目的分析整合式慢性病社区健康管理模式实施的促进和障碍因素,区分模式服务量高覆盖率组和低覆盖率组在实施性研究的整合性理论框架(consolidated framework for implementation research,CFIR)上的结构差异,为政府部门提供政策建议。...目的分析整合式慢性病社区健康管理模式实施的促进和障碍因素,区分模式服务量高覆盖率组和低覆盖率组在实施性研究的整合性理论框架(consolidated framework for implementation research,CFIR)上的结构差异,为政府部门提供政策建议。方法结合CFIR对22名专家进行半结构化访谈,采用定性结构评级法对13家社区卫生服务中心受访者评分,利用NVivo 12软件编码。结果高覆盖率组和低覆盖率组的相对优势、外部政策与激励、实施准备度、反思和评价、领导个人特质5个CFIR结构有差异。促进因素包括:测量数据更加精准,提高了高血压和糖尿病患者的异常检出率和控制率;模式实现了服务、技术、数据“三整合”,优化管理流程,提供管理抓手;基础性和个性化服务结合吸引患者到基层就诊;模式与我国政策背景,初级卫生保健工作和以患者为中心理念兼容;数字化工具的应用减轻医护人员工作负担;领导重视是基础,利益方间的通力合作是重要保障。障碍因素包括:宏观层面缺少卫生行政机构的支持性政策,组织架构和运行机制尚未建立,建设、投入主体以及具体工作规范和流程有待明确;缺乏监督管理机制和质量评估小组;模式推广目标模糊;缺乏规范化系统性的培训计划;为不同群体提供服务存在挑战,缺乏有效的社会面宣传;模式仍须提高需方获得感;社区布局限制了模式的服务提供。结论卫生行政部门应明确模式的建设、运行、投入主体,完善组织架构并明确各利益方的功能定位和职责分工,进一步制定工作规范和工作流程;建立信息反馈机制和质量控制小组并进行定期评估;制定清晰的目标;加大宣传教育,扩大宣传面;利用数字化工具形成良性医患互动机制。展开更多
Prognostics and health management （PHM） is very important to guarantee the reliability and safety of aerospace systems, and sensing and test are the precondition of PHM. Integrating design for testability into early...Prognostics and health management （PHM） is very important to guarantee the reliability and safety of aerospace systems, and sensing and test are the precondition of PHM. Integrating design for testability into early design stage of system early design stage is deemed as a fundamental way to improve PHM performance, and testability model is the base of testability analysis and design. This paper discusses a hierarchical model-based approach to testability modeling and analysis for heading attitude system health management. Quantified directed graph, of which the nodes represent components and tests and the directed edges represent fault propagation paths, is used to describe fault-test dependency, and quantitative testability information is assigned to nodes and directed edges. The fault dependencies between nodes can be obtained by functional fault analysis methodology that captures the physical architecture and material flows such as energy, heat, data, and so on. By incorporating physics of failure models into component, the dynamic process of a failing or degrading component can be projected onto system behavior, i.e., system symptoms. Then, the analysis of extended failure modes, mechanisms and effects is utilized to construct fault evolution-test dependency. Using this integrated model, the designers and system analysts can assess the test suite＇s fault detectability, fault isolability and fault predictability. And heading attitude system application results show that the proposed model can support testability analysis and design for PHM very well.展开更多
基金supported by National Natural Science Foundation of China (No. 51175502)
文摘Prognostics and health management （PHM） is very important to guarantee the reliability and safety of aerospace systems, and sensing and test are the precondition of PHM. Integrating design for testability into early design stage of system early design stage is deemed as a fundamental way to improve PHM performance, and testability model is the base of testability analysis and design. This paper discusses a hierarchical model-based approach to testability modeling and analysis for heading attitude system health management. Quantified directed graph, of which the nodes represent components and tests and the directed edges represent fault propagation paths, is used to describe fault-test dependency, and quantitative testability information is assigned to nodes and directed edges. The fault dependencies between nodes can be obtained by functional fault analysis methodology that captures the physical architecture and material flows such as energy, heat, data, and so on. By incorporating physics of failure models into component, the dynamic process of a failing or degrading component can be projected onto system behavior, i.e., system symptoms. Then, the analysis of extended failure modes, mechanisms and effects is utilized to construct fault evolution-test dependency. Using this integrated model, the designers and system analysts can assess the test suite＇s fault detectability, fault isolability and fault predictability. And heading attitude system application results show that the proposed model can support testability analysis and design for PHM very well.
