Simoes Eduardo J, Land Garland, Metzger Robert, Mokdad Ali
Prevention Research Centers Program, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
J Public Health Manag Pract. 2006 Mar-Apr;12(2):161-9. doi: 10.1097/00124784-200603000-00008.
Although setting priorities is an important step in making public health policy, the benefit of using epidemiology to prioritize scarce public health resources has not been fully recognized. This situation is mostly due to the complexity of proposed models for setting priorities. We describe a public health priority setting model, Missouri Information for Community Assessment Priority Setting Model (Priority MICA), which uses epidemiologic measures available in most surveillance systems across the United States. Priority MICA uses data from birth and death certificates, hospital discharges, emergency departments, risk factors from the Behavioral Risk Factors Surveillance System, and eight epidemiologic measures to construct six priority criteria: size (the number of emergency department visits, hospitalizations, and deaths), severity (number of deaths of people younger than 65), urgency (trends in deaths and hospital morbidity), preventability (evidence-based score), community support (score of social support for preventive action), and racial-disparity (race comparison through death and morbidity rate ratio). Priority MICA is part of a Web-based interactive tool that makes available data from a wide variety of surveillance systems (http://www.dhss.mo.gov/MICA). The top 10 priority diseases determined by Priority MICA were compared to a more traditional method of ranking diseases by mortality rates. Using the additional criteria in Priority MICA identified four more priority diseases than were identified using just mortality while the ranking of the other six priority diseases differed between methods.
尽管确定优先事项是制定公共卫生政策的重要一步，但利用流行病学来确定稀缺公共卫生资源的优先次序所带来的益处尚未得到充分认识。这种情况主要是由于所提出的确定优先事项模型的复杂性。我们描述了一种公共卫生优先事项确定模型，即密苏里州社区评估优先事项确定信息模型（Priority MICA），该模型使用美国大多数监测系统中可用的流行病学指标。Priority MICA利用出生和死亡证明、医院出院记录、急诊科数据、行为风险因素监测系统中的风险因素以及八项流行病学指标来构建六个优先标准：规模（急诊科就诊、住院和死亡人数）、严重程度（65岁以下人群的死亡人数）、紧迫性（死亡和医院发病率趋势）、可预防性（循证评分）、社区支持（对预防行动的社会支持评分）以及种族差异（通过死亡率和发病率比进行种族比较）。Priority MICA是一个基于网络的交互式工具的一部分，该工具提供来自各种监测系统的数据（http://www.dhss.mo.gov/MICA）。将Priority MICA确定的前10种优先疾病与一种更传统的按死亡率对疾病进行排名的方法进行了比较。使用Priority MICA中的额外标准比仅使用死亡率确定的优先疾病多四种，而其他六种优先疾病的排名在两种方法之间有所不同。
