【作者】 张立威；

【导师】 高晓虹；

【作者基本信息】 大连医科大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 研究目的社区公共卫生服务是社区卫生服务的重要组成部分,是各项公共卫生服务落实到社区、落实到人群的有效载体。然而,目前大多数社区卫生服务机构的公共卫生服务开展较少,且有些项目流于形式,因此迫切需要建立社区公共卫生服务的考核评价机制,以促进社区公共卫生服务职能的落实,保证居民享有基本公共卫生服务。本研究旨在探索建立符合当前社区卫生服务发展需要的社区公共卫生服务评价指标体系;并通过该评价体系的现场应用,了解社区公共卫生服务项目开展情况及存在的问题,为今后完善评价指标体系提供依据。研究方法1.初步拟订指标体系:项目协调小组在政策研究和文献研究的基础上初步拟订社区公共卫生服务评价指标体系。2.德尔菲专家咨询:选择公共卫生、卫生管理、全科医学等领域专家60名,采用信函的方式进行两轮德尔菲专家咨询,第一轮发出咨询表60份,第二轮发出咨询表49份。要求专家对每项指标的“重要性”进行打分,并说明“判断依据”和“熟悉程度”,同时要求专家对拟订的指标提出意见和修改建议。根据专家咨询结果确定评价指标体系,并计算指标权重。3.现场调查:采用方便抽样的方法选择广州市10家社区卫生服务中心,作为社区公共卫生服务现状调查对象。全部指标所需数据均采用现场调查和问卷调查相结合的方法,采用综合评分法对各社区卫生服务机构进行评价。研究结果1.经两轮德尔菲专家咨询,40项二级指标中剔除17项;将指标“居民健康档案建档率”和“健康档案计算机管理率”调整为1项指标:“电子健康档案建档率”;增加了1项指标:“居民对社区公共卫生服务满意率”。确立了城市社区公共卫生服务评价指标体系及指标的权重,指标体系共包含23项指标。两轮咨询的专家积极系数分别为81.67%和83.67%;专家权威程度分别为:0.700和0.704;协调系数分别为0.223(P>0.05)和0.472(P<0.05)。2.根据本评价指标体系得到了广州市10家社区卫生服务中心的评价结果,机构总得分在60.44～86.46之间,平均得分为68.9。研究结论1.确立了城市社区公共卫生服务评价指标体系及指标的权重。两轮德尔菲咨询中,专家对本研究的积极程度和权威程度较高,两轮咨询后专家的意见已经趋于一致,专家意见协调性较好。本指标体系能很好的反映社区公共卫生服务的现状,对社区公共卫生服务考核标准的制定具有较高的参考价值。2.从广州市10家社区卫生服务机构的评价结果看,目前社区公共卫生服务开展情况一般,在健康档案管理、重点慢性病管理、老年保健以及残疾康复等方面仍需进一步改进。更多还原

【Abstract】 ObjectiveBeing an important component of community health service, community public health service has great meaning to the implementation of public health function in community. However, most community health institutions do less public health service than they should do. In order to insure the basic public health, it is urgent to establish an evaluation mechanism of community public health. The objectives of this research is to explore and establish a scientific evaluation index system for urban community public health service, we try to find the deficiency of urban community health service after using the evaluation index system to evaluation 10 community health service centers.Methods1. Based on policy research and literature study, the co-ordination group developed an initial evaluation index system.2. We selected 60 experts who specialized in the field of public health, health administration, general practice, etc. Sixty and forty-nine consultation tables were delivered separately by mail in two rounds Delphi consultation. All the experts were asked to grade the evaluation indexes, and to explain the extent of similarity and the basis of judgment. The evaluation indexes and their weights were determined after two rounds Delphi consultation.3. By convenience sampling, we chose ten community health service centers as the subjects. All the data needed were collected by questionnaire survey and site investigation. The comprehensive scoring method was used to assess the ten community health service centers.Results1.The index system was established after two turn’s consultation, which consisting of twenty-three indexes. The active coefficient of two rounds Delphi is 81.67% and83.67% respectively; the authoritative coefficient of two rounds is 0.700 and 0.704; the harmonious coefficient of the two rounds Delphi is 0.223(P>0.05) and 0.472(P<0.05).2.The evaluation was conducted using the developed index system in the ten community health service centers of Guangzhou. The score of the selected community health service centers ranged from 86.46 to 60.44, the average score is only 68.9.Conclusions1.In the two rounds Delphi consultation, Panel of experts shown great initiative and have great authority on research subjects. All experts have been tending to consentience after two turn’s consultation, and the result is reliable. This index system has considerable reference value in the evaluation of community public health services.2.According to the appraisal results of the 10 community health service centers in Guangzhou, there is still much to be improved in health record management, chronic disease management, health care for aged and community-based rehabilitation.更多还原