层次分析法中求权重的一种改进

目的 以医保定点医院医保管理业务评价指标体系中指标权重的确定为例,探讨层次分析法中求指标权重的一种改进.方法 采用Delphi法由遴选出的32名专家对评价指标的重要性、代表性、可及性进行评价,共进行2轮咨询.采用改进的层次分析法计算一级指标的权重.结果 改进层次分析法所得指标权重与传统层次分析法相比,更逼近定点医院医疗保险业务监督评价的"实际优先次序".结论 改进的层次分析法充分利用原有判断矩阵的信息,体现既尊重个体判断的结果及其准确性程度,又重视群体综合意见的原则,是一种可行有效的方法.     

卫生统计

05 0 8 0 5　群组判断中求权向量的一种新方法 /何钦成…∥中国卫生统计 2 0 0 3 ,2 0 (2 ) 72～ 75研究了群组层次分析法 (TheAnalyticHierarchyPro cess ,简称AHP)中如何综合个人判断矩阵的问题。依据每位专家所构造的判断矩阵及判断矩阵的质量 ,即判断矩阵的一致性程度     

公立医院综合绩效评价体系指标权重研究

各指标权重的确定是否合理对于多指标综合评价体系模型的准确性是至关重要的。指标权重的确定方法很多,包括主观方法和客观方法。本文采用了群组层次分析法将不同的专家咨询意见与聚类方法相结合来确定出较为统一的专家意见,并以此来作为指标权重的确定依据。     

应用层次分析法确定县级疾控业务评估权重

目的确定县级疾控各项业务权重,为制定合理的县级疾控业务评估标准提供依据。方法应用层次分析法,通过专家咨询判断各指标间的两两相对重要程度,构建成对比较矩阵、计算指标的权重系数、检验权重系数的可接受性,根据专家权重调整权重系数,确定考核指标的组合权重等步骤,确立县级疾控各项业务评估权重。结果业务权重从高到低为传染病监测与防控、免疫预防、应急处置管理、艾滋病与结核病防控、慢性病与地方病防治、综合业务管理、健康教育与健康促进、健康危害监测与防治,权重系数分别为0.1790、0.1652、0.1414、0.1306、0.1224、0.1024、0.0804、0.0787。结论层次分析法可用于县级疾控业务评估权重的确定,为后续构建综合评价模型提供依据。     

应用层次分析法建立职业危害关键控制点评价的指标体系

为客观评价职业危害关键控制点控制措施的实施情况,建立评价指标体系,合理分配权重,利用层次分析法构建判断矩阵,计算权重向量并进行一致性检验。结果显示,一级指标工程技术措施、工程防护措施、职业卫生限值、个体防护措施、管理措施的权重系数分别为0.567、0.239、0.115、0.049、0.030;二级指标组合权重排序中,生产工艺先进,用无毒、低毒代替高毒,湿式作业的权重最高,达到0.425。利用层次分析法建立的职业危害关键控制点控制措施评价体系是科学可行的。     

应用层次分析法确定我国疾病预防控制绩效考核指标体系权重

在已构建的疾病预防控制绩效考核指标体系的基础上,选用层次分析法,通过：（1）专家咨询判断各指标间的两两相对重要程度,构建比较判断优选矩阵;（2）计算指标的权重系数;（3）检验权重系数的可接受性;（4）确定考核指标的组合权重等步骤,最终确立了我国疾病预防控制区域和省级机构绩效考核指标体系的权重,合理体现了各指标在总体绩效中的相对重要程度,也为后续构建综合评价模型提供了前提。     

医学科技人才评价指标体系权重的研究

目的确定医学科技人才评价体系各级指标的权重，探索建立系统规范的医学科技人才综合评价指标体系。方法对30名专家进行问卷调查，利用层次分析法（AHP）建立层次结构模型，构造判断矩阵，通过计算确定指标权重，并检验其逻辑一致性。结果Delphi法和层次分析法（AHP）联合应用确定了医学科技人才评价指标体系的3类共计30项指标的权重系数，各级指标权重均满足逻辑一致性要求，具有科学性和客观性。结论该医学科技人才评价指标体系，为公正、客观、准确地对医学科技人才进行评价提供了一种标准。     

层次分析法在基层疾控卫检岗位价值评估的应用

目的对基层疾控卫生检验岗位价值构成因素进行权重评估。方法层次分析法(AHP),按确定的价值构成因素建立层次结构图、建立判断矩阵、计算判断矩阵的最大特征根和因素权重。结果得到了构成价值因素的符合逻辑的权重系数。结论层次分析法将定性与定量相结合,把定性决策转化为定量决策,适合于卫生检验岗位价值评估。     

基于德尔菲法和层次分析法构建广州市健康村评估指标体系研究

目的建立一套能为广州市健康村创建工作指引方向并能较好地反映工作成效的评估指标体系。方法通过理论分析、文献回顾和专家访谈等方法初步构建广州市健康村评估指标体系,在此基础上、采用3轮专家咨询,包括2轮德尔菲法确定指标体系内容,1轮层次分析法确定各指标的权重。结果广州市健康村评估指标包括组织管理、建设健康环境、培养健康技能、提供健康服务、拥有健康人群、满意度和创建特色等7个一级指标、7个二级指标、46个三级指标入选。3轮咨询专家积极系数为94%、100%、93%。专家平均权威系数为0.85,2轮德尔菲法的专家协调系数分别为0.169、0.437(P0.01)。层次分析法得到一级指标权向量为0.0546~0.2413,最大特征值为7.1558;二级指标的权向量值为0.0961~0.7992,最大特征值为2.0000~6.2462;三级指标的权向量为0.0630~0.6697,最大特征值为2.0000~7.1252。各判断矩阵的一致性比率CR为0~0.0391。结论广州市健康村评估指标体系指标合理,专家的代表性、积极性、权威程度及意见的协调程度较好,判断矩阵一致性比率符合要求,体现了多部门共建、定性与定量相结合、与时俱进的特点。     

基于层次分析法的孕产妇保健服务利用指标权重分析

目的 计算孕产妇保健服务利用各项指标的权重,为分析孕产妇保健服务利用各个指标的重要性提供有效参考.方法 利用层次分析法建立孕产妇保健服务利用指标的层次结构,构建各个层次相应的判断矩阵,通过专家对利用指标进行对比打分,计算各个指标的权重.结果 得出了孕产妇保健服务利用指标的组合权重,并对其重要程度进行了排序.结论 指标的相对重要性排序与实际情况基本相符;应用层次分析法时要注意打分专家的选择和专家人数的确定;在对判断矩阵各指标对比打分时,要注意赋值的合理性和逻辑性.     

老年人数字健康素养评价指标体系构建研究

目的 构建老年人数字健康素养评估指标体系,为评价老年人数字健康素养提供参考。方法 2021年12月—2022年5月,采用文献研究法、焦点小组讨论法、德尔菲专家函询法筛选评估指标,运用层次分析法确定指标权重,建立老年人数字健康素养评价指标体系。结果 共开展3轮专家函询。函询问卷回收率为100%、100%、93.4%,专家权威系数为0.82、0.82、0.83,肯德尔和谐系数为0.095～0.211、0.095～0.149、0.159～0.200。所有专家的所有判断矩阵的一致性比例均小于0.1。最终确立老年人数字健康素养评价指标,共包括一级指标6个,二级指标21个,三级指标39 个。结论 构建的老年人数字健康素养的评价指标专家咨询意见趋于一致,内容科学、合理,今后需进一步在老年人群中开展实证工作。     

A social choice approach to expert consensus panels

This study uses recent theoretical work about group decision-making to assess the quality of decision-making by expert consensus panels. We specifically examine (1) when individual members of panels will divulge their private judgments about the decision to the panel, and (2) when the group judgment is superior to the judgment of individual panelists and will lead to better treatment for patients. We conclude that to maximize the chance of an accurate decision, panels should be made as large as possible, adopt the smallest supermajority rule, and attract members with the highest individual competencies. Furthermore, interdependence among panelists and the goal of reaching consensus can reduce the efficacy of these panels.     

Prevalence of Obesity: A Public Health Problem Poorly Understood

This review article discusses the Dietary Guidelines for Americans (DGA) in support of a total diet approach to achieving diet and health goals, especially as they relate to the obesity epidemic. However, some scientists and organizations have identified one food, food group, or nutrient as the cause of the obesity epidemic and recommend that simply reducing that food/food group/nutrient will solve the problem. This is simplistic and unlikely to be effective in long term management of the obesity problem. This article also acknowledges discrepancies in the literature and the lack of consensus opinions from systematic reviews. Failure to consider the evidence as a whole can lead to inaccurate reports which may, in turn, adversely influence clinical practice, public policy, and future research. This article also considers where the line should be drawn between individual choice and responsibility and public regulation. Using sugar sweetened beverages as an example, the article considers the lack of a consistent association between added sugars and weight in the literature and calls for policy recommendations that are based on science and emphasizes the need for evidence-based policies rather than policy-based evidence.     

Can dietary intervention produce long-term reduction in insulin resistance?

Insulin sensitivity is potentially enhanced by a range of diet-related changes including reduction of visceral adiposity, a reduction in saturated fatty acids, and possibly a redistribution of the proportions of various unsaturated fatty acids. While there is evidence to suggest that lifestyle changes can reduce the risk of progression of impaired glucose tolerance to type 2 diabetes, there are no clinical trials which have conclusively demonstrated that any measure can reduce insulin resistance in the long term to an extent that can prevent the development of type 2 diabetes and other clinical complications. Evidence concerning the possibilities for reducing visceral adiposity and altering the nature of dietary fat are therefore considered. Attempts to achieve prolonged and substantial weight reduction in adults have not been encouraging, and it may be that preventing further weight gain is the most realistic target in this age group. In childhood the attempts have been more successful. The development of new approaches to achieving behavioural change and an environment which facilitates physical activity and appropriate food choices will be essential for more successful individual and population attempts to facilitate reduction in insulin resistance by weight loss. Changes in the nature of dietary fat appear to be more easily achieved. This is already a component of dietary advice aimed at cardiovascular risk reduction, and should be reinforced now with a view to also achieving a reduction in insulin resistance.     

Clinical aspects of the hand-arm vibration syndrome. A review

At present it seems likely that the different components of the hand-arm vibration syndrome, eg, vibration-induced white finger (VWF), numbing of the hands and arms, muscular fatigue, and occasionally prevalent bone degeneration, may arise independently, and therefore they should be evaluated separately. Evidence of changes caused in the autonomic nervous functions of the body by local vibration is not conclusive. The vascular history should be confirmed objectively with a cold provocation test under laboratory conditions. In individual diagnostics it is useful to record (with modern plethysmographic techniques) the recovery of digital temperature, digital blood pressure, and flow after local cooling. Vibrotactile perception measurement seems to be suitable for group diagnosis. Much of the diagnostic weight for VWF can be obtained from accurate case histories, although, for early changes, the history may be atypical. The lack of simple objective tests for evaluating the hand-arm vibration syndrome makes it difficult to, eg, confirm the history of its different components objectively and estimate the extent of the disability it causes.     

Latent class analysis of diagnostic agreement

We describe methods based on latent class analysis for analysis and interpretation of agreement on dichotomous diagnostic ratings. This approach formulates agreement in terms of parameters directly related to diagnostic accuracy and leads to many practical applications, such as estimation of the accuracy of individual ratings and the extent to which accuracy may improve with multiple opinions. We describe refinements in the estimation of parameters for varying panel designs, and apply latent class methods successfully to examples of medical agreement data that include data previously found to be poorly fitted by two-class models. Latent class techniques provide a powerful and flexible set of tools to analyse diagnostic agreement and one should consider them routinely in the analysis of such data.     

Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population

Prior research has established associations between pregnancy outcomes and specific neighborhood characteristics, including economic disadvantage, violent crime, and racial/ethnic segregation. Recently, associations have also been found between various health outcomes and group density, the degree to which an individual is a racial or ethnic majority in his or her local community. The objective of this study was to determine the extent to which census tract economic disadvantage, violent crime rate, and group density are associated with pregnancy outcomes among White, Black, and Hispanic infants in a large metropolitan setting. This cross-sectional study utilized 1990 census data, 1991 crime data, and 1991 birth certificate information for singleton live births in Chicago, Illinois. Results show substantial racial segregation in Chicago, with 35% of census tracts having more than 90% Black residents and 45% of census tracts having fewer than 10% Black residents. After stratifying by maternal race/ethnicity, we used multilevel analyses to model pregnancy outcomes as a function of individual and census tract characteristics. Among all racial/ethnic groups, violent crime rate accounted for most of the negative association between tract economic disadvantage and birth weight. Group density was also associated with birth weight but this association was stronger among Whites and Hispanics than among Blacks. Further analysis revealed that group density was more strongly associated with preterm birth while violent crime rate was more strongly associated with small for gestational age. These results suggest that group density and violent crime may impact birth weight via different mechanisms.     

Validity of the Hospital Emergency Suitability Protocol

BACKGROUND: Different studies rate the proportional number of visits unsuited to the HER services at 20%-80% of all. This wide range is due, in good part, to no consensus existing as to the definition of the term "emergency" and the ideal degree of assistance for dealing with each possible situation which leads to the use of subjective judgments for evaluating unsuitability. The purpose of this study is that of developing and validating an objective tools for pinpointing unsuitable hospital emergencies. METHOD: Based on a conceptual framework which included as dimensions the seriousness of the clinical condition of the patient in question, the intensity of the services rendered and some situations which would warrant spontaneous visits being suitable, the Hospital Emergency Suitability Protocol (HESP), a tool entailing explicit criteria for assessing the suitability of the visits to the HER's, and a random sample of 100 emergency room clinical histories, the reliability thereof of observers on an individual and group basis and the validity of judgment and predictive validity thereof as regarding the opinion of experts having been analyzed. RESULTS: The HESP revealed itself to provide an excellent reliability rate of observers on an individual and group basis (indexes of agreement fond of 99%-100%; kappa statistic of 0.97-1.00), and judgment validity on the borderline between moderate and low (index of agreement found of 68%, kappa statistic 0.39). This low level of agreement is due to the fact that the HESP functions like a highly specific (the inappropriate cases accord to the clinical judgment are evaluated as inappropriate) yet not highly sensitive tool (solely 59% of the cases which the HESP considered to be suitable were evaluated as such by the clinical judgments). CONCLUSIONS: The HESP acts as a highly reliable tool capable of pinpointing the most clearly unsuitable fraction of the inappropriate visits to the HER's. These characteristics make it useful for drawing comparisons among hospitals and for long-range follow-up or monitoring of actions for lowering the percentages of unsuitable use.     

主成分分析法及模糊综合评判法用于医院科室效益评价的对比

目的比较主成分分析法和模糊综合评判法2种评价方法的优缺点,为卫生评价机构选用合适的多指标评价方法提供依据。方法应用主成分分析法和模糊综合评判法分析数据。结果主成分分析法和模糊综合评判法处理数据后的结果略有差别,用主成分分析法计算后各个科室对应的排序分别是第7、4、6、5、3、8、2、1名,而模糊综合评判法计算后的排序则分别是第7、5、4、6、3、8、2、1名。结论在处理难以准确确定权重的数据上,主成分分析法比模糊综合评判法有优势,评价结果更加客观合理。