Article(id=1321170057992982608, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169992024961657, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145256, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1719158400000, receivedDateStr=2024-06-24, revisedDate=1735488000000, revisedDateStr=2024-12-30, acceptedDate=1739203200000, acceptedDateStr=2025-02-11, onlineDate=1792921087978, onlineDateStr=2026-10-25, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921087978, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921087978, creator=13701087609, updateTime=1792921087978, updator=13701087609, issue=Issue{id=1321169992024961657, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='4', pageStart='385', pageEnd='512', issueExtLink='null', onlineDate='null', pubDate='1744214400000', pubDateStr='2025-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921072250, creator='13701087609', updateTime=1792921072250, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=452, endPage=456, ext={EN=ArticleExt(id=1321170058215280721, articleId=1321170057992982608, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Construction of a comprehensive evaluation index system for public health in hospitals from the perspective of integrated medicine and prevention, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct a comprehensive evaluation index system for public health in hospitals, providing a basis for evaluating the implementation of public health work in hospitals.

Methods

An initial draft of the evaluation index system was formulated through a review of relevant literature and policy documents and multiple rounds of thematic discussions by the research team. A two-round Delphi expert consultation method was used to screen the evaluation indicators and construct a comprehensive evaluation index system for public health in hospitals. The analytic hierarchy process was used to calculate the weight of each indicator, and SPSS 20.0 statistical software was used to analyze expert engagement, authority, and the degree of consensus.

Results

The recovery rate of the expert consultation questionnaires in both rounds was 100%. The expert authority coefficients were 0.869 and 0.902, respectively, indicating a high level of expert authority. The Kendall′s W coefficients of expert opinion coordination were 0.245 and 0.281, respectively (P < 0.05), indicating good consistency among expert opinions. The constructed comprehensive evaluation index system for public health in hospitals includes three first-level indicators, eight second-level indicators, and 25 third-level indicators. The first-level indicators are organizational resources, business processes, and disciplinary development, with weights of 0.257, 0.451, and 0.292, respectively. The weight distribution of each indicator is reasonable.

Conclusions

The comprehensive evaluation index system for public health in hospitals constructed in this study has good scientific validity and reliability and can provide a reference for the scientific evaluation of public health work in hospitals.

, authors=Guilan GONG1, Xue BAI1, Pengqian FANG2, Jing CHEN3, authorsList=Guilan GONG, Xue BAI, Pengqian FANG, Jing CHEN, authorCompany=null, correspAuthors=Jing CHEN, authorNote=null, correspAuthorsNote=
CHEN Jing, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321170058580185170, articleId=1321170057992982608, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=医防融合视角下医院公共卫生综合评价指标体系构建, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

构建医院公共卫生综合评价指标体系,为评价医院公共卫生工作开展情况提供依据。

方法

通过查阅相关文献和政策文件并经课题组的多轮专题讨论,拟定评价指标体系初稿;采用2轮德尔菲专家咨询法筛选评价指标,构建医院公共卫生综合评价指标体系,运用层次分析法计算各指标权重,通过SPSS 20.0 统计软件分析专家积极程度、权威程度、意见协调程度。

结果

2轮专家咨询问卷回收率均为100%,专家权威系数分别为0.869和0.902,专家权威程度较高;专家意见协调系数Kendall′s W分别为0.245、0.281(P<0.05),专家意见一致性较好。构建的医院公共卫生综合评价指标体系包括3个一级指标、8个二级指标和25个三级指标,一级指标为组织资源、业务流程和学科发展,其权重分别为0.257、0.451和0.292,各指标权重分配合理。

结论

本研究构建的医院公共卫生综合评价指标体系具有较好的科学性和可靠性,可为医院公共卫生工作的科学评价提供参考。

, authors=龚桂兰1, 白雪1, 方鹏骞2, 陈晶3, *, *, authorsList=龚桂兰, 白雪, 方鹏骞, 陈晶, authorCompany=null, correspAuthors=陈晶, authorNote=

龚桂兰(1986—),讲师,博士,研究方向:公共卫生

, correspAuthorsNote=
陈晶,E-mail:
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authorNames=null, journalName=null, refType=null, unstructuredReference=王少娜, 董瑞, 谢晖. 德尔菲法及其构建指标体系的应用进展[J]. 蚌埠医学院学报, 2016, 41(5): 695-698., articleTitle=null, refAbstract=null), Reference(id=1321170063856619658, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170057992982608, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=11, rfOrder=10, authorNames=null, journalName=null, refType=null, unstructuredReference=王晓欢, 汪晓军, 张山鹰. 层次分析法在建立德尔菲法评价指标体系中的应用[J]. 海峡预防医学杂志, 2015, 21(4): 85-88., articleTitle=null, refAbstract=null), Reference(id=1321170063923728523, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170057992982608, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=12, rfOrder=11, authorNames=null, journalName=null, refType=null, unstructuredReference=谢娇, 孙昱. 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Basic information of experts consulted in the two rounds based on gender, age, years of service, professional title, education background, professional field

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项目第1轮第2轮
人数构成比/%人数构成比/%
性别
 男性325.0960.0
 女性975.0640.0
年龄/岁
 31~45650.0640.0
 46~60650.0960.0
工作年限/年
 11~20650.0640.0
 ≥21650.0960.0
职称
 正高级18.31493.3
 副高级758.316.7
 中级433.300
学历
 博士研究生216.715100.0
 硕士研究生650.000
 大学本科433.300
专业领域
 公共卫生866.7640.0
 卫生管理216.7640.0
 卫生政策216.7320.0
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2轮咨询专家基本情况

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项目第1轮第2轮
人数构成比/%人数构成比/%
性别
 男性325.0960.0
 女性975.0640.0
年龄/岁
 31~45650.0640.0
 46~60650.0960.0
工作年限/年
 11~20650.0640.0
 ≥21650.0960.0
职称
 正高级18.31493.3
 副高级758.316.7
 中级433.300
学历
 博士研究生216.715100.0
 硕士研究生650.000
 大学本科433.300
专业领域
 公共卫生866.7640.0
 卫生管理216.7640.0
 卫生政策216.7320.0
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Comprehensive evaluation index system and index weights of public health in hospitals from the perspective of integrated medicine and prevention

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一级指标权重二级指标权重三级指标
指标组合权重
1 组织资源
0.2571.1 组织管理0.0961.1.1 院级领导中有公共卫生教育背景的人数0.051
1.1.2 医院公共卫生自筹工作经费投入比0.045
1.2 人力资源0.1611.2.1 发热门诊床护比0.043
1.2.2 专职公共卫生人员数量床位比0.033
1.2.3 公共卫生专业背景人员占专职公共卫生人员比例0.032
1.2.4 专职公共卫生人员高级职称比例0.053
2 业务流程
0.4512.1 疾病预防0.1632.1.1 法定传染病报告及时率0.035
2.1.2 法定呼吸道传染病报告及时率0.025
2.1.3 重点慢性病登记报告率0.010
2.1.4 死因监测迟报率(含漏报率)0.028
2.1.5 住院病人艾滋病检测咨询比例0.013
2.1.6 住院病人营养风险测评覆盖率0.015
2.1.7 食源性疾病网络报告及时率0.009
2.1.8 全年发布或播出区级以上健康科普作品数量0.018
2.1.9 放射诊疗人员超剂量发生率0.010
2.2 院感管理0.0982.2.1 住院患者抗菌药物使用率0.025
2.2.2 Ⅰ类切口手术部位感染率0.025
2.2.3 医院感染发病率0.048
2.3 卫生应急0.0992.3.1 可转换感染性疾病床位数占医院开放床位数的比例0.043
2.3.2 年突发公共卫生事件应急演练次数0.056
2.4 医防融合0.0902.4.1 晋升高级职称前公共卫生知识培训完成率0.056
2.4.2 医务人员公共卫生相关知识培训覆盖率0.034
3 学科发展0.2923.1 科研能力0.1703.1.1 年均每百张床位发表公共卫生相关论文数0.083
3.1.2 专职公共卫生人员院外科研项目数0.087
3.2 影响力0.1223.2.1 各级预防医学会及其专委会任职情况0.122
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医防融合视角下医院公共卫生综合评价指标体系及指标权重

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一级指标权重二级指标权重三级指标
指标组合权重
1 组织资源
0.2571.1 组织管理0.0961.1.1 院级领导中有公共卫生教育背景的人数0.051
1.1.2 医院公共卫生自筹工作经费投入比0.045
1.2 人力资源0.1611.2.1 发热门诊床护比0.043
1.2.2 专职公共卫生人员数量床位比0.033
1.2.3 公共卫生专业背景人员占专职公共卫生人员比例0.032
1.2.4 专职公共卫生人员高级职称比例0.053
2 业务流程
0.4512.1 疾病预防0.1632.1.1 法定传染病报告及时率0.035
2.1.2 法定呼吸道传染病报告及时率0.025
2.1.3 重点慢性病登记报告率0.010
2.1.4 死因监测迟报率(含漏报率)0.028
2.1.5 住院病人艾滋病检测咨询比例0.013
2.1.6 住院病人营养风险测评覆盖率0.015
2.1.7 食源性疾病网络报告及时率0.009
2.1.8 全年发布或播出区级以上健康科普作品数量0.018
2.1.9 放射诊疗人员超剂量发生率0.010
2.2 院感管理0.0982.2.1 住院患者抗菌药物使用率0.025
2.2.2 Ⅰ类切口手术部位感染率0.025
2.2.3 医院感染发病率0.048
2.3 卫生应急0.0992.3.1 可转换感染性疾病床位数占医院开放床位数的比例0.043
2.3.2 年突发公共卫生事件应急演练次数0.056
2.4 医防融合0.0902.4.1 晋升高级职称前公共卫生知识培训完成率0.056
2.4.2 医务人员公共卫生相关知识培训覆盖率0.034
3 学科发展0.2923.1 科研能力0.1703.1.1 年均每百张床位发表公共卫生相关论文数0.083
3.1.2 专职公共卫生人员院外科研项目数0.087
3.2 影响力0.1223.2.1 各级预防医学会及其专委会任职情况0.122
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医防融合视角下医院公共卫生综合评价指标体系构建
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龚桂兰 1 , 白雪 1 , 方鹏骞 2 , 陈晶 3, *, *
中国公共卫生 | 调查报告与分析 2025,41(4): 452-456
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中国公共卫生 |调查报告与分析 2025 , 41 (4) : 452 -456
医防融合视角下医院公共卫生综合评价指标体系构建
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龚桂兰1, 白雪1, 方鹏骞2, 陈晶3, *, *
作者信息
  • 1华中科技大学同济医学院护理学院,武汉 430030
  • 2华中科技大学健康政策与管理研究院,武汉 430030
  • 3武汉市疾病预防控制中心健康技术指导部,武汉 430022
通讯作者:
陈晶,E-mail:
作者简介:

龚桂兰(1986—),讲师,博士,研究方向:公共卫生

Construction of a comprehensive evaluation index system for public health in hospitals from the perspective of integrated medicine and prevention
Guilan GONG1, Xue BAI1, Pengqian FANG2, Jing CHEN3
Affiliations
  • 1School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • 2Institute of Health Policy and Management, Huazhong University of Science and Technology, Wuhan 430030, China
  • 3Health Technical Guidance Department, Wuhan Center for Disease Control and Prevention, Wuhan 430022, China
  • Corresponding Author:
    CHEN Jing, E-mail:
出版时间: 2025-04-10 doi: 10.11847/zgggws1145256
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目的

构建医院公共卫生综合评价指标体系,为评价医院公共卫生工作开展情况提供依据。

方法

通过查阅相关文献和政策文件并经课题组的多轮专题讨论,拟定评价指标体系初稿;采用2轮德尔菲专家咨询法筛选评价指标,构建医院公共卫生综合评价指标体系,运用层次分析法计算各指标权重,通过SPSS 20.0 统计软件分析专家积极程度、权威程度、意见协调程度。

结果

2轮专家咨询问卷回收率均为100%,专家权威系数分别为0.869和0.902,专家权威程度较高;专家意见协调系数Kendall′s W分别为0.245、0.281(P<0.05),专家意见一致性较好。构建的医院公共卫生综合评价指标体系包括3个一级指标、8个二级指标和25个三级指标,一级指标为组织资源、业务流程和学科发展,其权重分别为0.257、0.451和0.292,各指标权重分配合理。

结论

本研究构建的医院公共卫生综合评价指标体系具有较好的科学性和可靠性,可为医院公共卫生工作的科学评价提供参考。

医防融合  /  医院公共卫生  /  评价  /  指标体系  /  德尔菲法  /  层次分析法
Objective

To construct a comprehensive evaluation index system for public health in hospitals, providing a basis for evaluating the implementation of public health work in hospitals.

Methods

An initial draft of the evaluation index system was formulated through a review of relevant literature and policy documents and multiple rounds of thematic discussions by the research team. A two-round Delphi expert consultation method was used to screen the evaluation indicators and construct a comprehensive evaluation index system for public health in hospitals. The analytic hierarchy process was used to calculate the weight of each indicator, and SPSS 20.0 statistical software was used to analyze expert engagement, authority, and the degree of consensus.

Results

The recovery rate of the expert consultation questionnaires in both rounds was 100%. The expert authority coefficients were 0.869 and 0.902, respectively, indicating a high level of expert authority. The Kendall′s W coefficients of expert opinion coordination were 0.245 and 0.281, respectively (P < 0.05), indicating good consistency among expert opinions. The constructed comprehensive evaluation index system for public health in hospitals includes three first-level indicators, eight second-level indicators, and 25 third-level indicators. The first-level indicators are organizational resources, business processes, and disciplinary development, with weights of 0.257, 0.451, and 0.292, respectively. The weight distribution of each indicator is reasonable.

Conclusions

The comprehensive evaluation index system for public health in hospitals constructed in this study has good scientific validity and reliability and can provide a reference for the scientific evaluation of public health work in hospitals.

integrated medicine and prevention  /  hospital public health  /  evaluation  /  index system  /  Delphi method  /  analytic hierarchy process
龚桂兰, 白雪, 方鹏骞, 陈晶. 医防融合视角下医院公共卫生综合评价指标体系构建. 中国公共卫生, 2025 , 41 (4) : 452 -456 . DOI: 10.11847/zgggws1145256
Guilan GONG, Xue BAI, Pengqian FANG, Jing CHEN. Construction of a comprehensive evaluation index system for public health in hospitals from the perspective of integrated medicine and prevention[J]. Chinese Journal of Public Health, 2025 , 41 (4) : 452 -456 . DOI: 10.11847/zgggws1145256
“医防融合”,即“临床医疗与公共卫生融合”的简称,是指破除医疗服务体系与公共卫生服务体系之间的体制机制障碍,促进两者在组织管理、资源配置、业务流程、信息共享、队伍建设等方面的有机协同与有效衔接,使群众享受到更优质的一体化的医疗和公共卫生服务,获得全生命周期的连续性健康管理服务,提高人群健康水平[1–2]。“医防融合”作为国家提倡的健康治理策略,是推进健康中国建设,加强公共卫生服务体系建设,实现“以治病为中心”向“以健康为中心”的重要抓手[2]。医院作为我国医疗卫生服务体系的主体,不仅承担着疾病诊疗的重任,而且也承担着重要的公共卫生服务职能。
近年来,国务院及各级政府相关部门陆续出台了一系列政策及文件以明确医院的公共卫生职责,但对于具体内容、质量管理、绩效考核等均未作出明确要求,也尚无统一、权威的医院公共卫生评价体系,无法实现对医院间公共卫生工作的综合比较评价[3–5]。现有针对医院公共卫生工作评价多侧重于单一方面,如针对医院突发公共卫生事件应急能力评价指标体系的构建[6–7],而对于医院公共卫生综合评价指标体系的研究鲜有报道。医院公共卫生评价是复杂和多维的,因此全面准确地评价医院公共卫生工作的质量需要多个指标有机组合起来的综合指标体系[8]。鉴于此,本研究旨在通过文献分析法[9]、德尔菲法[10]和层次分析法[11]构建医防融合视角下医院公共卫生综合评价指标体系,为评价医院公共卫生工作水平及引导医院完善公共卫生服务提供参考。
以医院公共卫生、评价指标、考核、hospital public health、evaluation indicators、assessment等为主题,通过中国知网、万方数据库、中国生物医学文献服务系统、维普等中文数据库及PubMed、Web of Science、Embase等外文数据库检索国内外医院公共卫生评价指标体系的相关文献,通过国家和地方政府部门官方网站获取近年来我国卫生健康行政部门及省、市政府等相关机构出台的相关政策文件。对检索出的文献及获取的政策文件进行分析整理,以医院公共卫生评价指标为切入点,运用内容分析法[12]进行归纳和总结,课题组进行多轮专题讨论,梳理出医院公共卫生综合评价指标体系初稿。
按照(1)具有≥10年工作经验;(2)本科及以上学历;(3)中级及以上职称;(4)知情同意参加本研究的遴选标准,2022年3月,课题组遴选出12名专职从事公共卫生工作的管理者及专业技术人员(如公卫科、院感科、门办、医务科等主要相关科室负责人),并召开了第1轮专家咨询会,对梳理出的医院公共卫生综合评价指标体系初稿进行筛选和修改,专家从指标的重要性、敏感性和可及性3个方面对每个指标进行评价,按照0~10分进行赋值,分值越高表示该属性的意义越大;同时设有修改意见栏供专家对各级指标进行修正。在第1轮专家咨询对指标调整、明确指标内涵、灵敏性和可及性的基础上,课题组于2022年7月,在全国知名高校、研究机构、学术团体、卫生行政部门等邀请15名本领域内权威专家学者召开了第2轮专家咨询会(专家纳入标准为:(1)具有≥10年工作经验;(2)副高及以上职称;(3)在公共卫生、医院管理、卫生政策、卫生服务体系等研究领域工作;(4)对本研究感兴趣自愿参与,专家对指标的重要性程度进行赋值(0~10分),并对有异议的指标提出修改意见及建议。指标调整标准为:根据综合评分均值对指标进行排序,并计算其四分位数;排除得分25%以下的指标;直接纳入得分75%及以上的指标;得分为26%~74%的指标经课题组研讨分析后再决定取舍;专家认为需要增加、修改或合并的指标,课题组根据专家意见讨论后,对该指标进行相应修订。
根据德尔菲法确定的指标体系,建立评价指标体系层次结构模型,目标层为医院公共卫生综合评价指标体系,准则层为一级指标和二级指标,方案层为三级指标;设计成对比较判断矩阵的1~9标度评判调查表,邀请第2轮咨询专家对指标重要性程度进行两两比较打分,构建各层次指标重要性判断矩阵,计算指标的权重系数,并对判断矩阵进行一致性检验,当一致性比率CR值< 0.1时,表示各层指标的判断矩阵构建合理,有较好的一致性,CR = CI/RI,CI代表一致性指标、RI代表随机一致性指标;利用概率乘法原理,将各层相应因素的权重连乘,计算出各项评价指标的组合权重,以做出决策[11]。
采用SPSS 20.0统计软件分析专家一般资料(年龄、性别、学历、职称、工龄、专业领域等)及积极程度、权威程度、意见协调程度等,并进行指标体系条目筛选,通过计算专家学术水平权值(Cn)、指标判断系数(Ca)和指标熟悉程度系数(Cs)的平均数获取专家权威系数(Cr),当Cr≥0.7时,专家权威程度较好[13];用肯德尔协调系数(Kendall′s W)表示专家意见协调程度,其值为0~1,值越大表示专家意见协调程度越高,对Kendall′s W值进行χ2检验,当Kendall′s W的 P<0.05,表示专家意见一致性好、评价结果具有可信性[13]。采用SPSS AU软件完成层次分析法,确定指标权重。
通过整理、归纳和总结及多轮课题组的专题讨论,梳理出包括组织管理、人力资源、业务工作、效果评价和发展潜力共5个大项、42个具体项的医防融合视角下医院公共卫生综合评价指标体系初稿。
第1轮纳入的12名专家平均年龄(42.58±7.74)岁,男女比例为1:3,多为副高级职称(58.3%)和硕士(50.0%),从事公共卫生专业的占66.7%;第2轮纳入的15名专家平均年龄(48.93±6.81)岁,男女比例为3 : 2,93.3%为正高级,均为博士研究生,从事公共卫生和卫生管理的各占40%。
在2轮专家咨询会中,与会专家均积极讨论医院公共卫生综合评价指标,并认真填写咨询表,咨询表的有效回收率均为100%,表明专家参与本次咨询的积极性较高。
第1轮咨询,12名专家的Cn为0.858,Ca为0.933,Cs为0.817,计算得Cr为0.869;第2轮咨询,15名专家的Cn为0.993,Ca为0.907,Cs为0.807,计算的Cr为0.902,2轮咨询专家的Cr均>0.7,表明本研究咨询专家权威程度较高。
通过SPSS 20.0统计软件计算结果显示,第1轮专家咨询Kendall′s W=0.245,χ2=120.530、P<0.001;第2轮专家咨询Kendall′s W=0.281,χ2=193.769、P<0.001,P均<0.05,表明本研究专家意见的协调程度高、一致性好、评价结果具有可信性。
通过对指标重要性、敏感性、可及性的评价及对指标重要性程度进行的赋值,以及对有异议的指标提出的修改意见和建议,对梳理出的医院公共卫生综合评价指标体系5个大项、42个具体项进行的2轮专家咨询结果为:第1轮,将指标体系框架层次调整为三级,合并2个一级指标并重新命名;增设15个二级指标;删除平均分较低的13个三级指标,调整与修改有争议的14个三级指标,增加18个三级指标。第2轮,一级指标精简至3项并重新命名;二级指标精简至8项且重新命名;删除平均分较低的21个三级指标,调整与修改有争议的14个指标,增加3个三级指标,最终确立的医防融合视角下医院公共卫生综合评价指标体系为:一级指标3个、二级指标8个和三级指标25个。层次分析结果显示,3个一级指标的权重分别0.257、0.451和0.292,一致性比率CR值<0.001,其余各层指标的CR值均≤0.01,指标体系所有CR值均< 0.1,表明本研究各层指标的判断矩阵构建合理、层次分析结果有较好的一致性,即各指标权重分配合理。
随着经济社会的快速发展和广大群众健康需求的日益提高,医院公共卫生工作的地位日益突出,不断加强与完善医院公共卫生工作,有利于纠正我国长期存在的“医防分离”“防治断裂”问题,是促进医防深度融合的重要举措[3]。
本研究在系统梳理医防融合视角下医院公共卫生相关内涵、组织框架、职责定位和明确医院公共卫生的治理机制、工作模式、医防融合实现路径等基础上[14],严格遵循指标体系构建的科学性、系统性、可操作性、可比较性等核心原则[15],提炼和筛选评价指标,并综合考虑每个指标的重要性、敏感性和可及性,充分考虑了指标相关信息的可获得性,合理确定每个指标在指标体系中的重要程度,最终构建了包括3个一级指标(组织资源、业务流程、学科发展)、8个二级指标(组织管理、人力资源、疾病预防、院感管理、卫生应急、医防融合、科研能力、影响力)和25个三级指标的有机统一的医防融合视角下医院公共卫生综合评价指标体系。
目前,对于医院公共卫生综合评价指标体系构建的研究较少,王颖等[3]根据安徽省部分综合性公立医院工作实际,构建了包括8个一级指标(传染病诊治管理、卫生应急管理、慢性非传染病管理、妇幼保健管理、健康教育与健康促进、伤害监测与死亡监测、职业卫生与精神卫生管理、其他公共卫生服务)、19个二级指标和62个三级指标的综合性公立医院公共卫生服务实施现状评价指标体系,为评价公立医院公共卫生工作实际开展情况提供了依据;尚晓鹏等[16]结合浙江省二级及以上公立综合医疗机构开展的公共卫生工作实际,构建了包括8个一级指标(公共卫生组织与管理、传染病与重点传染病诊疗管理、免疫预防、慢性非传染病的防制与精神卫生服务、食源性疾病监测、妇幼卫生、依法执业、健康促进与教育)、28个二级指标和63个三级指标的二级及以上公立综合医疗机构公共卫生任务评估指标体系,为公立综合医疗机构规范开展公共卫生任务及系统评估提供了参考;王秀萍等[17]根据浙江省县域医共体公共卫生工作实际,构建了包括10个一级指标(综合管理、传染病与突发公共卫生事件报告管理、重点疾病监测管理、免疫规划综合监测管理、食源性疾病监测、健康危害因素监测、严重精神障碍患者健康管理、妇幼健康保健、健康促进与教育、卫生协管)、32个二级指标和120个三级指标的县域医共体公共卫生工作绩效评价指标体系,为评价县域医共体公共卫生工作绩效提供了依据,此三者构建的公共卫生评价指标体系均较本研究更为详细具体、评价对象更有针对性,内容上更为侧重于评价医院公共卫生具体业务开展现状,但缺少对促进医防融合和推动医院公共卫生高质量发展指标的考量。本研究构建的医院公共卫生综合评价指标体系突出了医防融合的重点,全面地反映了医院公共卫生工作整体水平,所选指标均为数量、比例或率等可量化的客观指标,且对评价指标的计算方式和数据采集途径进行了充分考量,保障了指标相关数据均可直接从公开渠道获取或相关系统调取,数据的可及性好,其直接运用到医院公共卫生实际评价工作中的操作性较强,便于行业评价和信息统计,适用于各级卫生健康行政部门、质控组织和各级各类医疗机构的管理工作;同时该体系有助于医疗卫生相关部门科学评价当前医院公共卫生工作情况,有效识别工作中存在的问题与不足,进而提出相应的优化改进策略,助推医院公共卫生工作逐步完善,对深入推动医院医防融合高质量发展具有积极意义。
本研究通过文献分析法、德尔菲法和层次分析法构建的医防融合视角下医院公共卫生综合评价指标体系有较好的科学性和可靠性,其主要是:(1)本研究获取的相关文献来自国内外权威数据库,获取的相关政策文件来自我国卫生健康行政部门以及省、市政府网站;梳理出的5个大项、42个具体项的医防融合视角下医院公共卫生综合评价指标体系初稿经过了课题组的多轮专题讨论。(2)本研究采用的德尔菲法具有匿名性、反馈性和统计性等特点,有利于提出各种不同的意见并予以修正,有助于提高指标的科学性和可靠性;2轮咨询专家不但有来自全国知名高校、研究机构、学术团体、卫生行政部门人员,还有专职从事公共卫生工作的管理者及专业技术人员,且多为硕士研究生及以上学历者,85%以上为高级职称者;2轮咨询专家的权威系数(Cr)均>0.7、协调系数(Kendall′s W)均>0.25、Kendall′s W的P<0.05,3个一级指标的权重分别0.257、0.451和0.292,一致性比率CR值均<0.1,各指标权重分配合理。(3)本研究采用的层次分析法具有定性与定量分析相结合的特点,能将专家的主观判断用数字的形式展示出来,从而降低主观判断所致的偏差。(4)采用德尔菲法与层次分析法相结合的方式,对专家群体意见进行科学分析和处理,既能够保证所得结果的客观性,同时也有效提高了评价体系的科学性。
在本研究的基础上,今后在对医院公共卫生综合评价指标体系的研究中还应推进和推广:(1)设立明确的评价周期。医院公共卫生综合评价工作以年度数据为评价单元,因此最小评价周期为1年。根据医院公共卫生工作的特点和效能,每年进行评价,结果敏感度不高,建议每2年进行一次评价,从而观测纵向发展情况。(2)建立医院公共卫生综合评价体系动态调整机制。随着国家相关政策的调整、专业领域科学的进步、人口社会经济的发展等,医院公共卫生服务项目和内容均在不断地发展与改善,指标体系中的部分指标会被逐步增减和完善。因此,指标体系需要与时俱进,不断更新,并在实践中持续改进以适应发展需求,可每4~5年组织专家对指标体系进行一次调整,通过动态调整机制的建立,保障评价工具的前沿性、实用性和科学性。(3)设计医院公共卫生综合评价项目成果推广机制。武汉市运用本项目开发的医院公共卫生综合评价指标体系,开展了全市二级及以上公立医院公共卫生综合评价工作,业内响应程度高,评价结果客观真实,已在全市范围内形成了良好的医防融合氛围和医院公共卫生高质量发展驱动力[14]。后续还需通过更大范围的实证研究对该评价指标体系的应用效果进行检验。

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2025年第41卷第4期
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doi: 10.11847/zgggws1145256
  • 接收时间:2024-06-24
  • 首发时间:2026-10-25
  • 出版时间:2025-04-10
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  • 收稿日期:2024-06-24
  • 修回日期:2024-12-30
  • 录用日期:2025-02-11
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    1华中科技大学同济医学院护理学院,武汉 430030
    2华中科技大学健康政策与管理研究院,武汉 430030
    3武汉市疾病预防控制中心健康技术指导部,武汉 430022

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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