Miller C A, Moore K S, Richards T B, McKaig C
Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill 27599-7400.
Public Health Rep. 1994 Sep-Oct;109(5):659-64.
Current studies are attempting to develop a national surveillance system to measure the extent that populations are served by local departments carrying out the core functions of public health. Early phases of the study featured observations on 14 health departments that have been subjects of a longitudinal study. These departments were surveyed using a protocol with 81 different indicators. The results permitted distinctions to be made among the departments on levels of performance according to core functions and their associated practices. To simplify the survey protocol so that it might be suitable for use with a large number of local public health jurisdictions, a subset of 26 indicators was selected from the previously developed protocol. Each indicator in the subset was linked with one of the three core functions of public health and with one of the associated practices. In an effort to display correlation between scores on the simplified survey and those in the full survey, scatter plots were prepared for overall scores and for those pertaining to each function and practice. Stepwise regressions were done to determine which queries or groups of queries were most predictive of variations in the screening responses. Four questions accounted for 96 percent of the variance in responses for overall performance. Results suggest that a three-tiered approach to the evaluation of local public health performance might be feasible. For the study departments, responses to four questions could be used to screen overall public health performance; responses to 26 questions could be used to yield information about performance of each of the three core public health functions; and responses to 84 questions could be used to yield more detailed information about performance for each of 10 public health practices. Experience with a larger set of departments might revise the number and nature of the screening queries.
当前的研究正试图建立一个国家监测系统，以衡量地方部门履行公共卫生核心职能时服务民众的程度。该研究的早期阶段对14个卫生部门进行了观察，这些部门是一项纵向研究的对象。使用包含81个不同指标的方案对这些部门进行了调查。结果能够根据核心职能及其相关实践区分各部门的绩效水平。为简化调查方案，使其适用于大量地方公共卫生辖区，从先前制定的方案中选取了26个指标组成一个子集。子集中的每个指标都与公共卫生的三项核心职能之一以及一项相关实践相联系。为了展示简化调查得分与完整调查得分之间的相关性，绘制了总体得分以及与每项职能和实践相关得分的散点图。进行了逐步回归分析，以确定哪些问题或问题组对筛查反应的变化最具预测性。四个问题解释了总体绩效反应中96%的方差。结果表明，对地方公共卫生绩效进行三层评估的方法可能是可行的。对于参与研究的部门，对四个问题的回答可用于筛查总体公共卫生绩效；对26个问题的回答可用于获取关于三项公共卫生核心职能各自绩效的信息；对84个问题的回答可用于获取关于10项公共卫生实践各自绩效的更详细信息。对更多部门的经验可能会改变筛查问题的数量和性质。
