基于德尔菲法和层次分析法的疾控机构应急能力评估

Assessment of CDC's emergency capability with Delphi method and analytic hierarchy process

目的建立广东省疾控机构应急能力评估指标体系,并对疾控机构应急能力进行评估。方法根据广东省疾控机构在应急工作中的职责和特点,在专家咨询、文献循证评价和专题小组讨论的基础上,拟定"广东省疾病预防控制机构卫生应急能力评估指标体系"草案,在全省选择26名专家,采用德尔菲法进行2轮咨询,应用层次分析法计算一、二级指标权重,采用比例分配法计算三级指标权重,建立评估指标体系。设计"广东省疾病预防控制机构卫生应急能力评估调查表"。采用问卷调查的方法对广东省22个地市(含顺德)进行普查。应用层次聚类法对广东省各地市疾控机构应急能力进行分类。结果共进行了2轮专家咨询,其中第1、2轮分别发送问卷26、24份,分别回收24、23份,总回收率为94%(47/50);第1、2轮专家咨询的肯德尔和谐系数分别为0.412、0.490;经过2轮专家咨询,确立了应急能力评估指标体系,其整体的克朗巴赫α系数=0.858;指标体系由8个一级指标、24个二级指标和60个三级指标组成,8个一级指标分别为应急管理体系建设、应急人力资源、监测预警能力、应急处置能力、实验室检测能力、应急保障能力、培训和演练、健教宣传与媒体沟通,权重系统分别为0.119 8、0.131 2、0.121 3、0.193 6、0.129 3、0.127 8、0.099 5和0.077 5。广东省疾控机构应急能力总分排名前3的地市是深圳、广州、珠海,分别为0.922、0.913、0.877。排名居后的地市分别是汕尾、河源和云浮,总分分别为0.475、0.523、0.541。应用层次聚类法将广东省22个地市分为4类,应急能力较低的第3、4类主要分布在粤东、粤西和粤北。各地应急综合能力评分与当地2011年人均GDP呈高度正相关(r=0.828 9,P<0.01)。结论该研究构建的指标体系贴近实际情况,指标体系的可信度较高。评估结果显示广东省各市应急能力发展不均衡,经济欠发达地区疾控中心的应急能力相对较弱。

Objective To construct an evaluation index system and assess emergency response ca- pacity of Guangdong CDCs. Methods Health emergency response capacity evaluation index system of Guangdong CDCs was drafted based upon expert consultation, documentary analysis and focus group discus- sion on the basis of Guangdong CDCs＇ duties and features of emergency work. The evaluation index system was established by applying Delphi method two rounds to consult 26 experts chosen from Guangdong Prov- ince. By conducting a questionnaire survey, a general investigation was made for 22 cities of Guangdong Province including Shunde. Analytic hierarchy process was applied to calculate the weight of primary and secondary indexes and proportionate allocation method was used to calculate the third-level. Hierarchical clustering was applied for the classification of the CDCs. Results Two rounds of expert consultations were conducted, 26 and 24 questionnaires were sent in each round, 24 and 23 were recovered respectively, and general recovery rate was 94% （47/50）. Kendall＇s coefficient of concordance was 0. 412 and 0. 490 at the first and second round of expert consultations respectively. After two rounds of consultations, the evaluation index system was established and its overall Crowns Bach alpha coefficient was 0. 858. The constructed in- dex system consists of 8 primary indexes, 24 secondary indexes, and 60 third-level indexes. The eight pri- mary indexes included emergency management system, human resources, surveillance and early- warning a- bility, emergency response capacity, laboratory＇ s testing capability, emergent supply capability, trainings and drills, health education and media communication, whose systematic weights were 0. 119 8, 0. 131 2, 0. 121 3, 0. 193 6, 0. 129 3, 0. 127 8, 0. 099 5, and 0. 077 5, respectively. The emergency capacity as- sessment states that the top 3 cities with the highest scores were Shenzhen （0. 922）, Guangzhou （0. 913） and Zhuhai （0. 877 ） while Shanwei （0. 475 ）, Heyuan （0. 523 ） and Yunfu （0. 541 ） were the last 3 cities with the lowest scores. The 22 CDCs in the province were classified into 4 categories through hierarchical clustering. The cities of Classes 3 and 4, with a lower emergency response capacity, were mainly in the western, eastern, and northern parts of Guangdong. A positive correlation was found between the scores and local GDP levels （ r = 0. 828 9, P 〈 0. 01 ）. Conclusion The index system constructed in this study possesses a high credibility. The emergency response capacity among CDCs in Guangdong is not balanced and the capability of CDCs in economic less-developed areas is relatively weak.