基于经济性与重要性的糖尿病防控重要性-绩效分析决策模型构建  

Construction of IPA decision model for diabetes prevention and control based on economy and importance

作　　者：李靓[1] 杨静[2] 冯佳雨 徐晓慧 徐婷玲 董文兰[2] 张岩波[1] 周脉耕[2] Li Jing;Yang Jing;Feng Jiayu;Xu Xiaohui;Xu Tingling;Dong Wenlan;Zhang Yanbo;Zhou Maigeng(Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment,Shanxi Medical University,Taiyuan 030000,China;National Center for Chronic and Noncommunicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]山西医科大学重大疾病风险评估山西省重点实验室,太原030000 [2]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100050

出　　处：《中华预防医学杂志》2022年第7期947-951,共5页Chinese Journal of Preventive Medicine

基　　金：国家重点研发计划项目(2018YFC1315304)。

摘　　要：目的构建糖尿病防控重要性-绩效分析(IPA)决策模型并探讨糖尿病防控措施的优先级。方法采用重大慢性病防控措施的重要性、可行性及实施情况调查问卷对488个国家慢性病综合防控示范区进行线上调查。调查内容分为个体和群体层面,共10个维度指标、44项措施,分别获取经济性和重要性得分。采用IPA模型对糖尿病防控维度指标进行象限划分;采用二阶验证性因子分析的标准化因子载荷系数确定同一象限内维度指标优先级;各维度内的防控措施优先级则采用项目反应理论的区分度参数确定。结果经济性和重要性总分均值分别为66.50和89.94分,由此将矩阵划分为4个象限,第1象限重要性和经济性均高,为"最高优先级",包括:医保与家庭医生、健康教育、高危发现与干预、患者管理和社区行动;第2象限重要性高而经济性低,为"优先改进级",仅包括并发症筛查1项维度指标;第3象限重要性和经济性均低,为"最低优先级",包括:个人健康服务评估随访、环境支持、糖尿病合并感染预防和降糖政策;第4象限重要性低而经济性高,为"其次改进级"。不同象限内优先考虑的措施分别为:(1)最高优先级:控制血脂、职业场所、防控工作计划、血糖检测、家庭医生签约服务;(2)优先改进级:年度神经病变筛查;(3)最低优先级:普及风险评分、健康饮食、健康餐饮创新活动和结核病筛查。结论 IPA模型可用于构建糖尿病防控决策模型并确定糖尿病防控措施的优先级。Objective To determine the priority of diabetes prevention and control measures in the perspective of the economy and importance,and provide theoretical support for guiding relevant departments to implement measures based on actual economic level.Methods An online survey was conducted on the importance,feasibility and implementation of major chronic disease prevention and control measures in 488 national demonstration areas for comprehensive chronic disease prevention and control.The content of the survey was divided into individual and group levels,with 10 dimensions and 44 measures,to obtain the scores of the economy and importance.IPA model was used to divide the dimension index of diabetes prevention and control into quadrants.The standardized factor load coefficient of the second-order confirmatory factor analysis was used to determine the priority of dimension index in the same quadrant.The priority of prevention and control measures in each dimension was determined by the discriminant parameter of project response theory.Results The mean scores of economy and importance were 66.50 and 89.94,respectively,and the matrix was divided into four quadrants.The first quadrant was the"highest priority"with high importance and economy,including medical insurance and family doctors,health education,high-risk detection and intervention,patient management and community action.The second quadrant was characterized as high importance but low economy,which was the priority for improvement,including only one dimension of complication screening.The third quadrant was the lowest priority due to low importance and economy,including personal health service evaluation and follow-up,environmental support,diabetes co-infection prevention and glycemic policy.The last quadrant had low importance but high economy,which was the second improvement level.The priority measures in different quadrants were:(1)the highest priority:blood lipid control,occupational site,prevention and control work plan,blood glucose testing,family doctor con

关 键 词：糖尿病 预防卫生服务 经济学 医学 决策支持技术 

分 类 号：R587.1[医药卫生—内分泌]