【作者】 段学葵；

【导师】 罗志勇； 张开宁； 贾贤杰； 邓睿；

【作者基本信息】 昆明医科大学 ， 社会医学与卫生事业管理， 2012， 硕士

【摘要】 研究目的本研究旨在评价基层农村宫内节育器(Intrauterine device, IUD)放置服务质量,初步构建一套适合我国基层农村IUD服务发展现状,具有一定科学性和可行性的评价指标体系,以提高基层农村IUD放置服务规范化、科学化程度,为基层农村IUD放置技术服务质量评价实践提供一些方法学基础和建议,同时探讨系统聚类分析在Delphi专家筛选中的运用。研究方法本研究采用选题小组法,收集并分析影响基层农村IUD放置服务质量的关键因素,并在此基础上结合文献研究、专家论证初步提出基层农村IUD放置服务质量评价指标。利用德尔菲专家咨询法(Delphi method),在全国范围内咨询IUD放置服务及管理的相关专家,对选题小组法初步提出的指标进行重要性、可测量性、可行性评价,进而对指标进行筛选和确定权重,从而初步构建基层农村IUD放置服务质量评价指标体系。在本轮Delphi法专家咨询的基础上,运用系统聚类方法对专家可靠度进行分类及筛选,通过筛选前后协调系数的比较对分类筛选结果加以验证。研究内容本研究主要以基层农村IUD放置服务质量为评价对象,用定性和定量方法筛选指标,建立综合评价指标体系。主要内容包括：(1)在国内外相关理论、文献研究及课题前期关于云南省县／乡两级IUD放置服务现状和全面质量管理研究的基础上,就IUD放置服务质量评价指标的初步构建召开选题小组讨论会,针对“有哪些因素或方面可能影响基层农村IUD放置服务的质量?”这一主题,请参会人员根据自己的知识和经验,在小纸片上写出影响基层农村IUD放置服务质量或水平的关键因素,并对其重要性进行排序。然后课题组成员对参会人员提出的关键因素进行系统整理和分析,进而初步提出基层农村IUD放置服务质量评价指标。(2)通过专家论证和Delphi专家咨询法进一步筛选指标并计算指标的权重。通过网络检索、专家推荐等方式,课题组确定拟咨询的专家,同时根据指标重要性的一致性分析结果和文献回顾,开发出第1轮德尔菲法咨询的调查表,包括三个部分,即专家评分表、专家信息表和开放式问卷。之后发放、回收、整理和录入、分析专家咨询调查表。最后结合Delphi问卷分析结果和专家讨论对指标进行进一步精选和确定权重。(3)在本轮Delphi法专家咨询的基础上,运用系统聚类方法对专家可靠度进行分类及筛选,通过筛选前后协调系数的比较对分类筛选结果加以验证。研究结果(1)通过选题小组法初步提出基层农村IUD放置服务质量评价指标,评价指标分三级：一级指标3个,二级指标11个,三级指标59个(2)第1轮Delphi专家咨询的积极系数为86.3%,专家权威系数>65%。通过上述一系列的研究活动,结合专家评议与课题组讨论初步构建了以IUD放置质量、基础管理工作质量和医疗过程工作质量三大类指标为主要结构的具有层次性的指标体系,包括一级指标3个、二级指标11个、三级指标39个。其中IUD放置质量指标包括放置前、放置中、放置后等3个二级指标；基础管理工作质量指标包括机构、人员、技术培训、规章制度、设备和物资保障等6个二级指标；医疗过程工作质量指标包括诊疗服务的能力以及咨询技术的能力等2个二级指标；三级指标在此不一一赘述。(3)运用系统聚类方法将63名咨询专家筛选出17人。筛选后45.46%指标协调系数升高,差异有统计学意义(Z=-4.70,p<0.01)。研究结论基于上述研究结果,本研究得出了以下几点结论(1)建立的指标体系层次分明,覆盖全面,有效、可信、可操作(2)指标的筛选方法合理(3)确定指标权重系数的方法科学、结果相对准确(4)在德尔菲法中,运用系统聚类分析筛选专家、提高协调系数、经过较少的Delphi法专家咨询次数、获得较可靠的专家意见是可行的。(5)定性与定量的有机结合是构建指标体系的有效方法(6)该评价指标体系还需在今后的研究中进一步修订、考核、验证和完善。更多还原

【Abstract】 ObjectiveThis study aimed to evaluate the grassroots rural IUD (Intrauterine device, IUD) insertion on the quality of service, and preliminarily to develop a suitable service development status of China’s grassroots rural IUD, with certain scientific and practical evaluation index system, to improve grass-roots level on IUD insertion services standardization and the degree of scientific in rural areas.Provide some of the methodological basis and recommendations for grassroots rural IUD insertion technical service quality evaluation practice, at the same time, explore the hierarchical cluster analysis in Delphi expert screening.MethodsThis study used the nominal group method to collect and analyze the key factors of grassroots rural IUD insertion service quality literature study, and on this basis, the expert panel discussion put forward to the grass-roots rural IUD insertion services quality evaluation index. Using Delphi experts consultation method (Delphi method) in the nationwide consultation service and management of IUD placed relevant experts, the author puts forward the method of subject group index importance, measurable, feasibility evaluation, and then to screening and determine the index weight, thus sets up an assessment indicator system for assessing the quality of IUD Insertion services provided in rural areas in ChinaContentsIn this study, grass-roots rural IUD insertion the quality of service for the evaluation of object, using qualitative and quantitative methods selection index, to set up a comprehensive evaluation index system. The main contents include:(1) On IUD insertion evaluation of the quality of service initially built to convene topics panel discussions on the basis of the domestic and foreign relevant theory and the literature research about the yunnan province county/township levels IUD placed service status and total quality management research, a nominal group discussion was held in order to IUD insertion the initial construction of the service quality evaluation for the "What are the factors or aspects that may affect the quality of the grass-roots rural IUD insertion services?" this theme. The participants write out the impact of grassroots rural IUD insertion quality of service or level of key factors, and their order of importance on small pieces of paper according to their own knowledge and experience. Then task group member of participants to the key factors proposed system collection and analysis, and then the author puts forward the basic IUD insertion the service quality evaluation index.(2) Screen index through the experts argumentation and Delphi experts consultation method and calculation of further screening index weight indicators. Determined by network retrieval, experts recommend other ways, the research group of experts to be consulted, at the same time according to the indicators of the importance of the consistency of analysis and literature review, developed a questionnaire of the Delphi consultation consists of three parts, namely, expert score sheet, the experts information table, and open-ended questionnaire. Then we distribute, recycle, sort, entry and analyze the expert consultation questionnaire. Finally, the further selection of indicators and to determine the weight Delphi questionnaire analysis and experts to discuss.(3) In the current round of Delphi method expert consultation, and on the basis of using the system clustering method to experts reliability of the classification and screening, through the coordination coefficient before and after screening Sort results be verified.Results(1) A series o f essential indicators, including three levels(3indicators at the primary level,11indicators at the second level and59indicators at the third level), were developed through the initial nominal group method.(2) In the first round of the Delphi expert consultation positive coefficient was86.3%, the experts coefficient>65%. Through the above a series of research activity, combining the expert evaluation and discussion group initially built to IUD placed quality, basic management quality and medical process quality index of three kinds of main structure are of different levels of index system, including one class index3, level2index11, level3index39. IUD insertion quality index of before, including insertion in place, placed three secondary indexes after; Basic management quality indexes including organization, personnel, technical training, and rules and regulations, equipment and material support such six level2index; Medical process quality indicators include work the ability of medical services and consulting technical capacity and two level2index; Level3index here for not a tautology.(3) Use of system clustering method63consultant filter17. Index coordinate coefficient of45.46%increased after screening, the difference was statistically significant (Z=-4.70,<0.01). ConclusionsBased on the above findings, this study obtained the following conclusions (1) to establish the index system structured, covering a comprehensive, effective, credible and actionable (2) reasonable indicators of the screening method (3) to determine the index weight coefficient the scientific method, the results are relatively accurate (4) screening experts in the Delphi method, the use of hierarchical cluster analysis to improve the coordination coefficient, after the number of less Delphi method expert consultation, to obtain more reliable expert advice is feasible.(5) The organic combination of qualitative and quantitative effective way to build the index system (6) The evaluation system needs to be further amendments in the future research, assessment, verification and improvement.更多还原