目的 调查分析北京市各级疾控中心实验室仪器设备配置状况,发现问题并分析原因,提出对策建议.方法 分别调查北京市17家疾控中心2015年和2020年仪器设备配置种类和数量,分析仪器设备增长情况.比较各疾控中心与《北京市市区疾控机构仪器装备配备标准(试行)》(京卫疾控[2020]83号)的差距,并对比配置水平.结果 十三五期间,A类设备种类全市各区平均增长率为46.03％,数量平均增长率为60.74％;B类设备种类平均增长率为44.66％.2020年,A类设备综合达标率平均水平为82.07％,其中达标率在85％以上的有8家,最高的为B区(95.08％),最低的为N区(64.50％).微生物类达标的比例平均为66.64％,理化类达标的比例平均为65.35％,通用类达标的比例平均为60.36％.结论 北京市、区两级疾控中心实验室仪器设备总体上有所改善,但仍存在实验室仪器设备数量不足、分布不均衡、实验室检测人员数量和用房面积与仪器设备不匹配等问题,建议下一步应综合施策,有效提升实验室检验检测综合能力.

目的 了解北京市市、区两级疾病预防控制机构(以下简称疾控机构)人员队伍基本情况,掌握人员配置现状,为提升北京市疾控机构人员队伍整体能力提供建议和依据.方法 对2015和2020年北京市17家疾控机构的人员编制、年龄、学历、职称、流失情况等进行问卷调查.结果 2020年全市疾控机构核定编制3 406人,较2015年增加205人;2020年现有编制2 832人,较2015年减少54人;现有编制到位率由2015年的90.16％下降到2020年的83.15％.北京市各级疾控机构35岁及以下人员占比均下降;硕士及以上人员占比和高级职称专业技术人员占比呈现从市级到城区到郊区比例依次降低的态势.2015-2020年间的离职人员,以初级职称和本科学历为主.结论 北京市疾控机构核定编制数未达到编制配置标准,现有编制到位率不足,人员流失严重.学历水平虽有提升,但高层次人才缺乏.应进一步加强政策支持,优化人员队伍结构,全面提升疾控机构人员队伍素质.

目的 调查分析北京市各区进行疾控机构标准化建设前后的变化情况,发现短板和不足,为进一步推动标准化建设,提升疾控机构能力提供依据.方法 利用问卷调查北京市16家区级疾控中心2019-2021年人员编制、实验室仪器设备配置、基础设施建设、信息化建设等情况.通过纵向比较,分析各机构标准化建设进展;通过与目标值比较,分析各机构存在的差距.纵向比较采用定基比、环比表示,与目标值的比较用百分比表示.应用SPSS 20.0统计软件,分别利用多元线性回归和二元Logistic回归进行多因素分析.结果 2019-2021年,7区疾控机构人员编制数增加,15区实验室仪器设备配置达标率均有不同程度提高.截至2021年底,9区(56.25％)每万常住人口核定疾控人员编制数未达到1.75名,8区(50％)人均建筑面积不足65 m2,10区(62.5％)实验室面积占比不足40％,与医疗机构5区实现传染病报告数据交换、2区实现慢性病相关数据交换、3区实现健康危害因素相关疾病数据交换,2区实现与区域居民电子健康档案交互共享,1区实现与区域居民电子病例交互共享,各区均未实现与区域人口库交互共享.人均GDP(t=6.60,P=0.00)、常住人口数(t=-4.25,P=0.00)对每万常住人口核定疾控人员编制数有影响.生产总值(t=3.61,P=0.00)、常住人口数(t=-2.18,P=0.04)、人员编制数(t=-2.61,P=0.01)对人均建筑面积有影响.结论 北京市疾控机构标准化建设取得了一定进展,但是整体发展水平不适应北京市实际需要,需进一步完善标准化建设内涵,持续推进标准化建设工作.

Background: During the fight against the COVID-19 pandemic, Beijing's community health institutions showed some weaknesses in infectious disease prevention and control. To improve their capabilities in this aspect to fully play their role as a sentinel for monitoring infectious diseases, it is urgent to investigate and analyze their current status to find problems, then put forward recommendations. Objective: To investigate the infectious disease prevention and control level in Beijing's community health institutions, and identify and analyze the problems, with suggestions put forward. Methods: From May to July 2020, a questionnaire survey was conducted in all community health centers(CHCs) in Beijing. Information was collected, including the basic situation, departments, staff structure, infrastructure situation, the provision of public health services, and emergency response capacity for infectious diseases and public health emergencies of the CHC, and was analyzed using descriptive analysis. The above-mentioned data were checked and supplemented if necessary in accordance with the information in the China's National COVID-19 Surveillance Network and Beijing Community Health Statistics 2019. Results: Of the 342 CHCs in total in Beijing as of 2019, 90(26.32%) had a fever clinic, 102(29.82%) had a gastrointestinal clinic, and 54(15.79%) had both a fever clinic and a gastrointestinal clinic. Among the incumbent workers in the CHCs(n=28 809), 2 887(10.02%) held a position in public health, and 178(6.17%) had a senior professional title. HIV testing was carried out in 159 CHCs(46.49%). SARS-CoV-2 nucleic acid testing was accessible in 11 CHCs(3.22%). For 29 kinds of common infectious diseases, 140(40.94%) CHCs had no diagnosis and treatment capabilities, 135(39.47%) had capabilities managing 1-5 kinds, only 29(8.48%) were able to diagnose and treat >10 kinds. Conclusion: The CHCs in Beijing may have a series of problems in the infectious disease prevention and control system and mechanism, sentinel fever clinic, infectious disease diagnosis and treatment capacity, public health workforce development and other aspects. Therefore, the infectious disease prevention and control plan of the CHCs should be developed more appropriately from an overall point of view, to address the problems and improve the current status as soon as possible. Copyright © 2021 by the Chinese General Practice.

目的 了解我国卫生健康相关标准现况,为完善卫生健康标准体系和制定卫生健康标准相关政策提供数据支持.方法 通过“全国标准信息公共服务平台”“卫生标准网”等收集我国卫生健康相关标准数据,并进行整理分析.结果 截至2019年5月31日,我国现行卫生健康相关的标准数量和占不同制定主体标准比例为:国家标准459项(1.3％)、行业标准701项(1.1％)、地方标准141项(0.3％)、团体标准341项(4.2％).2010年之前实施的国家标准299项,行业标准297项,地方标准29项;国家标准方法类标准245项;地方标准居于前三位的省份依次为广西47项、天津31项和北京30项;居于前三位的专业分别为职业卫生431项、放射卫生159项和临床检验110项.结论 建议进一步提高卫生健康标准的有效供给,加大对现行卫生健康标准的整合精简和优化完善,加强卫生健康标准的复审和修订工作.

利用文献分析、德尔菲法和专家咨询的方法初步建立一种对公共政策开展健康影响评价的实用工具.本研究将公共政策健康影响评价流程分为筛选、范围界定、实施评价、报告、监测与反馈五个步骤,并形成了筛选清单、评价深度选择清单和关键影响识别清单,供评价方实际操作使用.

Objective To compare the knowledge awareness,attitude and practice of smear positive tuberculosis (TB) patients before and after one-to-one health education,to analyze the factors influencing the knowledge awareness rate,and to put forward specific proposals.Methods Questionnaire surveys were conducted before and after the intervention.The categorical data were described by the number of cases and constituent ratios.Chi-square (x2) test was used for single factor analysis,and logistic regression for multiple-factor analysis.Results After the intervention,the awareness rates of 14 knowledge points were higher than before,but the awareness rate of 1 knowledge point was lower.The total awareness rate of all knowledge points rose from 37.17％ to 49.09％,with statistically significant differences (x2 =13.431,P=0.000).Logistic regression analysis showed that the factors influencing knowledge awareness of smear positive TB patients included place of residence,marital status and medical insurance.The awareness rate was higher in rural areas than in urban areas (OR=1.862),lower in the divorced(0R=0.084) and the widowed (OR=0.236) than in the married,higher in patients with urban residents' medical insurance (OR=3.513)or with urban workers' medical insurance(OR =1.919) than in the patients with self-paying medical expense.Conclusions The awareness rate of prevention and treatment knowledge in smear positive TB patients is improved through the health education.The knowledge awareness is affected by place of residence,marital status and medical insurance.

目的 了解北京市朝阳区社区居民干预前后结核病防治知识、信念、行为情况,评价其干预效果,为北京市制定结核病防治策略提供科学依据.方法 对朝阳区社区居民开展为期1年的结核病防治健康教育,分别开展基线和终末问卷调查,分析干预前后效果.结果 基线调查社区居民肺结核防治知识总知晓率58.6％,核心信息知晓率59.4％,终末调查总知晓率和核心信息知晓率分别提高至65.4％和66.4％;干预后,认为得了肺结核病对劳动能力有影响的信念持有率由77.5％提高至83.9％,差异有统计学意义(P＜0.00),邻居或同事得了肺结核病的态度比较,差异有统计学意义(P＜0.00);参加肺结核宣传活动和向别人宣讲肺结核病知识2种行为开展率由干预前32.8％和34.7％提高至40.0％和38.7％,差异有统计学意义(P＜0.05).结论 干预后居民肺结核病防治知识知晓率有明显提高,但仍需抓住短板知识点进一步提升知晓率,而肺结核相关信念/态度和行为的转变有限,需要长期干预和引导.

目的 比较结核病传染源住院综合治疗与居家隔离治疗效果,利用经济学评价探索最优结核病传染源管理模式,为政府决策提供依据.方法 以2012年1月1日-2015年9月30日在北京市朝阳区疾控中心结核门诊登记管理的所有痰涂片阳性的肺结核病例作为研究对象,将其治疗资料录入在线数据库,数据描述和分析采用SPSS 22.0软件;经济学评价采用质量调整生命年和马尔科夫模型进行模拟分析.结果 住院治疗仅占涂阳病例的21.25％;住院组病例采用个体化方案治疗的比例高于居家隔离治疗组(x2 =47.07,P＜0.001).住院和居家治疗初治病人痰涂片转阴率差异无统计学意义(HR=1.025,P=0.831),而住院治疗复治的患者则差异有统计学意义,住院治疗转阴率是居家隔离的8倍(HR=8.079,P=0.037).当政府支付意愿＜11 281元/QALY时,则采取传统的模式(88％居家+12％住院);当政府支付意愿值提高到11 281元/QALY时,则应开展80％居家隔离+20％住院模式;政府的支付意愿应增加到157 129元/QALY时,才能采用全住院模式.结论 畅通的双向转诊机制下的20％住院和80％居家强制隔离治疗的新传染源管理新模式符合国情,为结核病的控制提供了科学决策依据.

Objective To compare the effect of health education on tuberculosis between experimental group and control group, analyze the influencing factors and put forward specific proposals. Methods The experimental group received targeted training, and the control group did not receive special training. In the both groups the baseline knowledge, attitude and practice (KAP) survey and final survey were carried out respectively. The difference-in-differences method was used to compare the net effect of training. Results The knowledge awareness in the final survey of the experimental group (12.88%) was significantly higher than that in the baseline survey (5.16%; χ2 =5.72, = 0.017), but the knowledge awareness in the final survey of the control group (8.77%) was significantly lower than that in the baseline survey (33.33%; χ2 = 9.83, = 0.002). The average score in the final survey of the experimental group (89.71) was significantly higher than that in the baseline survey (84.98; = -3.78, = 0.000), but there was no significant difference between the average scores of the baseline and final surveys in the control group. The probability of improving the knowledge of the experimental group was 10.14 times that of the control group [ = 0.005, O^R = 10.14, 95% CI: 2.04, 50.48]. Conclusions The experimental intervention measures have improved the awareness of medical staff. We should carry out special training to improve knowledge awareness of tuberculosis.

Objective The aim of our study was to estimate the cost of the elderly′s health care model so as to bring data support for later economic analysis and evaluation and provide evidence for government to measure the budgetary subsidies and medical service prices. Methods The cost data were selected by the ways of literature study,questionnaire survey and inter-view in October 2010 and March 2011. The efficient working hours of medical personnel were determined via non - participant ob-servation. Results It cost about 183. 67 yuan for each elderly receiving health care service per year under the present model. The expected reference value of standard item cost after popularization would be 133. 58 yuan. Conclusion Accurate cost estimation can give a solid basis for policymakers to make an acceptable compensation standard and promote community health service institu-tions to provide better public health services.

Objective To explore the current status of human resources of general practitioner(GP) so as to predict the number of GPs needed and provide problem-solving strategies.Methods Eight GPs from the 8 community health service teams of a community health center in Beijing were included in the study.Job analysis methods including field observation,self recording,and structured interview analysis,combined with statistical analysis method were used to determine the quantitative work items,one-year workload,work time,and work saturation.One year′s working time was then calculated.The number of GP needed was predicted using the improved formula of health manpower demand.Results This community health center should be equipped with 14 GPs.The personnel demand index was 0.57 based on the current 8 GPs..Conclusion This community health center should be equipped with more GPs and should carry out relevant trainings among the current staff so as to narrow the personnel gap and improve the service capacity.

目的分析北京市2012年7·21洪涝灾害后存在的主要危险因素,确定传染病疫情风险评估结果,并提出应对策略。方法运用历史数据分析、文献法和专家咨询法以及现场观察,开展风险识别和客观评价,并利用矩阵法进行风险等级评估,确定洪涝灾后可能的传染病疫情和公共卫生风险,并制定管理策略。结果综合分析北京市2012年7月21日雨洪灾害后传染病发生的主要危险因素,确定北京市雨洪灾害后需重点防控的传染病主要包括肠道传染病(8种)、自然疫源性疾病(2种)、虫媒传染病(乙脑)以及狂犬病等12种疾病。并树立"大卫生"观念,制定出切实可行的风险控制管理策略。结论这些风险评估的结果和管理策略为政府决策提供了科学依据,落实到了灾后疫情应急管理的每个环节,为此次洪灾后的风险管理做到了有的放矢,"关口前移",实现了"大灾之后无大疫"的目标。

Objective To predict the needed amount of community nurses,discover the personnel placement problems in the community health service institutions,and put forward suggestions for improvement.Methods All the 8 community nurses of all the 8 community health service teams in a community health service center in Beijing were selected as the subjects.Such methods in job analysis as field inspection,self recording,and interview analysis were applied in combination with statistical analysis to determine the quantitative work items,one-year workload,work time,and work saturation,then one-year working time was calculated.The improved formula of health manpower demand was used to predict the needed amount of community nurses.Results This community health service center should be staffed with 18 community nurses,and now there are 8.The personnel demand index is 0.44.Conclusion The amount of community nurses is not enough in the community health service center,and the community nurses allocation is imbalanced in four of the community health service stations.It is necessary to supplement the gap of community nurses,and carry out the on-the-job training for improving the service ability so as to relieve the pressure due to quantitative shortage of personnel to a certain degree.

Objective To investigate the content of key job positions in community health service institutions. Methods Two community health service institutions were selected from each of the three districts using purposive sampling method.Routine work content,work hour allocation,and daily workload of general practitioners,nurses,and preventive health care workers in these six community health care centers were observed. Results The lack of the clear definition of job responsibilities resulted in overlapping work content and buckpassing.General practitioners in community health services were mainly responsible for community outpatient consultation;however,they also carried out chronic disease management,but in a relatively non-standardized way.Preventive health care workers had relatively less enthusiasm and motivation when providing public health services,and there health education was hardly accepted by the community residents due to the poorly designed content. Conclusion The non-participant observation of the key job positions may provide useful information for performance appraisal in community health service institutions.

Objective To explore the application of Modules of employment skills in health emergency managers training,we surveyed the needs of health emergency managers about training time,objective,teaching method,training form,trainer,assessment,and so on.Methods 1 606 health emergency managers in 20 provinces of China were investigated by non-random sampling.Results The demand rate of improving health emergency response capacity was 96.2%,which was the highest in training objective;the rate of case analysis,desktop deductive and special lecture were higher than other training methods,which were 94.0%,94.0% and 84.8% respectively;the rate of short-term training was the highest with 92.7%;for the trainer,demand rate of domestic experts was 90.0%,followed by health emergency management with 83.1%;86.5% of study objects selected simulation exercise as the assessment way;77.0% of study objects chose awarding a certificate as the way of completing training,and there were significant differences in some of the demand rates among different levels.Conclusions The training should aim to promote health emergency capacity,adopt multiple teaching methods,use short-term training form,choose who not only has rich emergency experiences,but also has some theoretical basis as trainer,assess trainee by simulation exercise,and award a certificate for finishing the study,and according to different levels we should take different training methods.

China has made remarkable achievement in health emergency managers training during the 11th five-year plan period,meanwhile,there are also some serious problems: the objectives of most training are short-term goals;training contents are unsystematic;training method is simple;lack of effective evaluations,etc.In our opinion,the future training should be done like this: the training goal should integrate short-term and long-term;the training contents should be more systemic and meet trainee's demands;adopt multiple methods according to the contents;divide into several short-term trainings and aviod training reduplicate contents.Here we have some following suggestions: design training program systematically;identify the training objective and contents according to demands and posts analysis;use modularity training model and multiple methods to accumulate knowledge;carry on systemic evaluation to training on the basic of education theory.

After the pilot evaluation of the performance appraisal indicator system for each post in a Community Health Service Organization,the methods of even multiplication and weighted sum were both used to calculate the total performance scores for each personnel.The comparative analysis found that the coefficient of variation by the first method was larger than that by the second method.Compared with the weighted sum method,the allocation of performance pay was more reasonable and with higher discrimination by the even multiplication method,presenting in a certain degree the principle of "more pay for more work" and "higher salary for better performance".The feedback of performance appraisal revealed a difference in preference for the methods among personnel in different posts.The general practitioners and community nurses were more inclined to accept the even multiplication method,while the personnel in preventive health care were more inclined to accept the weighted sum method.

Objective To explore the working content,pressure,ability,demand for training of general practitioners,community nurses,and prevention physicians in community health services(CHS) organizations,and key elements of post performance appraisal for them were proposed.Methods Totally 147 general practitioners,93 community nurses and 76 prevention physicians from 51 CHS organizations of 7 districts or counties of Beijing were enrolled by stratified sampling,and they were interviewed by using Job Analysis Questionnaire for CHS Personnel.Results CHS personnel of the above posts held that not only professional knowledge and skills were indispensable,but also the higher qualities of ability of communication,collaboration and teamwork were necessary.They felt a certain pressure on working and all had demand for professional training.Conclusion The performance appraisal indicators of each post reflecting its post characteristics in CHS organizations can be made only on the basis of scientific and reasonable job analysis.

An analysis of the existing incentives mechanism of performance appraisal for community health service centers, and insight into the challenges for linking the post performance appraisal in community health service centers with incentive measures. It is pointed out the administrators should take a variety of measures including material incentive, target incentive, knowledge incentive, and emotional incentive among others. In addition, such measures should be used sophistically, flexibly and reasonably, while timing of incentives should meet the human resource needs of the institution, notably a combination of positive incentive with negative ones,, mostly the former incentive.