Establishment of an evaluation index system for health system resilience in the context of catastrophic medical surge
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摘要:
目的 构建灾难性医疗需求激增情境下卫生系统韧性的评价指标体系,为提高中国灾难风险管理能力提供参考依据。 方法 采用德尔菲专家咨询法构建基于熵理论的灾难性医疗需求激增情境下卫生系统韧性评价指标体系,采用Saaty′s权重法确定指标的权重。 结果 专家咨询的积极系数为81.6 %;一级指标、二级指标和三级指标的权威系数分别为0.89、0.76和0.85,协调系数分别为0.352、0.301和0.260(均P < 0.05);经专家咨询后,最终确定了由2个一级指标、9个二级指标和35个三级指标构建的灾难性医疗需求激增情境下卫生系统韧性评价指标体系。一级指标中,“卫生系统供给能力与激增医疗需求的平衡”的权重系数最高(0.7500);二级指标中,“紧急医疗服务”的权重系数最高(0.4476);三级指标中,“危急重症监护室人员储备满足激增医疗需求程度”的权重系数最高(0.0799)。 结论 构建的灾难性医疗需求激增情境下卫生系统韧性评价指标体系具有科学性和可靠性,可为我国灾难风险管理能力的提高提供参考依据。 Abstract:Objective To construct an index system for the evaluation on health system resilience in the context of catastrophic medical surge and to provide references for improving medical institutions′ disaster risk management capability in China. Methods An entropy theory-based framework of the index system was primarily constructed through literature studies; then an online Delphi consultation was conducted among 31 domestic experts with at least ten years′ experiences in health emergency management/disaster medicine-related research/teaching/administration during September – November, 2020. Saaty′s weight method was adopted to calculate weight coefficients of the indexes in the evaluation system. Results The positive coefficient was 81.6% for the expert consultation; for the first-, second-, and third-level indicators included in the evaluation system, the authoritative coefficients were 0.89, 0.76, and 0.85 and the coordination coefficients were 0.352, 0.301, and 0.260, respectively (all P < 0.05). The finally established evaluation index system included 2 first-, 9 second-, and 35 third-level indicators. The first-level indicator with the highest weight coefficient (0.7500) was for the balance between a health system′s supply capacity and the demand of a catastrophic medical surge; the second-level indicator with the highest weight coefficient (0.4476) was for emergency medical services; and the third-level indicator with the highest weight coefficient (0.0799) was for the professional resources of intensive care unit against the demand of a catastrophic medical surge. Conclusion The established index system for the evaluation on health system resilience in the context of catastrophic medical surge is valid and reliable and could be preliminarily used in promoting public health risk management capability in China. -
Key words:
- health system resilience /
- evaluation /
- index system /
- surge in demand /
- catastrophic medical response /
- Delphi method
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表 1 灾难性医疗需求激增情境下卫生系统韧性评价指标体系及其权重
一级指标 权重系数 二级指标 权重系数 三级指标 层次单排序权重系数 层次总排序权重系数 A卫生系统供给能力与激增医疗需求的平衡 0.7500 A1人力熵流 0.3229 A11危急重症监护室人员储备满足激增医疗需求的程度 0.3301 0.0799 A12感染科医护人员储备满足激增医疗需求的程度 0.1097 0.0266 A13紧急情况下调动的志愿者储备满足激增医疗需求的程度 0.1867 0.0452 A14基层医护人员储备满足激增医疗需求的程度 0.1867 0.0452 A15公共卫生人员储备满足激增医疗需求的程度 0.1867 0.0452 A2物资熵流 0.1854 A21物资紧急储备模式满足激增医疗需求的程度 0.1953 0.0272 A22既有各类医疗供应模式满足激增医疗需求的程度 0.1381 0.0192 A23多元社会物资动员模式满足激增医疗需求的程度 0.3905 0.0543 A24药品及器械生产和流通规范满足激增医疗需求的程度 0.2761 0.0384 A3信息熵流 0.2447 A31信息风险管理监测预警能力满足激增医疗需求的程度 0.2392 0.0439 A32信息风险分析处理能力满足激增医疗需求的程度 0.1801 0.0331 A33信息风险综合反馈能力满足激增医疗需求的程度 0.3649 0.0670 A34信息风险管理平台技术保障满足激增医疗需求的程度 0.1079 0.0198 A35信息风险管理平台应用范围满足激增医疗需求的程度 0.1079 0.0198 A4技术熵流 0.1405 A41快速检测技术满足激增医疗需求的程度 0.3418 0.0360 A42样本采集技术满足激增医疗需求的程度 0.2212 0.0233 A43风险识别评估能力满足激增医疗需求的程度 0.1353 0.0143 A44风险处置能力满足激增医疗需求的程度 0.2212 0.0233 A45风险控制技术满足激增医疗需求的程度 0.0805 0.0085 A5机构熵流 0.1065 A51联防联控模式满足激增医疗需求的程度 0.2500 0.0200 A52机构应急管理响应速度满足激增医疗需求的程度 0.5000 0.0199 A53机构应急沟通和协调满足激增医疗需求的程度 0.2500 0.0399 B常规医疗卫生服务能力与紧急医疗卫生需求的平衡 0.2500 B1常规医疗服务 0.1059 B11紧急医疗需求与人群疾病筛查能力平衡的程度 0.4182 0.0111 B12紧急医疗需求与人群日常保健能力平衡的程度 0.2707 0.0072 B13紧急医疗需求与人群康复服务能力平衡的程度 0.1205 0.0032 B14紧急医疗需求与人群健康教育能力平衡的程度 0.1906 0.0050 B2紧急医疗服务 0.4476 B21紧急医疗需求与医疗救治现场科学指挥能力平衡的程度 0.4934 0.0552 B22紧急医疗需求与医疗救治应急响应行动准备能力平衡的程度 0.3108 0.0399 B23紧急医疗需求与规范化消杀能力平衡的程度 0.1958 0.0200 B3公共卫生服务 0.1636 B31紧急医疗需求与健康体检服务能力平衡的程度 0.4934 0.0202 B32紧急医疗需求与妇幼保健服务能力平衡的程度 0.3108 0.0127 B33紧急医疗需求与老年人保健服务能力平衡的程度 0.1958 0.0080 B4心理救助服务 0.2829 B41紧急医疗需求与急性应激反应疏导能力平衡的程度 0.4000 0.0283 B42紧急医疗需求与重点人群心理危机干预能力平衡的程度 0.4000 0.0283 B43紧急医疗需求与灾后心理救治能力平衡的程度 0.2000 0.0141 -
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