区域卫生协同发展评价指标构建

Development of the Coordinated Regional Health Development Assessment System

背景区域卫生协同发展通过构建结构合理、功能到位的区域协同体以提供连续性医疗服务,并通过充分开展资源整合和信息共享,发挥区域内医疗中心和社区卫生服务中心的服务特色和专长,可真正起到优化资源配置的目的。现存区域卫生协同发展评价指标以结果类为主,相对单一,缺乏系统性,需开展相关研究,填补该领域缺陷。目的本研究拟构建区域卫生协同发展评价指标体系,为区域协同发展能力评价提供科学依据。方法通过文献分析、半结构化访谈等研究方法收集区域卫生协同发展要素,初步构建评价指标体系。随后选取上海市熟悉区域卫生协同的相关专家(来自全科医学、医学教育、行政管理、公共卫生管理领域)19名作为函询对象,于2020年12月至2021年3月运用德尔菲法对其进行两轮函询,并采用层次分析法评价各级指标权重、检验各级指标逻辑一致性,最终确立区域卫生协同发展的评价指标体系。结果两轮专家函询问卷的有效回收率分别为95.0%、100.0%,专家权威系数分别为0.87、0.92。初步构建的区域卫生协同发展指标体系由4个一级指标、12个二级指标和31个三级指标构成。4个一级指标的权重分别为0.387、0.296、0.187、0.130。各层级指标的一致性比率均<0.100。结论初步构建的区域卫生协同发展评价指标体系具有较强的科学性和实用性,可以发现服务于社区卫生服务中心的协同模式的问题与不足,为下一步指导区域模式实践工作奠定理论及实践基础。

Background Coordinated regional health development aims to optimize resource allocation by constructing a well-structured and functional regional collaborative system to provide continuous medical services,and to leverage the unique features and strengths of medical centers and community health centers within a region via fully integrating resources and sharing information.However,current available systems for assessing coordinated regional health development mainly focus on outcomes,which are relatively non-diversified and unsystematic,thus further research is required to fill this gap.Objective We aimed to construct an evaluation system for coordinated regional health development,to provide scientific evidence for evaluating the coordinated development capacities of regions.Methods We collected essential factors related to coordinated regional health development through a literature review and semi-structured interviews,and used them to construct a draft version of the Coordinated Regional Health Development Assessment System(CRHDAS).Then we selected 19 experts who were familiar with coordinated regional health development(engaging in general medicine,medical education,administrative management,and public health management) from Shanghai to attend two rounds of online combined with offline Delphi questionnaire surveys from December 2020 to March 2021 to determine the weights of the indicators and test the logical consistency of the weights of indicators at each level using Analytic Hierarchy Process.After that,we established the final version of CRHDAS.Results The effective response rate and authoritative coefficient were 95.0% and 0.87,respectively,for the first round of survey,and were 100.0% and 0.92,respectively,for the second round of survey.The CRHDAS consists of four first-level indicators(with corresponding weights of 0.387,0.296,0.187 and 0.130),12 second-level indicators,and 31 third-level indicators.The consistency ratios for the weights of three levels of indicators are 0.100.Conclusion The CRHDAS is of high-level scientificity and practicality,which can help identify problems and deficiencies of the collaboration mode between community health centers,providing a theoretical and practical basis for guiding coordinated regional health practice in the future.