德尔菲法筛选耐多药结核病诊断治疗管理评价体系研究

The study on Delphi filtering the indicators of evaluation on the diagnosis, treatment and management of MDR-TB

目的通过德尔菲法筛选出耐多药结核病（MDR—TB）诊断治疗管理的评价体系。方法从有丰富经验的MDR—TB工作者中筛选出30名专家，采用3轮德尔菲咨询法征询专家对60个MDR—TB诊断治疗管理拟评价指标的评分及建议，统计分析每轮咨询时专家意见的集中程度（用各指标评分均数和满分比来反映）、协调程度（用协调系数w来反映），计算变异系数、积极系数、权威系数（Cr）等，重新确定指标体系后再次咨询专家建议，并以积极系数和协调系数衡量德尔菲法的效果。结果3轮专家咨询的积极系数均为100％（30／30），提出建议专家分别占专家总数的40％（12／30）、53％（16／30）、10％（3／30）。第、二轮咨询D值分别为0．82、0．86。经第一、二轮咨询，修改r6个指标，删除了26个指标，最终确定了评价体系的34个指标，其中10个为核心指标，34个指标的平均分均高于4．7，变异系数均低于0．1。3轮专家咨询w值分别为0．36、0．25和0．68。结论通过德尔菲法筛选MDR—TB诊断治疗管理指标效果较好，共确定了包含34个指标的MDR—TB防治工作评价体系。

Objective To filter the indicators of evaluation on the diagnosis, treatment and managemenl of MDR-TB through Delphi. Methods Three rounds Delphi was implemented by asking for the 30 experts＇ score and suggestion of 60 evaluation indicators. The experts were selected from experienced MDR-TB workers. Then the concentration degree （with each indicator＇s score average and full mark rate to reflect） and coordination degree （with coordination coefficient w to reflect ） were analyzed, and the coefficient of variation of each indicator, enthusiasm and authority coefficient Cretc were calculated. After that, new indicators system was constructed and the experts＇ were asked for suggestion again. The enthusiasm and coordinate coefficient were used to measure the effect of Delphi. Results All of the enthusiasm coefficients of experts in three rounds were 100% （ 30/30 ）, and 40% （12/30） , 53% （16/30） and 10% （3/30） of the experts gave suggestions. The degrees of experts＇ authority in the first 2 rounds were high and the averages were 0.82 and 0. 86, respectively. A total of 34 indicators were left after 6 indicators modified and 26 indicators deleted. The 10 indicators were the core indicators, and the average scores of 34 indicators were all higher than 4. 7 and the coefficients of variation were less than 0. 1, respectively. The coordination coefficients of specialists＇ opinion were 0. 36, 0. 25 and 0. 68, respectively. Conclusion The final evaluation indicator system include 34 indicators, and the result of the filtering indicators on the diagnosis, treatment and management of MDR-TB through Delphi is good.