基于系统动力学的社区高血压管理投入预测

Prediction of Hypertension Management Input in Community Based on System Dynamics

背景从接收到上级单位下达的管理目标到管理效果显现,社区高血压管理的服务量会呈现何种变化,为完成这些服务量,社区又需要投入多少人力,目前暂无确切答案。目的借助系统动力学方法,对社区高血压管理的历年服务量和社区投入进行预测,以对社区高血压管理体系的优化提供改进建议。方法于2017年9月—2018年3月,以上海市徐汇区枫林街道社区卫生服务中心为研究对象,通过历史资料查询和问卷调查,采集其2007—2016年社区高血压管理的历年服务量、社区投入等相关资料,借助系统动力学软件Vensim PLE,对2017—2021年社区高血压管理的历年服务量和社区投入进行预测,预测结果显示新增高血压管理人数、年初高血压在管人数等两个主要变量的相对误差绝对值不超过0.05,说明系统模型基本能真实反映枫林街道社区卫生服务中心社区高血压管理体系的运作过程,可用于枫林街道社区卫生服务中心社区高血压管理服务人数和社区投入的预测。结果结果显示,枫林街道社区卫生服务中心每年新增高血压管理人数预期从2018年起与高血压管理流失人数近乎持平,从而使高血压在管人数基本稳定在17 000人左右,而每年社区投入预计会达到100万元左右。结论基于系统动力学模型的社区高血压管理服务量和社区投入预测具有科学性,预测结果揭示了社区高血压管理体系所面临的压力,并由此提出社区高血压管理体系需要在近期对高血压管理执行人予以绩效倾斜,在远期则需要在信息化和培养低成本人才方面做出努力。

Background After receiving the management objectives issued by the superior units,there is no definite answer on the service volume change of hypertension management in the community and the number of medical stuffs needed.Objective To forecast the annual service volume and community input of hypertension management in by system dynamics method,so as to provide suggestions for the improvement of hypertension management system in community.Methods Fenglin Street Community Health Center,Xuhui District of Shanghai,was selected as the research subject from September 2017 to March 2018.Historical data query and questionnaire survey were conducted to collect the data about service volume and community input of hypertension management from 2007 to 2016.System dynamics software Vensim PLE was used to forecast the annual service volume and community input in hypertension management.The results showed that the absolute value of the relative error was less than 0.05 between forecasting data and actual data concerning the newly increased number of people involved in hypertension management and the number of people with hypertension under management at the beginning of the year.This indicated that the model could basically reflect the operation of hypertension management system,and could be used to forecast the volume of hypertension management service and community input in Fenglin Street Community Health Center.Results The results showed that the annual increase number in hypertension management in Fenglin Street Community Health Center was expected to be nearly equal to the loss number from 2018,thus basically stabilizing the number of people with hypertension in management at about 17000,and the annual community input is expected to reach about 1 million yuan.Conclusion Based on the system dynamics model,hypertension management service volume and input prediction in community are scientific,and the prediction results reveal the pressure of this system.Therefore,it is suggested that the hypertension management system in community should pay more attention to the performance of its executors in the near future,and make efforts in informationization and training low-cost personnel in the long run.