以效果为导向的国家基本公共卫生服务综合评价指标体系构建

Construction of health effect-oriented comprehensive evaluation index system for essential national public health service

目的构建效果导向的国家基本公共卫生服务综合评价指标体系,为创新基本公卫项目考核方式、推动从过程评价到健康结果评价转变提供方法和工具。方法通过文献综述、现场访谈、专家德尔菲咨询法和逻辑分析法构建并筛选一、二、三级指标,采用层次分析法、熵权法进行主客观权重计算。结果通过文献分析和访谈咨询,初步形成投入、执行、效果为3个一级指标、25个二级指标、104个三级指标的待选指标池,其中包括反映“效果”的三级指标共47个;通过第一轮专家德尔菲咨询筛选指标,专家积极系数为97.5%,专家权威系数为0.82,专家熟悉程度系数为0.88。最终形成的综合评价指标体系包括项目投入、执行、效果3个一级指标,所占权重分别为11.35%、26.48%和62.18%,包括20个二级指标和54个三级指标;在效果指标中,知晓率与满意度权重最高(16.39%),其次为慢性病患者健康管理(14.97%)、儿童健康管理(12.42%)、孕产妇健康管理(12.42%)、健康教育(5.43%);三级效果指标中,居民满意度权重最高(7.25%),其次为管理人群高血压并发生发生率(5.35%)、管理人群糖尿病并发症发生率(5.27%);除我国卫生统计的常规监测系统外,居民电子健康档案信息化系统可作为效果指标数据的主要来源。结论本研究构建的国家基本公共卫生服务综合评价指标体系突出效果导向,可在充分利用基本公卫居民健康档案信息系统的基础上,用于日常评价和阶段性评价。

Objective To construct an effect-oriented comprehensive evaluation index system for national basic public health services, and to provide methods and tools for innovating evaluation method of basic public health projects and promoting the transformation from process evaluation to health outcome evaluation. Methods Primary, secondary and tertiary indexes were constructed and selected with literature review, field interview of senior professionals, expert Delphi consulting and logical analysis;subjective and objective weights of the indexes were calculated through analytic hierarchy process and entropy weight method. Results Through literature analysis and interview consultation, an index pool consisting of 3 first-, 25 second-and 104 third-level indicators was preliminarily formed, including 47 third-level indicators reflecting health effects. For the first round of expert Delphi consultation on indicator screening, the positive coefficient of experts is 97.5%, the expert authority coefficient is 0.82, and the expert familiarity coefficient is 0.88. The final comprehensive evaluation index system consists of three first-level indexes of project investment, implementation and health effect, with the weights of 11.35%, 26.48% and 62.18%, along with 20 second-and 54 third-level indexes. Among the health effect indicators, the weight of awareness of and satisfaction to health services was the highest(16.39%), followed by the weight of health management in chronic disease patients(14.97%), children′s health management(12.42%), maternal health management(12.42%), and health education(5.43%). Among the three-level effect indexes, the weight of residents′satisfaction to health service was the highest(7.25%), followed by the incidence of hypertension and diabetes complications in the managed population(5.35%) and the incidence of diabetes complications in the managed population(5.27%). Besides the health statistics from routine monitoring system in China, the electronic health records in residents′ information system can be used as a main data source for health effect indicators. Conclusion The comprehensive index system constructed in this study for the evaluation on essential national public health service is effect-oriented and can be used for regular and periodical evaluation on the basis of making full use of residents′ health records in the basic public health information system.