基于系统思考的社区大肠癌筛查标准化模型构建

Construction of Standardized Model for Screening Colorectal Cancer in Community Based on Systems Thinking

目的以社区大肠癌筛查为例,探索社区筛查系统标准化模型,为建立系统化的评估方案标准做准备。方法于2015年7—8月,采用上海市闵行区古美社区卫生服务中心大肠癌筛查流程与2013—2015年社区大肠癌筛查的历史数据,基于系统动力学的系统思考方法,将系统中存在因果关系的各变量进行梳理,构建社区大肠癌筛查的标准化模型。结果该社区筛查体系的标准化模型由政策、技术、供方和需方4个子系统构成,系统的运作由政策启动,经供方在现有技术限制下按照政策制定的规则与需方发生交互,最终产生需方生命年、生命质量、治疗成本节约等方面的卫生经济学评价。结论大肠癌筛查体系的标准化模型可作为社区大肠癌筛查标准体系中"服务提供标准体系"下服务评价与改进的重要工具,为标准体系的运行和持续优化提供了可能。同时,本研究的系统分析结果及因果关系图,可为社区开展其他恶性肿瘤筛查体系的分析提供借鉴。

Objective This study aimed to establish a standardized model for colorectal cancer screening in community,which can provide reference for construction of systematic evaluation criteria. Methods From July to August 2015,the colorectal cancer screening process which used in Shanghai Minhang District Gumei Community Health Center,and historical data of colorectal cancer screening in community from 2013 to 2015 were adopted,systems thinking method which based on the system dynamics was used,various variables which had causal relationship with each other were taken into account, then a standardized model for colorectal cancer screening in community was established. Results The standardized model for colorectal cancer screening in community was made up of 4 subsystems,which included policy,technology,supply- side and demand-side. The policy subsystem droved the screening system into operation and the supply- side launched regular events for screening colorectal cancer on the demand- side,which shaped complex causal relationships under the constraints of policy and technology subsystems. The final indicators of health economics evaluation included the years of life,quality of life,treatment cost savings and so on. Conclusion The standardized model for colorectal cancer screening will help communities to improve the screening system of the colorectal cancer and offer a possibility to get the system optimized continuously by service evaluation. And the system analysis result and causality diagram also provide references for other cancer screening in communities with standardized process.