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首页> 外文期刊>BMC Public Health >Putting health metrics into practice: using the disability-adjusted life year for strategic decision making
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Putting health metrics into practice: using the disability-adjusted life year for strategic decision making

机译：将健康指标付诸实践：使用残疾调整生命年进行战略决策

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BackgroundImplementing organizations are pressured to be accountable for performance. Many health impact metrics present limitations for priority setting; they do not permit comparisons across different interventions or health areas. In response, Population Services International (PSI) adopted the disability-adjusted life year (DALY) averted as its bottom-line performance metric. While international standards exist for calculating DALYs to determine burden of disease (BOD), PSI's use of DALYs averted is novel. It uses DALYs averted to assess and compare the health impact of its country programs, and to understand the effectiveness of a portfolio of interventions. This paper describes how the adoption of DALYs averted influenced organizational strategy and presents the advantages and constraints of using the metric.MethodsHealth impact data from 2001-2011 were analyzed by program area and geographic region to measure PSI's performance against its goal of doubling health impact between 2007-2011. Analyzing 10 years of data permitted comparison with previous years' performance. A case study of PSI's Asia and Eastern European (A/EE) region, and PSI/Laos, is presented to illustrate how the adoption of DALYs averted affected strategic decision making.ResultsBetween 2007-2011, PSI's programs doubled the total number of DALYs averted from 2002-2006. Most DALYs averted were within malaria, followed by HIV/AIDS and family planning (FP). The performance of PSI's A/EE region relative to other regions declined with the switch to DALYs averted. As a result, the region made a strategic shift to align its work with countries' BOD. In PSI/Laos, this redirection led to better-targeted programs and an approximate 50% gain in DALYs averted from 2009-2011.ConclusionsPSI's adoption of DALYs averted shifted the organization's strategic direction away from product sales and toward BOD. Now, many strategic decisions are based on "BOD-relevance," the share of the BOD that interventions can potentially address. This switch resulted in more targeted strategies and greater program diversification. Challenges remain in convincing donors to support interventions in disease areas that are relevant to a country's BOD, and in developing modeling methodologies. The global health community will benefit from the use of standard health impact metrics to improve strategic decision making and more effectively respond to the changing global burden of disease.
机译：背景实施组织面临着对绩效负责的压力。许多健康影响指标为优先级设置提供了限制;他们不允许对不同干预措施或健康领域进行比较。作为回应，国际人口服务组织（PSI）采用了避免残障调整生命年（DALY）作为其底线绩效指标。尽管存在国际标准来计算DALY以确定疾病负担（BOD），但PSI对避免使用DALY的使用是新颖的。它使用避免的DALY评估和比较其国家计划对健康的影响，并了解一系列干预措施的有效性。本文描述了DALYs的采用如何避免了组织战略的影响，并提出了使用该指标的优势和约束条件。方法通过按计划区域和地理区域分析2001-2011年的健康影响数据，以衡量PSI的绩效，以实现其将健康影响增加一倍的目标2007-2011。分析10年的数据可以将其与前几年的性能进行比较。本文以PSI的亚洲和东欧（A / EE）地区以及PSI /老挝为例，说明采用DALY避免了如何影响战略决策。结果2007-2011年间，PSI的计划使避免DALY的总数增加了一倍从2002年至2006年。避免的大多数残疾调整生命年均在疟疾之内，其次是艾滋病毒/艾滋病和计划生育。 PSI的A / EE区域相对于其他区域的性能下降，这是因为避免了改用DALY。结果，该地区进行了战略调整，以使其工作与各国的BOD保持一致。在PSI /老挝，这种重新导向导致了针对性更强的计划，并且从2009年到2011年避免了DALY的大约50％的增长。结论PSI对DALY的采用避免了组织的战略方向从产品销售转向BOD。现在，许多战略决策都基于“ BOD相关性”，即干预可能解决的BOD份额。这种转变导致了更具针对性的战略和更大的计划多样化。在说服捐助者支持与国家BOD相关的疾病领域的干预以及开发建模方法方面仍然存在挑战。全球卫生界将从标准健康影响指标的使用中受益，以改善战略决策并更有效地应对不断变化的全球疾病负担。

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