摘要
研究背景：
随着工业化、城镇化、人口老年化进程加快和生活方式的转变,人类疾病谱已发生了明显改变,我国居民心脑血管病、糖尿病、恶性肿瘤等慢性疾病患病率快速增长。根据《中华人民共和国第四次国家卫生服务调查主要结果》,2008年调查地区居民慢性病患病率为20.0%,比2003年增加4.9个百分点,推算全国慢性病总病例数达到2.6亿,过去十年年均新增近1000万例。其中,高血压病和糖尿病的病例数增加了2倍,心脏病和恶性肿瘤的病例数增加了近1倍；慢性病持续到两周内的病例在过去十年内由39%增加到了61%,慢性病死亡占总死亡比例从73.8%上升到80.9%。2008年深圳慢性传染病发病报告总数比2004年增加了127%；全市性病发病率为224.95/10万,远远高于53.87/10万的全国平均水平；全市高血压患病率约为13%,患病人数130万(按全市1000万人口),高血压、糖尿病等慢性病形势更加严重。这些慢性疾病不仅对患者造成身体伤害、心理创伤,严重影响了居民的生活质量,成为家庭和社会的沉重负担,也已成为危害居民健康的主要公共卫生问题。
近年来,随着医疗卫生体制改革的不断深入,深圳市慢性病防治机构在防治机制、财政投入、工作绩效、服务质量等方面均有所改善,但整体水平还不足以应对快速增长的慢性病发病形势,难以满足居民日益增长的健康需求,各机构急需改善和提高服务能力与服务质量,以适应新形势的要求。
研究目的：
开展服务质量评价,不仅是各公共卫生机构提升服务能力、改善服务质量的重要手段,也是完善公共卫生体系建设、优化资源配置、提高公共卫生服务均等化、协助管理部门进行监督的有效方法。2009年《中共中央国务院关于深化医药卫生体制改革的意见》中也明确提出“加强公共卫生服务体系建设,完善公共卫生服务功能,提高运行效率、服务水平和服务质量”的要求。本研究的主要目的是：
1.构建深圳市慢性病防治机构服务质量评价指标体系。
2.构建深圳市慢性病防治机构服务质量综合评价模型。
3.对深圳市慢性病防治机构的服务质量状况进行实证研究。
研究方法：
本研究运用公共卫生管理学科的有关方法,以深圳市慢性病防治机构职能和核心业务为基础,结合其现有条件和自身特点,采用定性研究和定量研究相结合的方法,围绕“完整性、代表性、科学性、有效性”等基本原则,建立服务质量的评价指标体系和综合评价模型。采用文献查阅、现场调研、专家访谈和小组讨论等方法建立指标体系初稿；通过对30多位公共卫生专家的2轮专家咨询进行指标筛选和权重估计,其中第一轮35位专家,第二轮31位专家,在专家年龄、专业、学历、职称、地域分布方面都进行了较好的组合；指标的评价标准来源于国家卫生部门相关业务规范；实证研究以深圳市6家区级慢性病防治机构为研究对象,采用问卷调查和现场评价相结合的方法；运用综合评分法、加权RSR法和加权TOPSIS法对实证结果进行分析比较；采用Epidata3.0建立数据库,使用SPSS15.0、SAS9.0等统计分析软件对所有数据进行统计分析。
研究结果：
本研究以Donabedian的卫生服务评价理论为基础,建立了以“基础、过程和服务结果”为主体的质量评价概念性框架,其中基础质量包括政策保障、制度保障和能力保障3个维度；过程质量包括监测网络、疾病监测、健康调查、行为干预、健康教育和工作督导等6个维度；服务结果包括健康促进状况、疾病防治效果和满意度等3个维度。指标体系共有3个一级指标、12个二级指标、80个三级指标,并在此基础上建立了以综合评分法为基础的综合评价模型。
2轮专家咨询中,第一轮35位专家,第二轮31位专家,专家积极系数分别为88.6%和96.8%,说明专家合作程度很高；所有指标的专家判断系数、熟悉程度系数和权威程度系数均在在0.8以上,变异系数均在0.2以下；一、二、三级指标的专家协调系数分别为0.7613、0.7587和0.5661,在α=0.05的水平上均具有统计学意义；两轮专家咨询全部指标“重要性”均值分别为8.391和8.533,变异系数均在0.2以下,具有较好的集中度；3个一级指标的权重分别为0.198、0.408和0.394。实证研究发现,6家慢性病防治机构服务质量整体水平较好,其综合得分分别为913.9、880.7、849.5、804.4、762.9、698.9,从好到差的顺序是：H1、H2、H3、H4、H5、H6;本研究构建的综合评分模型与TOPSIS模型和RSR模型评价结果的相关系数分别为0.994和0.999(P<0.01),具有较好的一致性。
研究结论：
1.本研究率先构建了深圳市慢性病防治机构服务质量综合评价指标体系。指标体系涵盖了深圳市慢性病防治机构的基本职能和主要业务,数量精简,重点突出；指标权重分配合理,具有较好的科学性和可行性,是当前最为完整、系统的慢性病防治机构服务质量评价指标体系；
2.本研究率先构建了基于综合评分法的综合评价模型。对每个三级指标提出了具体的标准和评分方法,制定了相应的操作量表,明确了评价要素、评分规则,提出了各评价对象的综合得分计算公式,具有较好的操作性。
3.实证研究发现,深圳市慢性病防治机构服务质量整体水平较好。采用上、中、下3档分类标准,H1为上档,其余5个机构均为中档,没有属于下档的单位；6家区级慢性病防治机构服务质量从高到低的排序为H1、H2、H3、H4、H5、H6;本研究构建的综合评分模型与常用的TOPSIS模型和RSR模型的评价结果具有较高的一致性。
Background:
With the industrialization, urbanization and aging population, our lifestyle changes, and this leads to the obvious changes in human disease spectrum. Rapid growth of cerebrovascular disease, diabetes, cancer and other chronic diseases are also found in our residents. According to " Major findings of the fourth national health services survey in the People's Republic of China ", residents surveyed suffering from chronic disease rose to 20.0%, increasing 4.9 percentage in comparison to that of 2003. Hence the estimation that cases of chronic diseases nationwide totals to 2.6 million, with the annual increase of 10 million over the past decade. Among them, cases of hypertension and diabetes increased by 2 times, heart disease and cancer by nearly 1-fold; chronic disease lasting two weeks increased from 39% to 61% in the past decade, and 80.9% died from chronic disease, while 10 years ago,73.8% died from those diseases. Chronic infectious diseases in Shenzhen in 2008 reported an increase of 127% than in 2004; 224.95 of 10 million citizens are found to be suffering from the chronic diseases, which is far higher than that of the national average (53.87/10 million); 13% citizens are suffering from hypertension, with victims of 1.3 million (according to the city's 10 million population). It is worse with hypertension, diabetes and other chronic diseases. These chronic diseases not only cause physical injury, psychological trauma in the victims, and become the heavy burden of their families and the community, influencing their quality of life, but also become a major public health problem for their being great health hazard to residents.
In recent years, with the health system reform in depth, Shenzhen agencies for preventing chronic diseases improved their service in disease prevention and control mechanisms, financial investment, job performance and service quality, though left a lot to be done in coping with the fast deterioration of the chronic disease outburst, in meeting resident's growing needs for healthiness. Thus those agencies need breakthroughs in their service and self development.
Objectives:
To launch the Service Quality Evaluation in public health agencies, is not only an important means to enhance their serving capability, improve their serving quality, but also an effective method to perfect the public health system, to optimize the allocation of resources, to improve the equalization of public health services and to assist the supervision of the management. In 2009, "the CPC Central Committee State Council Views on Deepening the Reform of Medical and Health System" also clearly stated the requirements of "strengthening the public health service system, improving public health services, improving operating efficiency, service level and service quality". The purposes of this study are:
1. Constructing Shenzhen Municipal Chronic Diseases Service Quality Evaluation Index System.
2. Constructing Shenzhen Municipal Chronic Diseases Service Quality of Integrated Evaluation Model.
3. Studying on service quality of Shenzhen chronic disease prevention and control institutions.
Methods:
Public health management approaches are applied in this study. Service Quality Evaluation Index System and Evaluation Model is established, based on the functions and core business of the chronic disease prevention and control institutions in Shenzhen City, combined with the existing conditions and its own characteristics, including the qualitative and quantitative research method, obeying the principles of "integrated, typical, scientific, and effective". Literature review, field research, expert interviews and group discussions were applied to establish the first draft index system; target screening and weight design are conducted among more than 30 public health experts consulted in two rounds, in which 35 experts in the first round and 31 experts in the second round. The age, profession, education, job title, geographic distribution of the experts gained consideration and a good combination. The criteria for the indicator evaluation derived from the national health departments'related business rules; 6 district-level chronic disease prevention and control institutions in Shenzhen are subject to the empirical study, who are investigated by the combination of questionnaire survey and field evaluation; the results of the empirical study are analyzed comparatively by using comprehensive score, weighted RSR method and the weighted TOPSIS method; A database is established by using Epidata3.0, and the data are analyzed by SPSS 15.0, SAS9.0 etc.
Results:
In this study, based on the Donabedian Theory of health services evaluation, a conceptual framework of quality assessment is established with "basis, process and service outcome" as its main part. The "basis" includes 3 dimensions of policy guarantee, system guarantee and the ability guarantee; the "Process" includes 6 dimensions of monitoring network, disease monitoring, health surveys, behavior intervention, health education and work supervision; the "service outcome" includes 3 dimensions of health promotion state, disease control efficacy and satisfaction. A comprehensive evaluation model is established on the basis of comprehensive scores received from the Index System which includes 3 level one indicators,12 level two indicators,80 level 3 indicators.
In 2 rounds of expert consultation, including 35 experts in the first round and 31 in the second, positive coefficients were 88.6% and 96.8% respectively, indicating experts'high level of cooperation; all indicators' expert judgments coefficient, familiarity coefficient and authority degree coefficient are above 0.8, with the variation coefficient of below 0.2; experts coordination coefficients in level one, level two, level three indicators were respectively 0.7613,0.7587 and 0.5661, statistically significant at the level ofα= 0.05. In 2 rounds of expert consultation, the mean "importance" of all the indicators are 8.391 and 8.533 separately, with the variation of below 0.2, showing good concentration; 3 level one indicators weights 0.198,0.408 and 0.394. It is found in the empirical study that the overall service levels of the 6 chronic disease prevention and control agencies are good, with the integrated score of 913.9,880.7,849.5, 804.4,762.9,698.9 respectively, and the order from best to worst is:H1, H2, H3, H4, H5, H6; the correlation coefficients of the 3 evaluation methods are 0.994 and 0.999 (P<0.01).
Conclusions:
1. It is the first in building quality evaluation index system of Shenzhen chronic disease prevention and control institutions. Concise and highlighting, the index system covers the basic functions of the chronic disease prevention and control institutions and their main business; with the reasonable target weight, being scientific and practical, it is currently the most complete and systematic service quality evaluation index system of chronic disease prevention and control agencies.
2. It is the first in building evaluations of comprehensive scores based on a comprehensive evaluation model. Specific criteria and scoring methods are developed in indicators of 3 levels; operating scales for each indicator are developed, clarifying the evaluation factors and rating rules; the evaluation formula of integrated score received by the subjects are also proposed, hence a operative model.
3. It is found in the empirical study that chronic disease prevention and control institutions in Shenzhen can provide good services overall and they can be classified into 3:upper, middle and lower. H1 belongs to the upper class, and the other five are middle, leaving no one to the lower class. According to their service quality, the six district-level chronic disease prevention and control institutions can be ordered from upper class to lower class as following:H1, H2, H3, H4, H5, H6; and 3 kinds of assessment methods were consistent.
引文
[1]WHO.The wold Health Repert.2002
[2]WHO.Preventing chronic diseases:a vital investment WHO global report,2005
[3]孔灵芝.慢性非传染性疾病流行现状、发展趋势及防治策略.中国慢性病预防与控制,2002,10(1)：1-2
[4]中国慢性病报告.卫生部疾控局,2006,5
[5]第四次国家卫生服务调查主要结果.中华人民共和国卫生部.2009,2
[6]深圳市看病难、看病贵调查报告.深圳市卫生局,2008
[7]慢性病预防控制能力建设的政策研究.深圳市慢性病防治中心,2009
[8]贾恩志.我国慢性病的疾病负担及防治策略.中国慢性病防治与控制,2001,6(2)：49-51
[9]李栋,许琨.我国主要慢性病的流行特点及疾病负担.中国初级卫生保健,2003,17(1)：32-33
[10]孔灵芝.慢性非传染性疾病防治与社区卫生服务.中国慢病预防与控制,1998,6(1)：35-38
[11]深圳市卫生服务公平性与可及性研究报告.深圳市卫生局,2009
[12]关于全面加强我市公共卫生体系建设实施意见.深圳市政府[2004]87号文件,2004
[13]深圳市公共卫生现状与问题.深圳市卫生局,2008
[14]杨芬,段纪俊.世界卫生系统绩效现状及其改进建议.环球瞭望,2002,12：19-22
[15]中共中央国务院关于深化医药卫生体制改革的意见.中国卫生部,2009,4
[16]深圳关于推进医药卫生体制改革的意见.深圳市政府[2009]11号文件,2009
[17]Lichiello P,Turning Point Collaborating for a New Century in Public Health: Guidebook for Performance Measurement. Turning Point National Program Office at the University of Washington.December 1999
[18]Turnock BJ,Handler AS. From measuring to improving public health practice. Annual Review of Public Health.1997,18:261-282
[19]江琴,胡善联.公共卫生体系绩效评估的概念性框架.中国卫生事业管理,2004,5：206-262
[20]郝艳华,吴群红,苏华.加强疾病预防控制机构组织绩效评估研究的必要性.中国卫生事业管理,2008,239(5)：292-294
[21]疾病预防控制体系建设研究课题组.疾病预防控制体系建设研究报告.人民卫生出版社,2008.11：323-336
[22]王海军,金水高,刘丽华.卫生服务绩效评价的概念框架研究与公共卫生应用.中国卫生经济,2008(7)：67-70
[23]梁万年,王红,杨兴华.中国城市社区卫生服务评价指标体系的建立.中国卫生事业管理,2002,8：460-461
[24]刘金辉.卫生经济学研究中的评估方法和指标.预防医学,2006,4：65-66
[25]付冰.医院绩效评价指标考核体系的探讨与实施.中国医院管理,2009,29(1)：59-60
[26]谢虹,詹思延,孔灵芝.我国社区慢病综合防治示范点组织管理评价指标体系的建立.中国农村卫生事业管理,2002,22(5)：31-34
[27]陈瑞安,杜亚平,张淑艺.社区卫生服务中心综合评价指标体系及其应用研究.中国全科医学,2005,8(13)：1112-4
[28]魏澄敏,陈雪珠,张克红.区级卫生监督机构绩效评估指标体系研究.中国卫生监督杂志,2005,12(5)：340-344
[29]Lehtinen U,LehtinenJ.Service quality:a study of quality dimensions.Working Paper,University of Tampere,Finland,1983
[30]黄耀杰,徐远.服务质量的定义及内涵界定.武汉理工大学学报信息与管理工程版,2008,30(1)：165-168
[31]Robert Johnston. The determinants of service quality:satisfiers and dissatisfiers.International Journal of Service Industry Management,1995,6(5):53-71
[32]Donabedian著,李岩编译,医疗指标评估与监测.北京大学医学出版社,2007.8：27-32
[33]World Health Organization Regional Office for the Western Pacific.Essential public health functions:a three-country study in the western pacific region. Manila. Publications Office of the World Health Organization Regional Office for the Western Pacific.2003.25-30.
[34]柴盈,福祥.服务质量内涵的综述与思考.科技与管理,2004,25(3)：36-38
[35]万建成,王小万.英国卫生服务系统绩效管理的发展过程.中国卫生经 济,2008,27(8)：95-96
[36]WHO. Essential public health functions:results of the Interntional Delphi Study. World Health Statistics Quarterly 1998,51(1):44-54
[37]WHO. Health systems:Improving performance. The World Health Report 2000, Geneva:World Health Organization
[38]梁万年.卫生事业管理学.北京：人民卫生出版社,2003
[39]徐国华等.管理学.北京：清华大学出版社,2001
[40]丹尼尔 A.雷恩.管理思想的演变.北京：中国社会科学出版社,2000
[41]斯蒂芬.P.罗宾斯.管理学(第四版).北京：中国人民大学出版社,2002
[42]郭岩.卫生事业管理学.北京：北京大学医学出版社,2003
[43]杨芬,段纪俊.世界卫生系统绩效现状及其改进建议.2002(12)：19-22
[44]Josee bloemer,Ko de ruyter,Martin wetzels. Linking perceived service quality and service loyalty:a multi2dimensional perspective. European journal of marketing vol.33,No.11,1999:1082-1106
[45]Stephen F.derose, Public health quality assessment:Concepts and Challenges,annu.rev.Public Health 2002,23:1-21.
[46]Gronroos C.Service management and marketing. Lexington Massachusetts: Lexington Books,1990
[47]WHO. Trends and challenges in world health genera.2000
[48]Marc.J.roberts et al. Getting health reform right-A guide to improving performance and equity. oxford university press,2004
[49]WHO. reducing risk, promoting health life. The world health report,2002
[50]A.Parasuraman,Valarie A.Zeithaml,Leonard L Berry. A conceptual model of service quality and its implications for future research.Journal of Marketing, 1985,(49):41-50
[51]胡善联.循证决策研究方法的进展.卫生经济研究,2006(8)39-40
[52]Kelley E, Hurst J:Health Care Quality Indicators Project:Conceptual Framework Paper", OECD Health Working Papers, No.23, OECD Publishing,2006
[53]Centers for Disease Control and Prevention:National Nosocomial Infection Surveillance System Semiannual Report.Atlanta, Ga,1996
[54]A.Parasuraman,Valarie A.Zeithaml,Leonard L Berry. SERVQUAL:A multiple item scale for measuring consumer perceptions of service quality. Journal of Retailing.1988,64(1):12-4
[55]Wenger NS, Young RT:Quality indicators for continuity and coordination of care in vulnerable elders. J Am Geriatr Soc 55 Suppl 2:S285-92,2007
[56]耿先锋,董进才,何志哲.服务质量的构成及其测量方法述评.工业技术经济,2007,26(3)：111-113
[57]Michael K.brady,J.Joseph Cronin Jr.Some new thoughts on conceptualizing perceived service quality:a hierarchical approach.Journal of marketing,vol.65 july 2001:34-49
[58]王淑翠,王伟.服务质量文献综述.山东经济,2005,5：22-25
[59]Donabedian A:Explorations in Quality Assessment and Monitoring.1982
[60]National Public Health Performance Standards Program. Local public health performance assessment instrument. version1.0. Atlanta. US Center for Disease Control and Prevention.2005.1-78
[61]Murray CJ, Frenk J:A framework for assessing the performance of health systems. Bull World Health Organ 2000,78:717-31
[62]Juran JM, Godfrey AB:Juran's quality handbook (ed 5th). New York, McGraw Hill,1999
[63]Blumenthal D, Kilo CM:A report card on continuous quality improvement. Milbank Q 76:625-48,511,1998
[64]Winslow CM KJ, Chassin MR, Kanouse DE, Brook RH:The appropriateness of performing coronary artery bypass surgery. JAMA 260:505-9,1988
[65]Handler AS,A Conceptual Framework to Measure Performance of the Public Health System,American Journal of Public Health,2001,91(8):1235-1239
[66]Mainz J.Defining and classifying clinical indicators for quality improvement.Int J Qual Health Care,2003,15(6):523-30
[67]World Bank.Strengthening essential public health functions. New York. World Bank.2004.6-11
[68]胡善联.评价卫生系统绩效的新框架—介绍2000年世界卫生报告.卫生经济研究,2000,7：1-5
[69]Tonmyr L,MacMillan HL, Jamieson E, et al:The population health perspective as a framework for studying child maltreatment outcomes. Chronic Dis Can 2002,23:123-9
[70]世界卫生组织.2006年世界卫生报告：通力合作促进健康.WHO,2006
[71]Pan American Health Organization. Public health in Americas:Conceptual renewal, performance assessment,and bases for action. Washington DC. Pan American Health Organization,2002.141-143.
[72]National Public Health Performance Standards Program. State public health perfomance assessment instrument.versionl.Atlanta. US Center for Disease Control and Prevention.2005.10-95
[73]Kelley E, Hurst J:Health Care Quality Indicators Project Conceptual Framework Paper, pp DELSA/HEA/WD/HWP(2006)3
[74]关于疾病预防控制体系建设的若干规定.中华人民共和国卫生部令(第40号),2005,5
[75]Davis K:Health Care Cost Containment, Johns Hopkins University Press, 1990
[76]Folland S, Goodman AC, Stano M:The economics of health and health care, Prentice Hall Upper Saddle River, NJ,2001
[77]Derose SF, Schuster MA, Fielding JE, et al:Public health quality measurement: concepts and challenges. Annu Rev Public Health 23:1-21,2002
[78]McGlynn EA, Asch SM:Developing a clinical performance measure. Am J Prev Med 14:14-21,1998
[79]Levine A:A model for health projections using knowledgeable informants. World Health Stat Q 37:306-17,1984
[80]杨功焕.健康模式转变与中国慢性病控制策略.中国慢性病预防与控制,2001,4：145-148
[8l]刘圣来.浅议疾病控制机构绩效评估的指标体系.中国卫生事业管理,2004,4：248-249
[82]王跃平.慢性非传染性疾病防治管理工作的现状分析与对策.实用预防医学,2006,13(5)：1365-1367
[83]Georg Bauer. Advancing a theoretical model for public health and health promotion indicator development. European journal of public health,2003,13 (3supplement):107-113
[84]程晋烽.西方公共卫生评估的演化逻辑及其启示,卫生软科学,2007.6：192-194
[85]World Health Organisation. The Ottawa Charter for Health Promotion. Geneva: WHO,1986
[86]Mainz J.Defining and classifying clinical indicators for quality improvement.Int J Qual Health Care,2003,15(6):523-30
[87]Murray CJJ.Frenk.A framework for assessing the performance of health systems.Bull World Health Organ,2000,78(6):717-31
[88]中国公共卫生信息分类与基本数据集.中国疾病预防控制中心,2007.1：15-19
[89]Lehtinen U,LehtinenJ.Service quality:a study of quality dimensions.Working Paper,University of Tampere,Finland,1983
[90]Ware JE,Snyder Jr MK,et al.Defining and measuring patient satisfaction with medical care.Evaluation and Planning,1983,6:247-248
[91]谢娟,马亚楠,何钦成等.沈阳市社区卫生服务满意度调查与评价.预防医学情报杂志,2009,25(7)：513-516
[92]胡晓玲,朱新侠,陈丽云等.城市社区卫生服务评价指标体系的确立和初步应用.中国全科医学,2003(12)：1001-1002
[93]许铁锋,王剑萍,连斌等.上海市临床医学中心评估指标体系构建与应用研究.中国卫生事业管理,2006,4(214)：202-203
[94]孙振球,王乐三.医学综合评价方法及其应用.北京：化学工业出版社,2006
[95]王一任,孙振球.医用综合评价方法研究进展.中南大学学报(医学版),2005,30(2)：35-38
[96]孙振球,田凤调等.医用综合评价方法.北京：中国科学技术出版社,1994
[97]孙振球.医学统计学.第2版,北京：人民卫生出版社,2005
[98]杨昕,孙振球,曾小敏等.中国14所医科大学核心竞争力综合评价模型研究.中国卫生统计,2007,24(3)：263-267
[99]郭清,汪盛,汪小合.中国城市社区卫生服务评价指标研究.中国全科医学,2002,5(11)：887-888
[100]郭燕芳,史静争,胡明.良性前列腺增生症患者生活质量量表的修订与考评.中国卫生统计,2008,25(3)：260-263
[101]胡明.学生常见心理问题简易筛查量表的编制及其筛查参考值、影响因素的分析：[博士学位论文].长沙：中南大学,2007
[102]汤磊,唐国瑶,苏炳华等.教学质量评价体系中指标权重的咨询专家选择与分析.上海第二医科大学学报,2004,24(3)：211-214
[103]高云,李亚洁.基于Delphi法和AHP的一级护理质量评价指标权重确定. 第四军医大学学报,2009,30(2)：181-183
[104]刘仁义,陈士俊.高校教师科技绩效评价中指标与权重的设定.科研管理,2007,28(3)：39-45
[105]蔡志明,刘颜,王琦,王光明等.应用多种卫生统计方法建立医院技校评估指标体系.现代医院制度,2004,8(7)：47-49
[106]王芳,金建强,张全红等.综合评价方法在社区卫生服务中应用.中国公共卫生,2008,24(4)：442-443
[107]梁万年,王红,杨兴华.中国城市社区卫生服务评价指标体系的建立.中国卫生事业管理,2002,18(8)：460-462
[108]王国平.中国妇幼保健机构绩效评价指标体系研究：[博士学位论文].武汉：华中科技大学,2009
[109]李立明.公共卫生的绩效考核和循证决策.中国医改前言,2008,2：14
[110]闵祥云.应用EXCEL进行TOPSIS综合评价.疾病控制杂志,2003,7(3)：252-253
[111]高永,王玖,石德文.加权TOPSIS法综合评价在Excel中的实现.中国卫生统计,2007,24(4)：428-429
[112]黄宝龙,于力.综合指数法和TOPSIS法在医疗质量综合评价中的应用.中国医院统计,2008,15(3)：219-221
[113]林佩贤,王维,钟倩红等.应用EXCEL实现秩和比法的计算及其评价.数理医药学杂志,2009,22(2)：1 83-1 86
[114]王宝玉.运用秩和比法综合评价我院工作质量.中国卫生统计2009,26(1)：111
[115]赵拥军,陈景武,唐军.主成分分析与因子分析法在医院管理质量综合评价中的应用研究.中国卫生统计,2006,23(5)：403-406
[116]陈晓冬,陈晓玲,郭希风等.3种医院综合评价方法的比较分析.中国医院统计,2001,8(2)：67-70
[117]潘志明,郑振佺,刘贤忠等.应用TOPSIS法和RSR法评价社区卫生服务中心的工作绩效.中国医院统计,2007,14(3)：236-238
[118]中华人民共和国卫生部.中国居民营养与健康现状.2004.10
[119]孙德俊.城市社区居民慢性病防治对策研究.中国慢性病预防与控 制,2007,15(5)：487-490
[120]王跃平.慢性非传染性疾病防治管理工作的现状分析与对策.实用预防医学,2006,13(5)：1365-1367
[121]张洁,俞敏.慢性非传染性疾病防治进展.浙江预防医学,2006,18(12)：55-57
[122]李绍忱.诠释慢性病涵义拓宽防治研究范畴.中国慢性病预防与控制,2007,15(1)：1-2
[123]任苒.公共卫生的作用及政府职责.医学与哲学,2005,26(8)：7-11
[124]娄培安,林敬德,余加席.徐州市慢性非传染性疾病防治现状与防治对策.中国校医,2007,21(5)：593-593-594
[125]冯超,吴琴琴,马继红.健康管理中心的慢性病管理.现代预防医学,2008,35(8)：1517-1518
[126]林中,曾念彬,潘建清.深圳市福田区社区慢性病防治现状与对策.中国慢性病预防与控制,2005,13(2)：82-83
[127]李立明.21世纪我国公共卫生面临的挑战及对策.中国健康教育,2003,19(1)：1-3
[128]黄建始.公共卫生的价值和功能.中国健康教育,2006,2(1)：67-69
[129]Haggerty JL, Reid RJ, Freeman GK, et al:Continuity of care:a multidisciplinary review. Bmj 327:1219-21,2003
[130]吕筠,李立明.我国疾控和监督体系职能与现代公共卫生体系职能内涵的比较.中国公共卫生管理,2006,22(5)：365-368
[131]万美,唐婴,饶华.现代公共卫生职能及发展趋势.中国健康教育,2008,24(4)：304-305
[132]吕筠,李立明.现代公共卫生体系的基本职能及其内涵.中国公共卫生,2007,23(8)：1022-1024
[133]徐缓.论公共卫生内涵的分层界定及其政策含义.中国卫生法制,2007,15(3)：6-8
[134]徐昆亭,付百年,齐兴中.疾病预防控制工作考核指标体系.中国公共卫生管理,2004,20(3)：213-215
[135]梁鸿,国有德,李佩珊.社区卫生服务发展评价指标体系研究.中国卫生经济,2004,23(2)：64-67
[136]胡国清.我国突发公共卫生事件应对能力评价体系研究：[博士学位论文].长沙：中南大学,2006
[137]汪云,陈霞,程勇等.社区卫生服务系统绩效评价框架构建.医学与社会,2008,21(2)：29-31
[138]朱新侠,胡晓玲,陈丽云.城市社区卫生服务评价体系的研究.江苏卫生保健,2003,5(3)：19-21
[139]杨人懿,赵先柱,李运明,孙娜等.军队大型医院医技科室医疗质量指标评价体系的构建.西南国防医药,2005,15(3)：266-269
[140]Winslow CE:The Untilled Fields of Public Health. Science 51:23-33,1920
[141]Handler AS. A Conceptual Framework to Measure Performance of the Public Health System.American Journal of Public Health,2001,91(8) 1235-1239
[142]Arah OA, Westert GP, Hurst J, et al:A conceptual framework for the OECD Health Care Quality Indicators Project. Int J Qual Health Care 18 Suppl 1:5-13,2006
[143]裴丽昆.澳大利亚卫生系统绩效评价框架.中华医院管理杂志,2004,20(8)：10-12
[144]徐勇勇.国家卫生信息标准基础框架研究概况和应用前景.中国数字医学,2008,3(1)：14-16
[145]徐勇勇,刘丹红,王霞等.国家卫生系统绩效测量与统计指标的概念框架.中国卫生统计,2006,23(5)：386-390
[146]刘宝,姚经建,胡善联等.基本公共卫生功能界定的国际比较.中国卫生资源,2006,9(5)：233-235
[147]杜进林,李颖琰,王禄生.新型农村合作医疗综合评价指标体系研究.中国公共卫生管理,2006,22(3)：257-259
[148]沈艳红,常文虎,彭迎春.对北京市妇幼保健机构测评指标体系的研究.中华医院管理,2004,20(6)：321-323
[149]李军,陈晨,彭迎春.关于建立北京市农村社区卫生服务效果、效益评价指标体系的研究.中国初级卫生保健,2005,19(1)：33-36
[150]周学君,王扬,杨俊.医院综合竞争力的评价研究.中华医院管理杂志,2003,19(11)：689-690
[151]郑景山.常规免疫接种质量综合评价指标体系与方法的探讨.中国计划免疫,2001,7(2)：106-108
[152]骆福添,凌莉,柳青.社区肿瘤防治效果评价指标体系.中国肿瘤,2002,11(3)：146-148
[153]胡润华.浅谈公共卫生的涵义.中华医学科研管理杂志,2003,16(3)：133-134
[154]张肖敏.美国的卫生管理与医疗保险制度.卫生经济研究,2000,7：7-9
[155]任丽梅.英国的医疗保障体制改革.中国改革报,2005,12.22(6)
[156]Turnock B,Handler A.ThelOpublic health practices vs the public health services:a clarification. American Journal of Public Health,1995,85(9):1295-1296
[157]committee Nhp:National Health Performance framework report. Queen and health. Brisbane,2001
[158]Aharony L, Strasser S:Patient satisfaction:what we know about and what we still need to explore. Med Care Rev 50:49-79,1993
[159]Briss PA, Zaza S, Pappaioanou M, et al:Developing an evidence-based Guide to Community Preventive Services-methods. The Task Force on Community Preventive Services. Am J Prev Med 18:35-43,2000
[160]Berk ML, Schur CL:Measuring access to care:improving information for policymakers. Health Aff (Millwood) 17:180-6,1998
[161]Brook RH, Chassin MR, Fink A, et al:A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 2:53-63,1986
[162]McLoughlin V, Leatherman S, Fletcher M, et al:Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia. Int J Qual Health Care 13:455-62,2001
[1]卫生部公布第四次国家卫生服务调查主要结果.中华人民共和国卫生部.2009,2
[2]中国慢性病报告.卫生部疾控局,2006,5
[3]胡国清.我国突发公共卫生事件应对能力评价体系研究：[博士学位论文].长沙：中南大学,2006
[4]杨芬,段纪俊.世界卫生系统绩效现状及其改进建议.环球瞭望,2002,12：19-22
[5]郝艳华,吴群红,苏华.加强疾病预防控制机构组织绩效评估研究的必要性.中国卫生事业管理,2008,239(5)：292-294
[6]胡善联.评价卫生系统绩效的新框架—介绍2000年世界卫生报告.卫生经济研究,2000,7：1-5
[7]中共中央国务院关于深化医药卫生体制改革的意见.中国卫生部,2009,4
[8]黄耀杰,徐远.服务质量的定义及内涵界定.武汉理工大学学报,2008,30(1)：165-168
[9]柴盈,福祥.服务质量内涵的综述与思考.科技与管理,2004,25(3)：36-38
[10]耿先锋,董进才,何志哲.服务质量的构成及其测量方法述评.工业技术经济,2007,26(3)：111-113
[11]王淑翠,王伟.服务质量文献综述.山东经济,2005,5：22-25
[12]Lehtinen U,LehtinenJ.Service quality:a study of quality dimensions.Working Paper,University of Tampere,Finland,1983.
[13]A.Parasuraman,Valarie A.Zeithaml,Leonard L Berry.A conceptual model of service quality and its implications for future research.Journal of Marketing,1985,(49):41-50
[14]Michael K.brady,J.Joseph Cronin Jr.Some new thoughts on conceptualizing perceived service quality:a hierarchical approach.Journal of marketing,vol.65 july 2001:34-49
[15]WHO, Health systems:Improving performance. The World Health Report 2000, Geneva:World Health Organization
[16]王海军,金水高,刘丽华.卫生服务绩效评价的概念框架研究与公共卫生应用.中国卫生经济,2008(7)：67-70
[17]Murray CJ, Frenk J:A framework for assessing the performance of health systems. Bull World Health Organ 2000.78:717-31
[18]王国平.中国妇幼保健机构绩效评价指标体系研究：[博士学位论文].武汉：华中科技大学,2009
[19]疾病预防控制体系建设研究课题组.疾病预防控制体系建设研究报告.人民卫生出版社,2008.11：323-336
[20]刘圣来.浅议疾病控制机构绩效评估的指标体系.中国卫生事业管理,2004,4：248-249
[21]Lichiello P,Turning Point Collaborating for a New Century in Public Health: Guidebook for Performance Measurement. Turning Point National Program Office at the University of Washington.December 1999
[22]Handler AS,A Conceptual Framework to Measure Performance of the Public Health System,American Journal of Public Health,2001,91(8):1235-1239
[23]Turnock BJ,Handler AS.From measuring to improving public health practice.Annual Review of Public Health.1997.18:261-282
[24]Stephen F.derose, Public health quality assessment:Concepts and Challenges[J],annu.rev.Public Health 2002.23:1-21
[25]江琴,胡善联.公共卫生体系绩效评估的概念性框架,中国卫生事业管理,2004.5：206-262
[26]Mainz J.Defining and classifying clinical indicators for quality improvement.Int J Qual Health Care,2003.15(6):523-30
[27]Georg Bauer,Advancing a theoretical model for public health and health promotion indicator development, European journal of public health 2003.13(3supplement):107-113
[28]程晋烽.西方公共卫生评估的演化逻辑及其启示,卫生软科学,2007,6：192-194
[29]Murray CJJ.Frenk.A framework for assessing the performance of health systems[J].Bull World Health Organ,2000.78(6):717-31
[30]Winslow CE:The Untilled Fields of Public Health. Science 51:23-33,1920
[31]WHO.Essential public health functions:results of the International Delphi Study.World Health Statistics Quarterly,1998.51(1):44-54.
[32]Pan American Health Organization.Public health in Americas:Conceptual renewal,performance assessment,and bases for action.Washington DC.Pan American Health Organization,2002.141-143.
[33]World Bank.Strengthening essential public health functions. New York. World Bank.2004.6-11
[34]World Health Organization Regional Office for the Western Pacific.Essential public health functions:a three-country study in the western pacific region. Manila. Publications Office of the World Health Organization Regional Office for the Western Pacific.2003.25-30
[35]Turnock B,Handler A.ThelOpublic health practices vs the public health services:a clarification American Journal of Public Health,1995.85(9):1295-1296
[36]National Public Health Performance Standards Program.Local public health performance assessment instrument.version 1.0.Atlanta.US Center for Disease Control and Prevention.2005.1-78
[37]National Public Health Performance Standards Program.State public health perfomance assessment instrument.version1.0. Atlanta. US Center for Disease Control and Prevention.2005.10-95
[38]关于疾病预防控制体系建设的若干规定.中华人民共和国卫生部令(第40号),2005,5
[39]Levine A:A model for health projections using knowledgeable informants. World Health Stat Q 1984.37:306-17
[40]Donabedian A:Explorations in Quality Assessment and Monitoring.1982
[41]Donabedian著,李岩编译,医疗指标评估与监测[M].北京大学医学出版社,2007,8：27-32
[42]Derose SF,Schuster MA,Fielding JE,et al:Public health quality measurement:concepts and challenges.Annu Rev Public Health 2002,23:1-21
[43]McGlynn EA, Asch SM:Developing a clinical performance measure.Am J Prev Med 1998.14:14-21
[44]Briss PA, Zaza S, Pappaioanou M, et al:Developing an evidence-based Guide to Community Preventive Services-methods. The Task Force on Community Preventive Services. Am J Prev Med 2000.18:35-43
[45]Brook RH, Chassin MR, Fink A, et al:A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 1986.2:53-63
[46]Jaffe ES, Bookman MA, Longo DL:Lymphocytic lymphoma of intermediate differentiation-mantle zone lymphoma:a distinct subtype of B-cell lymphoma. Hum Pathol 1987.18:877-80
[47]Aharony L, Strasser S:Patient satisfaction:what we know about and what we still need to explore. Med Care Rev 1993.50:49-79
[48]Handler AS. A Conceptual Framework to Measure Performance of the Public Health System.American Journal of Public Health,2001.91(8)1235-1239
[49]Murray CJ, Frenk J:A framework for assessing the performance of health systems. Bull World Health Organ 2000.78:717-31
[50]Arah OA, Westert GP, Hurst J, et al:A conceptual framework for the OECD Health Care Quality Indicators Project. Int J Qual Health Care 18 Suppl 1,2006:5-13
[51]committee Nhp:National Health Performance framework report. Queenl and health. Brisbane,2001
[52]McLoughlin V, Leatherman S, Fletcher M, et al:Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia. Int J Qual Health Care 2001.13:455-62
[53]Chang IS, Tsujimura Y, Gen M, et al:An efficient approach for large scale project planning based on fuzzy Delphi method. Fuzzy Sets and Systems 1995.76:277-288
[54]Institute of Medicine (U.S.). Committee on Quality of Health Care in America.: Crossing the quality chasm:a new health system for the 21st century. Washington, D.C., National Academy Press,2001
[55]Agency for Healthcare Research and Quality:National Healthcare Quality Report,2005. Rockville, MD
[56]Agency for Healthcare Research and Quality:National Healthcare Disparities Report,2005.Rockville, MD
[57]Canadian Institute for Health Information:Health indicators 2004. Ottawa,2004
[58]Donabedian A:An introduction to quality assurance in health care, Oxford University Press,2003
[59]Institute of Medicine (U.S.). Committee on Monitoring Access to Personal Health Care Services, Millman ML:Access to health care in America. Washington, D.C., National Academy Press,1993
[60]Berk ML, Schur CL:Measuring access to care:improving information for policymakers. Health Aff (Millwood) 1998.17:180-6
[61]Kelley E, Hurst J:Health Care Quality Indicators Project:Conceptual Framework Paper", OECD Health Working Papers, No.23, OECD Publishing,2006
[62]Centers for Disease Control and Prevention:National Nosocomial Infection Surveillance System Semiannual Report Atlanta,Ga,1996
[63]Kelley E, Hurst J:Health Care Quality Indicators Project Conceptual Framework Paper,pp DELSA/HEA/WD/HWP(2006)3
[64]Winslow CM KJ, Chassin MR, Kanouse DE, Brook RH:The appropriateness of performing coronary artery bypass surgery.JAMA 1988.260:505-9
[65]Haggerty JL, Reid RJ, Freeman GK, et al:Continuity of care:a multidisciplinary review. Bmj 2003.327:1219-21
[66]Wenger NS, Young RT:Quality indicators for continuity and coordination of care in vulnerable elders. J Am Geriatr Soc 55 Suppl 2:S285-92,2007
[67]Groocock JM:The chain of quality:market dominance through product superiority. New York, Wiley,1986
[68]Juran JM, Godfrey AB:Juran's quality handbook (ed 5th). New York, McGraw Hill,1999
[69]Blumenthal D, Kilo CM:A report card on continuous quality improvement. Milbank Q 1998.76:625-48
[70]Folland S, Goodman AC, Stano M:The economics of health and health care, Prentice Hall Upper Saddle River, NJ,2001
[71]Davis K:Health Care Cost Containment, Johns Hopkins University Press, 1990
[72]Abraham LK:Mama might be better off dead:the failure of health care in urban America (ed Paperback). Chicago, University of Chicago Press,1994
[73]Stephen F.derose, Public health quality assessment:Concepts and Challenges[J],annu.rev.Public Health 2002.23:1-21