) provided flu assessment centers, with public health as a partner providing infection control advice, funding, coordination, antiviral medication, clinical care guidelines, supplemental nurse staffing, and arrangement of communication strategies with the public.The family health team structure offers a new capacity for timely, coordinated, and comprehensive response to public health emergencies, in partnership with public health, and provides a promising new direction for healthcare organization.The H1N1 pandemic of 2009 killed nearly 13 000 people worldwide by year’s end.1 More specifically, H1N1 had a substantial impact on Canada’s health care system, resulting in 8596 hospitalizations, 1446 intensive care unit admissions, and 426 deaths.2 In just nine months in the province of Ontario, emergency departments (EDs) received roughly 140 000 more patients with flu-like symptoms than they had in previous years, and the national cost of responding to H1N1 has been estimated at more than $2 billion.3 In southeastern Ontario’s Kingston, Frontenac, and Lennox & Addington (KFLA) Health Unit, the new primary care provider (PCP) structure facilitated a partnership between PCPs and public health and an optimal response to the 2009 pandemic. The improved PCP structure allowed a timely and comprehensive response to pandemic H1N1 by providing enhanced coordination, communication, and collaboration among PCPs and with public health and offered a new capacity for ongoing partnerships between PCPs and public health.     

Corporate Funding for Schools of Public Health: Confronting the Ethical and Economic Challenges

We discuss the public and private sponsoring of university research and the issues it raises in a context of diminished federal funding. We consider research funding at schools of public health and why these schools have historically had weaker links to industry than have other academic units.We argue that the possibility of enhanced links with industry at schools of public health may raise specific concerns beyond those facing universities generally.Six issues should be considered before entering into these relationships: (1) the effects on research orientation, (2) unacceptability of some funders, (3) potential threats to objectivity and academic freedom, (4) effects on academic standards, (5) the effects on dissemination of knowledge, and (6) reputational risks.

“As federal funds get tight, and institutions have built up capacity during the heady days of the doubling of the NIH budget, I think it’s inevitable that they’re going to turn more and more to industry to amortize their investments in people and buildings. I don’t think that industry funds anything that isn’t part of their business. It may be very near term or it may be a little longer term, but they’re not philanthropic.”

—David Korn, senior vice president, Association of American Medical Colleges, and former dean, Stanford University School of Medicine1^(p38)

In an era when federal funds are increasingly scarce, should schools of public health (SPH) consider more actively seeking corporate funding for their research and teaching activities?University–industry relationships have a long history in the United States. They have taken numerous forms, including cooperative research projects and programs, research consortia, procurement of services from universities, work for hire arrangements, and more unrestricted industrial funding of individual departments and training programs. Previous research suggests that these relationships have generated benefits for both sectors and for society. In addition to financial benefits, such relationships have facilitated the translation of academic research into practice, generated new research questions, enhanced university training, created employment opportunities for graduates, and increased academic access to cutting-edge research tools and techniques.2Some have viewed such links as having the potential to corrupt the academic mission and undermine the unique roles universities should play in American society.3 The controversy over the potential impacts of university–industry relationships will almost certainly be amplified at SPH, which have typically been committed to population health, robust conceptions of equity, and the broad dissemination of knowledge and have had an ethics that has at times viewed corporate interests as antagonistic to the very heart of public health.We provide a context for the discussion that we believe should occur in SPH and the questions that should guide faculty debates about the prospects of increased corporate support for research and training.