在绩效评价指标体系中,指标无疑是关键,但指标的权重系数是用来表示各项绩效指标相对重要性的百分比,因此,科学合理地确定每一项指标的权重,是保证综合指标体系在实际评价工作中切实可行的关键.

Objective To establish an indicator system for performance assessment of women and children health care institutions,and provide basis for performance management of such institutions.Methods In this study,literature searching,expert discussion,Delphi method,coefficient of variation method,correlation analysis,principal components analysis,factor analysis and cluster analysis were used to establish the indicator system.In addition,expert scoring and CRITIC methods were called into play to calculate the weight coefficient of each index,and to test the validity and reliability of such an indicator system.Results Thanks to the framework of this indicator system,we set up six class 1 indicators,including heahhcare quality,healthcare efficiency,quality and efficiency of public health service,social efficiency,economic benefit,and development potential.Conclusions Scientific studies can help us build a scientific and practical general performance assessment indicator system applicable to women and children care hospitals at all levels.

目的:探讨妇幼保健机构综合绩效评估方法.方法:运用本课题前期研究结果建立的"妇幼保健机构综合绩效评估指标体系",采用层次分析法与TOPSIS法相结合的方法,对妇幼保健机构综合绩效进行评估.结果:两种评估方法的绩效排名基本一致,评估结果较为可靠,综合两种方法的评估结果作为最终绩效排名.结论:本研究绩效评估方法较为合理,且简单实用,可用于对妇幼保健机构的综合绩效评估.

绩效评估离不开科学的指标体系.妇幼保健机构区别于综合性医院或专科医院的重要因素是妇幼保健机构承担了对辖区妇幼保健群体管理的公共卫生职能.因此,在对妇幼保健机构的综合绩效评价指标体系的研究过程中,对其公共卫生服务质量和效率的考核指标选择显得尤为重要,本文以省级妇幼保健机构为例阐述了在对妇幼保健机构绩效评价指标体系的研究过程中对其公共卫生服务质量和效率指标的筛选过程.为保证筛选出的指标灵敏、准确和实用,本研究采用了专家主观评价与对客观数据数理分析相结合的方法进行指标筛选[1].

BACKGROUND: Recently, it has been reported that blood lead level lower than 24 μmol/L can lead to learning and cognitive deficits. OBJECTIVE: To investigate the relationship of lead level in foremilk and early neurobehavioral development of neonates taking lead level in foremilk as lead exposure index. DESIGN: A controlled observation. SETTING: Maternal and Child Health Center, Shanxi Children's Hospital. PARTICIPANTS: Totally 128 neonates of full-term normal delivery, 76 male and 52 female, from Shanxi Provincial Maternal and Child Health Center and Jiexiu Maternal and Child Health Center were involved in this study. All the involved neonates had no peripartal ischemic/hypoxic history. The corresponding puerperants were aged (27±5)years. They had no various acute and chronic diseases during pregnancy, and family history of neurological disease as well as occupational lead exposure. Informed consents of detected items were obtained from the puerperants. METHODS: ① Determination of lead level in foremilk: Altogether 128 foremilk samples, 1 mL each, were collected between January and February 2005. The same amount of violet acid was added to each sample. After foremilk was fully dissolved, 0.2 mL solution was taken for determining lead level with atomic absorption spectrometer in graphite stove. The determined process strictly followed the internal quantity control of laboratory and was involved in the blind quality control of Institute of Environmental Health of Chinese Academy. ② Participants grouping: Totally 128 neonates were involved, and the normal reference value of lead level of foremilk was 0.06–0.48 μmol/L. The involved neonates were assigned into high-level lead group (≥ 0.24 μmol/L, n =60) and low-level lead group (< 0.24 μmol/L, n =68). ③ Assessment of neurobehavioral development of neonates: Neurobehavioral development level of neonates who was born 24 to 72 hours was assessed with 20-item neonatal neurobehavioral determination method, which involved behavioral ability (6 items), passive muscular tension (4 items), active muscular tension (4 items), primitive reflection (3 items) and general evaluation (3 items). Each above-mentioned scoring had 3 scales (0,1 and 2 points). The full mark of 20 items was 40 points. Neurological behaviors of neonates might be unabnormal when scoring was < 35 points. MAIN OUTCOME MEASURES: Assessment results of neurobehavioral development of neonates in high- and low-level lead neonates. RESULTS: After lead-level determination, the involved neonates in two groups participated in the final analysis. Neurobehavioral total scores of neonates of high-level lead group were lower than those in the low-level lead group ([35.9±1.3) points vs(.37.7±1.4) points,P < 0.01]. The scores of neonatal erection in high-level lead group were lower than those in low-level lead group [(1.4±0.4) points vs.(1.8±0.5) points,P <0.01], and time for head erection of neonates in the high-level lead group was shortened as compared with that in the low-level lead group [(1.8±1.7) minutes vs.(3.3±2.2) minutes,P < 0.01]. CONCLUSION: 0.24 μmol/L lead level in foremilk has certain relationship with neurobehavioral development. The main influenced manifestations are shortened duration of neonatal head erection andactively contracted extensor, i.e. cervical curved ability is weakened.

AIM: To study the effects on the neurobehavioral development of neonates exposed to low-level lead in fetus. METHODS: 128 neonates (76 males, 52 females) with the pregnant period of (40.4±1.3)weeks, the body mass of (3 200±430)g and the body length of (50.1±0.4) cm at term were selected from the Shanxi Maternal and Child Health Hospital and Jiexiu Maternal and Child Health Hospital of Shanxi Province from September 2004 to January 2005. All subjects had no history of ischema or hypoxia at perinatal stage, and 20 items of neonates were scored by Neonatal Behavioral Neurological Assessment (NBNA) to detect the neurobehavioral development neonates. The atomic absorption spectrum of graphite was used to estimate the contents of lead in umbilical blood, and the subjects were divided into 3 groups according to the level of lead in umbilical blood, neonates with the level of lead ≥0.24 μmol/L were taken as high-lead group (n=27), and those between 0.12 μmol/L and 0.24 μmol/L were taken as middle-lead group (n=65), while those with the level below 0.12 μmol/L were taken as low-lead group (n=36). RESULTS: A total of 128 enrolled neonates were involved in the analysis of results.①The neurobehavioral development was obviously poorer in neonates with the lead level below 0.24 μmol/L than those with the lead level above 0.24 μmol/L, and there were significant differences between two groups.②The umbilical blood lead level of 128 neonates was (0.17±0.13) μmol/L, which was(0.17±0.12) μmol/L in males and (0.17 ±0.15) μmol/L in females, and there were no significant differences between two sexes (t=0.65 P=0.54).③The score of neuro-behavioral development of neonates in high-lead group was markedly lower than that of low-lead group with marked differences [(35.2±1.4),(37.9±1.5) points,P < 0.01]. The score of head-erect was markedly lower in the high-lead group than in low-lead group [(1.3±0.5),(1.9±0.4)points,P < 0.05], and the time of head-erect was markedly shorter in the high-lead group than the low-lead group with remarkable differences [(1.4±1.5),(3.2±2.2) s,P < 0.05]. CONCLUSION: Exposure to low-level lead has side-effects on neurobehavioral development of neonates.