基层医疗卫生机构开展乳腺癌筛查能力评价指标体系构建研究

Development of a Breast Cancer Screening Capacity Assessment System for Primary Care Institutions

背景基层医疗卫生机构在开展乳腺癌筛查过程中受到许多因素制约,难以保证筛查工作取得实质性进展,因此建立一套科学、有效的基层医疗卫生机构开展乳腺癌筛查能力评价指标体系尤为重要。目的构建基层医疗卫生机构开展乳腺癌筛查能力评价指标体系。方法于2022年9—10月,通过文献检索和小组讨论初步拟定基层医疗卫生机构开展乳腺癌筛查能力评价指标体系库并设计专家函询表,于2022年11—12月采用目的抽样法邀请21名专家作为函询对象,根据函询结果计算专家积极系数、专家权威系数和专家协调系数,经过小组讨论最终确定指标体系,应用层次分析法确定各级指标权重系数并检验各级指标逻辑一致性。结果专家咨询表全部收回且有效,专家积极系数为100.0%,专家权威系数为0.812,重要性专家协调系数为0.209(P<0.001),最终确立的指标体系由结构、过程、结果3个一级指标,10个二级指标和56个三级指标构成,3个一级指标的权重分别为0.3108、0.1958和0.4934,各层级指标的一致性比率均<0.100。结论初步构建的基层医疗卫生机构开展乳腺癌筛查能力评价指标体系具有较高的权威性和科学性,有望为乳腺癌筛查能力评估相关研究提供指导与参考,指标体系的适用性和应用效果仍有待进一步验证。

Background Due to many barriers,it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening.So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening.Objective To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening.Methods From September to October 2022,through literature review and group discussion,we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions(BCSCASPCI).Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI,and the response coefficient,authority coefficient,and the Kendall's W of the survey were calculated.Finally,based on the results of the survey and a group discussion,the final version of the BCSCASPCI was determined.The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators.Results All the experts returned effective questionnaires,achieving a response rate of 100.0%,and the authority coefficient was 0.812,and the Kendall's W was 0.209(P<0.001).The final version of the BCSCASPCI consists of 3 primary indicators(structure,process,and outcome),10 secondary indicators,and 56 tertiary indicators.The weight coefficients of the 3 primary indicators were 0.3108,0.1958 and 0.4934,respectively.The consistency ratios of indicators at each level were<0.100.Conclusion Our BCSCASPCI has proven to be highly authoritative and scientific,and is expected to provide guidance and reference for studies related to breast cancer screening capacity assessment.But the applicability and application effects of the system still needs further verification.