济南市新型冠状病毒肺炎疫情急救资源分配和使用效能的实证与经验分析
Empirical and experiential analysis of pre-hospital coronavirus disease 2019 epidemic emergency care resource allocation and usage in Jinan
摘要目的:通过分析济南市新型冠状病毒肺炎(新冠肺炎)疫情期间疫情急救资源的分配与使用特点,发现疫情急救资源的分配问题,探讨提高疫情急救资源分配效率与使用效能的方法。方法:通过实证分析判断2020年1月24日至6月30日济南市疫情急救资源分配数据是否与新冠肺炎疫情流行病学数据来自同一总体,以证明疫情急救资源分配是否与新冠肺炎疫情发展状况有效贴合。其中流行病学数据(确诊病例人数、疑似病例人数、疑似病例留存人数、医学观察中人数、密切接触者人数)来源于济南市与山东省卫生健康委员会(卫健委)每日疫情信息公布;疫情急救资源分配数据(疫情车组出车次数)来源于济南市市区多家急救分中心的出车统计随访。同时随访了各急救分中心疫情车组医护人员的具体工作状况与接诊病例细节,经验分析指出疫情急救资源在具体使用中的低效能现象。结果:疫情急救资源分配数据与任意一个所考察的流行病学意义指标不属于同一总体,出车增量与确诊增量、疑似增量、疑似存量、密接增量均无相关性(均 P<0.05),出车增量与医观存量有相关性但相关性极弱〔相关系数为0.048,∈(0.0,0.2), P=0.550〕。说明疫情急救资源分配与疫情流行病学指标存在系统性差异,不能有效贴合。通过对随访获得的医护人员工作状况与部分病例的经验分析可知,疫情急救资源的使用存在分配不够精细、基层单位低效、无效呼救等效能浪费现象。 结论:加强调度中心的业务能力,建立初筛环节减少效能浪费;加强社区、单位的综合防疫能力,辅助急救系统;加强普通车组的防疫能力,提高综合救治水平。
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abstractsObjective:To find effective methods to improve the distribution and usage efficiency of pre-hospital epidemic emergency care resource (PEECR) by analyzing the PEECR allocation and usage in Jinan City during the coronavirus disease 2019 (COVID-19) epidemic.Methods:Correlation significance test between the COVID-19 epidemiology sample and the PEECR allocation sample was conducted to estimate whether they came from the same population in Jinan from January 24 to June 30, 2020. The data used in empirical analysis were collected from the Health Commission of Shandong Province's daily epidemic information announcement (definite case increment, suspected case increment, suspected case stock, medical observation stock, close contact increment) and interview with some epidemic branch centers in Jinan City (vehicle using increment). Experiential analysis was used to analyze the waste of PEECR usage.Results:All the 5 COVID-19 epidemiology samples and the PEECR allocation sample came from different population. There was no correlation between the vehicle using increment and definite case increment, suspected case increment, suspected case stock, close contact increment (all P < 0.05), there was a weak correlation between the vehicle using increment and medical observation stock [the correlation coefficient was 0.048, ∈ (0.0, 0.2), P = 0.550]. There was systematic difference between PEECR indicator and COVID-19 epidemiology indicator. The waste in practice was also amplified by improper usage such as unsophisticated allocation, low effectiveness in primary units and unvalid emergency calling. Conclusions:① A primary screening system should be established in control center to decrease the waste of efficiency. ② Communities and units should improve overall epidemic dealing ability to assist emergency system. ③ The medical treatment ability and protection resource should be increased in normal pre-hospital care.
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