陕西省公共卫生信息系统数据整合和使用

通过将陕西卫生信息系统数据整合和使用各项指标的得分与评价分析结果模板得分范围作比较,分析评价陕西卫生信息系统在数据整合和利用方面的现状,针对存在不足提出相关政策建议。     

Contextual factors affecting health information system strengthening

At the turn of the century, several major efforts were initiated to combat HIV/AIDS and other major epidemics affecting low- and middle-income countries (LMICs). They were accompanied by initiatives to enable recipient countries to collect and use data to guide their public health programmes. These health information systems (HIS) typify systems in that they have multiple interacting components, and they are embedded within larger systems. Components of a larger system act as the context for all lower-level systems. Their effects can be pervasive, and thus be taken for granted or regarded as unchangeable. We identify four contextual factors that affect efforts to strengthen HIS: hierarchical roles, aid funding, corruption, and competing priorities. We provide examples of each as experienced by those working to strengthen HIS in LMICs. Each of these contextual factors can seriously diminish the effectiveness of HIS strengthening efforts and their long-term sustainability. We propose research questions about each that would enable those engaged in HIS strengthening to work effectively and sustainably.     

医院统计年报数据质量分析

目的分析医院统计年报数据质量存在的问题,探讨其影响因素,以便有针对性地采取措施,提高数据质量。方法通过制定审核流程,对医院年报数据质量进行详细审核,了解医院统计数据质量存在的问题。结果医院的年报数据质量以三级医院最好,二级及以下医院尤其是民营医院出现异常指标数量较多。数据质量问题主要表现在：统计人员对调查制度、医改政策不熟悉;对统计指标不理解、统计口径模糊不清;部分统计人员工作责任心不强;数据监管制度不健全;使用的数据采集系统存在缺陷等。结论制定严密的审核流程、按照同系统审核同系统数据、多级审核的原则对数据质量进行审核,可快速发现数据质量存在的问题,根据这些问题有针对性地采取措施是提高数据质量的重要方法。     

卫生统计数据质量审核方法的探讨

目的探讨卫生统计数据质量审核的方法 ,提高数据质量。方法以会审的方式组织业务技术骨干对卫生统计年报、月报、医改监测季报等已上报的统计数据按照流程进行审核。结果不同地区、不同类别机构数据质量不同,三级医院的数据质量最好,二级及以下医院尤其是民营医院、诊所、村卫生室出现异常指标数量较多;数据质量存在的主要问题为:对调查制度不熟悉、统计口径不清楚;漏报、迟报;缺项、误填、误录入、编数据、拼凑数据、出现垃圾数据;对医改政策不了解,对医改指标不熟悉等。结论制定严密的审核流程定期组织会审,根据审核出的问题有针对性地采取措施是控制数据质量的重要方法 ,在整个审核流程中加强自审对提高数据质量尤为重要。     

Factors limiting data quality in the expanded programme on immunization in low and middle-income countries: A scoping review

Few public health interventions can match the immense achievements of immunization in terms of mortality and morbidity reduction. However, progress in reaching global coverage goals and achieving universal immunization coverage have stalled; with key stakeholders concerned about the accuracy of reported coverage figures. Incomplete and incorrect data has made it challenging to obtain an accurate overview of immunization coverage, particularly in low- and middle-income countries (LMIC).To date, only one literature review concerning immunization data quality exists. However, it only included articles from Gavi-eligible countries, did not go deep into the characteristics of the data quality problems, and used a narrow ‘data quality’ definition. This scoping review builds upon that work; exploring the “state of data quality” in LMIC, factors affecting data quality in these settings and potential means to improve it.Only a small volume of literature addressing immunization data quality in LMIC was found and definitions of ‘data quality’ varied widely. Data quality was, on the whole, considered poor in the articles included. Coverage numerators were seen to be inflated for official reports and denominators were inaccurate and infrequently adjusted. Numerous factors related to these deficiencies were reported, including health information system fragmentation, overreliance on targets and poor data management processes. Factors associated with health workers were noted most frequently. Authors suggested that data quality could be improved by ensuring proper data collection tools, increasing workers’ capacities and motivation through training and supervision, whilst also ensuring adequate and timely feedback on the data collected.The findings of this scoping review can serve as the basis to identify and address barriers to good quality immunization data in LMICs. Overcoming said barriers is essential if immunization’s historic successes are to continue.     

Towards the creation of a health information system for cancer in KwaZulu-Natal,South Africa

The paper aims to evaluate the potential of Geographical Information Systems (GIS) in the creation of a health information system (HIS) for cancer. A case study describes the spatial distribution of reported cancer in KwaZulu-Natal, South Africa and correlates this with levels of development. The study illustrates the problems of data shortage in a developing country.The mapping of reported cancer reveals a concentration of cancer in the developed metropolitan districts, where the hospitals are located. The study therefore provides a 'geography of accessibility to treatment centres' due to the under-reporting of the disease. Despite incomplete data and under-reporting of the disease, the study illustrates the potential of GIS to add value to a HIS for cancer.     

Ensuring data quality in medical research through an integrated data management system

An effective data management system ensures high quality research data by making certain of the proper execution of the study design. This paper presents the components of a data management system and describes procedures for use in each component of the system to obtain high quality data. We discuss the interrelationship among the components of the data management system and the relationship of the data management system to other parts of the research project. We identify underlying principles in design and implementation of a data management system to ensure high quality data.     

山东省预防接种信息系统数据质量评价

目的 对山东省预防接种信息系统（Immunization Information System,IIS）数据质量进行评价,为进一步规范预防接种管理提供参考。方法　从个案管理率、上传及时性、信息完整性、信息准确性和个案重复率等方面对山东省IIS平台收集的数据质量进行分析。结果　截至2016年底,全省0～6岁儿童估算管理率为104.34%,预防接种门诊7日内数据上传率为99.16%,10日内数据上传率为99.48%;产科接种室10日内数据上传率为93.50%,30日内数据上传率为97.22%。个案基本信息完整率为51.87%,接种信息完整率为62.31%,个案修改率为0.48‰,个案补录率为2.49‰,个案重复率为1.94‰。结论　山东省IIS数据质量总体较好,部分地区数据录入不完整、不及时、不准确,重复率较高。应进一步规范预防接种信息管理,提高数据质量。     

社区卫生服务中心主任综合素质对社区卫生信息化建设的影响

目的研究社区卫生信息化建设与中心主任综合素质的关系。方法运用定性与定量研究方法进行现场调查。结果社区卫生信息化建设与中心主任综合素质有密切关系。中心主任的洞察能力、战略思维能力、决策能力、意志及率先垂范精神积极推动了社区卫生信息化建设。结论开展社区卫生信息化建设，需要加强中心主任素质培训，促进中心主任吸收先进的社区卫生服务理念，不断提高其综合能力，从而加速社区卫生信息化建设与发展。     

Research gaps in routine health information system design barriers to data quality and use in low‐ and middle‐income countries: A literature review

Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low‐ and middle‐income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases—PubMed, Web of Science, Embase, and Global Health—and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human‐computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design‐user reality gap.     

综合管理体系在山东口岸卫生检疫工作中的应用

目的进一步提高口岸卫生检疫工作依法行政能力。方法分析总结山东口岸卫生检疫综合管理体系筹备、动员和实施等过程的经验,探讨如何完善口岸卫生检疫综合管理体系建设。结果综合管理体系的建立有利于系统梳理卫生检疫工作流程,形成持续改进的机制,提高工作质量。结论构建综合管理体系对于卫生检疫执法工作的规范化、科学化建设具有积极的意义。     

对应分析在病案信息数据挖掘中的应用

目的 介绍对应分析的基本原理、基本思想和适用条件,并通过一个简单对应分析实例,分析医院感染类型与月份的关联,试图为病案信息数据的挖掘提供一种实用有效的统计分析方法方法 利用SPSS13.0统计软件包data reduction模块下的correspondence analysis过程,对佛山市中医院2010年1-12月住院病人的医院感染发生情况进行简单对应分析结果 对应分析结果摘要显示,第一维惯量0.076,占总惯量构成比的63.5%;第二维惯量0.025,占总惯量构成比的21.2%;前二维惯量累积贡献率为84.7%,二维因子能解释资料的大部分信息,对应分析较好地揭示了月份和医院感染类型之间的联系.从因子载荷图可以清楚地看出不同种类的医院感染与季节有明显的相关性,不同月份的感染类型不尽相同,呼吸系统感染与1月份、3月份、11月份联系紧密,泌尿系统感染与5月份、6月份、7月份、9月份联系紧密,消化系统感染与8月份联系紧密结论 对应分析是一种实用、方便、有效的多元统计方法,其因子载荷图简单直观,尤其针对多分类、多变量资料优势明显,在病案信息数据挖掘中有较高的推广价值.     

预防艾滋病母婴传播信息质量控制体系对数据质量的影响分析

目的:探索预防艾滋病母婴传播信息质量控制体系建立的可行性,为方案进一步修改、完善和推广提供科学依据。方法:根据艾滋病流行状况,选择云南省开远市和隆阳区开展建立预防艾滋病母婴传播信息质量控制体系试点。主要做法包括:在当地建立质量控制小组,抽取妇幼保健院、疾控中心和一定比例的助产机构,每季度做1次数据质量控制,分析数据质量的变化情况。结果:通过质量控制,建立原始登记台帐的机构由60.00%上升到100.00%,信息管理人员固定的助产机构的孕产妇HIV抗体检测人数错报率由1.58%下降到0.15%,婚姻登记人群HIV抗体检测人数错报率从0.63%下降到0,孕产妇HIV抗体阳性漏报率从4.82%下降到0。综合医院孕产妇HIV抗体检测人数错报率高于妇幼保健院,信息人员更换会影响数据质量。结论:建立预防艾滋病母婴传播信息质量控制体系对规范信息管理和提高数据质量十分重要和必要。     

公共卫生信息系统基本数据集的研究

目的研究建立我国公共卫生领域信息系统建设中基本数据集内容的设计方法及相关数据元规范。方法通过业务视图分析,确定系统目标和范围;通过业务流程分析,进行功能建模;通过信息视图分析,确定基本数据集内容与数据结构,根据数据结构,提取数据元。结果研究建立了我国公共卫生领域8个主业务领域和1个公共领域的50个基本数据集和1513个数据元规范。8个主业务领域为免疫规划类（含7个基本数据集、326个数据元）、职业卫生与中毒类（含5个基本数据集、158个数据元）、实验室管理类（含9个基本数据集、118数据元）、突发公共卫生事件类（含3个基本数据集、47个数据元）、传染病监测类（含4个基本数据集、177个数据元）、慢性病监测类（含3个基本数据集、64个数据元）、妇幼卫生类（含8个基本数据集、368个数据元）、环境卫生类（含4个基本数据集、72个数据元）。公共领域类（公用类）数据集是从各个领域中提取的公用数据元组成的一类,包含7个基本数据集、183个公共数据元。结论公共卫生信息基本数据集的规范化研究是促进领域信息系统统筹规划和信息资源利用的基础。     

Perceptual structure of the desired functionality of internet-based health information systems

With the emergence of the Internet, new health information systems are being designed and implemented that focus on coordination between providers, patients, payors and other constituents. While the importance of end user input in identifying the desired functionality of systems has long been recognized, very little work focuses on how users perceive the desired functionalities of these new systems to group together, and the implications of these groupings for the organization of functionalities into program modules and associated user interfaces. In this paper, we advance the construct, user based perceptual structure of desired functionality, in the context of these new coordination-intensive health information systems. Perceptual structure depicts how users perceive different desired system functions to group together. A conceptual framework is advanced which links perceptual structure to two broad categories of components, external coordination and internal coordination, which are related to prospective beliefs about system value. The framework is tested empirically via two field studies conducted by a hospital chain focusing on two major user groups, physicians and office administrators. The setting involves a proposed Internet-based health information system that links various constituencies in the service delivery chain. The empirically generated perceptual structure is found to be largely supportive of its conceptual counterpart. Implications for the design and development of this new class of systems, and public policy implications of such new systems are presented.     

地理信息系统在公共卫生领域的应用

地理信息系统（GIS）是一门综合性学科,具有海量空间数据管理分析、可视化结果展示等特点,已经广泛应用在不同的领域.近年来,GIS在流行病学研究、疾病监测、突发公共卫生事件应对、环境健康研究和卫生决策等方面发挥着重要作用,具有较好的应用前景.此文就GIS在公共卫生领域的应用研究进行综述.     

The effects of health information technology on the costs and quality of medical care

Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.     

社区健康信息系统的应用与评价

社区健康信息系统涵盖公民基础健康档案以及预防免疫、就诊记录、健康检查记录和计划生育等方面的健康档案信息。对社区健康信息系统的评价主要包括信息系统的构建、运行过程、成效和其它相关方面。系统评价将有助于不断完善社区健康信息系统。     

健康体检“全面质量管理体系”的建立与实施

目的通过建立与实施“全面质量管理体系”来提高健康体检的质量、效率和效益。方法对2007年1月至5月5955人次和2008年1月至5月7520人次实施“顾客至上，由下至上，全程覆盖，环节把关，及时反馈，持续改进”的健康体检“全面质量管理体系”，并对实施前后的相关资料进行统计、分析和评价。结果实施健康体检“全面质量管理体系”后，体检报告合格率从82．6％提高到98．2％；基本体检项目检查时间从51min提前到35min，出具体检报告时间从5d缩短到1d；客户满意率从86．3％提高到98．1％，投诉率从0．05％下降到0．01％；体检人数增长率从7．22％提高到26．38％。健康体检“全面质量管理体系”实施前后比较差异均有统计学意义（均P〈0．05）。结论建立与实施健康体检“全面质量管理体系”，对提高健康体检的质量、效率和效益是十分可行和有效的。     

基于HIS的住院业务收入报表数据差异的分析

医院的住院业务收入数据都来自同一个医院信息系统的数据库，但计算机室、财务科、病案统计室3个部门制作的住院业务收入报表数据并不一致。通过对3个部门相关工作流程的调研，发现不同部门的报表从不同角度反映了业务收入，各报表收入数据不一致的主要原因是由于统计口径、统计时点和部分内容不同所致。