【作者】 杜方冬；

【导师】 孙振球； 饶克勤；

【作者基本信息】 中南大学 ， 社会医学与卫生事业管理学， 2007， 博士

【摘要】 目的:构建一套适合我国医院的信息化水平评估指标体系及评估方法,并利用它对我国医院的信息化水平进行评估,发现存在的问题,并提出相应的对策。方法:在卫生部《中国医院信息化现状调查和对策研究》(课题负责人:原总后卫生部副部长、中国卫生信息学会副会长傅征、中国医院协会信息管理专业委员会主任委员李包罗)课题的整体设计方案指导下,通过广泛查阅文献,参考国内外相关研究成果,组织专家小组开展专题讨论,结合我国医院信息化建设的实际与医院信息化建设的特点,编制了我国医院信息化水平评估指标体系框架。采用综合评分法,通过专家咨询对评估指标进行筛选,并对评估指标的权重进行确定,构建了我国医院信息化水平综合评价评分量表。在构建我国医院信息化水平综合评价指标体系的基础上,通过对我国县级及以上医院中被评为二级和三级的1136所医院进行抽样调查,运用评分量表对我国医院信息化水平评估进行了实证研究,并对评估指标体系的信度和效度进行了考评。结果:编制了包括6个维度及57个二级指标的我国医院信息化水平评估指标体系,6个维度分别为:医院重视程度、信息化基础建设、信息技术应用、人力资源与信息资源、信息安全、信息化绩效。信度与效度考核:(1)内部一致性信度较好,各维度的克朗巴赫α系数分别达到“较好(0.6-0.8)”或“极好(0.8以上)”以上认定标准;(2)折半信度为0.95;(3)本评估指标体系从构想、指标的提出与筛选,均采用了专家咨询方法,并得到专家的认可,保证了该评估指标体系良好的内容效度;(4)结构效度较好,探索性因子分析各个维度所提取公因子均可获得较好的专业解释,累积方差贡献率介于45.3%--67.5%;(5)该评估指标体系能有效区分不同类别、不同等级、不同性质、不同隶属关系的医院,检验结果均提示该指标体系具有较好的区分效度。实证研究显示:不同发展水平地区间医院信息化水平存在较大差距。由东部沿海地区到西部地区,医院信息化水平逐渐降低。部分省(市)医院信息化水平平均得分与其发达程度不符。不同等级医院、不同性质医院、不同隶属关系医院、不同类别医院之间的信息化水平差别较明显。高等级医院信息化水平普遍高于低等级医院;中医医院的信息化水平低于综合型医院、中西医结合医院及专科医院;大学附属医院的信息化水平高于教学医院,教学医院的信息化水平高于非教学医院;地市级医院、县级医院的信息化水平低于部属医院和省级医院,其中县级医院最低。在各维度,医院信息化重视程度得分最高,信息化基础建设维度、信息安全维度得分次之,人力资源与信息资源维度、信息化绩效维度得分更低,信息技术应用维度得分最低。除医院信息化重视程度的平均标准得分大部分在80分左右外,其它各维度的平均标准得分均低于60分,其中信息技术应用维度平均标准得分仅为40分左右。在抽样调查的1136家医院中,相对而言,20.60%的医院信息化水平为很好,38.64%的医院为较好,16.20%的医院为一般,15.23%的医院为较差,9.33%的医院为很差。结论:(1)本课题研制的医院信息化水平评估指标体系及构建的综合评价评分量表在信度和效度上达到了测量学的基本要求,是可靠、有效、灵敏的。能够较全面地反映医院信息化建设的水平,具有推广应用价值。(2)评估结果显示,我国医院信息化建设尚处于初级发展阶段,医院信息化水平整体较低;不同经济发展水平地区医院信息化水平差距较大;不同等级、不同类别、不同隶属关系、不同性质医院间差距较大。(3)医院对信息化建设的重视程度相对较高,但在信息化基础建设、信息安全方面的投入与建设水平较低,人力资源与信息资源的拥有量严重不足,信息化绩效低下,信息技术应用是目前医院信息化建设中最薄弱的环节。更多还原

【Abstract】 Objective:To develop a comprehensive evaluation model and evaluation methods to evaluate the informatization level of hospital in China.Methods:Subject to the supervision of "An Investigation on the Status and Developing Strategies of Chinese hospital informatization"(a research project of Ministry of Health of the PRC,project managers are Fu zheng and Li Baoluo).During this research,related literature had been extensively reviewed,related instruments developed domestic and abroad already had been consulted,suggestions from experts had been considered,particularities of hospital informatizatoin had been considered before the initial evaluation model formed.Selection items and calculation the weights of indexes had based on experts’ suggestions and comprehensive scoring method.Finally,a rating scale for hospital informatization level evaluation formed,with the stratified random sampling method,1136 hospitals were recruited in the study,only hospitals in cities and have gotten degree 2 or 3 included.The reliability and validity of the evaluation model were also tested.Results:(1)57 items were retained.The evaluation model consisted of 6 dimensionalities which were attaching importance to HIT,IT Infrastructure,IT application,human resource and information resource, IT security,IT performance.(2)Reliability and Validity ①Internal consistency is good,Cronbach’sαcoefficients of all dimensions are more than 0.60,some of them are even more than 0.8;②Split-halves reliability is 0.95;③Content validity is good,because this research was based on experts suggestions and it was recognized by informants also;④Construct validity is good,factor analysis conform to logic relation,and the cumulative variance ranged between 45.3%--67.5%;⑤Discriminant validity is good,the evaluation model can be used to relatively accurately distinguish different types of hospitals.(3)Empirical ResearchIn general,Chinese hospital informatization level is low,and the informatization level of hospitals in the east is higher than which in the west,and there is obvious difference between different types of hospitals. But it has relation to economic horizontal span.Among 6 dimensionalities been evaluated,most of hospitals seemed to attach importance to HIT,but the level of IT Infrastructure,IT application, human resource and information resource,IT security,and IT performance is low.The level of IT application is the lowest.Among 1136 samples,only 20.60%of them can be considered best, 38.64%of them is better,16.20%of them is middle,15.23%of them is worse,and 9.33%of them is worst.Conclusions:(1)The evaluation model and rating scale is reliable,valid and sensitive,and it can be used to evaluate hospital informatization level at larger scope.(2)In a word,the informatization level of Chinese hospitals is low. Hospital informatization level has relation to economic horizontal span in China.There is obviously difference between different types of hospitals on information level.(3)Among 6 dimensionalities been evaluated,most of hospitals seemed to attach importance to HIT,but the investment in IT Infrastructure and IT security is very limited.Human resource and information resource are also not enough to hospitals.The inefficient IT performance is the best evidence.Among all of 6 dimensionalities,IT application is the key to hospital informatization.更多还原