糖尿病防控可及性IPA决策模型构建

Construction of an IPA Decision-making Model for the Accessibility of Diabetes Prevention and Control

目的探究糖尿病防控措施的优先级排序,提供决策依据。方法基于重要性-绩效分析(importance-performance analysis,IPA)模型对糖尿病防控一级指标进行象限划分,采用二阶验证性因子分析的标准化因子载荷系数确定同一象限内一级指标优先级,二级指标优先级则采用项目反应理论的区分度参数确定。结果最高优先级区域内,医保与家庭医生、社区行动、高危发现与干预三个一级指标优先于健康教育;优先改进级区域内,患者管理优先于并发症筛查;最低优先级区域内,各一级指标优先级顺序为:个人健康服务评估随访、环境支持、降糖政策、糖尿病合并感染预防。结论结合验证性因子分析与基于现代测量理论的项目反应理论,IPA模型可以很好地实现糖尿病防控决策模型构建。

Objective To explore the priority of diabetes prevention and control measures and provide a theoretical basis.Methods Based on the Importance-Performance Analysis(IPA)model,the primary indexes of the diabetes prevention and control were divided into four quadrants,the standardized factor loading coefficients of the second-order Confirmatory Factor Analysis were used to determine the priority of the primary indexes in the same quadrant,and the priority of the secondary indexes was determined by the discrimination parameter of the Item Response Theory.Results In the highest priority area,medical insurance and family doctors,community action,and high-risk detection with intervention had priority over health education;in the priority improvement area,patient management had priority over complication screening;in the lowest priority area,the priority order of the primary indexes:personal health service assessment follow-up,environmental support,hypoglycemic policy,diabetes co-infection prevention.Conclusion Combining Confirmatory Factor Analysis and Item Response Theory based on modern testing theory,IPA model achieved the decision-making of diabetes prevention and control well.