国际医疗质量指标体系及其特点

对"国际医疗质量评价指标体系"中评价急症性医疗机构医疗质量的基本临床指标进行了介绍。与国内目前所使用的医疗质量评价指标相比,该指标体系的主要特点是:更加注重医疗服务的结果和患者利益;更加关注"负性事件";更加强调指标的"可比性";指标的选择标准更加严格。     

美国责任医疗组织的制度设计与启示

责任医疗组织(ACOs)是美国的一种新兴卫生保健服务提供模式,《保护患者和平价医疗法案》(ACA法案)实施后在美国发展迅速。ACOs的提出是为了改变美国医疗服务碎片化的状况,并控制美国卫生费用,提高费用的使用效率。ACOs采取结余共享计划,联邦医疗保险与医疗服务中心打分测评ACOs的服务绩效和质量,ACOs信息共享与公开。ACOs模式鼓励市场自发建立医疗联合体整合卫生资源,收益分红激发卫生服务提供者的积极性,签订长期合同促使供方关注受益人健康水平,量化的卫生服务质量评价与收入直接挂钩促进质量提高,这些改革思路值得我国医疗领域借鉴。     

苏州市卫生综合效益研究报告

一、资料收集与指标选择 1.为保证资料的可靠性,本次研究中有关国民经济、医疗消费、职工工资等资料,均来自市统计局年报;卫生资源的分配使用及医院就诊人次以市卫生局年报为依据;对厂矿卫生机构、农村基层组织的业务情况及居民医疗需求等资料,采取随机抽样调查测算。 2.指标选择。根据科学性、系统性、敏感性、可靠性原则,选择4个方面23项指标,其中卫生投入指标5项;卫生资源投向指标4项,卫生机构服务能力及服务效率指标6项;经济效益指标2项;健康指标6项。 3.研究方法。采取典型研究、全市综     

美国医院质量评价体系及评价方法

介绍美国目前采用的四个医院质量评价体系,即美国年度最佳医院评价体系、美国百佳医院评价体系、国际医疗质量评价体系和医疗机构评审联合委员会评价体系。其中最佳医院评价体系是由基础建设指标、过程指标、结果指标三部分组成,先按专科领域进行排名,然后采用加权指数法计算医院质量指数,再根据医院专科排名和数量产生最佳医院。百佳医院评价体系是在同规模医院范围内,根据医院质量与安全指标评出百佳医院,评价指标包括风险调整死亡率指数、并发症指数、病情严重度调整平均住院日等8项。国际医疗质量和医疗机构评审联合委员会评价体系也在多个国家应用,用于评定临床医疗效率,在医疗质量临测和促进方面,享有较高的信誉。     

综合医院开展精神卫生医疗服务的探索

《中国精神卫生工作规划》(2002～2010年)提出，要提高国民精神健康的水平和享有精神卫生服务的水平，这是衡量一个国家社会稳定和文明程度的重要指标之一。我国精神科专业队伍的数量和质量均严重不足，其服务范围不足精神卫生需求的1％。这与我国的经济发展状况、医疗管理模式以及对精神卫生服务的认识水平紧密相关。     

美国的医疗服务组织

美国的卫生服务,根据卫生与社会事务部的分类有六类:预防、一级、二级(通科医院)、三级(专科医院)、康复医疗、医院后服务。     

深圳市2005年～2009年医疗服务质量的综合评价

以病人为中心提高医疗服务质量是医院发展永恒的主题[1].医疗服务质量直接影响到病人的生命和健康,也影响到医院的信誉和综合效益,是医院各项工作和综合实力的集中体现,是评价医院整体水平的重要指标.深圳市卫生和人口计划生育委员会(原深圳市卫生局)高度重视医疗服务质量管理工作,2002年以来,在全面推进三级、二级医院改造及大规模建设区域医疗中心和基本医疗服务网络的同时,吸收国内外医疗服务质量管理的新成果,并结合深圳市医疗卫生事业发展的实际情况,制定并连续几年实施了<医疗服务整体管理与质量控制>,使全市各级医疗机构朝着标准化、规范化的轨道迈进[2].     

我国常见病与罕见病住院患者医疗服务需求特点分析

目的:探索不同疾病类患者住院医疗服务需求的经济成本与治疗选择之间的关系。方法:通过计算家庭卫生筹资贡献率划分灾难性卫生支出疾病类型,应用需求函数模型预测常见病和罕见病患者住院需求的弹性系数。结果:罕见病成为灾难性疾病的比例更高;11种常见病和11种罕见病患者住院需求的价格弹性和收入弹性系数的估计值分别为-0.967、1.253和2.354、1.805。结论:我国常见病和罕见病患者的住院医疗服务均属奢侈性服务,罕见病患者的住院医疗服务需求短期呈现吉芬商品需求特点。     

利用加权秩和比法评价甘肃省各市州2011年医疗服务质量

目的 分析甘肃省医疗卫生服务质量现状,为政府部门优化卫生资源配置,提高医疗服务质量,提高医疗服务效率提供依据.方法 通过查阅文献、专家咨询等方法筛选12个医疗服务指标,采用加权秩和比法对甘肃省14个州市医疗服务质量进行评价.结果 经济较发达的兰州市、天水市、武威市医疗服务质量较高,经济欠发达的甘南藏族自治区医疗服务质量较差.经济较发达的银川市由于其管理模式的限制,医疗服务质量也较差.结论 甘肃省各市州医疗服务质量不仅与该地区的经济发展水平息息相关,而且与各地区医疗管理模式相关.政府需加大卫生投入,改善医疗卫生机构管理模式,提高各地医疗卫生服务质量.     

影响肉灌肠类制品卫生质量因素及控制

肉灌肠类制品卫生质量直接关系到消费者的身体健康,必须给予高度重视。齐齐哈尔市肉灌肠类制品的监测合格率近几年来一直保持80%以上,该类制品卫生质量所以能够得以保证,主要体现在原料肉的选择、修割、腌制、灌肠熟制加工、储运销售等过程中,掌握住起关键作用的环节,严格控制产品卫生质量。确定影响产品卫生质量的技术控制措施,是保证和提高产品卫生质量的关键因素。     

Physician turned politician

Robert Marder, M.D., went from medicine to politics the day he became project manager of indicator development at the Joint Commission on Accreditation of Healthcare Organizations. Just assembling the task forces was a challenge to represent all disciplines affected by clinical indicators.     

Collecting data for clinical indicators.

The Joint Commission for Accreditation of Healthcare Organizations is currently testing clinical indicators that will become an important part of hospital quality assurance programs. Implementation of clinical indicators may necessitate more extensive data collection than is now being done. This article reviews important considerations in the development of a data collection system that facilitates the evaluation of indicators of clinical performance. The evolution of the system currently used by the Nutritional Support Service at Pennsylvania Hospital is provided.     

Development and implementation of a nationwide health care quality indicator system in Taiwan.

QUALITY ISSUES: Quality is an increasingly important issue to the health care sector. The Taiwanese government also recognizes the need to implement a nationwide health care quality indicator system to strengthen quality surveillance. CHOICE OF SOLUTION: In 1999, the Department of Health funded a 2-year project led by the Taiwan Healthcare Executive College to develop a comprehensive performance assessment system, subsequently named as Taiwan Healthcare Indicator Series (THIS). The series includes four categories of indicators, namely outpatient, in-patient, emergency care, and intensive care, and has 139 items in total. IMPLEMENTATION: The system was officially launched in 2001. Participation is voluntary. The Taiwan Healthcare Executive College processes the data and provides feedback to the participating hospitals. The information is for the participating hospitals' own use and is not released to the public. EVALUATION: Participating hospitals have increased from 45 in 2001 to 227 in 2006 and now constitute approximately 50% of the total hospital population in Taiwan. The reporting rate averaged 77.7% in 2004. The first five most reported indicators are the percentage of first-visit outpatients to outpatient clinics, the average length of in-patient stay, the nosocomial infection rate, the occupancy rate, and the crude mortality rate. LESSONS LEARNED: How the data are interpreted and how data interpretation can lead to quality improvement are the principal concerns of participating hospitals. In light of the success of the indicator series, the Bureau of National Health Insurance (BNHI) of Taiwan has proposed participation in the series as being one of the criteria to be reimbursed for quality.     

JCAHO hits a wall with plan on indicators. Hospitals balk at costly and inefficient program to measure clinical outcomes

The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This cover story is the first installment of a two-part status report on the JCAHO. The first part examines the development of the JCAHO's clinical indicator monitoring system and its acceptance by hospitals and others, and the ability of the system to improve patient care The second part, to be published in an upcoming issue of Modern Healthcare, will focus on the JCAHO's efforts to position itself for reform.     

Clinical indicators in accreditation: an effective stimulus to improve patient care.

The Australian Council on Healthcare Standards (ACHS) established the Care Evaluation Program (CEP) of clinical performance measures in its accreditation program to increase the clinical component of that program and to increase medical practitioner involvement in formal quality activities in their health care organizations. From the introduction of a set of generic indicators in 1993 the program expanded through all of the various medical disciplines and from January 2000 there will be 18 sets (well over 200 indicators) in the program. More than half of Australia's acute hospitals (covering the majority of patient separations) are monitoring the indicators and reporting clinical data twice yearly to the ACHS. In turn they receive a 6-monthly feedback of aggregate and peer comparative results. The ACHS policy had no specific requirement for a set number of indicators to be monitored and it was not mandatory to achieve any specific data threshold to be accredited. However, where an organization's results differed unfavorably from those of its peers some action was expected. Qualitative information is also sent to the CEP and this has enabled a determination of the effectiveness of the indicators. There is documented evidence of improved management and numerous examples of improved patient outcomes. The program remains unique in the scope of the medical disciplines covered and in the formal provider involvement with indicator development. Both the clinical component of accreditation and clinician involvement in quality activities have been increased in an educational process. However, not all of the indicators are of equal value and a reduction in the number of indicators to a 'core' group of the most reliable and responsive ones is in process.     

我国评价医疗质量指标中存在的主要问题剖析

以国际医疗质量评价指标体系为基准，对国内目前所使用的医疗质量评价指标进行分析．发现国内目前评价医疗质量所使用的指标存在着如下主要问题：（1）现行指标与现代医疗服务质量概念和指标设计原则之间存在较大差距：（2）现行评价医疗质量的指标没有形成完整的体系；（3）现行指标在科学性、客观性和准确性方面存在较大问题：（4）过多使用“间接指标”。     

医疗质量及其评价指标概述

医疗质量指标作为质量评价的重要工具,需要从大量的科学研究和应用实践中提炼得到,并经过效度、精度等方面深入、系统的分析,使评价结果的偏倚达到最小。很多国家和组织已逐步建立了自己的医疗质量评价方法和指标体系,并且广泛应用于医疗质量管理。我国目前还没有成熟的、可用于医疗质量评价和控制的主流指标体系,传统的指标大多未经过深入、系统的考核,也没有完善的患者分类和指标调整方案,结果缺乏真实性和权威性,未能发挥指导医疗质量改进的作用。急需借鉴国外经验,加强医疗质量评价方法研究。     

Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access

Background  

The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes.     

Health and environmental indicator systems in health institutions

This article presents a discussion on conceptual and methodological aspects involved in the establishment of a system of indicators for Health and Environment, with the purpose of integrating the management of research, education and health services institutes while also taking Biosafety into account. The initial task was the study of international indicator models, paying special attention to the World Health Organization model, more apropriate to this article, which was used in the process of collection, organization and synthesis of data. This work aims to create methodological instruments for the monitoring and evaluation of these procedures and support the decision making process.