| BackgroundDisease control and prevention is a kind of core work that will improve and promote people's health and welfare. Many facts have proved that disease control and prevention is the most active and initiative medical service with low investment and high profits, and that it is the best project for social investment. Since the founding of new China, the work of disease control and prevention has made great contributions to people' s health protection, social stability promotion, and economic development in our country. It has created great social and economic benefits. However, it has long been a problem that we lack a set of objective and quantized indexes to synthetically appraise social and economic benefits brought by the work of disease control and prevention, so the true benefits cannot be fully reflected, and the longitudinal self-comparison and transverse comparison among institutions also cannot be carried out, which has interfered with the improvement of disease control and prevention level. With the development in the aspect of disease control and prevention in the recent years, that how to appraise in a scientific way has drawn people's attention gradually. However, the precondition and core problemof appraise is to set up an effective and scientific appraisal index system. This study is to do some investigation on this aspect.ObjectivesTo establish a set of scientific and applied index system of integrated benefits appraisal in disease control and prevention institutions ' resources utilization, which should emphasize particularly on social benefits and adapt social development, and to provide quant if icational evidences for the longitudinal self-comparison and transverse comparison among institutions and promote the development of disease control and prevention.MethodsThe method of literature search was applied and National Criteria on Disease Control and Prevention (2002 edition) was used as reference, and finally with consulting experts' opinions, 43 input, utilization, and effect primary indexes that could be quantized on the lowest level were confirmed;expert consultation method, variation coefficient method, and cluster analysis method were applied to select appraisal indexes that should reflect the integrated benefits about resources utilization among disease control and prevention institutions;with the selected indexes and TOPSIS method, we did an simulant appraisal to 13 Centers for Disease Control and Prevention (CDCs) of the districts and counties in Hangzhou, and the results were compared to the real appraisal results done by Hangzhou CDC in 2004 to demonstrate their coherence.ResultsAfter two times' applying to experts by letters, 31 and 21 useablequestionnaires were reclaimed respectively, and the questionnaires' effective ratios of return were 77.5% and 67. 7% respectively. The number of experts and the rations of return accorded with designing requirements. In the first applying to experts, the authority coefficients of the three indexes (input, utilization, and effect) were 0.816, 0.792, and 0.721 respectively, and the corresponding coefficient of experts' opinion was 0.23 ( x2R =163.26, K0.01). In the second applying, the authority coefficients of the three indexes were 0.808, 0.774, and 0.717 respectively, and the corresponding coefficient of experts' opinion was 0.41 (xj;=195. 95, K0.01). In the two times' consultation, the mean values of experts' authority degree were 0.776 and 0.766, which suggested that experts' authority was quite good, and thus the indexes' reliability was guaranteed.Among the three primary input, utilization, and effect indexes' values of integrated benefits appraisal in disease control and prevention institutions' resources utilization, the variation coefficients' ranges were [0.04, 1.00], [0.14, 1.95], and [0.02, 2.33] respectively. The indexes' values had a certain discrete trend and some distinguishing ability.The seven input indexes were converged to one category after six times' incorporation, the 24 utilization indexes were converged to one category after 22 times' incorporation, and the 12 output indexes were converged to one category after 10 times' incorporation. Totally 31 indexes were selected by cluster analysis.After comprehensively considering the selecting with expert consultation method, variation coefficient method, and cluster analysismethod, and combining the practical work, totally 17 representative indexes were selected from 43 primary indexes, among which there were four input indexes (the number of personnel in disease control and prevention institutions per 10,000 persons, the constituent ratio of senior title of professional post in disease control and prevention institutions, the operation expenses for disease control and prevention per person, and the number of instruments valued more than 100,000 Yuan), 8 utilization indexes (cases with infectious disease failed to report per person, new registered tuberculosis cases per person, times for endemic and verminosis examining per person, surveillance samples of disinfection quality per person, times of inspecting to poisonous and deleterious spots per person, times of inspecting to centralized second water supply facilities per person, numbers of testing programs carried out per person, and numbers of scientific programs carried out per person), and 5 effect indexes (incidences of reported infectious diseases required by law, five vaccines' rates of vaccination in the whole course, qualification rate of disinfection surveillance, qualification rate of centralized second water supply, and qualification rate of occupational diseases' risk factors monitoring). And among these 17 indexes, new registered tuberculosis cases per person and incidences of reported infectious diseases required by law were regarded as negative indexes, and the other 15 were positive. At the same time, input index, utilization index, and effect index were regarded as three big categories, and these three categories and those 17 basic indexes were grouped into two levels, and thus a set of appraisal index system with 3 categories and 2 levels wereestablished.During 1999 to 2004, CDC7, CDC8, CDC4, CDC4, CDC2, and CDC2 had the highest comparative approaching value & (between the index value and the optimum value) among the whole 13 CDCs. And in the 6 years, CDC8 ranked before the third in three years, CDC7 ranked before the third in five years, and CDC2 ranked before the third in six consecutive years, while CDC6 ranked the last in six consecutive years.Spearman's rank-related method was applied to prove the coherence of the following two appraisal results: one was the real appraisal results of the 13 CDCs which were got in 2004 by Hangzhou CDC, and the other was the standardized simulant appraisal results after this study's investigation and statistical analysis. Finally we got rs=0. 825 P <0. 05, which suggested the existing of a positive correlation between them.ConclusionsThe complete set of appraisal indexes established in this study is representative, and the 17 selected indexes basically represent the information of the whole 43 primary indexes;they can comprehensively appraise disease control and prevention institutions in a comparative way, and are easy to operate, which suggests that this study' s index system has a preferable and practical application value. . |
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