Vilnius D, Dandoy S
Division of Community Health Services, Utah Department of Health, Salt Lake City 84116-0660.
Public Health Rep. 1990 Sep-Oct;105(5):463-70.
When resources are limited, decisions must be made regarding which public health activities to undertake. A priority rating system, which incorporates various data sources, can be used to quantify disease problems or risk factors, or both. The model described in this paper ranks public health issues according to size, urgency, severity of the problem, economic loss, impact on others, effectiveness, propriety, economics, acceptability, legality of solutions, and availability of resources. As examples of how one State can use the model, rankings have been applied to the following health issues: acquired immunodeficiency syndrome, coronary heart disease, injuries from motor vehicle accidents, and cigarette smoking as a risk factor. In this exercise, smoking is the issue with the highest overall priority rating. The model is sensitive to the precision of the data used to develop the rankings and works best for health issues that are not undergoing rapid change. Cost-benefit and cost-effectiveness analyses can be incorporated into the model or used independently in the priority-setting process. Ideally, the model is used in a group setting with six to eight decision makers who represent the primary agency as well as external organizations. Using this method, health agencies, program directors, or community groups can identify the most critical issues or problems requiring intervention programs.
当资源有限时，必须就开展哪些公共卫生活动做出决策。一个纳入了各种数据来源的优先评级系统可用于量化疾病问题或风险因素，或两者兼而有之。本文所述模型根据问题的规模、紧迫性、严重程度、经济损失、对他人的影响、有效性、适当性、经济性、可接受性、解决方案的合法性以及资源的可用性对公共卫生问题进行排名。作为一个州如何使用该模型的示例，排名已应用于以下健康问题：获得性免疫缺陷综合征、冠心病、机动车事故伤害以及吸烟作为一种风险因素。在此次评估中，吸烟是总体优先评级最高的问题。该模型对用于制定排名的数据精度较为敏感，并且对于那些没有迅速变化的健康问题效果最佳。成本效益分析和成本效果分析可以纳入该模型，或者在确定优先事项的过程中单独使用。理想情况下，该模型在一个由六到八名决策者组成的小组中使用，这些决策者代表主要机构以及外部组织。通过使用这种方法，卫生机构、项目主管或社区团体可以确定最关键的问题或需要干预项目的问题。
