突发公共卫生事件医务人员应对能力评价指标选择和初步模型构建
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摘要
1、背景
突发公共卫生事件是指突然发生,造成或者可能造成社会公众健康严重损害的重大传染病疫情、群体性不明原因疾病、重大食物和职业中毒以及其他严重影响公众健康的事件。突发公共卫生事件具有突发性和意外性、严重的社会经济危害性、罹及的群体性、事件处理的统一性和协调性以及决策的风险性和时效性等特点。自2003年“非典型肺炎”发生以来,突发公共卫生事件就成为社会关注的焦点。根据国家卫生部公布的全国突发公共卫生事件信息显示,2007年,共收到全国除港澳台外31个省、白治区、直辖市通过突发公共卫生事件报告管理信息系统报告的突发公共卫生事件共2552起,报告病例98254人,死亡515人。可见,我国每年防治突发公共卫生事件形势还比较严峻。医务人员是应对突发公共卫生事件的主体。每次突发公共卫生事件发生后,需要大量的医务人员参与应对。例如在汶川地震发生后,全国约10万名卫生人员参加抗震救灾医疗卫生防疫工作。累计救治受伤利患病人员约437万人次,开展手术近4万台次,累计住院伤员9万余人,向20个省、区、市转送伤病员1万余名。
2、目的意义
为了应对突发公共卫生事件,人们逐渐认识到必须加强医院应急型人力资源管理。根据医疗救治系统尤其是医院在突发公共卫生事件应对中职责与作用,构建一套适应于突发公共卫生事件应对能力评价的科学、合理、可靠、可行的综合评价体系,并以此为医院应对突发公共卫生事件时抽组、选拔、培养、储备应急人员,打造一支拉得出、有水平、能力强的应急型人员队伍,提高医院突发公共卫生事件应急水平,具有非常重要的现实意义。
3、研究方法
首先通过文献分析、参考标准以及专家咨询的方法,在严格遵循构建综合评价指标体系一般原则的基础上,拟订初步的突发公共卫生事件医务人员应对能力评价指标体系的框架。为了筛选指标,借助德尔菲法进行第一轮的专家咨询,将各指标的评价等级依重要性分为十分重要、很重要、重要、不太重要、不重要5个等级,并赋相应的量化值为10、7.5、5、2.5、0。根据专家反馈的意见进行综合分析,对指标进行必要的增、减、删、修,尔后确定突发公共卫生事件医务人员应对能力评价的指标体系。进行第二轮德尔菲法专家咨询的主要目的在于获得每个指标的权重。根据专家对指标的赋值求其平均分值,将指标平均分值累加,计算出每个指标得分所占总分的比例,作为该项指标的权重系数,以此构建突发公共卫生事件医务人员应对能力的线性模型。本研究的主体方法是德尔菲法,专家的选择是影响德尔菲法成功的关键要素。因此,通过选定6个限定条件,确定咨询专家共31名。第一轮全部专家接受咨询,至第二轮咨询有2名专家因故未能接受咨询。通过对专家的结构分析和权威程度分析,表明选择的咨询专家具有丰富的突发公共卫生事件的应对经验,也非常熟悉突发公共卫生事件的发生、发展的规律,对医务工作者应对突发公共卫生事件应具备的素质和能力也应该非常的清晰,具有典型的代表性,保证了调查结果的准确性和可靠性。两轮德尔菲法专家咨询的质量控制效果主要通过计算应答率以及专家的协调系数来反映。
4、结果
第一轮德尔菲法专家咨询后,接受专家对初步拟订指标的修改意见,调整了个别指标的结构并对部分指标的内涵做了重新说明,确定了突发公共卫生事件医务人员应对能力评价指标,以基本概况、知识体系、实践和技能三个指标作为一级指标,其中在基本概况一级指标下再细分年龄、工作时间、学历、职称、健康状况、学术任职以及专业背景7个方面作为二级指标;在知识体系一级指标下再细分基本认知、基础知识、专业知识、管理知识、法律知识、心理知识以及其它知识7个方而作为二级指标;在实践和技能一级指标下再细分专业技术、培训演练、参与经历、沟通协调以及风险承担5个方面作为二级指标,由此形成一个完整的具有二级结构的突发公共卫生事件医务人员应对能力评价的指标体系。通过第二轮德尔菲法专家咨询,获得一级指标和二级指标的权重。最终,建立突发公共卫生事件医务人员应对能力评价的初步线性模型为:Y=0.281X_1+0.344X_2+0.375X_3.X_1=0.124X_(11)+0.147X_(12)+0.128X_(13)+0.145X_(14)+0.181X_(15)+0.061X_(16)+0.215X_(17).X_2=0.168X_(21)+0.164X_(22)+0.178X_(23)+0.129X_(24)+0.132X_(25)+0.142X_(26)+0.087X_(27).X_3=0.23X_(31)+0.203X_(32)+0.205X_(33)+0.18X_(34)+0.182X_(35)。其中:Y表示综合评价得分;X_1,X_2,X_3分别表示3个一级指标的评价得分;X_(11),X_(12),…,X_(17)分别表示第一个一级指标下7个二级指标的单项得分;X_(21),X_(22),…,X_(27)分别表示第二个一级指标下7个二级指标的单项得分;X_(31),X_(32),…,X_(35)分别表示第三个一级指标下5个二级指标的单项得分;各单项指标的得分及综合得分可视具体情况采用百分制或千分制。
在质量控制效果方面,两轮专家的应答率分别是:100%和94%,两轮专家的协调系数分别为:0.448和0.765。两轮协调系数经x~2检验,结果均有统计学意义,表明两轮专家意见有较好的协调性。
5、结论和讨论
本课题主要是基于近年来突发公共卫生事件的频繁发生且种类更加多样化,导致对医务人员需求增加为背景的研究,着眼于医院的突发公共卫生事件人力资源管理,以医务人员应对突发公共卫生事件能力为研究落脚点,以德尔菲法、文献分析、专家咨询、科学统计分析等方法综合运用为技术手段,探索了评价医务人员应对突发公共卫生事件的能力指标,并构建了初步的综合评价模型。
本研究的特色之处有:
1、首次构建了突发公共卫生事件医务人员应对能力的评价指标体系
构建一个评价指标体系最核心的价值和主要目的是科学、客观的对评估对象作出综合评价。突发公共卫生事件医务人员的应对能力评估体系是一个庞杂的指标系统,目前可供参考的文献资料几乎没有。本研究主要是通过德尔菲的方法,首次建立了一套完整的突发公共卫生事件医务人员应对能力的评价指标体系。
2、评价指标具有较好客观性
本次研究所建立的指标体系主要是针对能力的综合评价。能力是一种抽象概念,从本质上而言,属人的自然本性和内在潜力,客观性的指标选择的范围比较少,直接评价的困难比较大。本次研究在指标的选择上抛弃了一些主观性比较强的指标,主要选择了客观性的指标,增加了可比性和可操作性。
3、评价体系适应性强
医务人员是本研究所建立评价指标体系的评价对象。医务人员是一个集合的概念,包括各类医务人员,不同的专业背景和分工造成工作性质和工作特点都不相同。本研究在构建突发公共卫生事件医务人员应对能力评价指标体系时,注意选择了通用性的指标,因此本研究所建立的指标评价体系适用于各类参与应对突发公共卫生事件的医务人员应对能力评价。
4、各种综合评价方法的应用
本研究的主体方法是借助了德尔菲法的思想。为保证德尔菲法专家咨询结果的准确可靠,严格设定了选择专家的条件,这其中不但要求专家要有丰富的实践经验,还要求专家要有很高的学术水平。除了采用德尔菲外,本研究还运用了文献分析、专家访谈、统计分析等方法,主观性方法加上客观性方法相结合,尽量保证研究所构建指标体系评价结果的准确可靠。
本课题研究只是构建了突发公共卫生事件医务人员应对能力评价指标体系框架,明确了评价的一二级指标,确定了相应的权重系数,但并没有进行实际的评价,评价的实际效果如何尚需要进行实证性的研究,后续工作可考虑采用多元数理统计、专家考核评分等方法,检验模型的信度和效度,提高此评价指标体系的实用性和可靠性。其次,理论上评价指标体系中各指标数据的获得在不同人群的评价时应建立标准化的方法,例如医、药、护、技以及医疗管理人员的专业知识、技能的考核应保持一致的难度系数。本项研究所建立的模型是一个简单的初步线性模型,由于突发公共卫生事件的复杂性、能力评价的多变化、医务人员的多样性等决定了突发公共卫生事件医务人员应对能力评价指标体系时,在指标的选择、方法的运用上还必须在实践中不断优化完善。
Background
The public health emergency refers to major infectious diseases,community diseases of unknown causes,major food and occupational poisoning and other serious events that occur suddenly and cause or threaten to cause serious harm to the public health.It is characterized by abruptness,unexpectedness,heavy damages to society,economy and community,unity and coordination in handling the events,as well as the risk and timeliness of decision-making.Since the occurrence of SARS in 2003,the public health emergency has become the focus of attention.According to the information released by the Chinese Ministry of Health,2,552 public health emergencies occurred in 2007,reported through the Information System of Public Health Emergency Management,involving 98,254 people and causing 515 deaths in 31 provinces,autonomous regions and municipalities throughout the country,except Hong Kong,Macao and Taiwan.This shows that the situation of China's annual public health emergency is relatively grim.
Medical workers are proved to be the main force in response to public health emergencies.Take the Wenchuan earthquake for example,it involved approximately 100,000 medical workers in medical rescue and epidemic prevention,with some 4.37 million person-times treated,nearly 40,000 operations performed,over 90,000 hospital admissions,and more than 10,000 transferees to the other parts of the country.
Purpose and Significance
In response to public health emergencies,people are gradually becoming aware of the necessity of strengthening the management of hospital emergency human resources.According to the medical treatment system,especially the hospital's responsibility and role in dealing with public health emergencies,it is of vital importance and practical significance to establish a scientific,rational and reliable comprehensive evaluation system against public health emergency.Based on this system,anti-emergency personnel are selected,organized,trained and reserved,a highly efficient fast-reaction contingent is established,and the hospital's comprehensive ability is raised in coping with public health emergency.
Methods
First of all,through the analysis of literature,reference standards and specialist consultation,based on strict compliance with the general principles for constructing the comprehensive evaluation index system,the preliminary framework of the index system was designed for evaluating medical personnel's abilities of coping with a public health emergency.Using the Delphi method,the first specialist consultation was held to grade each of the evaluation indexes into 5 levels:extremely important, very important,important,less important and unimportant,given the corresponding quantitative value of 10,7.5,5,2.5 and 0,respectively.Then the indexes were revised according to the feedback from the specialists and the results of comprehensive analysis.The main purpose of the second Delphi specialist consultation was to obtain the weight of each index.According to the average scores of the specialists' evaluation of the indexes,the mean cumulative score was calculated for each index in proportion to the total score,as the weight coefficient of the index.Based on this,a linear model of medical personnel's abilities of dealing with public health emergency was established.The main method used in this study was Delphi,in which the selection of specialists plays a key role.Therefore,we decided upon 31 specialists as advisers who met the six basic requirements previously set.All were consulted in the first round,and all but two in the second. Structure and authority analyses of the selected specialists showed that they were typically representative,well experienced in dealing with public health emergency, with perfect knowledge of its occurrence and development,and the qualities and abilities required of medical personnel,which ensured the accuracy and reliability of the investigation results.The results of quality control of the two Delphi specialist consultations were reflected in the rate of responses and the coordination coefficient of the specialists.
Results
After the first Delphi specialist consultation,the structure of some indexes was readjusted,their implications specified,and the evaluation indexes for medical personnel's abilities of dealing with public health emergency according to the specialists' revision proposals.The first-level indexes were concerned with general data,knowledge system and practical skills.General data included age,work eXperience,education,professional title,health,academic position and background as the second-level indeXes;knowledge system included the basic cognition,basic knowledge,eXpertise,management know-how,legal knowledge,psychological knowledge as the second-level indeXes;practical skills included professional skills, training background,drilling eXperience,communication and coordination ability as the second-level indeXes.All this constituted a complete two-level evaluation system of indeXes for evaluating medical personnel's abilities of dealing with public health emergency.The weights of both the first- and second-level indeXes were achieved through the second Delphi specialist consultation.The initial linear model of evaluating medical personnel's abilities of dealing with public health emergency was established as follows:
Y = 0.281 X_1 + 0.344 X_2 + 0.375 X_3.
X_1 = 0.124X_(11)+0.147 X_(12)+0.128 X_(13)+0.145 X_(14)+0.181 X_(15)+0.061 X_(16)+ 0.215 X_(17);
X_2 = O.I68X_(21)+0.164 X_(22)+0.178 X_(23)+0.129 X_(24)+0.132 X_(25)+0.142 X_(26)+ 0.087 X_(27);
X_3 = 0.23X_(31)+0.203 X_(32)+0.205 X_(33)+0.18 X_(34)+0.182 X_(35).
Y represents the comprehensive evaluation scores; X_1-X_3 represent the scores on the 3 first-level indeXes; X_(11)-X_(17) represent the scores on the 7 second-level indeXes of general data;
X_(21)-X_(27) represent the scores on the 7 second-level indeXes of knowledge system;
X_(31)-X_(35) represent the scores on the 5 second-level indeXes of practical skills.
The comprehensive score and the score on an individual indeX were made by the hundred- or thousand-mark system according to the specific circumstances.
As to the effect of quality control,the answer rates were 100%and 94%and the coordination coefficients were 0.448 and 0.765 in the two specialist consultations. The results of theχ~2 test of the coordination coefficients showed statistical significance.
Discussion and Conclusion
This study was conducted against the background of the frequentness and variety of public health emergencies in recent years,which led to the requirement of increased number of related medical personnel,focusing on public health emergency human resources management of the hospital and medical personnel's abilities of dealing with public health emergency.The Delphi method and statistical analysis were employed in the investigation the evaluation indeXes of medical personnel's abilities of dealing with public health emergency,and the establishment of an initial comprehensive evaluation model.
Characterization of the Study
1.Originality of the evaluation index system
It is the first evaluation index system ever established for assessing medical personnel's abilities in response to public health emergency.The scientific,objective and comprehensive assessment of the subjects is the core value and the main purpose of the evaluation index system.It is a large and complex system,with hardly any existing literature available for reference.
2.Objectivity of the evaluation index system
This index system aimed at the comprehensive evaluation of the abilities.The ability,as an abstract concept,is the innate potential of human beings by nature,with very few objective indexes and real difficulty for direct evaluation.In the choice of the indexes,we decided upon the strongly subjective ones,with emphasis on their comparability and maneuverability.
3.Adaptability of the evaluation index system
The subjects to be evaluated by the index system were different types of medical personnel,varying widely in professional backgrounds,division of responsibilities and characteristics of work.In this study,we paid special attention to the universality of the indexes to be included,so that they could be applicable to the evaluation of all types of medical personnel involved in public health emergency.
4.Integration of a variety of methods
This study drew much on the Delphi method.In order to ensure the accuracy and reliability of the results of the specialist consultations,strict criteria were set for the selection of the specialists,who were required to have not only rich practical experience but also high academic positions.In addition to the Delphi method,we used various other methods,such as literature reviews,specialist interviews, statistical analyses,and the combination of subjective and objective ones,so as to best ensure the accuracy and reliability of the results of the evaluation index system.
In this study,we established a framework of the evaluation index system for medical personnel's abilities in response to a public health emergency,specified the first-and second-level evaluation indexes,and set the corresponding weight coefficients,but did not conduct the actual assessment.Therefore the effect of the evaluation system is yet to be confirmed by further empirical researches,which could be conducted by such methods as multi-mathematical statistics and specialist evaluation score to test and improve the reliability,validity and practicability of the evaluation index system.Besides,standardized criteria should be established in the theoretical evaluation index system for the assessment of those of different specialties.And the coefficients of difficulty should be consistent in the examinations on the expertise and skills of medicine,pharmacology,nursing, medico-technology,medical management,and so on.The model established in this study is but a simple preliminary linear one.As the evaluation indexes are easily influenced by the complexity of public health emergencies,the variety of medical personnel and the consequent variability of evaluation indexes,the determination of the indexes and the methods to be used have to be optimized and perfected in the future practice.
突发公共卫生事件是指突然发生,造成或者可能造成社会公众健康严重损害的重大传染病疫情、群体性不明原因疾病、重大食物和职业中毒以及其他严重影响公众健康的事件。突发公共卫生事件具有突发性和意外性、严重的社会经济危害性、罹及的群体性、事件处理的统一性和协调性以及决策的风险性和时效性等特点。自2003年“非典型肺炎”发生以来,突发公共卫生事件就成为社会关注的焦点。根据国家卫生部公布的全国突发公共卫生事件信息显示,2007年,共收到全国除港澳台外31个省、白治区、直辖市通过突发公共卫生事件报告管理信息系统报告的突发公共卫生事件共2552起,报告病例98254人,死亡515人。可见,我国每年防治突发公共卫生事件形势还比较严峻。医务人员是应对突发公共卫生事件的主体。每次突发公共卫生事件发生后,需要大量的医务人员参与应对。例如在汶川地震发生后,全国约10万名卫生人员参加抗震救灾医疗卫生防疫工作。累计救治受伤利患病人员约437万人次,开展手术近4万台次,累计住院伤员9万余人,向20个省、区、市转送伤病员1万余名。
2、目的意义
为了应对突发公共卫生事件,人们逐渐认识到必须加强医院应急型人力资源管理。根据医疗救治系统尤其是医院在突发公共卫生事件应对中职责与作用,构建一套适应于突发公共卫生事件应对能力评价的科学、合理、可靠、可行的综合评价体系,并以此为医院应对突发公共卫生事件时抽组、选拔、培养、储备应急人员,打造一支拉得出、有水平、能力强的应急型人员队伍,提高医院突发公共卫生事件应急水平,具有非常重要的现实意义。
3、研究方法
首先通过文献分析、参考标准以及专家咨询的方法,在严格遵循构建综合评价指标体系一般原则的基础上,拟订初步的突发公共卫生事件医务人员应对能力评价指标体系的框架。为了筛选指标,借助德尔菲法进行第一轮的专家咨询,将各指标的评价等级依重要性分为十分重要、很重要、重要、不太重要、不重要5个等级,并赋相应的量化值为10、7.5、5、2.5、0。根据专家反馈的意见进行综合分析,对指标进行必要的增、减、删、修,尔后确定突发公共卫生事件医务人员应对能力评价的指标体系。进行第二轮德尔菲法专家咨询的主要目的在于获得每个指标的权重。根据专家对指标的赋值求其平均分值,将指标平均分值累加,计算出每个指标得分所占总分的比例,作为该项指标的权重系数,以此构建突发公共卫生事件医务人员应对能力的线性模型。本研究的主体方法是德尔菲法,专家的选择是影响德尔菲法成功的关键要素。因此,通过选定6个限定条件,确定咨询专家共31名。第一轮全部专家接受咨询,至第二轮咨询有2名专家因故未能接受咨询。通过对专家的结构分析和权威程度分析,表明选择的咨询专家具有丰富的突发公共卫生事件的应对经验,也非常熟悉突发公共卫生事件的发生、发展的规律,对医务工作者应对突发公共卫生事件应具备的素质和能力也应该非常的清晰,具有典型的代表性,保证了调查结果的准确性和可靠性。两轮德尔菲法专家咨询的质量控制效果主要通过计算应答率以及专家的协调系数来反映。
4、结果
第一轮德尔菲法专家咨询后,接受专家对初步拟订指标的修改意见,调整了个别指标的结构并对部分指标的内涵做了重新说明,确定了突发公共卫生事件医务人员应对能力评价指标,以基本概况、知识体系、实践和技能三个指标作为一级指标,其中在基本概况一级指标下再细分年龄、工作时间、学历、职称、健康状况、学术任职以及专业背景7个方面作为二级指标;在知识体系一级指标下再细分基本认知、基础知识、专业知识、管理知识、法律知识、心理知识以及其它知识7个方而作为二级指标;在实践和技能一级指标下再细分专业技术、培训演练、参与经历、沟通协调以及风险承担5个方面作为二级指标,由此形成一个完整的具有二级结构的突发公共卫生事件医务人员应对能力评价的指标体系。通过第二轮德尔菲法专家咨询,获得一级指标和二级指标的权重。最终,建立突发公共卫生事件医务人员应对能力评价的初步线性模型为:Y=0.281X_1+0.344X_2+0.375X_3.X_1=0.124X_(11)+0.147X_(12)+0.128X_(13)+0.145X_(14)+0.181X_(15)+0.061X_(16)+0.215X_(17).X_2=0.168X_(21)+0.164X_(22)+0.178X_(23)+0.129X_(24)+0.132X_(25)+0.142X_(26)+0.087X_(27).X_3=0.23X_(31)+0.203X_(32)+0.205X_(33)+0.18X_(34)+0.182X_(35)。其中:Y表示综合评价得分;X_1,X_2,X_3分别表示3个一级指标的评价得分;X_(11),X_(12),…,X_(17)分别表示第一个一级指标下7个二级指标的单项得分;X_(21),X_(22),…,X_(27)分别表示第二个一级指标下7个二级指标的单项得分;X_(31),X_(32),…,X_(35)分别表示第三个一级指标下5个二级指标的单项得分;各单项指标的得分及综合得分可视具体情况采用百分制或千分制。
在质量控制效果方面,两轮专家的应答率分别是:100%和94%,两轮专家的协调系数分别为:0.448和0.765。两轮协调系数经x~2检验,结果均有统计学意义,表明两轮专家意见有较好的协调性。
5、结论和讨论
本课题主要是基于近年来突发公共卫生事件的频繁发生且种类更加多样化,导致对医务人员需求增加为背景的研究,着眼于医院的突发公共卫生事件人力资源管理,以医务人员应对突发公共卫生事件能力为研究落脚点,以德尔菲法、文献分析、专家咨询、科学统计分析等方法综合运用为技术手段,探索了评价医务人员应对突发公共卫生事件的能力指标,并构建了初步的综合评价模型。
本研究的特色之处有:
1、首次构建了突发公共卫生事件医务人员应对能力的评价指标体系
构建一个评价指标体系最核心的价值和主要目的是科学、客观的对评估对象作出综合评价。突发公共卫生事件医务人员的应对能力评估体系是一个庞杂的指标系统,目前可供参考的文献资料几乎没有。本研究主要是通过德尔菲的方法,首次建立了一套完整的突发公共卫生事件医务人员应对能力的评价指标体系。
2、评价指标具有较好客观性
本次研究所建立的指标体系主要是针对能力的综合评价。能力是一种抽象概念,从本质上而言,属人的自然本性和内在潜力,客观性的指标选择的范围比较少,直接评价的困难比较大。本次研究在指标的选择上抛弃了一些主观性比较强的指标,主要选择了客观性的指标,增加了可比性和可操作性。
3、评价体系适应性强
医务人员是本研究所建立评价指标体系的评价对象。医务人员是一个集合的概念,包括各类医务人员,不同的专业背景和分工造成工作性质和工作特点都不相同。本研究在构建突发公共卫生事件医务人员应对能力评价指标体系时,注意选择了通用性的指标,因此本研究所建立的指标评价体系适用于各类参与应对突发公共卫生事件的医务人员应对能力评价。
4、各种综合评价方法的应用
本研究的主体方法是借助了德尔菲法的思想。为保证德尔菲法专家咨询结果的准确可靠,严格设定了选择专家的条件,这其中不但要求专家要有丰富的实践经验,还要求专家要有很高的学术水平。除了采用德尔菲外,本研究还运用了文献分析、专家访谈、统计分析等方法,主观性方法加上客观性方法相结合,尽量保证研究所构建指标体系评价结果的准确可靠。
本课题研究只是构建了突发公共卫生事件医务人员应对能力评价指标体系框架,明确了评价的一二级指标,确定了相应的权重系数,但并没有进行实际的评价,评价的实际效果如何尚需要进行实证性的研究,后续工作可考虑采用多元数理统计、专家考核评分等方法,检验模型的信度和效度,提高此评价指标体系的实用性和可靠性。其次,理论上评价指标体系中各指标数据的获得在不同人群的评价时应建立标准化的方法,例如医、药、护、技以及医疗管理人员的专业知识、技能的考核应保持一致的难度系数。本项研究所建立的模型是一个简单的初步线性模型,由于突发公共卫生事件的复杂性、能力评价的多变化、医务人员的多样性等决定了突发公共卫生事件医务人员应对能力评价指标体系时,在指标的选择、方法的运用上还必须在实践中不断优化完善。
Background
The public health emergency refers to major infectious diseases,community diseases of unknown causes,major food and occupational poisoning and other serious events that occur suddenly and cause or threaten to cause serious harm to the public health.It is characterized by abruptness,unexpectedness,heavy damages to society,economy and community,unity and coordination in handling the events,as well as the risk and timeliness of decision-making.Since the occurrence of SARS in 2003,the public health emergency has become the focus of attention.According to the information released by the Chinese Ministry of Health,2,552 public health emergencies occurred in 2007,reported through the Information System of Public Health Emergency Management,involving 98,254 people and causing 515 deaths in 31 provinces,autonomous regions and municipalities throughout the country,except Hong Kong,Macao and Taiwan.This shows that the situation of China's annual public health emergency is relatively grim.
Medical workers are proved to be the main force in response to public health emergencies.Take the Wenchuan earthquake for example,it involved approximately 100,000 medical workers in medical rescue and epidemic prevention,with some 4.37 million person-times treated,nearly 40,000 operations performed,over 90,000 hospital admissions,and more than 10,000 transferees to the other parts of the country.
Purpose and Significance
In response to public health emergencies,people are gradually becoming aware of the necessity of strengthening the management of hospital emergency human resources.According to the medical treatment system,especially the hospital's responsibility and role in dealing with public health emergencies,it is of vital importance and practical significance to establish a scientific,rational and reliable comprehensive evaluation system against public health emergency.Based on this system,anti-emergency personnel are selected,organized,trained and reserved,a highly efficient fast-reaction contingent is established,and the hospital's comprehensive ability is raised in coping with public health emergency.
Methods
First of all,through the analysis of literature,reference standards and specialist consultation,based on strict compliance with the general principles for constructing the comprehensive evaluation index system,the preliminary framework of the index system was designed for evaluating medical personnel's abilities of coping with a public health emergency.Using the Delphi method,the first specialist consultation was held to grade each of the evaluation indexes into 5 levels:extremely important, very important,important,less important and unimportant,given the corresponding quantitative value of 10,7.5,5,2.5 and 0,respectively.Then the indexes were revised according to the feedback from the specialists and the results of comprehensive analysis.The main purpose of the second Delphi specialist consultation was to obtain the weight of each index.According to the average scores of the specialists' evaluation of the indexes,the mean cumulative score was calculated for each index in proportion to the total score,as the weight coefficient of the index.Based on this,a linear model of medical personnel's abilities of dealing with public health emergency was established.The main method used in this study was Delphi,in which the selection of specialists plays a key role.Therefore,we decided upon 31 specialists as advisers who met the six basic requirements previously set.All were consulted in the first round,and all but two in the second. Structure and authority analyses of the selected specialists showed that they were typically representative,well experienced in dealing with public health emergency, with perfect knowledge of its occurrence and development,and the qualities and abilities required of medical personnel,which ensured the accuracy and reliability of the investigation results.The results of quality control of the two Delphi specialist consultations were reflected in the rate of responses and the coordination coefficient of the specialists.
Results
After the first Delphi specialist consultation,the structure of some indexes was readjusted,their implications specified,and the evaluation indexes for medical personnel's abilities of dealing with public health emergency according to the specialists' revision proposals.The first-level indexes were concerned with general data,knowledge system and practical skills.General data included age,work eXperience,education,professional title,health,academic position and background as the second-level indeXes;knowledge system included the basic cognition,basic knowledge,eXpertise,management know-how,legal knowledge,psychological knowledge as the second-level indeXes;practical skills included professional skills, training background,drilling eXperience,communication and coordination ability as the second-level indeXes.All this constituted a complete two-level evaluation system of indeXes for evaluating medical personnel's abilities of dealing with public health emergency.The weights of both the first- and second-level indeXes were achieved through the second Delphi specialist consultation.The initial linear model of evaluating medical personnel's abilities of dealing with public health emergency was established as follows:
Y = 0.281 X_1 + 0.344 X_2 + 0.375 X_3.
X_1 = 0.124X_(11)+0.147 X_(12)+0.128 X_(13)+0.145 X_(14)+0.181 X_(15)+0.061 X_(16)+ 0.215 X_(17);
X_2 = O.I68X_(21)+0.164 X_(22)+0.178 X_(23)+0.129 X_(24)+0.132 X_(25)+0.142 X_(26)+ 0.087 X_(27);
X_3 = 0.23X_(31)+0.203 X_(32)+0.205 X_(33)+0.18 X_(34)+0.182 X_(35).
Y represents the comprehensive evaluation scores; X_1-X_3 represent the scores on the 3 first-level indeXes; X_(11)-X_(17) represent the scores on the 7 second-level indeXes of general data;
X_(21)-X_(27) represent the scores on the 7 second-level indeXes of knowledge system;
X_(31)-X_(35) represent the scores on the 5 second-level indeXes of practical skills.
The comprehensive score and the score on an individual indeX were made by the hundred- or thousand-mark system according to the specific circumstances.
As to the effect of quality control,the answer rates were 100%and 94%and the coordination coefficients were 0.448 and 0.765 in the two specialist consultations. The results of theχ~2 test of the coordination coefficients showed statistical significance.
Discussion and Conclusion
This study was conducted against the background of the frequentness and variety of public health emergencies in recent years,which led to the requirement of increased number of related medical personnel,focusing on public health emergency human resources management of the hospital and medical personnel's abilities of dealing with public health emergency.The Delphi method and statistical analysis were employed in the investigation the evaluation indeXes of medical personnel's abilities of dealing with public health emergency,and the establishment of an initial comprehensive evaluation model.
Characterization of the Study
1.Originality of the evaluation index system
It is the first evaluation index system ever established for assessing medical personnel's abilities in response to public health emergency.The scientific,objective and comprehensive assessment of the subjects is the core value and the main purpose of the evaluation index system.It is a large and complex system,with hardly any existing literature available for reference.
2.Objectivity of the evaluation index system
This index system aimed at the comprehensive evaluation of the abilities.The ability,as an abstract concept,is the innate potential of human beings by nature,with very few objective indexes and real difficulty for direct evaluation.In the choice of the indexes,we decided upon the strongly subjective ones,with emphasis on their comparability and maneuverability.
3.Adaptability of the evaluation index system
The subjects to be evaluated by the index system were different types of medical personnel,varying widely in professional backgrounds,division of responsibilities and characteristics of work.In this study,we paid special attention to the universality of the indexes to be included,so that they could be applicable to the evaluation of all types of medical personnel involved in public health emergency.
4.Integration of a variety of methods
This study drew much on the Delphi method.In order to ensure the accuracy and reliability of the results of the specialist consultations,strict criteria were set for the selection of the specialists,who were required to have not only rich practical experience but also high academic positions.In addition to the Delphi method,we used various other methods,such as literature reviews,specialist interviews, statistical analyses,and the combination of subjective and objective ones,so as to best ensure the accuracy and reliability of the results of the evaluation index system.
In this study,we established a framework of the evaluation index system for medical personnel's abilities in response to a public health emergency,specified the first-and second-level evaluation indexes,and set the corresponding weight coefficients,but did not conduct the actual assessment.Therefore the effect of the evaluation system is yet to be confirmed by further empirical researches,which could be conducted by such methods as multi-mathematical statistics and specialist evaluation score to test and improve the reliability,validity and practicability of the evaluation index system.Besides,standardized criteria should be established in the theoretical evaluation index system for the assessment of those of different specialties.And the coefficients of difficulty should be consistent in the examinations on the expertise and skills of medicine,pharmacology,nursing, medico-technology,medical management,and so on.The model established in this study is but a simple preliminary linear one.As the evaluation indexes are easily influenced by the complexity of public health emergencies,the variety of medical personnel and the consequent variability of evaluation indexes,the determination of the indexes and the methods to be used have to be optimized and perfected in the future practice.
引文
[1]董海波.浅谈突发公共卫生事件应急型人力资源管理研究[S].消费导刊,2008,4:126.
[2]张艳春,吴群红,郝艳华,等.黑龙江省医疗救治系统医院救治能力现状分析[J].中国公共卫生,2007,23(3):345-346.
[3]中华人民共和国国家发展与改革革委员会.国务院关于转发发展改革委卫生部突发公共卫生事件医疗救治体系建设规划的通知[OL].http://www.sdpc.gov.cn/shfz/t20070418_130228.htm.2009-3-18.
[4]姜晓梅,姜文海,于精红.医院在突发公共卫生事件中的地位与对策[J],中国医院管理,2005,25(9):36.
[5]罗乐宣,冯占春,张剑.医疗机构在突发公共卫生事件应急反应体系中的地位[J].中国医院管理,2004,24(3):3-5.
[6]何维林.医院在突发公共卫生事件中的作用[J].中国医院管理,2004,24(3):9-10.
[7]中华人民共和国中央人民政府.卫生部公布2007年全国突发公共卫生事件信息情况[OL]http://www.gov.cn/gzdt/2008-01/15/content_858516.htm.2009-3-19.
[8]健康报网.不寻常的2008年不平凡的卫生事业[OL].http://www.jkb.com.cn/document/69393.htm?docid=69393&cat=0D&sKsyWor d=null.2009-3-18.
[9]国务院.突发公共卫生事件应急条例[S].中华人民共和国国务院令第376号,2003.5.
[10]刘文彪,匡维华.国境口岸突发公共卫生事件的应对与危机管理[J].口岸卫生控制,2005,10(3):43-44.
[11]丁启龙,夏晨.突发公共卫生事件卫勤保障特点与亏对策探讨[J],解放军预防医学杂志,2006,24(1):49-50.
[12]铁永波,唐川.城市灾害应急能力评价指标体系建构[J].城市问题,2005,6:76-79.
[13]马光辉.突发公共卫生事件的特性及处置[J].灾害学,2008,23(增刊):36-39.
[14]蔡筱英,麦慧祯.突发公共卫生事件的分类分级管理探讨[J],中国公共卫生,2006,22(7):895-896.
[15]申井强,徐勇.现代城市突发公共卫生事件应对能力的评价指标体系构建[J].中国卫生事业管理,2007,4:270-272.
[16]孙振球,徐勇勇.医学统计学-供研究生用[M].北京:人民卫生出版社,2004:373.
[17]吴俊卿,郑慕琦,张志兴.绩效评价的原理与方法-在科研机构的实践[M].北京:科学技术文献出版社,1992.
[18]王孝玲.教育评价的理论与技术[M].上海:上海教育出版社,1999:62-64.
[19]姜凤华.现代教育评价[M].广东:广东人民出版社,2003:20-22.
[20]李晓霞,刘永泰.科技指标体系完备性与可行性的对策研究[J].科技情报开发与经济:2007,17(18):176-178.
[21]张文生,张之伦,周萍.区县疾控机构应急能力评价指标体系的构建[J].中国公共卫生管理,2008,(24)4:356-357.
[22]赵丽云,符大伟,贾凤梅,等.中国食物营养规划与管理-人力资源培训项目的结果与作用[J].中国健康教育,2005,21(11):873-875.
[23]薄涛,李士雪.突发公共卫生事件应急能力评价研究现状与展望[J].预防医学论坛,2007,13(7):628-632.
[24]Robert L.Armacost,Julia J.A.Pet-Armacost Risk-based management of waterway safty[J].Intemational Journal of Emergency management,2002,1(2):96-109.
[25]张文昌.突发公共卫生事件应急体系建设与管理面临的主要问题[J].海峡预防医学杂志,2006,12(2):1-3.
[26]阎岩,华琳,张建,等.影响医务工作者应对突发公共卫生事件能力的路径分析[J].预防医学情报杂志,2006,22(4):466-467.
[27]Federal Emergency Management Agency(FEMA) and National Emergency Management Association(NEMA).State Capability Assessment for Readiness (CAR)[OL].www.fema.gov/library/file?type=publishedFile&file=365toc.pdf&fileid=cb583270-46ed-11db-a421-000bdba87d5b.March 18,2009.
[28]CDC.Pubic health performance assessment-emergency preparedness[OL].http://www.in.gov/isdh/files/Public_Health_Emergencies_Reference_Manual.pdf.March 18,2009.
[29]Council of State and Territorial Epidemiologists.National assessment of epidemiologic capacity:finding and recommendations[OL].http://www.cste.org/pdffiles/ecacover.pdf.March 18,2009.
[30]Healthcare Association of Hawaii.Hospital capability assessment for rediness[OL].http://www.ncha.org/public/docs/bioterrorism/Capability.pdf.Ma rch 18,2009.
[31]Columbia University School of Nursing center for Health Policy.Bioterrorism & emergency readiness:competencies for all public health workers[OL]http://www.cumc.columbia.edu/dept/nursing/chphsr/pdf/btcomps.pdf.March 18,2009.
[32]胡国清,饶克勤,孙振球.突发公共卫生事件应对能力评价工具研究[J],中华医学杂志,2006,86(43):3031-3034.
[33]Linstone,H.A and Turoff,M.The Delphi Method Techniques and Applications[M].Network:Addison-wesley,2001:3.
[34]郭亚军.综合评价理论与方法[M].北京:科学出版社,2002:12.
[35]平卫伟.Delphi法的研究进展及其在医学中的应用[J].疾病控制杂 志,2003,7(3):243-246.
[36]李建国,贲智强,阙文进,等.县级公共卫生应急反应能力评价方法的研究[J].数理医药学杂志,2006,19(1):93-96.
[37]袁树华,师鉴,高伟,等.应用德尔菲法选择疾病预防控制机构公共卫生应急反应能力评价指标[J].环境与健康杂志,2007,24(9):732-733.
[38]陈平雁,黄浙明.SPSS13.0统计软件应用教程-“研究生教学用书”配套教材[M].北京:人民卫生出版社,2006:269.
[39]刘自远,刘成福.综合评价中指标权重系数确定方法探讨[J].中国卫生质量管理,2006,13(2):44-47.
[40]刘桂芬,刘玉秀.医学统计学[M].北京:中国协和医科大学出版社,2007:67-72.
[2]张艳春,吴群红,郝艳华,等.黑龙江省医疗救治系统医院救治能力现状分析[J].中国公共卫生,2007,23(3):345-346.
[3]中华人民共和国国家发展与改革革委员会.国务院关于转发发展改革委卫生部突发公共卫生事件医疗救治体系建设规划的通知[OL].http://www.sdpc.gov.cn/shfz/t20070418_130228.htm.2009-3-18.
[4]姜晓梅,姜文海,于精红.医院在突发公共卫生事件中的地位与对策[J],中国医院管理,2005,25(9):36.
[5]罗乐宣,冯占春,张剑.医疗机构在突发公共卫生事件应急反应体系中的地位[J].中国医院管理,2004,24(3):3-5.
[6]何维林.医院在突发公共卫生事件中的作用[J].中国医院管理,2004,24(3):9-10.
[7]中华人民共和国中央人民政府.卫生部公布2007年全国突发公共卫生事件信息情况[OL]http://www.gov.cn/gzdt/2008-01/15/content_858516.htm.2009-3-19.
[8]健康报网.不寻常的2008年不平凡的卫生事业[OL].http://www.jkb.com.cn/document/69393.htm?docid=69393&cat=0D&sKsyWor d=null.2009-3-18.
[9]国务院.突发公共卫生事件应急条例[S].中华人民共和国国务院令第376号,2003.5.
[10]刘文彪,匡维华.国境口岸突发公共卫生事件的应对与危机管理[J].口岸卫生控制,2005,10(3):43-44.
[11]丁启龙,夏晨.突发公共卫生事件卫勤保障特点与亏对策探讨[J],解放军预防医学杂志,2006,24(1):49-50.
[12]铁永波,唐川.城市灾害应急能力评价指标体系建构[J].城市问题,2005,6:76-79.
[13]马光辉.突发公共卫生事件的特性及处置[J].灾害学,2008,23(增刊):36-39.
[14]蔡筱英,麦慧祯.突发公共卫生事件的分类分级管理探讨[J],中国公共卫生,2006,22(7):895-896.
[15]申井强,徐勇.现代城市突发公共卫生事件应对能力的评价指标体系构建[J].中国卫生事业管理,2007,4:270-272.
[16]孙振球,徐勇勇.医学统计学-供研究生用[M].北京:人民卫生出版社,2004:373.
[17]吴俊卿,郑慕琦,张志兴.绩效评价的原理与方法-在科研机构的实践[M].北京:科学技术文献出版社,1992.
[18]王孝玲.教育评价的理论与技术[M].上海:上海教育出版社,1999:62-64.
[19]姜凤华.现代教育评价[M].广东:广东人民出版社,2003:20-22.
[20]李晓霞,刘永泰.科技指标体系完备性与可行性的对策研究[J].科技情报开发与经济:2007,17(18):176-178.
[21]张文生,张之伦,周萍.区县疾控机构应急能力评价指标体系的构建[J].中国公共卫生管理,2008,(24)4:356-357.
[22]赵丽云,符大伟,贾凤梅,等.中国食物营养规划与管理-人力资源培训项目的结果与作用[J].中国健康教育,2005,21(11):873-875.
[23]薄涛,李士雪.突发公共卫生事件应急能力评价研究现状与展望[J].预防医学论坛,2007,13(7):628-632.
[24]Robert L.Armacost,Julia J.A.Pet-Armacost Risk-based management of waterway safty[J].Intemational Journal of Emergency management,2002,1(2):96-109.
[25]张文昌.突发公共卫生事件应急体系建设与管理面临的主要问题[J].海峡预防医学杂志,2006,12(2):1-3.
[26]阎岩,华琳,张建,等.影响医务工作者应对突发公共卫生事件能力的路径分析[J].预防医学情报杂志,2006,22(4):466-467.
[27]Federal Emergency Management Agency(FEMA) and National Emergency Management Association(NEMA).State Capability Assessment for Readiness (CAR)[OL].www.fema.gov/library/file?type=publishedFile&file=365toc.pdf&fileid=cb583270-46ed-11db-a421-000bdba87d5b.March 18,2009.
[28]CDC.Pubic health performance assessment-emergency preparedness[OL].http://www.in.gov/isdh/files/Public_Health_Emergencies_Reference_Manual.pdf.March 18,2009.
[29]Council of State and Territorial Epidemiologists.National assessment of epidemiologic capacity:finding and recommendations[OL].http://www.cste.org/pdffiles/ecacover.pdf.March 18,2009.
[30]Healthcare Association of Hawaii.Hospital capability assessment for rediness[OL].http://www.ncha.org/public/docs/bioterrorism/Capability.pdf.Ma rch 18,2009.
[31]Columbia University School of Nursing center for Health Policy.Bioterrorism & emergency readiness:competencies for all public health workers[OL]http://www.cumc.columbia.edu/dept/nursing/chphsr/pdf/btcomps.pdf.March 18,2009.
[32]胡国清,饶克勤,孙振球.突发公共卫生事件应对能力评价工具研究[J],中华医学杂志,2006,86(43):3031-3034.
[33]Linstone,H.A and Turoff,M.The Delphi Method Techniques and Applications[M].Network:Addison-wesley,2001:3.
[34]郭亚军.综合评价理论与方法[M].北京:科学出版社,2002:12.
[35]平卫伟.Delphi法的研究进展及其在医学中的应用[J].疾病控制杂 志,2003,7(3):243-246.
[36]李建国,贲智强,阙文进,等.县级公共卫生应急反应能力评价方法的研究[J].数理医药学杂志,2006,19(1):93-96.
[37]袁树华,师鉴,高伟,等.应用德尔菲法选择疾病预防控制机构公共卫生应急反应能力评价指标[J].环境与健康杂志,2007,24(9):732-733.
[38]陈平雁,黄浙明.SPSS13.0统计软件应用教程-“研究生教学用书”配套教材[M].北京:人民卫生出版社,2006:269.
[39]刘自远,刘成福.综合评价中指标权重系数确定方法探讨[J].中国卫生质量管理,2006,13(2):44-47.
[40]刘桂芬,刘玉秀.医学统计学[M].北京:中国协和医科大学出版社,2007:67-72.