【作者】 夏志远；

【导师】 陈洁；

【作者基本信息】 复旦大学 ， 社会医学与卫生事业管理， 2011， 博士

【摘要】 背景及研究意义在经济全球化、社会信息化的进程中,医疗卫生领域信息化也在迅速发展,国内外在医院信息化方面都取得了快速进展,目前已开始区域卫生信息化的探索。随着我国社区卫生服务工作的迅速发展,社区卫生服务中心信息化的重要性也不断提高,但其目前还处于初级阶段,尚存在诸多问题。对构成社区卫生服务中心信息化体系的各个方面和环节进行综合评价,一方面可帮助社区卫生服务中心进行自我诊断和评价,了解现有信息化工作的长处、弱点、存在的问题以及改进对策,发挥借鉴、参考和对照的导向作用,另一方面可帮助各级卫生行政主管部门了解社区卫生服务中心信息化工作状况,从而有利于作出决策,更好推进社区卫生服务中心信息化发展的进程。研究目的本研究旨在构建一套符合上海市社区卫生服务中心信息化工作实际情况的信息化水平综合评价指标体系；并在此指标体系的基础上,制定相应的评价方法,对上海市浦东新区各家社区卫生服务中心的信息化水平进行现状调查和综合评价,一方面了解现状,找出问题,为浦东新区卫生行政主管部门和相关机构提供政策建议,另一方面检验评价指标体系的科学性与可操作性,以便进一步完善此评价指标体系。研究方法本研究通过文献回顾、专家组专题小组讨论等方法建立社区卫生服务中心信息化水平综合评价的指标体系初步框架；再通过德尔菲法专家咨询对指标体系进行筛选优化,并通过AHP层次分析法确定各指标的权重；根据研究确定的评价指标体系,对浦东新区29家社区卫生服务中心进行信息化水平现状调查,应用加权综合评分法进行综合评价,并对加权综合评分法、Topsis法与秩和比法所得综合评价排序进行组合评价,为社区卫生服务中心信息化工作提出政策建议。主要研究结果一、研究构建了社区卫生服务中心信息化水平综合评价指标体系。1、该指标体系包括一级指标6项,二级指标18项,三级指标59项,其中一级指标为信息化保障体系、信息化基础设施、信息化建设与应用、信息的整合共享与标准化、信息化安全、信息化效益,其权重分别为18.00%、18.00%、33.60%、10.20%、12.20%、8.00%。2、指标体系在信度与效度方面：内部一致性信度较好,各维度的克朗巴赫α系数分别达到“较好(0.6-0.8)”或“极好(0.8以上)”的认定标准；通过专家咨询保证了良好的内容效度；6个评价维度之间的Spearman等级相关系数在0.171-0.585之间,6个维度与总分之间的相关系数在0.506-0.898之间,各维度与总分之间的相关系数均大于各维度之间的相关系数,显示具有良好的结构效度；在实证研究中发现不同地域社区卫生服务中心信息化水平不同,显示具有良好的区分效度。二、对浦东新区各社区卫生服务中心信息化水平进行了现状调查与综合评价1、各单位信息化水平的不同评价维度之间存在很大差异。信息化保障体系与信息化基础设施两个方面情况较好,这两个维度的综合评价标化得分均数优于其他维度；而信息化建设与应用及信息的整合共享与标准化两个方面情况不理想,是社区卫生服务中心信息化工作中的薄弱环节。2、各单位之间的信息化水平参差不齐。各单位的信息化加权综合评分法综合评价得分从最高分的71.55分到最低分的35.87分,差距较大,有62.07%的单位得分位于40—60分之间。3、不同地域单位的信息化水平存在差异。就平均水平而言,城市化地区信息化水平最高,农村地区的社区卫生服务中心信息化水平最低。不同信息化水平类别的单位在六个维度的标化得分上都存在差异,“好类”单位六个维度标化得分均数全部最高,“差类”单位六个维度标化得分均数全部最低4、通过对二级指标的进一步比较,发现从平均水平来看,组织保障、制度保障、资金保障、信息化安全制度、提高工作效率等方面的标化得分均数较高,而电子健康档案建设应用水平、综合管理信息化水平、社区卫生服务信息化特色应用水平、信息的整合与共享、信息化安全措施、优化工作流程等方面的标化得分均数较低。5、应用Topsis法、秩和比法对各单位的信息化水平进行综合评价排序,并应用平均值法、Borda法、Copeland法、模糊Borda法对评价结果进行了组合评价,结果发现用不同方法得出的评价结果基本接近。主要结论1、本研究制定的社区卫生服务中心信息化水平综合评价指标体系在信度和效度上达到了测量学的基本要求,是可靠、有效、灵敏的。能够较全面地反映社区卫生服务中心的信息化水平,具有推广价值。2、评价结果显示,浦东新区各社区卫生服务中心信息化水平的不同评价维度之间存在很大差异,需要改善信息化建设与应用及信息的整合共享与标准化这两个薄弱环节,尤其需要提高电子健康档案建设应用水平、综合管理信息化水平与社区卫生服务信息化特色应用水平、信息的整合与共享水平。政策建议1、统一规划、统一标准、建立规范、分级管理；2、以加强信息化建设与应用、提高信息的整合共享与标准化水平为今后工作重点；3、继续完善信息化保障体系、信息化基础设施、提高信息化安全水平、提高信息化效益水平,以及加大扶持农村地区社区卫生服务中心信息化工作的力度。本研究的创新之处1、在国内首次构建了社区卫生服务中心信息化水平综合评价指标体系；2、在国内首次对社区卫生服务中心的信息化水平进行了综合评价。更多还原

【Abstract】 BackgroundAs the continuous development of social informatization and economic globalization, information technology is now being widely used in healthcare field. Many countries in the world including China have made significant progress in hospital informatization, and now many of them have commenced regional health information sharing. With the rapid development of community health services in China, the importance to improve the informatization level of community health service center (CHSC) is raising fast. But it is still on the initial stage for the CHSC to employ the information technology, we need overcome many obstacles.Making comprehensive evaluation of the diverse dimensions of the informatization system of CHSC, on one hand it can help the CHSCs to diagnose and evaluate by themselves and understand the current status of their informatization work including strength, weakness, problems and treatment, in the other hand it can help the government to find out the current situation of informatization in CHSCs and advance the policy making to promote the informatization process of them.ObjectivesThis study was aimed to develop an indicator system for evaluating the informatization level of CHSCs in Shanghai. Based on this indicator system we developed relative evaluation methods to make current status survey and comprehensive evaluation for the CHSCs in Pudong new district, Shanghai. On one hand this survey and comprehensive evaluation would provide the information of current status of informatization in CHSCs and policy commendations to the government, on the other hand it would test the validity, reliability and operability of the indicator system for the further improvement.MethodsIn this study, literature review and focus group discussion method were used to establish the initial indicator system, Delphi method was used to filter the indicators and improve the structure of the indicator system, and Analytic Hierarchy Process (AHP) method was used to calculate the weight of the indicators. According to this indicator system, we surveyed the current status of the 29 CHSC of Pudong new district by questionnaire. Based on the survey data we made the comprehensive evaluation by weighted linear complicated method. We also made the comprehensive evaluation by Topsis method and Rank Sum Ratio (RSR) method for ranking. We combined the different comprehensive evaluation results by synthetical evaluation methods in the last.Main findings1. Developed an indicator system for evaluating the informatization level of CHSC.·The indicator system included 6 dimensions,18 topics and 59 indicators. Six dimensions were IT support system, IT infrastructures, Information system development and application, Information sharing and standardization, IT security, IT benefit, the weight of them were 18.00%,18.00%,33.60%, 10.20%,12.20%,8.00%.·Reliability and Validity of the indicator system:Internal consistency was good, Cronbach’s a coefficients of all dimensions are more than 0.60, some of them were even more than 0.80; Content validity was good, because this study was based on experts suggestions; Construct validity was good, Spearman correlation coefficient between the dimension and total score(0.506～0.898) were higher than which between dimensions(0.171～0.585); Discriminant validity was good, the indicator system could be used to relatively accurately distinguish different types of community health service centers. 2. Current status survey and comprehensive evaluation of informatization level of CHSC in Pudong new district.·There were large variances between different dimensions. IT support system and IT infrastructures were better than other dimensions, and Information system development and application, Information sharing and standardization were the weakest two dimensions.·The informatization level varied between CHSCs. The score of weighted linear complicated method ranged from 71.55 to 35.87,62.07% of these CHSCs were scored between 40 and 60.·There were variances between CHSCs from different area type groups. By the mean level, the urban group was the best and the rural group was lowest. When the centers were divided to three groups by K-means cluster analysis, there were groups including good, moderate and weak. Also there were variances between CHSCs from these different level groups. The mean standardized score of six dimensions of good level group were the best, and which of the weak level group were the lowest.·When compared the diverse topics, it showed that the mean standardized score of organization support, planning support, financial support, information security regulation, work efficiency improvement were higher, and that of development and application level of electronic health record (HER), informatization level of comprehensive administration, informatization level of special applications in CHSC, integration and sharing of data, information security arrangement, improvement of work flow were lower.·We made the comprehensive evaluation by weighted linear complicated method, Topsis method and Rank Sum Ratio(RSR) method for ranking. We combined the comprehensive evaluation results by synthetical evaluation methods mean rank method, Borda method, Copeland method and fuzzy Borda method, and we found that the results of different evaluation methods had high consistency. Main conclusions1. The indicator system is reliable, valid and sensitive, and it can be used to evaluate the informatization level of CHSC at larger scope.2. The evaluation results show that there are large variances between different evaluation dimensions, Information system development and application, Information sharing and standardization are the weakest two dimensions, especially we should improve the development and application level of EHR, informatization level of comprehensive administration, informatization level of special applications in CHSC, integration and sharing of data..Policy recommendations1. To promote the informatization level of CHSCs in Pudong new district, the government should develop an integrated planning, unified the information standardization in CHSC, set up guidelines and classification management.2. In the future the informatization work should focus on promoting Information system development and application, Information sharing and standardization of CHSC.3. In the future we also should continually promote IT support system, IT infrastructures, IT security, IT benefit of CHSC and strengthen the informatization work of CHSCs in rural area.Contributions of this study1. This is the first study to develop an indicator system for evaluating the informatization level of CHSC in China.2. This is the first study to carry out a comprehensive evaluation of the informatization level of CHSC in China.更多还原