2009 年 H1N1 大流行期间学校关闭决策的差异：一项定性系统改进分析。
Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis.
机构信息
Jefferson University School of Population Health, 105 Walnut Street, Philadelphia, Pennsylvania 19107, USA.
出版信息
BMC Public Health. 2011 Feb 1;11:73. doi: 10.1186/1471-2458-11-73.
BACKGROUND
School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making.
METHODS
We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members.
RESULTS
There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance.
CONCLUSIONS
The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly.
背景
学校关闭是针对大流行 2009 H1N1 的非药物干预措施，特别是在第一波期间。美国有超过 700 所学校关闭。然而，关闭决策反映了在关闭理由、决策触发因素和关闭权限方面存在显著差异。这种可变性为提高效率和决策提供了机会。
方法
我们通过监测高知名度的来源并搜索 Lexis-Nexis 和 Google 新闻警报，以及审查有关关键主题的报告，来识别与 2009 H1N1 大流行作为应对措施而关闭学校的媒体报道。新闻报道还通过观察与卫生部门和学校官员的电话会议和会议以及与决策者和社区成员的讨论得到补充。
结果
关闭决策的陈述目标存在显著差异，包括限制病毒在社区中的传播、保护特别脆弱的学生以及应对员工短缺或学生缺勤问题。由于关闭的目标与其时间、性质和持续时间有关，因此关闭理由不明确可能会影响其效果。不同司法管辖区关闭学校的决策权限也存在显著差异，在某些情况下，这反映了学校和公共卫生官员之间存在明显分歧。最后，决策者似乎没有预料到大流行早期遇到的科学不确定性程度，并且他们经常对疾病预防控制中心指导意见的不断变化表示出极大的沮丧。
结论
通过确保官员阐明关闭的目标并根据这些目标调整关闭决策，可以改进将学校关闭作为传染病公共卫生应对措施的使用。此外，应事先明确关闭学校的权限，决策者应预期在疾病紧急情况出现时会遇到不确定性，并相应地进行计划。
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