Construction of an evaluation indicator system for Zero Tuberculosis Community in Zhejiang Province

doi:10.19982/j.issn.1000-6621.20240412

Abstract

Abstract:

Objective: To develop a practical evaluation indicator system for “Zero Tuberculosis Community” in Zhejiang Province, which could provide a scientific basis for the standardized construction of “Zero Tuberculosis Community” throughout the province and to optimize tuberculosis prevention and control strategies. Methods: First, a set of indicator pool was constructed through the literature review. Second, two rounds of correspondence were conducted by jointly applying the Delphi method and Analytic Hierarchy Process (AHP) method. Finally, the indicator system was determined based on expert ratings and opinions, and the indicator weights were calculated. Results: A total of 26 experts were invited. The indicator system includes 3 first-level indicators, 13 secondary indicators, and 50 tertiary indicators. The experts had a relatively high level of enthusiasm, authority and coordination. The first-level indicators, in descending order of indicator weight, were implementation actions (0.412), construction effectiveness (0.324), and organizational support (0.264). Conclusion: The indicator system constructed in this study has a certain degree of scientificity and reliability, which can provide a reference for a comprehensive and objective evaluation of the effectiveness of the construction of “Zero Tuberculosis Community”.

Key words: Tuberculosis, pulmonary, Delphi method, Quality indicators, health care, Program evaluation, Zero tuberculosis community

CLC Number:

Wu Qian, Wang Wei, Zhang Yu, Chen Songhua, Chen Bin. Construction of an evaluation indicator system for Zero Tuberculosis Community in Zhejiang Province[J]. Chinese Journal of Antituberculosis, 2025, 47(3): 331-337. doi: 10.19982/j.issn.1000-6621.20240412

Figures/Tables 2

一级指标	二级指标	三级指标	重要性			可获得性			初始权重	组合权重
一级指标	二级指标	三级指标	均值	变异系数	满分比 (%)	均值	变异系数	满分比 (%)	初始权重	组合权重
组织保障	政府主导								0.527	0.139
		成立无结核社区建设多部门领导小组、协调小组或联防联控机制	4.73	0.088	65.38	4.18	0.157	26.92	0.173	0.024
		制定实施细则并正式发文	4.81	0.075	73.08	4.30	0.135	30.77	0.237	0.033
		无结核社区建设工作纳入政府考核(修改前);县级政府将无结核社区建设工作纳入各相关部门年度目标管理和绩效考核(修改后)	4.77	0.082	69.23	3.40	0.267	7.69	0.590	0.082
	经费投入								0.473	0.125
		建立无结核社区专项经费投入长效机制,至少保障5年建设期经费	4.88	0.059	80.77	3.39	0.236	7.69	0.368	0.046
		结核病专项经费的人均投入	4.77	0.082	69.23	3.61	0.243	11.54	0.296	0.037
		出台结核病兜底补助政策(修改前);当地政府出台肺结核患者诊疗费用自付部分兜底或补助政策(修改后)	4.77	0.084	69.23	3.11	0.327	3.85	0.336	0.042
实施行动	健康促进								0.073	0.030
		开展现场宣传教育活动次数	3.96	0.161	11.54	4.54	0.121	50.00	0.367	0.011
		百千万志愿者发展的志愿者数量	3.74	0.165	7.69	4.12	0.220	34.62	0.167	0.005
		应用新媒体宣传次数	4.16	0.157	26.92	4.52	0.108	46.15	0.267	0.008
		在乡镇、街道等政府宣传平台宣传次数(修改前);在县区级、乡镇、街道等政府宣传平台宣传次数(修改后)	4.10	0.133	15.38	4.32	0.123	30.77	0.100	0.003
		无结核社区建设工作经地、市级以上主流媒体报道、宣传次数(调整后)	4.10	0.117	15.38	4.11	0.152	23.08	0.100	0.003
	主动筛查								0.262	0.108
		活动性肺结核患者密切接触者胸部X线摄片筛查率	4.90	0.056	80.77	4.16	0.138	19.23	0.231	0.025
		65岁及以上老年人胸部X线摄片筛查率	4.74	0.093	69.23	4.10	0.097	11.54	0.157	0.017
		糖尿病患者胸部X线摄片筛查率	4.68	0.093	61.54	4.02	0.102	7.69	0.139	0.015
		入学新生结核病检查比例	4.74	0.123	76.92	4.37	0.124	34.62	0.083	0.009
		病原学阳性患者耐药筛查率	4.96	0.023	88.46	4.61	0.095	50.00	0.185	0.020
		耐药筛查中使用快速分子耐药检测的比例	4.70	0.088	61.54	4.44	0.121	38.46	0.074	0.008
		既往2年已治愈的肺结核患者结核病检查比例(新增)							0.130	0.014
	感染检测								0.150	0.062
		活动性肺结核患者密切接触者感染检测比例	4.77	0.082	69.23	4.07	0.160	19.23	0.403	0.025
		艾滋病病毒感染者和艾滋病患者感染检测比例	4.85	0.067	76.92	4.23	0.130	23.08	0.306	0.019
		免疫受损人群感染检测比例	4.76	0.083	69.23	3.61	0.187	7.69	0.290	0.018
	预防性治疗								0.141	0.058
		负责预防性治疗的医务人员人数(删除)	4.18	0.110	19.23	3.71	0.198	11.54	-	-
		建立预防性治疗服务机构或部门	4.35	0.123	34.62	3.85	0.169	11.54	0.224	0.013
		活动性肺结核患者密切接触者接受预防性治疗比例	4.88	0.081	84.62	3.53	0.237	3.85	0.155	0.009
		艾滋病病毒感染者和艾滋病患者接受预防性治疗比例	4.72	0.088	65.38	3.75	0.183	7.69	0.138	0.008
		免疫受损人群接受预防性治疗比例	4.63	0.115	61.54	3.26	0.241	3.85	0.138	0.008
		学生及教职工接受预防性治疗比例	4.54	0.150	61.54	3.37	0.216	0.00	0.052	0.003
		预防性治疗完成率(删除)	4.73	0.106	69.23	3.55	0.199	7.69	-	-
		预防性治疗者采用医护人员/志愿者/家庭成员直接面试下督导服药比例(删除)	4.35	0.169	46.15	3.42	0.315	11.54	-	-
		预防性治疗者中断治疗比例(调整后)	4.76	0.097	69.23	4.18	0.104	15.38	0.190	0.011
		预防性治疗者不良反应及时处理率	4.84	0.068	76.92	4.30	0.148	34.62	0.103	0.006
	规范化治疗								0.153	0.063
		病原学阳性患者住院隔离治疗比例(调整后)	4.83	0.069	73.08	3.59	0.214	7.69	0.127	0.008
		利福平敏感患者初始使用标准化疗方案的比例(删除)	4.87	0.059	76.92	4.18	0.124	19.23	-	-
		利福平敏感患者成功治疗率	4.96	0.022	88.46	4.57	0.098	46.15	0.333	0.021
		耐多药/利福平耐药肺结核患者成功治疗率	4.96	0.022	88.46	4.14	0.167	26.92	0.286	0.018
		耐多药/利福平耐药肺结核患者纳入治疗率	4.96	0.024	88.46	4.26	0.131	26.92	0.254	0.016
	健康管理								0.066	0.027
		肺结核患者规范管理率	4.95	0.028	84.62	4.43	0.103	34.62	0.296	0.008
		肺结核患者规则服药率	4.97	0.021	88.46	4.29	0.118	26.92	0.259	0.007
		肺结核患者管理率(新增)							0.444	0.012
	患者关怀								0.061	0.025
		开展心理咨询的活动次数(删除)	3.99	0.122	7.69	3.38	0.284	7.69	-	-
		进行过心理咨询活动的结核病患者占比	3.99	0.171	19.23	3.59	0.223	11.54	0.240	0.006
		心理咨询活动覆盖的结核分枝杆菌潜伏感染者占比(删除)	3.82	0.237	19.23	3.18	0.311	7.69	-	-
		提供营养补助人数/患者占比	4.09	0.152	19.23	3.46	0.257	11.54	0.320	0.008
		人均营养补助标准(删除)	4.25	0.139	30.77	3.43	0.252	7.69	-	-
		慈善机构等多渠道经费的人均投入(调整后)	4.17	0.124	19.23	3.10	0.303	3.85	0.440	0.011
	督导培训								0.058	0.024
		开展主动筛查质控工作完成率	4.80	0.076	73.08	4.28	0.117	26.92	0.375	0.009
		开展感染检测质控工作完成率	4.72	0.088	65.38	4.16	0.140	23.08	0.292	0.007
		疾病预防控制机构对基层医疗机构督导次数(修改前);对无结核社区建设工作的督导次数(修改后)	4.45	0.106	38.46	4.55	0.101	46.15	0.167	0.004
		疾病预防控制机构对基层医疗机构培训次数(修改前);对无结核社区建设工作的培训次数(修改后)	4.34	0.121	30.77	4.60	0.116	53.85	0.167	0.004
	信息化建设								0.036	0.015
		采用人工智能阅片辅助结核病筛查比例	4.29	0.119	26.92	3.67	0.172	3.85	0.333	0.005
		建立多点触发风险预警工具(删除)	4.34	0.143	38.46	3.45	0.186	3.85	-	-
		采用智能随访工具辅助患者管理的比例	4.12	0.152	23.08	3.60	0.183	3.85	0.333	0.005
		结核病筛查信息纳入健康档案比例	4.36	0.126	34.62	4.03	0.147	15.38	0.333	0.005
建设成效	防治成效								0.565	0.183
		肺结核疫情下降距目标值完成率(修改前);无结核社区常住人口的肺结核报告发病率下降幅度(修改后)	4.74	0.088	69.23	4.01	0.137	11.54	0.639	0.117
		无结核社区建设工作(以案例、报告等形式)获政府部门肯定、采纳、批示等(删除)	4.49	0.122	46.15	3.95	0.124	7.69	-	-
		患者、主动筛查人群、患者家庭成员等对无结核社区建设工作的满意度	4.19	0.148	26.92	3.99	0.137	11.54	0.361	0.066
	创新试点工作(修改前);建设进展(修改后)								0.435	0.141
		居民结核病防治核心知识知晓率(调整后)	4.47	0.108	42.31	4.09	0.114	11.54	0.433	0.061
		承担国家级及省级的创新性工作任务试点并按要求完成任务	4.15	0.123	19.23	3.79	0.157	3.85	0.340	0.048
		在无结核社区建设工作基础上,开展经省级认定为具有突破性、创新性的工作并取得显著成效	4.26	0.098	23.08	3.51	0.203	3.85	0.227	0.032

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指标	重要性			可获得性
指标	W值	χ²值	P值	W值	χ²值	P值
第一轮
一级指标	0.091	4.727	0.094	0.097	5.033	0.081
二级指标	0.416	140.472	<0.05	0.176	59.469	<0.05
三级指标	0.233	339.624	<0.05	0.199	289.212	<0.05
第二轮
一级指标	0.340	17.706	<0.05	0.311	16.179	<0.05
二级指标	0.275	85.727	<0.05	0.427	127.982	<0.05
三级指标	0.400	592.707	<0.05	0.377	558.035	<0.05

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