社会办基层医疗卫生机构疫情防控风险量化评估实践研究

Application of a quantitative risk assessment system for COVID-19 prevention and control in private grassroots health care institutions

目的设计一套适用于社会办基层医疗卫生机构的疫情防控风险量化评估体系,并用于风险评估实践。方法以天津市社会办基层医疗卫生机构为研究对象,首先利用头脑风暴法、文献荟萃法和专家咨询法识别社会办基层医疗卫生机构疫情防控风险要素,形成风险评估体系的基本框架,然后利用层次分析法计算各风险要素权重,设计量化评分指标用于评估实践。根据评估结果利用加权秩和比法划分社会办基层医疗卫生机构风险等级。结果共识别出风险要素25个,分为“未落实首诊负责制”“未严格落实预检分诊管理”“未规范处理医疗废物”“医院感染防控管理混乱”“未规范进行住院病房陪护与探视管理”“机构人员健康监测与定期核酸检测执行不到位”“机构培训演练不到位”7大类。量化评估体系针对25个风险因素共设计出单项选择类指标8项及多项选择类指标17项。研究结果显示,高风险等级机构29个,中风险等级机构125个,低风险等级机构30个。结论本研究构建了一套适用于社会办基层医疗卫生机构的疫情防控风险量化评估体系,研究结果可用于社会办基层医疗卫生机构分类管理。

Objective To develop a quantitative risk assessment(QRA)system for COVID-19 prevention and control in private grassroots health care institutions.Methods The basic framework of the risk assessment system was developed by identifying the risk elements of COVID-19 prevention and control in private grassroots health care institutions in Tianjin using brainstorming methods,meta-analysis,and expert consultations.Subsequently,the weight of each risk element was calculated using hierarchical analysis,and quantitative scoring indicators were designed for the assessment.The risk levels in these institutions were classified according to the assessment results using the weighted rank-sum ratio method.Results A total of 25 risk factors were identified,which were divided into seven categories including"failure to implement the first-inquiry accountability system","failure to strictly implement pre-screening and triage management","failure to dispose medical waste in a standardized way",“failure to manage hospital infection prevention and control orderly",“failure to implement inpatient escort and visitation policies properly”,"inadequate implementation of institutional staff in health monitoring and regular nucleic acid testing",and"inadequate training and exercise for emergency response".Eight single-choice items and 17 multiple-choice items were designed for the QRA system.Based on this system,we identified 29 high-risk institutions,125 medium-risk institutions,and 30 low-risk institutions.Conclusions A QRA system for COVID-19 prevention and control in private grassroots health care institutions was successfully developed and can be used for the categorized management of private grassroots health care institutions.