【作者】 王重建；

【导师】 聂绍发；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2008， 博士

【摘要】 研究目的1.阐明疾病预防控制机构应急能力现状及存在的问题,为我国疾病预防控制机构应急体系建设提供客观依据。2.完善提高疾病预防控制机构应急能力的应对策略和措施,为我国疾病预防控制事业的可持续发展提供政策建议。3.制定培训方案,评价培训效果,探索出一套科学可行的培训模式,为我国应急培训的顺利实施提供理论和技术支持。研究方法1.采用文献回顾法对国内外关于突发公共卫生事件的研究现状及存在的问题进行回顾性调查分析。2.采用定性和定量相结合的“双轨”研究方法,对湖北省疾病预防控制中心、13个市/州和84个县/区,共98个疾病预防控制机构应急建设情况进行普查;采用分层随机抽样的方法,对湖北省疾病预防控制中心、3个市/州和6个县/区,共10个疾病预防控制中心应急人员的应急能力进行半结构式访谈和问卷调查,并对相关因素进行多因素Logistic回归分析。3.采用实证研究的方法,对来自湖北省各级疾病预防控制机构的315名学员开展三期“提高应急能力”的应急培训;对来自湖北省17个市/州卫生局及河南、安徽、湖南、江西等省卫生厅应急办的负责人共21名卫生行政人员开展“提高卫生行政领导应急能力”的应急培训,通过半结构式访谈和问卷调查评价培训效果。研究结果1.湖北省三级疾病预防控制机构现有工作人员8371人,其中应急人员2729人,占32.60%;年龄构成呈纺锤型分布,以35～44岁龄组为主,占34.33%;学历以大中专为主,占80.57%;职称以中级为主,占44.86%;预防医学专业的人员比例不足1/5(19.44%);不同单位之间人员素质得分不均衡,省级人员平均素质得分是市/州级的1.12倍,县/区级的1.39倍;同时,最近三年流入人员的素质得分低于流出人员的素质得分。2.对突发公共卫生事件应急能力的调查结果显示,虽然100%的单位制定了突发公共卫生事件的监测方案,但由于缺乏有效的宣传学习手段,应急人员对预案的掌握理解程度较低;虽然所有的单位均能开展传染病疫情的分析,但分析手段和能力不能满足预测预警工作的需要;对实验室的调查结果显示,实验室的仪器设备严重缺乏,管理工作落后,检验检测能力不能满足突发公共卫生事件应急处理工作的需要;对应急物质储备的调查结果显示,各级政府高度重视突发公共卫生事件工作,但是应急资金和应急物质的储备等后勤保障方面还明显滞后于实际工作的需要,如仅80.61%的单位指定了专门机构负责突发公共卫生事件应急物资的储备、管理和调配;绝大多数疾病预防控制机构认为当前的应急处理工作的费用完全不能满足实际工作的需要(74.49%)或者是勉强能够满足实际工作的需要(24.49%)。3.对培训和继续教育情况的调查结果显示,仅25.51%的单位开展了应急人员的培训需求调查,仅52.04%的单位制定了应急人员的培训规划,仅60.20%的单位制定了应急培训效果的评价办法等。同时,绝大多数调查对象认为通过培训和应急演练是迅速提高各级CDC应急能力较为可行的途径。4.疾病预防控制机构专业人员的应急能力虽然较SARS暴发前有了一定程度的提高,但应对突发公共卫生事件的能力不能满足实际工作的需要,尤其是对疾病监测数据的利用、分析能力明显不足。多因素Logistic回归分析显示,影响疾病预防控制人员应急能力的因素主要有:工作单位(OR=3.61)、文化程度(OR=2.69)、所学专业(OR=2.90)、从事业务(OR=2.07)、培训时间(OR=2.16)及培训层次(OR=4.12)等。5.实证研究的结果显示,应急培训更新了学员的应急知识,增强了应对突发公共卫生事件的信心,提高了应急处置能力。统计分析显示,培训后的应急知识和自评价得分与培训前相比均有统计学意义(P<0.05)。随访结果显示,12个月后的应急知识和自评价得分与培训后相比出现轻微的下降,但是差异均无统计学意义(P>0.05),而与培训前的应急知识和自评价得分相比,差异均有统计学意义(P<0.05)。同时,超过80%的学员对培训效果和培训资源感到满意。研究结论1.政府对疾病预防控制机构应急工作投入不足,经费得不到保障。2.疾病预防控制机构专业人员的应急能力不能满足实际工作需求,人员配置难以适应当前工作需要;同时,现阶段人员的流动对于CDC而言意味着人才流失。3.监测体系不健全,监测数据利用能力低下,不能满足预测预警的需要。4.疾病预防控制机构仪器设备缺乏,检验检测能力较差,影响了工作的正常开展。5.后勤保障能力较弱,应急资金和应急物质的储备和管理滞后于实际工作需要。6.通过应急培训能显著提高疾病预防控制机构分析决策及应急处置能力,本研究开发的培训方案和培训模式是科学可行的。政策建议1.落实政府及相关部门的疾病预防控制职责,建立健全各项保障机制。2.优化人事制度改革,完善人员配置,提高疾病预防控制机构人员的综合素质。3.完善疫情监测体系,健全应急预案,增强预测预警能力。4.更新实验仪器设备,优化人力资源配置,提高检验检测能力。5.加强应急物质储备,完善应急物质管理制度,提高应急保障能力。6.完善应急培训机制,加大培训力度,提高CDC专业人员的综合素质。创新和应用本研究不但开展了相关的现况研究,而且针对提出的策略和建议进行了实证研究,根据研究结果开发了相应的突发公共卫生事件应急能力培训模式,并在全国部分地区进行推广。国务院应急办与卫生部在研究制定《2006年～2010年应急管理培训工作总体实施方案》时,参考了该课题的研究成果。更多还原

【Abstract】 Objectives1. To explore the current situation and problems of response capacity of Center for Disease Prevention and Control (CDC) and public health staff, and then provide some related evidences for the construction of emergency system in China.2. To improve the strategies and measures of increasing the capacity of emergency response to CDC and public health staff, and then provide some policy suggestions for CDC’s sustainable development in China.3. To provide technical support for emergency preparedness training project’s successfully implementation through develop training program, evaluate training effectiveness, and then explore a feasible and effective training mode in China.MethodsLiterature reviewing, census, semi-structured interview, questionnaire and empirical study were used to assess preparedness and response capacity for public health emergency in Hubei province.1. The current situation and problems of public health emergency were analyzed by literature reviewing and retrospective investigation.2. The 98 CDC participated in this census in Hubei province. The response capacity of personnel from 10 CDC was investigated by questionnaire and semi-structured interview, and the related factors were analyzed by Logistic regression. The qualitation and quantitation study methods were applied including questionnaire and semi-structured interview.3. The empirical study was used in this research. 315 public health staff from 98 CDC of Hubei province participated in the emergency training in 2005. There were 78 participants from the class June, 119 from the class of August, and 118 from the class of October. Thirteen participants did not complete their training because of some unrelated factors with the training, and were not part of the evaluation (N=302, 95.87% response rate). Twenty-one public health leaders from Health department of Hubei, Henan, Hunan, Jiangxi, and Anhui, participated in the leadership training program in 2006, and the response rate was 100%. The training programs were evaluated by anonymous questionnaire and semi-structured interviews at pre-training, immediately post-training and 12-month after training (Follow-up).Results1. There were 8371 staff in 98 CDC of Hubei Province, and 2729 staff were emergency personnel with 32.60%. The age structure was fusiform, and most of personnel belong to 35~44 age group (34.33%). A majority of personnel qualification were associate degree or secondary school diploma with 80.57%. People with middle-level professional title were 44.86%, and preventative medicine personnel were only one-fifth (19.44%). Distribution of average quality score of personnel were imbalance in different CDC, and the average quality score of personnel in province CDC are 1.12 times than that in city CDC and 1.39 times than that in county CDC. At the same time, the average quality score of personnel of enrolling in CDC was lower than the average quality score of resignation’s personnel within last three years.2. The survey results of response capacity of public health emergency indicated that 100% agency developed the monitoring scheme, but there had a low level of understanding due to lack of effective methods to promote learning. Although all of CDC could carry out the analysis of monitoring data, the capacity and methods were not satisfied to the demand of prediction and precaution. The results of research about laboratory showed that the performance of detection could not fit with the actual requirement of public health emergency response because of the deficiency of instrumentation and management. According to the research results of emergency material and fund, we found the every government gave great importance to public health emergencies after SARS, but there were not enough response material and fund which could not satisfy the practical work needs. For example, only eighty percent CDC designated the specialized department in charge of emergency material and emergency fund, and the majority of CDC (74.49%) had not enough fund to response to the public health emergency.3. The results of investigation about training and continuing education showed that only twenty-five percent of CDC carried out the requirement research to emergency training, and sixty percent of CDC developed the measures about training effectiveness evaluation. Meanwhile, the majority of public health personnel indicated that emergency training and emergency drilling were scientific and feasible way to improve the response capacity. 4. The response capacity of personnel has been promoted after crisis of SARS in CDC. However, the disposition of personnel and response capacity regarding public health emergency did not always satisfy with the requirement of current situation. Factors influencing on the response capacity regarding public health emergency might include: levels of work (OR=3.61), standard of culture (OR=2.69), major of graduation (OR=2.90), department of work (OR=2.07), length of training’s time (OR=2.16) and levels of training (OR=4.12).5. The emergency training improved the knowledge levels and increased attitudinal and behavioral intentions scores regarding emergency preparedness. The results of post-test showed that the emergency knowledge and self-assessment scores of participants increased significantly as compared with pre-test(P<0.05), The results of the follow-up measure showed that the emergency knowledge and self-assessment scores of participants declined slightly as compared with post-test levels (P>0.05). However, there was a significant increase as compared with pre-test (P<0.05). Moreover, more than eighty percent of participants reported that the training process and resources were scientific and feasible.Conclusions1. Public health emergency has not obtained enough support from government, especially fund investment.2. The response capacity regarding public health emergency was difficult to adapt to the current needs for disease prevention and control. For example, personnel composition, professional title, educational background and major of graduation did not always satisfy with the requirement of current situation. At the same time, there was a brain drain for personnel movement at this stage for center of disease prevention and control.3. The monitoring system regarding public health emergency is not perfect, and the analysis capacity of monitoring data did not always satisfy with the requirement of predict and precaution.4. There had no enough instrumentation in CDC, and the performance of disease control and public health emergency response were restricted by the poor detectivity.5. The capacity of logistical support was poor. The reserve, management and dispatching regarding emergency material and fund did not satisfy with the need of practical work.6. The emergency preparedness capability could be improved by emergency training, and the emergency training model was effective and feasible in improving the emergency preparedness capability of public health personnel. Suggestions1. Government and relevant departments should implement the responsibilities of disease prevention and control, and perfect the ensure mechanism of emergency material and fund.2. Center of disease prevention and control should improve the personnel system reform and improve human resources allocation, and then increase the capacity of public health emergency response.3. Disease surveillance system and emergency plans should be improved to strengthen the performance of prediction and precaution.4. Government and relevant departments should purchase laboratory apparatus and equipment, and optimize human resources allocation, and then improve the performance of measure and analysis.5. The emergency material and fund should be reserved, and the regulatory regime should be improved at present in order to enhance the emergency ensure capacity.6. Develop and improve the emergency training model, and strengthen emergency preparedness training for public health staff, and then increase the performance of public health emergency response.Innovation and ApplicationThis research not only carried out the present study, but also developed the empirical study according to the related strategies and suggestions. The emergency preparedness training model for public health staff in CDC was developed according to the research results, and it was spread in China. Meanwhile, the study and research results were referenced by State Council and the Ministry of Health when they developed the project of emergency management training from 2006 to 2010.更多还原