老年人虚弱的测评和干预研究进展

  目的  了解高龄老年人衰弱程度,分析亲子关系对衰弱的影响。  方法  于2016年7月 — 2017年1月采用分层随机整群抽样方法,选取河北省唐山市10个社区卫生服务中心辖区居民中的≥ 75岁高领老年人,进行衰弱综合评估工具（CFAI）评测。  结果  3 448名高龄老年人均有衰弱,其中轻度衰弱1 093人（31.70 %）,中度衰弱1 230人（35.67 %）,重度衰弱1 125人（32.63 %）;多元回归分析显示,女性（OR = 1.220）、年龄≥ 80岁（OR = 2.030）、有同城居住的子女（OR = 2.376、）、与子女关系不和睦（OR = 6.314）、子女不轮流看望（OR = 1.309）、不经常与子女交流（OR = 1.869）、不经常与子女打电话（OR = 1.366）是高龄老年人衰弱程度的危险因素（P < 0.05）。文化程度高中及以上（OR = 0.607）、子女经常采取老人意见（OR = 0.506）是高龄老人衰弱程度的保护因素（P < 0.05）。  结论  不良亲子关系可加速中高龄老年人衰弱进程,子女应注重加强与老年人之间的沟通,增进与老年人的感情,延缓衰弱进程,实现健康老龄化。     

Use of indicators for comprehensive assessment of life quality

The paper presents a procedure for quantitative sociomedical and hygienic assessment of the quality of life. Several combinations of factors that have the greatest influence on the quality of life and human health: medicodemographic indices; the prevalence and incidence rates of all classes of diseases in different age population groups; health care quality; socioeconomic conditions; natural, climatic, and sanitary conditions; quality of the population's nutrition; sociological assessment of living conditions. Based on the performed study, the indicators were estimated by each combination of factors. The quantitative determination of the integrated index of life quality may be used to assess the socioeconomic position, the health status of the population in some administrative districts and regions over time.     

Surveillance for quality assessment: III. The critical assessment of quality indicators

Increased attention to healthcare quality issues by insurers, the public and providers has created the desire for quantitative indicators of high quality care. Attributes of quality indicators, including primary and secondary definitions, predictive accuracy and potential to define avoidable problems in care, have been discussed in an effort to allow the reader to critique suggested quality indicators as they appear through legislation and the literature. A continuous feedback process between reviewers and reviewees in the quality assessment process is mandatory to optimize the performance of quality indicators.     

The case for domains of function in quality of life assessment

Over the past 20 years, there has been a growing interest in the inclusion of health-related quality of life (HRQL) measures to assess the effects of a condition and/or its therapies on a person's health. In response to this interest, methods to assess health status and HRQL have proliferated. There are now a number of valid and reliable instruments available for use in research investigations, which are the culmination of years of research with various populations, and reflect the target populations' perceptions of their health status and HRQL. In this article, we provide a definition of HRQL and its dimensions; describe types of HRQL instruments; discuss variations in how HRQL measures are scored and how these methods influence the interpretation of results; briefly describe utility measures; and summarize by discussing basic issues in the selection of HRQL instruments for research investigations.     

应用层次分析法建立卫生技术综合评价指标体系

该研究利用专家研讨会、专家评分与层次分析法建立了卫生技术综合评价的指标体系及其权重系数，为农村卫生适宜技术推广项目评价、筛选适宜技术提供了方法学基础。     

Consulting the community for environmental health indicator development: the case of air quality

As health promotion practitioners advocate for an integrationof health and environmental concerns, they must struggle withthe role of environmental health indicators in fostering andmonitoring change to address these concerns. This paper reportson consultations we held with four Ontario communities as partof the development of health-based indicators of air quality(HBIAQ). Jointly with local non-governmental organizations,our university-based team invited a diverse group of participantsrepresenting a spectrum of stakeholders in air quality issuesto evening consultations lasting 4 h. Participants identifieda wide range of directly observable indicators of air qualitybased on all five senses. They were aware of relationships betweenair pollution and adverse health impacts, but felt that currentair quality indicators did not easily permit this linkage. Participantsthought that useful indicators should be relevant to communityconcerns, credible in their linking of observable air pollutionand health outcomes, and communicable to distinct audiencesin ways that stimulate changes in behaviour. Significant improvementsin participants' self-reported ability to assess and use airquality indicators were documented by pre- and post-questionnaires.Suggestions emerged for resolving some tensions inherent inthe development of environmental health indicators: measuresof air quality versus measures of potential health outcomes;observations by residents versus technical measurements by governmentagency staff; expert interpretation versus community ‘complaints';neighbourhood versus urban/rural area versus wider region; changein public behaviour versus reductions of point sources; andresources internal versus external to communities. Evaluationof the utility of HBIAQ as health promotion tools must awaittheir implementation.     

Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development

ObjectiveIn this article, we describe one approach for evaluating the value of developing quality indicators (QIs).Study Design and SettingWe focus on describing how to develop a conceptual measurement framework and how to evaluate the need to develop QIs. A recent process to develop QIs for injury care is used for illustration.ResultsKey steps to perform before developing QIs include creating a conceptual measurement framework, determining stakeholder perspectives, and performing a QI needs assessment. QI development is likely to be most beneficial for medical problems for which quality measures have not been previously developed or are inadequate and that have a large burden of illness to justify quality measurement and improvement efforts, are characterized by variable or substandard care such that opportunities for improvement exist, and have evidence that improving quality of care will improve patient health.ConclusionBy developing a conceptual measurement framework and performing a QI needs assessment, developers and users of QIs can target their efforts.     

The hospital multistay rate as an indicator of quality of care.

OBJECTIVES: To evaluate the hospital multistay rate to determine if it has the attributes necessary for a performance indicator that can be applied to administrative databases. DATA SOURCES/STUDY SETTING: The fiscal year 1994 Veterans Affairs Patient Treatment File (PTF), which contains discharge data on all VA inpatients. STUDY DESIGN: Using a retrospective study design, we assessed cross-hospital variation in (a) the multistay rate and (b) the standardized multistay ratio. A hospital's multistay rate is the observed average number of hospitalizations for patients with one or more hospital stays. A hospital's standardized multistay ratio is the ratio of the geometric mean of the observed number of hospitalizations per patient to the geometric mean of the expected number of hospitalizations per patient, conditional on the types of patients admitted to that hospital. DATA COLLECTION/EXTRACTION METHODS: Discharge data were extracted for the 135,434 VA patients who had one or more admissions in one of seven disease groups. PRINCIPAL FINDINGS: We found that 17.3 percent (28,300) of the admissions in the seven disease categories were readmissions. The average number of stays per person (multistay rate) for an average of seven months of follow-up ranged from 1.15 to 1.45 across the disease categories. The maximum standardized multistay ratio ranged from 1.12 to 1.39. CONCLUSIONS: This study has shown that the hospital multistay rate offers sufficient ease of measurement, frequency, and variation to potentially serve as a performance indicator.     

Quantitative assessment of groundwater quality using a biological indicator: Some preliminary observations

The genotoxicity of groundwater was evaluated, using a novel application of the SOS microplate assay (SOSMA). Organic residues were extracted from groundwater samples from Maryland, Pennsylvania, and Delaware by using C-18 bonded silica solid phase extraction tubes. Total organic carbon content (TOC) of water samples was also determined. The genotoxicity of the extracts was determined by the SOSMA. Relative activity (RA) as determined by the SOSMA is a quantitative measure of genotoxicity based on a comparison to the activity of the mutagen, 4-nitroquinoline oxide. Low levels of RA (about 2× background) were detected in waters from sites within these states. There was considerable temporal and spatial variation in the observed RA, but no definite patterns were observed in the variation. Between sampling sites there was a positive correlation between RA and TOC; however, this relationship appeared to be reversed occasionally within a sampling site. The extraction and bioassay methods provide an easy and relatively inexpensive means of determining water quality.     

新型农村合作医疗综合评价指标体系研究阶段报告

目的:开发新型农村合作医疗综合评价指标体系,以作为政府相关部门、经办机构督导新型农村合作医疗工作不断完善的工具。方法:以Donabedian的结构、过程、结果架构,用AHP法和Delphi法建立评价指标体系及指标权重,用指数法进行评价和原因追溯。结果:建立了由1个综合目标指标、3个二级指标、12个三级指标、41个四级初始指标组成的4层次评价指标体系,这些指标重点评价了新型农村合作医疗的运行状况,并可由现状追溯原因。结论:新型农村合作医疗综合评价指标体系及其评价方法,以计算机作为管理工具,基本实现了预期目的,可以认为,指标体系具有较高的实用价值和理论价值。     

The use of qualitative research criteria for portfolio assessment as an alternative to reliability evaluation: a case study

AIM: Because it deals with qualitative information, portfolio assessment inevitably involves some degree of subjectivity. The use of stricter assessment criteria or more structured and prescribed content would improve interrater reliability, but would obliterate the essence of portfolio assessment in terms of flexibility, personal orientation and authenticity. We resolved this dilemma by using qualitative research criteria as opposed to reliability in the evaluation of portfolio assessment. METHODOLOGY/RESEARCH DESIGN: Five qualitative research strategies were used to achieve credibility and dependability of assessment: triangulation, prolonged engagement, member checking, audit trail and dependability audit. Mentors read portfolios at least twice during the year, providing feedback and guidance (prolonged engagement). Their recommendation for the end-of-year grade was discussed with the student (member checking) and submitted to a member of the portfolio committee. Information from different sources was combined (triangulation). Portfolios causing persistent disagreement were submitted to the full portfolio assessment committee. Quality assurance procedures with external auditors were used (dependability audit) and the assessment process was thoroughly documented (audit trail). RESULTS: A total of 233 portfolios were assessed. Students and mentors disagreed on 7 (3%) portfolios and 9 portfolios were submitted to the full committee. The final decision on 29 (12%) portfolios differed from the mentor's recommendation. CONCLUSION: We think we have devised an assessment procedure that safeguards the characteristics of portfolio assessment, with credibility and dependability of assessment built into the judgement procedure. Further support for credibility and dependability might be sought by means of a study involving different assessment committees.     

New measurable indicator for tuberculosis case detection

The World Health Organization's goal for tuberculosis (TB) control is to detect 70% of new, smear-positive TB cases and cure 85% of these cases. The case detection rate is the number of reported cases per 100,000 persons per year divided by the estimated incidence rate per 100,000 per year. TB incidence is uncertain and not measured but estimated; therefore, the case detection rate is uncertain. This article proposes a new indicator to assess case detection: the patient diagnostic rate. The patient diagnostic rate is the rate at which prevalent cases are detected by control programs and can be measured as the number of reported cases per 100,000 persons per year divided by the prevalence per 100,000. Prevalence can be measured directly through national prevalence surveys. Conducting prevalence surveys at 5- to 10-year intervals would allow countries with high rates of disease to determine their case detection performance by using the patient diagnostic rate and determine the effect of control measures.