面向卫生政策研究的协同科研系统的设计与实现

介绍了一个面向卫生政策研究的协同科研系统,分析了该系统的协同需求,设计了课题管理、协作交流、科研资源、课题文档、课题成果和个人工具等功能模块。系统架构由数据层、应用层和用户层组成,采用B/S模式进行总体设计并实现了卫生政策研究的协同科研系统。     

The Linkage Approach Applied to a School-Based Smoking Prevention Program in the Netherlands

ABSTRACT: Effective diffusion strategies are necessary to enhance use of innovative health promotion programs. One strategy uses the linkage approach to innovation-development and diffusion planning. The linkage approach enhances collaboration among three systems: resource system (university-based researchers), linkage system (district health educators), and user system (teachers). This article illustrates how the linkage approach was applied in a smoking prevention research project. Identification of the linkage system and the collaborative process between the resource system and linkage system are described. Results from a process evaluation indicated the linkage approach was feasible in a school-based smoking prevention project.     

Partnering with public health: a model for baccalaureate nursing education

This article discusses the implementation of a one-year project developed to increase and improve the quality of public health nursing experiences for baccalaureate nursing students at one state-assisted university. The partnership model involved collaboration with public health departments, the academic nursing programs, and community agencies and leaders. The project led to the development of increased student skills related to interdisciplinary team work, program development, and cultural competency skills. A needs assessment questionnaire of the public health department partner staff supported a need to develop public health work force skills. The project provided opportunities for nursing faculty development. The project results support the need for service-academic partnerships to develop the public health nursing workforce.     

Community assessment in a vertically integrated health care system

OBJECTIVES: In this report, the authors present a representative case of the implementation of community assessment and the subsequent application of findings by a large, vertically integrated health care system. METHODS: Geographic information systems technology was used to access and analyze secondary data for a geographically defined community. Primary data included a community survey and asset maps. RESULTS: In this case presentation, information has been collected on demographics, prevalent health problems, access to health care, citizens' perceptions, and community assets. The assessment has been used to plan services for a new health center and to engage community members in health promotion interventions. CONCLUSIONS: Geographically focused assessments help target specific community needs and promote community participation. This project provides a practical application for integrating aspects of medicine and public health.     

Opportunity model of collaboration: a model for assessment instrument development

Collaboration between allied health educators and clinicians has a long history in terms of fieldwork education. Use of collaborative partnerships for practice endeavors and research also has been reported in the literature. Another possible area in which collaboration could be effective is the development of an assessment instrument. Collaboration can have negative and positive results, however, and individuals who plan an instrument development project are cautioned to pay attention to the collaborative nature of the project as well as to the instrument development task itself. This article describes a model for collaboration that evolved out of an instrument development project involving educators from the occupational therapy programs at Utica College and the University of Illinois, Chicago; clinicians in school-based practice; and occupational therapy students. Experiences from the project are used to illustrate concepts of the model.     

Physical access to primary health care in Andean Bolivia

Limited physical access to primary health care is a major factor contributing to the poor health of populations in developing countries, particularly in mountain areas with rugged topography, harsh climates and extensive socioeconomic barriers. Assessing physical access to primary health care is an important exercise for health care planners and policy makers. The development of geographic information system (GIS) technology has greatly improved this assessment process in industrialized countries where digital cartographic data are widely available. In developing countries particularly in mountain areas, however, detailed cartographic data, even in hardcopy form, are nonexistent, inaccurate or severely lacking. This paper uses GIS technology to assess physical access to primary health care in a remote and impoverished region of Andean Bolivia. In addition, it proposes an alternative model of health personnel distribution to maximize physical accessibility. Methods involved extensive fieldwork in the region, utilizing GPS (global positioning system) technology in the development of the GIS and gathering other pertinent health data for the study. Satellite imagery also contributed to the development of the GIS and in the modeling process. The results indicate significant variation in physical access to primary health care across the three study sites. More importantly, this paper highlights the use of GIS technology as a powerful tool in improving physical accessibility in mountain areas of developing countries.     

Building geographic information system capacity in local health departments: lessons from a North Carolina project

State government, university, and local health department (LHD) partners collaborated to build the geographic information system (GIS) capacity of 5 LHDs in North Carolina. Project elements included procuring hardware and software, conducting individualized and group training, developing data layers, guiding the project development process, coordinating participation in technical conferences, providing ongoing project consultation, and evaluating project milestones. The project provided health department personnel with the skills and resources required to use sophisticated information management systems, particularly those that address spatial dimensions of public health practice. This capacity-building project helped LHDs incorporate GIS technology into daily operations, resulting in improved time and cost efficiency. Keys to success included (1) methods training rooted in problems specific to the LHD, (2) required project identification by LHD staff with associated timelines for development, (3) ongoing technical support as staff returned to home offices after training, (4) subgrants to LHDs to ease hardware and software resource constraints, (5) networks of relationships among LHDs and other professional GIS users, and (6) senior LHD leadership who supported the professional development activities being undertaken by staff.     

Problem posing and cultural tailoring: developing an HIV/AIDS health literacy toolkit with the African American community

The rate of HIV infection among African Americans is disproportionately higher than for other racial groups in the United States. Previous research suggests that low level of health literacy (HL) is an underlying factor to explain racial disparities in the prevalence and incidence of HIV/AIDS. The present research describes a community and university project to develop a culturally tailored HIV/AIDS HL toolkit in the African American community. Paulo Freire's pedagogical philosophy and problem-posing methodology served as the guiding framework throughout the development process. Developing the HIV/AIDS HL toolkit occurred in a two-stage process. In Stage 1, a nonprofit organization and research team established a collaborative partnership to develop a culturally tailored HIV/AIDS HL toolkit. In Stage 2, African American community members participated in focus groups conducted as Freirian cultural circles to further refine the HIV/AIDS HL toolkit. In both stages, problem posing engaged participants' knowledge, experiences, and concerns to evaluate a working draft toolkit. The discussion and implications highlight how Freire's pedagogical philosophy and methodology enhances the development of culturally tailored health information.     

Information technology strategic planning: art or science?

It had been almost a decade since the hospitals that make up the Daughters of Charity Health System (DCHS) had engaged in a formal information technology strategic planning process. In the summer of 2002, as the health system re-formed, there was a unique opportunity to introduce a planning process that reflected the governance style of the new health system. DCHS embarked on this journey, with the CIO initiating and formally sponsoring the information technology strategic planning process in a dynamic and collaborative manner The system sought to develop a plan tailored to encompass both enterprise-wide and local requirements; to develop a governance model to engage the members of the local health ministries in plan development, both now and in the future; and to conduct the process in a manner that reflected the values of the Daughters of Charity. The DCHS CIO outlined a premise that the CIO would guide and be continuously involved in the development of this tailored process, in conjunction with an external resource. Together, there would be joint responsibility for introducing a flexible information technology strategic planning methodology; providing an education on the current state of healthcare IT, including future trends and success factors; facilitating support to tap into existing internal talent; cultivating a collaborative process to support both current requirements and future vision; and developing a well-functioning governance structure that would enable the plan to evolve and reflect user community requirements. This article highlights the planning process, including the lessons learned, the benchmarking during and in post-planning, and finally, but most importantly, the unexpected benefit that resulted from this planning process.     

Visual localisation of community health needs to rational decision-making in public health services

The objectives were to visualise the locations of community health needs and to develop a community health needs assessment geographic information system (GIS) for rational decision-making in public health services. We compiled census data, digital data of basic planning maps, digital data of topographic maps, contents of registers of medical and welfare facilities, and statistics of establishments into a geographical database; visualised geographical distributions of specific community health needs by integrating sets of indicators to reflect individual needs; and quantified their clustering by the nearest neighbour method. The database aggregated 3400 items of demographic, life and environmental factors. Thematic maps and clustering values showed different patterns of geographical distribution of the individual community needs. Means to match needs with services in smaller geographical units were discussed. This GIS will support appropriate resource allocation, intersectoral collaboration and greater transparency in planning and implementing services, by visualising locations of community health needs.     

The GLBT Health Access Project: a state-funded effort to improve access to care

The Gay, Lesbian, Bisexual, and Transgender (GLBT) Health Access Project is a unique public-private collaboration working to eliminate barriers to health care for the GLBT community, foster development of comprehensive, culturally appropriate health promotion policies and health care services for GLBT people and their families, and expand appropriate data collection on GLBT health. Funded by the Massachusetts Department of Public Health, the project developed community standards of practice for provision of quality health care services to GLBT clients. A health access training curriculum was developed and technical assistance was offered to health care providers implementing the standards, which cover personnel, clients' rights, intake and assessment, service delivery and planning, confidentiality, and community outreach and health promotion. Training participants (324 individuals from 89 agencies) reported positive though not statistically significant changes in attitude.     

From Planning to Implementation of the YouthCan IMPACT Project: a Formative Evaluation

In order to improve the youth mental health system, there is an international movement toward developing community-based service hubs that provide integrated, collaborative care to youth. However, the implementation of multisystem collaboration is complex and can be hampered by barriers. This paper presents a formative evaluation of the YouthCan IMPACT integrated youth services project based on the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers to successful implementation. Results highlight that previous positive working relationships along with collaborative investment of resources from partnering organizations are essential to implement an integrated youth service model. In addition, it is important that representative members of all key stakeholder groups, including staff, youth, and caregivers, be involved in the development and execution of the project to ensure effective implementation. Attention to the facilitators and barriers to implementation may help teams seeking to implement highly collaborative, integrated models of service delivery for youth in the community.

     

Collaborative intersectoral approaches to nutrition in a community on the urban fringe.

A case study is presented that describes the 10-year evolution of a local intersectoral project aimed at improving components of a community's food system as an approach to improving nutrition. Aspects of innovation and good contemporary practice in collaborating for health promotion are illustrated. Key initiators of the project were a university public health department, a community health service, and a local government authority. Players brought into the process included the agricultural sector and food retailers. Several strategies have contributed to the success and institutionalization of the project. These include a specific focus on organizational development and capacity building among the key intersectoral partners and the use of formative evaluation methods to hasten the natural phases of collaborative problem solving. The project achieved many policy- and system-level changes. The impact on food consumption patterns is still to be evaluated.     

构建顶层体系结构 推动医疗信息化建设

对医疗行业信息系统体系结构的国内外研究现状、存在问题和建立的必要性进行了阐述，首次提出了由6个层次、两大支柱组成的体系结构框架，即需求驱动的医疗信息与管理系统自适应体系结构（HIMS—RDAA），该结构既考虑了组织管理多方面的因素。又通过层次结构及层间映射机制，可根据用户需求与环境的变化．能动态地识别、组织和调整系统功能，智能地满足用户需求，具有自适应性、自我完善和自我发展能力。并将本成果方法应用于“区域协同医疗服务示范工程”进行实证研究．为行业信息系统建设与应用提供理论、方法和规范方面的指导，对建设医疗卫生信息系统具有重要的指导意义。     

Collaborative community empowerment: an illustration of a six-step process

This article illustrates a method used in a community empowerment project where community members and university facilitators collaborated to increase the capacity of the community. The method may have practical uses in collaborations with community groups. The six-step process enabled the community groups to accomplish their short-term community goals: developing effective after-school programs and resolving problems of damaged homes and blighted properties in a relatively short time and continuing on their collaborative work. Having a social ecological model as a conceptual framework was helpful for the community to assess their status and develop action plans. Consistent community meetings, open communication, focused community leadership, community networking, and collaboration of community organizations and a university were the factors that reinforced the empowerment process. Challenges such as maximizing limited resources and generating more participation from the community need to be resolved while the reinforcing factors are cultivated.     

A model for collaborative evaluation of university-community partnerships

INTRODUCTION: Manitoba's The Need to Know project was presented with a unique opportunity to develop a collaborative approach to evaluation, and to explore the effectiveness of a variety of evaluation methods for assessment of university-community collaborative health research partnerships. OBJECTIVES: The evaluation was designed to incorporate participation of community partners in planning, developing, and evaluating all aspects of the project. Objectives included: (a) assessment of extent to which the project met its initial objectives; (b) assessment of extent participants needs and expectations were met; (c) refinement of evaluation questions; (d) identification of unanticipated impacts; (e) assessment of participant confidence as research team members; (f) development of knowledge translation theory; and (g) component analysis. METHODS: A "utilisation focused" approach was used. Primary stakeholders identified evaluation questions of concern, and how findings would be used. The multimethod time series design incorporated key informant interviews, a pre/post-test survey, written workshop evaluations, and participant and unobtrusive observation. All aspects of the evaluation were made transparent to participants, and formal feedback processes were instituted. RESULTS: There was a high level of participation in evaluation activities. Identifying evaluation questions of concern to community partners helped shape project development. While all methods provided useful information, only key informant interviews, participant observation and feedback processes provided insights into all evaluation objectives. CONCLUSION: Collaborative evaluation can make an important contribution to development of university-community partnerships. Qualitative methods (particularly key informant interviews, participant observation, and feedback processes) provided the richest source of data, and made an important contribution to team development.     

The value template process: a participatory evaluation method for community health partnerships.

This article presents the results of a pilot implementation of an evaluation process designed to help community health collaboratives obtain relevant information for planning and evaluation. The Value Template Process assists collaboratives to identify performance and impact indicators that are meaningful and measurable with accessible data. The process also encourages communication and engagement in assessment among collaborative members. The pilot study demonstrated that the process's underlying assumptions of social capital were valid and that the process was feasible and useful to the community health collaborative.     

Student research projects: the experiences of student dietitians, university faculty members, and collaborators

Two universities in the United Kingdom made systematic attempts to increase the number of student dietitians' research projects that are supervised by university faculty members in conjunction with external collaborators (collaborative projects), rather than by faculty alone (faculty-only projects). A questionnaire survey was used to evaluate the experiences of student dietitians (n=110), university faculty members (n=38), and collaborators (n=31) involved in a student research project, comparing those involved in a faculty-only project with those involved in a collaborative project. Students undertaking collaborative projects reported greater involvement in most areas of the research process and greater skill development in obtaining research ethics approval (P=0.005), data collection (P=0.05), and statistical analysis (P=0.004) than students undertaking faculty-only projects. In addition, collaborative projects were more frequently considered to produce results that would change dietetics practice than faculty-only projects by both student dietitians (60% vs 30%, P=0.01) and university faculty members (62% vs 19%, P<0.001). The collaborators also considered that in the majority of instances (61%) their involvement helped them to organize their own time to do research. The type of project did not appear to influence student's expectations of future involvement in research and audit. In general, both types of projects resulted in positive experiences for student dietitians, university faculty members, and collaborators. We recommend that those involved in dietetics education, practice, and management consider the potential value of senior-level student dietitian involvement in collaborative research projects.     

Making public health data available to community-level decision makers--goals, issues, and a case report.

Effective community health assessment and planning depends on the availability of appropriate public health data. Web-based technologies have created an unprecedented opportunity for making data available to community-level public health decision makers. An interactive data retrieval system targeted to the community-level user must provide an intuitive and easy-to-learn user interface with functionality and statistical complexity appropriate to the expected users while maintaining confidentiality of personal health information. The authors use the Missouri Information for Community Assessment Web site as an example to discuss goals and issues involved in the development of such systems.     

Surveillance of drinking water supply with a geographic information system: a pilot project of the of the Iogd NRM and the Hoxter district

Drinking water surveillance includes the use of spatial data. A geographic information system (GIS) is a practicable tool for work with spatial data in the health sector as well. Co-operation between the Institute of Public Health for North Rhine Westphalia, the local health authority of the Hoexter district and the Institute for Geoinformatics of the University of Muenster started a project testing the use of GIS for drinking water surveillance. A special application was programmed. It includes functions of retrieval and classification of the measured values of drinking water wells, in order to show time trends in a diagram and to visualise the location of the wells and the analysis data in a map. The members of the Public Health Office accepted the method and started using it regularly. In addition, the collaboration between the health authority and other local authorities was strengthened. Several data sets were included in the GIS, such as wells and results of water analysis, water protection areas, land use data, and topographical maps. Basing on to the experiences with this project, the development of a standard application is planned that is supposed to be communicated to all local health authorities in North Rhine Westphalia.