Establishment Of A Preliminary Index Model For Evaluating Medical Personnel's Abilities Of Responding To Public Health Emergencies

BackgroundThe public health emergency refers to major infectious diseases,community diseases of unknown causes,major food and occupational poisoning and other serious events that occur suddenly and cause or threaten to cause serious harm to the public health.It is characterized by abruptness,unexpectedness,heavy damages to society,economy and community,unity and coordination in handling the events,as well as the risk and timeliness of decision-making.Since the occurrence of SARS in 2003,the public health emergency has become the focus of attention.According to the information released by the Chinese Ministry of Health,2,552 public health emergencies occurred in 2007,reported through the Information System of Public Health Emergency Management,involving 98,254 people and causing 515 deaths in 31 provinces,autonomous regions and municipalities throughout the country,except Hong Kong,Macao and Taiwan.This shows that the situation of China's annual public health emergency is relatively grim.Medical workers are proved to be the main force in response to public health emergencies.Take the Wenchuan earthquake for example,it involved approximately 100,000 medical workers in medical rescue and epidemic prevention,with some 4.37 million person-times treated,nearly 40,000 operations performed,over 90,000 hospital admissions,and more than 10,000 transferees to the other parts of the country.Purpose and SignificanceIn response to public health emergencies,people are gradually becoming aware of the necessity of strengthening the management of hospital emergency human resources.According to the medical treatment system,especially the hospital's responsibility and role in dealing with public health emergencies,it is of vital importance and practical significance to establish a scientific,rational and reliable comprehensive evaluation system against public health emergency.Based on this system,anti-emergency personnel are selected,organized,trained and reserved,a highly efficient fast-reaction contingent is established,and the hospital's comprehensive ability is raised in coping with public health emergency.MethodsFirst of all,through the analysis of literature,reference standards and specialist consultation,based on strict compliance with the general principles for constructing the comprehensive evaluation index system,the preliminary framework of the index system was designed for evaluating medical personnel's abilities of coping with a public health emergency.Using the Delphi method,the first specialist consultation was held to grade each of the evaluation indexes into 5 levels:extremely important, very important,important,less important and unimportant,given the corresponding quantitative value of 10,7.5,5,2.5 and 0,respectively.Then the indexes were revised according to the feedback from the specialists and the results of comprehensive analysis.The main purpose of the second Delphi specialist consultation was to obtain the weight of each index.According to the average scores of the specialists' evaluation of the indexes,the mean cumulative score was calculated for each index in proportion to the total score,as the weight coefficient of the index.Based on this,a linear model of medical personnel's abilities of dealing with public health emergency was established.The main method used in this study was Delphi,in which the selection of specialists plays a key role.Therefore,we decided upon 31 specialists as advisers who met the six basic requirements previously set.All were consulted in the first round,and all but two in the second. Structure and authority analyses of the selected specialists showed that they were typically representative,well experienced in dealing with public health emergency, with perfect knowledge of its occurrence and development,and the qualities and abilities required of medical personnel,which ensured the accuracy and reliability of the investigation results.The results of quality control of the two Delphi specialist consultations were reflected in the rate of responses and the coordination coefficient of the specialists.ResultsAfter the first Delphi specialist consultation,the structure of some indexes was readjusted,their implications specified,and the evaluation indexes for medical personnel's abilities of dealing with public health emergency according to the specialists' revision proposals.The first-level indexes were concerned with general data,knowledge system and practical skills.General data included age,work eXperience,education,professional title,health,academic position and background as the second-level indeXes;knowledge system included the basic cognition,basic knowledge,eXpertise,management know-how,legal knowledge,psychological knowledge as the second-level indeXes;practical skills included professional skills, training background,drilling eXperience,communication and coordination ability as the second-level indeXes.All this constituted a complete two-level evaluation system of indeXes for evaluating medical personnel's abilities of dealing with public health emergency.The weights of both the first- and second-level indeXes were achieved through the second Delphi specialist consultation.The initial linear model of evaluating medical personnel's abilities of dealing with public health emergency was established as follows:Y = 0.281 X₁ + 0.344 X₂ + 0.375 X₃.X₁ = 0.124X₁₁+0.147 X₁₂+0.128 X₁₃+0.145 X₁₄+0.181 X₁₅+0.061 X₁₆+ 0.215 X₁₇;X₂ = O.I68X₂₁+0.164 X₂₂+0.178 X₂₃+0.129 X₂₄+0.132 X₂₅+0.142 X₂₆+ 0.087 X₂₇;X₃ = 0.23X₃₁+0.203 X₃₂+0.205 X₃₃+0.18 X₃₄+0.182 X₃₅.Y represents the comprehensive evaluation scores; X₁-X₃ represent the scores on the 3 first-level indeXes; X₁₁-X₁₇ represent the scores on the 7 second-level indeXes of general data;X₂₁-X₂₇ represent the scores on the 7 second-level indeXes of knowledge system;X₃₁-X₃₅ represent the scores on the 5 second-level indeXes of practical skills.The comprehensive score and the score on an individual indeX were made by the hundred- or thousand-mark system according to the specific circumstances.As to the effect of quality control,the answer rates were 100%and 94%and the coordination coefficients were 0.448 and 0.765 in the two specialist consultations. The results of theχ² test of the coordination coefficients showed statistical significance.Discussion and ConclusionThis study was conducted against the background of the frequentness and variety of public health emergencies in recent years,which led to the requirement of increased number of related medical personnel,focusing on public health emergency human resources management of the hospital and medical personnel's abilities of dealing with public health emergency.The Delphi method and statistical analysis were employed in the investigation the evaluation indeXes of medical personnel's abilities of dealing with public health emergency,and the establishment of an initial comprehensive evaluation model. Characterization of the Study1.Originality of the evaluation index systemIt is the first evaluation index system ever established for assessing medical personnel's abilities in response to public health emergency.The scientific,objective and comprehensive assessment of the subjects is the core value and the main purpose of the evaluation index system.It is a large and complex system,with hardly any existing literature available for reference.2.Objectivity of the evaluation index systemThis index system aimed at the comprehensive evaluation of the abilities.The ability,as an abstract concept,is the innate potential of human beings by nature,with very few objective indexes and real difficulty for direct evaluation.In the choice of the indexes,we decided upon the strongly subjective ones,with emphasis on their comparability and maneuverability.3.Adaptability of the evaluation index systemThe subjects to be evaluated by the index system were different types of medical personnel,varying widely in professional backgrounds,division of responsibilities and characteristics of work.In this study,we paid special attention to the universality of the indexes to be included,so that they could be applicable to the evaluation of all types of medical personnel involved in public health emergency.4.Integration of a variety of methodsThis study drew much on the Delphi method.In order to ensure the accuracy and reliability of the results of the specialist consultations,strict criteria were set for the selection of the specialists,who were required to have not only rich practical experience but also high academic positions.In addition to the Delphi method,we used various other methods,such as literature reviews,specialist interviews, statistical analyses,and the combination of subjective and objective ones,so as to best ensure the accuracy and reliability of the results of the evaluation index system.In this study,we established a framework of the evaluation index system for medical personnel's abilities in response to a public health emergency,specified the first-and second-level evaluation indexes,and set the corresponding weight coefficients,but did not conduct the actual assessment.Therefore the effect of the evaluation system is yet to be confirmed by further empirical researches,which could be conducted by such methods as multi-mathematical statistics and specialist evaluation score to test and improve the reliability,validity and practicability of the evaluation index system.Besides,standardized criteria should be established in the theoretical evaluation index system for the assessment of those of different specialties.And the coefficients of difficulty should be consistent in the examinations on the expertise and skills of medicine,pharmacology,nursing, medico-technology,medical management,and so on.The model established in this study is but a simple preliminary linear one.As the evaluation indexes are easily influenced by the complexity of public health emergencies,the variety of medical personnel and the consequent variability of evaluation indexes,the determination of the indexes and the methods to be used have to be optimized and perfected in the future practice.