健康生态学视角下慢性心力衰竭健康管理综合评价指标体系的构建

Establish a comprehensive evaluation index system for health management of chronic heart failure from the perspective of health ecology

目的基于健康生态学构建适合我国国情的慢性心力衰竭健康管理综合评价指标体系。方法以健康生态学为理论依据,通过文献回顾法初步构建慢性心力衰竭健康管理综合评价指标体系框架。采用德尔菲专家咨询法,选取30名专家,进行2轮专家咨询,对条目进行筛选和修改。结果第2轮专家积极系数为100%,权威系数为0.882,一、二、三级指标专家意见协调系数分别为0.516、0.267、0.312(P<0.001)。满分比范围为0.23~0.97,变异系数值范围为0.037~0.188,重要性赋值均数范围为4.10~4.97,标准差范围为0.18~0.78。最终形成的健康生态学视角下慢性心力衰竭健康管理综合评价指标体系包括患者个体、社会支持、医疗卫生服务、卫生经济学4个一级指标;症状和体征、心功能、检验指标、心理状态、健康行为、其他相关指标、领悟(主观)社会支持、实际(客观)社会支持、支持可利用度、健康管理团队、信息平台、管理质量、实际经济状况、实际支出费用等14个二级指标以及血压、心率、呼吸等43个三级指标。结论本研究构建的健康生态学视角下慢性心力衰竭健康管理综合评价指标体系科学、可靠,能为临床医护人员优化健康管理模式提供依据。

Objective To establish a comprehensive evaluation index system for the health management of chronic heart failure.Methods Based on the health ecology,a framework of the comprehensive evaluation index system for the health management of chronic heart failure was established by literature review.Delphi’s expert consultation method was adopted to select 30 experts,who conducted two rounds of expert consultations to screen and modify the entries.Results The expert positive coefficient in the second round was at 100%and the authority coefficient was at 0.882.The full score ratio ranged from 0.23 to 0.97,the coefficient of variation ranged from 0.037 to 0.188,the mean value of importance ranged from 4.10 to 4.97,and the standard deviation ranged from 0.18 to 0.78.The expert opinion coordination coefficients of the first,second and third indexes were 0.516,0.267 and 0.312,respectively(P<0.001).Finally,the comprehensive evaluation index system was established for the health management of chronic heart failure from the perspective of health ecology.It composed of Tier-1 index which has 4 indicators including individual patients,social support,medical and health services,and health economics;Tier-2 index which has 14 indicators including symptoms and signs,heart function,test indicators,mental state,health behaviour as well as other relevant indicators including perceptive(subjective)social support,actual(objective)social support,support availability,health management team,information platform,management quality,actual economic status and costs,and Tier-3 index which has 43 indicators including blood pressure,heart rate,breathing,etc.Conclusion The comprehensive evaluation index system established in this study for health management of chronic heart failure from the perspective of health ecology is scientific and reliable,and it provides a basis for clinical medical staff to optimise the health management model.