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Real-Time Co-optimization of Gear Shifting and Engine Torque for Predictive Cruise Control of Heavy-Duty Trucks
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作者 Hongqing Chu Xiaoxiang Na +4 位作者 Huan Liu Yuhai Wang Zhuo Yang Lin Zhang Hong Chen 《Chinese Journal of Mechanical Engineering》 SCIE EI CAS CSCD 2024年第2期294-317,共24页
Fuel consumption is one of the main concerns for heavy-duty trucks.Predictive cruise control(PCC)provides an intriguing opportunity to reduce fuel consumption by using the upcoming road information.In this study,a rea... Fuel consumption is one of the main concerns for heavy-duty trucks.Predictive cruise control(PCC)provides an intriguing opportunity to reduce fuel consumption by using the upcoming road information.In this study,a real-time implementable PCC,which simultaneously optimizes engine torque and gear shifting,is proposed for heavy-duty trucks.To minimize fuel consumption,the problem of the PCC is formulated as a nonlinear model predictive control(MPC),in which the upcoming road elevation information is used.Finding the solution of the nonlinear MPC is time consuming;thus,a real-time implementable solver is developed based on Pontryagin’s maximum principle and indirect shooting method.Dynamic programming(DP)algorithm,as a global optimization algorithm,is used as a performance benchmark for the proposed solver.Simulation,hardware-in-the-loop and real-truck experiments are conducted to verify the performance of the proposed controller.The results demonstrate that the MPC-based solution performs nearly as well as the DP-based solution,with less than 1%deviation for testing roads.Moreover,the proposed co-optimization controller is implementable in a real-truck,and the proposed MPC-based PCC algorithm achieves a fuel-saving rate of 7.9%without compromising the truck’s travel time. 展开更多
关键词 Heavy-duty truck Predictive cruise control Model predictive control Pontryagin’s maximum principle Real-truck implementation
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Acupuncture:Effective and Recommended but More Implementation Needed
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作者 Mel Hopper Koppelman 《Chinese Medicine and Culture》 2024年第1期86-93,共8页
Acupuncture enjoys a robust evidence base for dozens of clinical conditions and decades of research exploring its mechanisms of action. It has over 9,000 positive recommendations from official government and clinical ... Acupuncture enjoys a robust evidence base for dozens of clinical conditions and decades of research exploring its mechanisms of action. It has over 9,000 positive recommendations from official government and clinical guidelines. However, it still remains relatively inaccessible in the United States, Europe and elsewhere, especially compared to the strength of evidence-based recommendations for its use. Acupuncture would benefit from robust implementation strategies, utilizing insights and approaches from implementation science. The clinical use of Botox for migraine suffered from weaker evidence of effectiveness and greater evidence of harm, but using a streamlined and robust implementation strategy, Allergan was able to achieve widespread implementation from when it began its efforts around 2010. Such a systematic approach that identifies and overcomes barriers to implementation for acupuncture would benefit millions of people who currently are offered less effective and more invasive treatments, contrary to the recommendations of clinical guidelines. 展开更多
关键词 ACUPUNCTURE Implementation science ACCESSIBILITY Emergency use MIGRAINE
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Implementation Status and Development Strategies of Study Tour in Primary Schools in Nanchang City : A Case Study of L Primary School
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作者 Hua LI Gang YAO +1 位作者 Shinan XIANG Feiping CHEN 《Asian Agricultural Research》 2024年第4期37-40,共4页
In recent years,with the support and promotion of relevant policies such as the Opinions on Promoting Study Tour for Primary and Secondary School Students jointly issued by the Ministry of Education and 11 other depar... In recent years,with the support and promotion of relevant policies such as the Opinions on Promoting Study Tour for Primary and Secondary School Students jointly issued by the Ministry of Education and 11 other departments,a wave of study tour has been sparked nationwide from individual pilot projects to gradual promotion.In this paper,students and teachers from grades 4 to 6 of L Primary School in Nanchang City,Jiangxi Province were selected as the survey objects.Combining the survey questionnaire,the current situation of conducting study tour in the primary school was sorted out and analyzed in depth from several aspects such as study tour cognition,study tour participation,study tour implementation,etc.Based on the survey results and relevant research,the current problems in conducting study tours in primary schools were summarized,and targeted improvement measures were proposed,in order to promote the healthy development of study tours in primary schools. 展开更多
关键词 Nanchang CITY Study TOUR IMPLEMENTATION STATUS COUNTERMEASURE
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Machine learning algorithm partially reconfigured on FPGA for an image edge detection system
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作者 Gracieth Cavalcanti Batista Johnny Oberg +3 位作者 Osamu Saotome Haroldo F.de Campos Velho Elcio Hideiti Shiguemori Ingemar Soderquist 《Journal of Electronic Science and Technology》 EI CAS CSCD 2024年第2期48-68,共21页
Unmanned aerial vehicles(UAVs)have been widely used in military,medical,wireless communications,aerial surveillance,etc.One key topic involving UAVs is pose estimation in autonomous navigation.A standard procedure for... Unmanned aerial vehicles(UAVs)have been widely used in military,medical,wireless communications,aerial surveillance,etc.One key topic involving UAVs is pose estimation in autonomous navigation.A standard procedure for this process is to combine inertial navigation system sensor information with the global navigation satellite system(GNSS)signal.However,some factors can interfere with the GNSS signal,such as ionospheric scintillation,jamming,or spoofing.One alternative method to avoid using the GNSS signal is to apply an image processing approach by matching UAV images with georeferenced images.But a high effort is required for image edge extraction.Here a support vector regression(SVR)model is proposed to reduce this computational load and processing time.The dynamic partial reconfiguration(DPR)of part of the SVR datapath is implemented to accelerate the process,reduce the area,and analyze its granularity by increasing the grain size of the reconfigurable region.Results show that the implementation in hardware is 68 times faster than that in software.This architecture with DPR also facilitates the low power consumption of 4 mW,leading to a reduction of 57%than that without DPR.This is also the lowest power consumption in current machine learning hardware implementations.Besides,the circuitry area is 41 times smaller.SVR with Gaussian kernel shows a success rate of 99.18%and minimum square error of 0.0146 for testing with the planning trajectory.This system is useful for adaptive applications where the user/designer can modify/reconfigure the hardware layout during its application,thus contributing to lower power consumption,smaller hardware area,and shorter execution time. 展开更多
关键词 Dynamic partial reconfiguration(DPR) Field programmable gate array(FPGA)implementation Image edge detection Support vector regression(SVR) Unmanned aerial vehicle(UAV) pose estimation
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Artificial Intelligence for Global Health: Difficulties and Challenges: A Narrative Review
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作者 Nazia S. Sadat Maryam S. Shuttari Mir Sadat-Ali 《Open Journal of Epidemiology》 2024年第1期122-130,共9页
Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improvin... Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improving patient outcomes by shuffling enormous volumes of health data—from health records and clinical studies to genetic information analyzing it much faster than humans. AI also helps in the improvement of medical imaging and medical diagnosis. There is an increased optimism regarding the use of applications of AI locally but can these facets be translated globally in the advancement and delivery of healthcare with the help of AI. At present majority of AI developments and applications in health care provide to the needs of developed countries and there is little effort to develop programs which could help to improve healthcare delivery globally. We performed this narrative review to assess the difficulties and discrepancies in implementing AI in global health delivery and find ways to improve. 展开更多
关键词 Artificial Intelligence Global Health IMPLEMENTATION PITFALLS
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Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework
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作者 Anthony Obiyom Kamalu Austin Ebhodaghe Ekeoba +5 位作者 Emeka Canice Uzor Christian Chukwuka Duru Obinna Princewill Anyatonwu Ogemdi Emmanuel Adiele Chibuike Reginald Amuzie Chima Lawrence Odoemenam 《Open Journal of Ophthalmology》 2024年第2期103-116,共14页
As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for u... As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes. 展开更多
关键词 Chronic Care Model DIABETES Diabetic Retinopathy Model Implementation Vision Care
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Observation on the Effect of Health Education in Health Management of Chronic Disease Patients
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作者 Wen Zhong 《Journal of Biosciences and Medicines》 2024年第2期294-302,共9页
Objective: By the end of 2021, the aging rate of China’s population is 18.9%, and the prevalence rate of chronic diseases in the elderly population is increasing year by year, and chronic diseases have become the mai... Objective: By the end of 2021, the aging rate of China’s population is 18.9%, and the prevalence rate of chronic diseases in the elderly population is increasing year by year, and chronic diseases have become the main causes of death and health threats of Chinese residents. Therefore, how to manage this huge group well is crucial. This paper analyzes the value of health education in the process of health management for patients with chronic diseases. Methods: 102 patients with chronic diseases treated from January 2021 to December 2021 were divided into control group and experimental group by random number table method. The control group was given routine health management while the experimental group was given health education based on the control group, and the implementation effect was analyzed. Results: After management, the scores of chronic disease knowledge in the experimental group were significantly higher than those in the control group, and the dimensions of ESCA were higher than those in the control group, and P < 0.05;Conclusion: The implementation of health education in the process of chronic disease health management is helpful to improve patients’ self-care ability and better control disease progression. 展开更多
关键词 Chronic Disease Patients Health Education Health Management Implementation Effect
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Effect of Intrauterine Laser Therapy at the IVF Success Rate on Infertile Patients with a History of IVF Failure: A Pilot Non-Blinded Study
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作者 Fateme Hoseinzade Hatav Tehrani +2 位作者 Shahriyar Mirshams Yasaman Zandi Mehran Michael Hans Weber 《Advances in Sexual Medicine》 2024年第3期21-30,共10页
Backgrounds: While there’s developing proof aimed toward improving embryo implantation thru a focal point on great development, restrained studies have been performed on enhancing endometrial receptivity. Intrauterin... Backgrounds: While there’s developing proof aimed toward improving embryo implantation thru a focal point on great development, restrained studies have been performed on enhancing endometrial receptivity. Intrauterine Laser Therapy (LT) can be powerful in selling endometrial cell proliferation, therefore enhancing the achievement of assisted reproductive techniques (ART). The contemporary look at aimed to research the effectiveness of effective intrauterine lasers in growing endometrial thickness and the achievement of being pregnant rate. Materials and Methods: In the current clinical randomized trial (RTC) study, the infertile women (20 - 42 years old) referred to the infertility clinic in 2023-2024 who were candidates for IVF treatment with recurrent implantation failure (RIF) history were included. The patients were divided into two main groups: the intervention group;low level laser therapy (LLLT) after hormone administration) (n = 52) and the control group (hormone administration without LT) (n = 52). The IVF success rate and change in endometrial thickness before and after the LT were compared in groups. Results: There was a significant difference between groups (p Conclusion: It appears that the incorporation of Intrauterine LT in the realm of infertility could significantly impact as a novel supplementary treatment in improving endometrial receptivity and pregnancy rate. 展开更多
关键词 INFERTILITY IVF Implementation Intrauterine Low Level Laser Therapy
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A Case Study in Complex Concrete Construction in Australia:A Hybrid Approach of Hand and Machine
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作者 Chris Knapp 《Journal of Civil Engineering and Architecture》 2024年第2期69-79,共11页
This paper describes and provides a critique of the design and implementation of the“scoops”-a set of bespoke multifunctioning architectural free-form elements that are a highlight of the new Soheil Abedian School o... This paper describes and provides a critique of the design and implementation of the“scoops”-a set of bespoke multifunctioning architectural free-form elements that are a highlight of the new Soheil Abedian School of Architecture at Bond University,Australia,by the office of Sir Peter Cook and Gavin Robotham,CRAB(Cook Robotham Architecture Bureau,London).The development includes the transfer of analogue design processes into digital 3d modeling,which is then analyzed and rationalized via an exchange with consultants and procurement contractors.The complexity of the concrete works necessitated the use of digital fabrication to make their implementation affordable and within time constraints,with said complexity creating a variety of challenges for many aspects of the entire delivery team.The 3d model played a critical role in communicating intent and accuracy at all stages.The use of site-based craftsmanship combined with computer aided design and fabrication overlapped to realize the project. 展开更多
关键词 Concrete construction design and implementation MODELING
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The Enforcement of Occupational Safety and Health Requirements in Public and Private Sectors in the Emirate of Abu Dhabi, the United Arab Emirates
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作者 Alyazya Alhosani 《Occupational Diseases and Environmental Medicine》 2024年第2期78-114,共37页
Research Problem: In Abu Dhabi, limited implementation of OSH Regulations contributes to the general unawareness among employees and workers about occupational hazards and safety measures, resulting in slow responsive... Research Problem: In Abu Dhabi, limited implementation of OSH Regulations contributes to the general unawareness among employees and workers about occupational hazards and safety measures, resulting in slow responsiveness toward enforcement measures and a lack of self-regulatory approaches within companies. Purpose: The purpose of this study is to examine the implementation methods practised in Abu Dhabi with those in developed countries with established OSH regulatory bodies. Methodology: Qualitative and quantitative research methods were employed to gather primary research data. Workers from various industries in Abu Dhabi were sampled on purpose and asked to respond to questionnaires and interviews on OSH protocol awareness and implementation, and circumstances of workplace incidence. Results: The findings of this study showed that the enforcement of OSH requirements in UAE positively correlated to a reduction in the rate of work-related injury and improved business performance. The quantitative research data showed that the energy sector had the highest score (15) while the tourism sector had the lowest score (5.3) in occupational health systems and improvements in business efficiency and productivity. Implications: The outcomes of this study shed light on the importance of implementing OSH Guidelines for companies to empower their safety managers to fully enforce OSH requirements in their organisations. In conclusion, effective OSH enforcement requires cooperation between general workers and OSH managers and facilitation from business owners. 展开更多
关键词 Occupational Health and Safety Abu Dhabi The United Arab Emirates IMPLEMENTATION
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Sensitive Information Security Based on Elliptic Curves
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作者 Nadine Nibigira Vincent Havyarimana Zhu Xiao 《World Journal of Engineering and Technology》 2024年第2期274-285,共12页
The elliptic curve cryptography algorithm represents a major advancement in the field of computer security. This innovative algorithm uses elliptic curves to encrypt and secure data, providing an exceptional level of ... The elliptic curve cryptography algorithm represents a major advancement in the field of computer security. This innovative algorithm uses elliptic curves to encrypt and secure data, providing an exceptional level of security while optimizing the efficiency of computer resources. This study focuses on how elliptic curves cryptography helps to protect sensitive data. Text is encrypted using the elliptic curve technique because it provides great security with a smaller key on devices with limited resources, such as mobile phones. The elliptic curves cryptography of this study is better than using a 256-bit RSA key. To achieve equivalent protection by using the elliptic curves cryptography, several Python libraries such as cryptography, pycryptodome, pyQt5, secp256k1, etc. were used. These technologies are used to develop a software based on elliptic curves. If built, the software helps to encrypt and decrypt data such as a text messages and it offers the authentication for the communication. 展开更多
关键词 CRYPTOGRAPHY Elliptic Curves Digital Security Data Sensitive Data IMPLEMENTATION
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Study on Path Selection and Implementation Effect of Counselors in College Students’Career Planning Education
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作者 Fang Guo Shujun Luo Weihan Li 《Journal of Contemporary Educational Research》 2024年第5期59-64,共6页
Under the background of a severe job market and fierce talent competition,the career planning education of college students is of great importance.In this study,a combination of quantitative and qualitative research m... Under the background of a severe job market and fierce talent competition,the career planning education of college students is of great importance.In this study,a combination of quantitative and qualitative research methods was used;500 students in Shenzhen Polytechnic of Information Technology were surveyed by questionnaire,and 40 counselors were interviewed in depth to comprehensively analyze the role and practical effect of counselors in career planning education.The research showed that the role positioning of counselors includes the guide of students’career development,emotional support,and job-hunting strategy,and the specific path selection involves the strengthening of professional knowledge,the construction of interpersonal relationship networks,and personalized counseling.Based on the survey and interview data,this paper constructed a model for enhancing the role of counselors in career planning education and put forward a set of targeted work paths. 展开更多
关键词 College counselors Career planning Role positioning Path selection Implementation effect
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Research on the Evaluation System of Community Daycare Center Planning and Implementation from the Perspective of Subject-Object Relationships
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作者 Tijin Gui 《Journal of Architectural Research and Development》 2024年第3期117-127,共11页
Through literature review,we found that evaluations of urban planning implementation often focus narrowly on either the subject(stakeholders)or the object(projects),while micro-level aspects such as site selection and... Through literature review,we found that evaluations of urban planning implementation often focus narrowly on either the subject(stakeholders)or the object(projects),while micro-level aspects such as site selection and construction are primarily considered within the context of planning implementation.There is insufficient research on the evaluation of implementation.Community daycare centers play a crucial role in the community home care model,yet there is relatively little research on their usage efficiency,satisfaction levels,and spatial evaluation of planning implementation.Based on the theoretical understanding of the human environment,including the subject,object,and their interactions,an evaluation system for the planning and implementation of community day care centers was constructed,incorporating subjective evaluation,objective evaluation,and comparative analysis. 展开更多
关键词 Subject-object relationship Daycare center Planning implementation Evaluation system
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Research on the Implementation Path of Labor Education in Colleges and Universities from an International Perspective
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作者 Rui Zhang 《Journal of Contemporary Educational Research》 2024年第2期230-235,共6页
Universities shoulder the important mission of talent cultivation,scientific research,social service,cultural heritage and innovation,and international exchange and cooperation.International exchange and cooperation h... Universities shoulder the important mission of talent cultivation,scientific research,social service,cultural heritage and innovation,and international exchange and cooperation.International exchange and cooperation have become the fifth major function of universities.Based on the background of the globalization era,undergraduate colleges and universities should pay more attention to the cultivation of students’intercultural communication and understanding ability while cultivating their professional skills,and take expanding students’international vision and enhancing the international competitiveness of China’s education as important tasks.Labor education is an important content of the national education system,which has the comprehensive nurturing value of cultivating morality,increasing intelligence,strengthening physical fitness,and cultivating beauty.Higher education institutions should further optimize the system of labor education,expand students’space and field of thinking in the process of labor education,and broaden students’international perspectives. 展开更多
关键词 International perspective Colleges and universities Labor education Implementation paths
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Economic Growth:The Fundamental Path to the Realization of Social Security Rights for Migrant Workers
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作者 Zhang Yuqing 《Economics World》 2024年第3期117-121,共5页
The International Labour Organization seems to only see the aspect of social security promoting economic growth,while neglecting the aspect of economic growth supporting social security.From the standpoint of material... The International Labour Organization seems to only see the aspect of social security promoting economic growth,while neglecting the aspect of economic growth supporting social security.From the standpoint of materialism and the practice of social security,the realization of social security rights for migrant workers fundamentally depends on economic growth.The Belt and Road Initiative has provided a Chinese solution for creating a strong material and technological foundation to meet the social security needs of all people,including migrant workers. 展开更多
关键词 economic growth migrant workers social security rights implementation pathways
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Integration of Ideological and Political Education in College Physics Courses Under the Reform of Smart Teaching
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作者 Lei Su 《Journal of Contemporary Educational Research》 2024年第5期148-153,共6页
The development of the times has prompted China to enhance the quality of education and the value of talent.As guides for students,teachers should conscientiously implement ideological and political education,create c... The development of the times has prompted China to enhance the quality of education and the value of talent.As guides for students,teachers should conscientiously implement ideological and political education,create college physics courses that are more in line with modern talent cultivation,eliminate the fixed and singular nature of traditional teaching,and find the integration points of ideological and political education.Teachers need to use the textbook itself,the expansion of resources in smart classrooms,and current technological progress to implement ideological and political education in order to cultivate more high-quality and high-level comprehensive talents for society. 展开更多
关键词 Smart teaching College physics courses Ideological and political education Implementation strategy
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Research on the Evaluation of the Implementation Effect of Curriculum Examination Reform: Taking the Course of “Introduction to Language” as an Example
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作者 Qianwen Yi 《Journal of Contemporary Educational Research》 2024年第3期193-198,共6页
“Introduction to Language,”as the core course of the English major,mainly reveals the basic laws of language,enabling the students to have the ability to apply linguistic theories to explain language phenomena and s... “Introduction to Language,”as the core course of the English major,mainly reveals the basic laws of language,enabling the students to have the ability to apply linguistic theories to explain language phenomena and solve specific language problems.This course is highly theoretical and has a certain degree of difficulty.The evaluation of student grades has always been based on examination reform,but several problems have been encountered during the implementation process.This article analyzes the current situation of the reform and implementation of the“Introduction to Language”course examination in applied universities and puts forth suggestions and specific measures to improve the assessment of the course,aiming to enhance the teaching effectiveness of the course and scientifically and comprehensively evaluate students’abilities. 展开更多
关键词 Introduction to Language Examination reform Implementation effect
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Exploration of the Construction of the Civic and Political Education in Engineering Geology Course
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作者 Dingyuan Luo 《Journal of Contemporary Educational Research》 2024年第2期14-18,共5页
The purpose of this paper is to discuss the integration of the elements of civic and political education into the engineering geology course to improve students’ideological and moral qualities.It is proposed that by ... The purpose of this paper is to discuss the integration of the elements of civic and political education into the engineering geology course to improve students’ideological and moral qualities.It is proposed that by integrating elements of civic and political education,students are guided to form a positive attitude toward engineering practice as well as correct values and ethics.With regard to the teaching design and implementation of the course,the implementation paths of teacher team building,careful teaching design,innovative teaching methods,and the integration of civic and politics in practical teaching are proposed to summarize the significance of integrating the elements of civic and political education in the construction of the engineering geology course.It is pointed out that this integration not only improves the quality of the course,but also provides a reference for the civic and political education of other similar professional courses.This integration not only focuses on the teaching of professional knowledge,but also pays more attention to the cultivation of students’ideology and morality,which provides a model and guidance for shaping new talents with all-round development. 展开更多
关键词 Engineering geology Civic and political education Implementation approach
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A High Efficiency Hardware Implementation of S-Boxes Based on Composite Field for Advanced Encryption Standard
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作者 Yawen Wang Sini Bin +1 位作者 Shikai Zhu Xiaoting Hu 《Journal of Computer and Communications》 2024年第4期228-246,共19页
The SubBytes (S-box) transformation is the most crucial operation in the AES algorithm, significantly impacting the implementation performance of AES chips. To design a high-performance S-box, a segmented optimization... The SubBytes (S-box) transformation is the most crucial operation in the AES algorithm, significantly impacting the implementation performance of AES chips. To design a high-performance S-box, a segmented optimization implementation of the S-box is proposed based on the composite field inverse operation in this paper. This proposed S-box implementation is modeled using Verilog language and synthesized using Design Complier software under the premise of ensuring the correctness of the simulation result. The synthesis results show that, compared to several current S-box implementation schemes, the proposed implementation of the S-box significantly reduces the area overhead and critical path delay, then gets higher hardware efficiency. This provides strong support for realizing efficient and compact S-box ASIC designs. 展开更多
关键词 Advanced Encryption Standard (AES) S-BOX Tower Field Hardware Implementation Application Specific Integration Circuit (ASIC)
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上海市实施整合式慢性病社区健康管理模式的促进和障碍因素 被引量:3
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作者 隋梦芸 张晟 +11 位作者 程旻娜 王玉恒 严青华 吴菲 王梦妍 常兆玉 薛龙 陈秀芝 王晨曦 施燕 应晓华 付晨 《中国卫生资源》 CSCD 北大核心 2023年第4期346-351,共6页
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
关键词 慢性病chronic disease 社区健康管理模式community health management model 促进因素facilitator 障碍因素barrier factor 实施性研究的整合性理论框架consolidated framework for implementation research CFIR
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