城市区域医疗集团突发公共卫生事件应急反应系统构建

目的 以广州市花都区人民医院医疗集团抗击新冠肺炎的实战做法为例,提出医疗集团突发公共卫生事件应急反应体系的理论框架和具体实施策略。 方法 本研究采用文献研究、自由访谈咨询和专家评分法对医疗集团应对突发公共卫生事件要素构成进行了研究。 结果 本研究以广州市花都区为例,通过文献阅读、专家自由访谈咨询、531评价法,最终确定了医疗集团应急反应系统的36项指标内容,问卷克朗巴赫α系数均大于0.9,可信度高,构建了花都区医疗集团突发公共卫生事件应急反应体系框架。 结论 本研究构建了医疗集团突发公共卫生事件应急反应体系框架,为医疗集团提供平战结合的管控思路、提升精准管理水平、有效防范处置突发公共卫生事件发挥有力支撑作用。     

影响男性参与计划生育的因素:中国定性研究的发现

本项目于1993～1994年在中国开展。为达到研究的预期目的,在方法学方面采用定性研究技术,即通过集体访谈(FGDs)和个人深入访谈的方式来获取各类访谈对象的观念和行为方面的广泛信息,以探究影响男性参与的深层原因。访谈现场确定在四川、云南和吉林三省。本项目集体访谈对象类型主要包括避孕套使用者及其妻子,五年内男扎接受者及其妻子,采用女性方法的妇女及其丈夫等;个人访谈对象类型主要包括政策制定者、项目管理者、节育技术提供者和宗教领袖等。各省现场调查结束后,研究者使用统一拟定的提纲对集体访谈资料进行观点归类,并以个人访谈获取的关键信息加以补充,进而找出研究之主要发现。研究结果提示,影响男性参与计划生育的因素主要涉及政策与宣传、服务与技术、地理与文化和社会与心理等相互联系的诸多方面。根据主要发现提出的建议要点主要包括改善决策者男扎方面的知识,制定出有利于男性参与的鼓励性政策;加强避孕套提供过程的全面质量管理;进一步提高男扎服务质量并制定切实可行的规范;通过各种渠道宣传男扎知识,改进服务提供者的人际交流技巧,为广大群众提供咨询服务,进一步改善男性参与计划生育的意识并分担责任。     

一体化医疗卫生服务体系评价框架研究

目的:建立一体化医疗卫生服务体系评价框架,为进一步构建相应的评价指标体系提供依据。方法:综合运用系统综述法、主题框架分析法及专家咨询法筛选、构建和完善一体化医疗卫生服务体系评价框架。结果:最终确定的一体化医疗卫生服务体系评价框架包括制度一体化、组织一体化、专业一体化、服务一体化4个一级指标和25个相应的二级指标。结论:本研究构建的一体化医疗卫生服务体系评价框架相关指标具有较强的有效性和必要性,为进一步开发相应的评价指标体系奠定了较好的基础。     

出院脑卒中患者延续护理的质性研究

目的了解专家对怎样开展针对脑卒中患者的延续护理的看法,提出脑卒中患者延续护理的建议方案。方法采用访谈法,共访谈相关专家16名,访谈资料采用主题框架法进行分析。结果通过对访谈数据的分析,共得到一级主题4个,二级主题12个。结论开展针对出院脑卒中患者的延续护理,需要建立评估体系;构建医院和社区卫生机构合作模式;制定相关制度规范,促进可持续发展。     

访谈

访谈 (interview)是一种常用的收集定性资料的方法 ,尤其在社会医学与卫生服务领域 ,很多的定性研究都是采用访谈的方法收集基础的资料。通过这种方法不仅能收集到我们需要的信息 ,有时还能得到意外的信息 ,发现新的问题。访谈主要是通过调查人员有目的的和被访谈者之间的谈话或向其提出一系列问题 ,来了解被访谈者的认知、态度和行为等[1]。1　访谈的分类访谈有多种形式 ,根据访谈问题的种类可大致分为 3种 :结构式访谈 (structuredinterview) ,半结构式访谈 (semi-structuredinterview)和深入访谈 (in -depthinterview) [2 ]。1.1　结构式…     

新医改背景下委属委管医院绩效评价体系研究

目的建立国家卫生计生委委属、委管医院绩效评价指标体系。方法通过文献查询梳理医院绩效评价指标、理论研究并设计结构化访谈提纲,对专家进行结构化访谈,设计问卷进行专家咨询。结果根据新医改要求并结合国家卫生计生委委属委管医院职能定位,初步制定了评价指标体系。结论指标体系的建立应充分考虑研究对象、本阶段政府的引导方向以及指标的内涵。     

“一带一路”妇幼卫生培训基地准入的评估指标框架构建

目的：建立应用于“一带一路”妇幼卫生培训基地的准入指标体系,为将来全球妇幼卫生领域培训基地的准入评估提供工具,为实现标准化、规范化地建立妇幼卫生培训基地提供科学依据。方法：以ADDIE教学理论和5M1E分析法作为理论基础,结合文献检索评阅和专家访谈,采用Delphi法开展两轮函询,以确立三级指标框架。结果：共20名专家完成了两轮专家函询,两轮函询中专家积极系数均为100%,权威系数分别为0.94和0.93。第二轮函询后,一、二、三级指标的协调系数分别为0.352、0.362和0.375。最终建立了包括5个一级指标、13个二级指标和36个三级指标的指标框架。一级指标包括培训设施、培训制度、培训能力、专业能力和国际合作能力,指标权重系数均通过一致性检验。结论：本研究建立了我国在“一带一路”妇幼卫生领域培训基地准入的标准框架,可为妇幼卫生培训基地的建设提供科学、有效的评估工具。     

突发公共卫生事件影响综合评价指标体系构建

目的 构建突发公共卫生事件影响的综合评价指标体系.方法 采用文献法和专家咨询法,初拟指标体系框架;采用德尔菲法进行指标筛选,同时考虑专家定性访谈、专题小组讨论的结果,进行指标的综合筛选;在德尔菲法问卷结果的基础上,采用改进的Saaty’s权重法进行指标权重的确定.结果 39名专家2轮咨询问卷回收率均为100％,一级指标的权威系数(Ca)为0.73,协调系数(W)差异均有统计学意义(P＜0.05),一级指标权重系数分别为0.4575、0.2452、0.2973.结论 通过德尔菲法结合专家定性访谈、专题小组讨论所建立的突发公共卫生事件影响的综合评价指标体系具有较为合理的结构,评价内容较为完整和全面,具有一定的科学合理性和适用性.     

医院临床科主任胜任特征模型的构建

目的构建医院临床科主任胜任特征模型。方法采用开放、回顾式的"行为事件访谈"探索技术,获得数据进行编码,并经过项目分析和探索性因素分析,编制调查问卷,构建了临床科主任胜任特征模型,最后通过验证性因素分析和信度效度分析对该模型进行验证。结果临床科主任胜任特征模型包括成就动机、专业知识与技能、个人特质、沟通能力、管理能力5个层次、12项指标特征。性别、学历、专业年限对胜任特征有一定影响。结论临床科主任胜任特征模型的构建为选拔和培养对学科发展有责任心和成就欲的科室领导提供了选拔和评价的目标。     

动机性访谈对高血压患者干预效果的系统评价*

目的系统评价动机性访谈对高血压患者的干预效果。方法检索多个中英文数据库自建库至2018年12月发表的动机性访谈干预高血压患者的随机对照试验(RCT),使用Cochrane偏倚风险评估工具进行文献评价,采用RevMan 5.3软件进行数据合并分析,无法转换合并的数据采用描述性分析。结果本研究共纳入17篇RCT,2 445例患者。Meta分析结果显示,与对照组相比,动机性访谈能够提高患者的生活质量、自我效能,差异均有统计学意义(P0.05);在降压方面,对不同干预时间进行亚组分析,结果显示,试验组收缩压明显低于对照组(P0.05),且仅有干预时间12周或48周时两组舒张压差异有统计学意义(P0.05)。描述性分析结果显示,动机性访谈能够提高患者自我管理能力。结论动机性访谈能够改善患者的生活质量,提高患者自我管理能力和自我效能,同时能够降低收缩压;但对干预时间为12周、24周的舒张压无明显作用,还有待临床多中心和大样本的RCT开展,以验证其效果。     

National decision-making on adopting new vaccines: a systematic review

In recent years numerous new vaccines have been developed, offering potential reductions in the morbidity and mortality caused by a range of diseases. This has led to increased interest in decision-making about the adoption of new vaccines into national immunization programmes. This paper aims to systematically review the literature on national decision-making around the adoption of new vaccines. A thematic framework was developed inductively through analysis of the vaccine adoption decision-making frameworks included in the review. This thematic framework was then applied to the remaining studies included in the review. In total, 85 articles were included in the review: 39 articles describing examples of vaccine adoption decision-making, 26 presenting vaccine decision-making frameworks, 21 empirical articles of decision-making relating to vaccine adoption and 19 theoretical essays. An analysis of vaccine adoption decision-making frameworks identified nine broad categories of criteria: the importance of the health problem; vaccine characteristics; immunization programme considerations; acceptability; accessibility, equity and ethics; financial/economic issues; impact; alternative interventions and the decision-making process. The quality of the empirical studies was varied. Although some of the issues included in the frameworks were similar to those considered in the studies, there were also some notable differences. On the whole, the frameworks were more comprehensive than the studies, including a greater range of criteria. The existing literature provides a good foundation for further research into vaccine adoption decision-making. The current review, in pulling together what is already known and by identifying strengths, weaknesses and gaps in the existing evidence base, aims to encourage a more focused and rigorous approach to the topic in future. This could help to identify the most appropriate ways to develop vaccine adoption decision-making, so as to improve decisions and, ultimately, health outcomes.     

Multiple accountabilities: development cooperation,transparency, and the politics of unknowing in Tanzania’s health sector

Accountability and transparency are considered best practices within development cooperation frameworks characteristic of global health practice today. In this article, I ask: How do accountability and transparency work, and for whom? I develop three main arguments. Drawing on Geissler’s concept ‘unknowing,’ I first demonstrate that global health actors are aware, yet strategically obscure, the instabilities and problematics of data and indicators in Tanzania. Second, I suggest that multiple and contradictory forms of accountability are pursued by global health actors, while this multiplicity is often unspoken in order to render accountability frameworks legitimate to sustain the existing development cooperation system. Third, I argue that foreign and Tanzanian actors within the health sector perpetuate accountability and development cooperation frameworks which are neither cooperative, nor accountable to citizens and purported beneficiaries of aid, because doing so allows actors to pursue interests often unrelated to formal policy goals.     

Development of key indicators to quantify the health impacts of climate change on Canadians

Objectives

This study aimed at developing a list of key human health indicators for quantifying the health impacts of climate change in Canada.

Methods

A literature review was conducted in OVID Medline to identify health morbidity and mortality indicators currently used to quantify climate change impacts. Public health frameworks and other studies of climate change indicators were reviewed to identify criteria with which to evaluate the list of proposed key indicators and a rating scale was developed. Total scores for each indicator were calculated based on the rating scale.

Results

A total of 77 health indicators were identified from the literature. After evaluation using the chosen criteria, 8 indicators were identified as the best for use. They include excess daily all-cause mortality due to heat, premature deaths due to air pollution (ozone and particulate matter 2.5), preventable deaths from climate change, disability-adjusted life years lost from climate change, daily all-cause mortality, daily non-accidental mortality, West Nile Disease incidence, and Lyme borreliosis incidence.

Conclusions

There is need for further data and research related to health effect quantification in the area of climate change.     

社区卫生服务评价指标体系研究文献综述

目的:综述当前城市社区卫生服务评价指标体系研究文献,总结归纳基本理论、框架、研究方法,分析主要问题,提出规范和完善社区卫生服务评价指标体系的建议。方法:文献综述法。结果:目前,社区卫生服务评价指标体系构建的理论框架依据一是"结构—过程—结果"模式或"投入—过程—产出"逻辑框架,二是国家政策目标或社区卫生发展模式研究报告结果;研究方法主要为Delphi法,部分研究可见对评价指标体系的信度和效度检验。结论与建议:社区卫生服务评价指标模型逐渐成熟,但是评价指标不够完善,活动指标中管理活动涉及较少,某些指标体系构建研究步骤不全;建议统一并完善评价指标体系逻辑框架,综合各类研究方法,理清指标体系构建及应用主要步骤,建立完善的社区卫生服务评价指标体系。     

The National Health Insurance system as one type of new typology: the case of South Korea and Taiwan

A typology is the useful way of understanding the key frameworks of health care system. With many different criteria of health care system, several typologies have been introduced and applied to each country's health care system. Among those, National Health Service (NHS), Social Health Insurance (SHI), and Private Health Insurance (PHI) are three most well-known types of health care system in the 3-model typology. Differentiated from the existing 3-model typology of health care system, South Korea and Taiwan implemented new concept of National Health Insurance (NHI) system. Since none of previous typologies can be applied to these countries' NHI to explain its unique features in a proper manner, a new typology needs to be introduced. Therefore, this paper introduces a new typology with two crucial variables that are 'state administration for health care financing' and 'main body for health care provision'. With these two variables, the world's national health care systems can be divided into four types of model: NHS, SHI, NHI, and PHI (Liberal model). This research outlines the rationale of developing new typology and introduces main features and frameworks of the NHI that South Korea and Taiwan implemented in the 1990 s.     

Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement.

ISSUES: Countries and international organizations have recently renewed their interest in how health systems perform. This has led to the development of performance indicators for monitoring, assessing, and managing health systems to achieve effectiveness, equity, efficiency, and quality. Although the indicators populate conceptual frameworks, it is often not very clear just what the underlying concepts might be or how effectiveness is conceptualized and measured. Furthermore, there is a gap in the knowledge of how the resultant performance data are used to stimulate improvement and to ensure health care quality. ADDRESSING THE ISSUES: This paper therefore explores, individually, the conceptual bases, effectiveness and its indicators, as well as the quality improvement dynamics of the performance frameworks of the UK, Canada, Australia, US, World Health Organization, and Organisation for Economic Co-operation and Development. RESULTS: We see that they all conceive health and health system performance in one or more supportive frameworks, but differ in concepts and operations. Effectiveness often implies, nationally, the achievement of high quality outcomes of care, or internationally, the efficient achievement of system objectives, or both. Its indicators are therefore mainly outcome and, less so, process measures. The frameworks are linked to a combination of tools and initiatives to stimulate and manage performance and quality improvement. CONCLUSIONS: These dynamics may ensure the proper environment for these conceptual frameworks where, alongside objectives such as equity and efficiency, effectiveness (therefore, quality) becomes the core of health systems performance.     

精准医学技术的国际价值判断框架指标构建及归纳

目的:归纳并构建适用于精准医学技术的价值判断指标,为我国医保决策提供科学的价值判断体系支撑。方法:从国际上不同的卫生技术评估和价值判断框架体系中梳理和总结出20个价值判断框架,摘录核心指标,对指标进行主题归纳和频数分析。结果与结论:精准医学价值判断框架有8个一级指标及21个二级维度。研究者和决策者可以在不同的决策情景下有选择的使用,提升价值判断的规范性和科学性。     

我国环境健康综合监测指标体系建立的初步研究

目的通过梳理国内外环境健康指标,初步建立我国环境健康综合监测指标体系,探索国内外环境健康监测指标差异,以期为开展环境健康综合监测工作提供依据。方法对国外环境健康综合监测网站平台和国内环境健康数据资源开展调研,归纳总结出国内监测指标中的不足,在此基础上初步建立我国的环境健康综合监测指标体系。结果本研究初步整理的环境健康指标监测体系分为环境类、健康效应类和人口与社会经济学因素类,环境类包括空气、气象、土壤和饮用水监测数据;健康效应类包括慢性病监测、医院监测、死亡监测、高温中暑、出生监测和地方疾病监测数据;人口与社会经济学类包括人口、社会经济、空间数据和生活方式等数据。基于国内外监测指标对比,发现我国目前缺乏对婴儿死亡率、吸烟率、期望寿命和空调拥有率等指标的全国性综合监测。结论通过对国内外环境健康指标的调研,初步建立了我国环境健康指标综合监测体系,探讨了国内外环境健康指标的差别,为进一步完善指标监测体系和为开展综合监测工作提供依据。     

Environmental health indicators and a case study of air pollution in Latin American cities

Environmental health indicators (EHIs) are applied in a variety of research and decision-making settings to gauge the health consequences of environmental hazards, to summarize complex information, or to compare policy impacts across locations or time periods. While EHIs can provide a useful means of conveying information, they also can be misused. Additional research is needed to help researchers and policy-makers understand categories of indicators and their appropriate application. In this article, we review current frameworks for environmental health indicators and discuss the advantages and limitations of various forms. A case study EHI system was developed for air pollution and health for urban Latin American centers in order to explore how underlying assumptions affect indicator results. Sixteen cities were ranked according to five indicators that considered: population exposed, children exposed, comparison to health-based guidelines, and overall PM₁₀ levels. Results indicate that although some overall patterns in rankings were observed, cities’ relative rankings were highly dependent on the indicator used. In fact, a city that was ranked best under one indicator was ranked worst with another. The sensitivity of rankings, even when considering a simple case of a single pollutant, highlights the need for clear understanding of EHIs and how they may be affected by underlying assumptions. Careful consideration should be given to the purpose, assumptions, and limitations of EHIs used individually or in combination in order to minimize misinterpretation of their implications and enhance their usefulness.     

Indicators in environmental health: identifying and selecting common sets

In association with the proposed goals of the conference, this paper is presented to support the conference discussions on environmental health indicators by providing background on indicators for environmental health and their identification, selection, organization and use. This paper discusses the purpose of indicator use, frameworks used to organize indicators and the common types of indicators in use in monitoring programs today. It proposes a process for the identification and selection of indicators within the different environments, stressing the importance of clear goal definition and scientific and use-based criteria selection to support decisions. Finally, the paper suggests methods by which to organize and limit the number of indicators retained within a program, and the development of a potential "core" of indicators common to many environments and geographical scales.