综合性医院绩效评价的现状调查与分析

目的了解医院绩效评价现状与存在的主要问题,为医院探索新的绩效评价方法和构建以战略为导向的绩效评价体系提供依据。方法采用问卷调查法获得医院绩效评价的基本数据,运用统计描述法对问卷进行分析。结果现行医院的绩效评价缺乏系统性,与外部环境相脱节,未能反映利益相关者需求,在指标设计时缺少员工参与,重视短期财务结果,在实施、反馈等方面缺乏有效沟通,绩效考评没能实现与医院战略的有效连接。结论现行绩效评价体系同医院战略脱节,未能有效体现医院战略,评价指标侧重于医院内部评价与财务类指标,而忽视非财务类指标,绩效评价指标设置与评价结果的应用存在矛盾。     

黑龙江省县级医院绩效评价指标体系构建研究

目的构建适用于黑龙江省县级医院的绩效评价模型和指标体系,为县级医院开展绩效评价、改善绩效管理提供决策参考。方法应用文献分析法和专题小组讨论法构建评价模型和初始指标库,运用专家咨询法筛选评价指标并确定指标权重。结果运用关键绩效指标理念构建了以工作质量、工作效率、医疗费用、综合管理及满意度评价为核心维度的县级医院绩效评价模型及指标体系。结论指标体系的可信程度较高,能有效反映县级医院绩效管理的核心环节。     

三甲医院绩效评价指标体系构建研究

目的 为了客观地考核三甲医院的整体绩效,提高医院的工作效率,增强三甲医院的综合竞争力,应该以医院的战略为目标,从更为完整的体系和更为实际的层面出发,设计出全面的绩效评价指标体系,为医院自我评价提供参考依据,也为卫生行政部门检查、评价医院提供参考指标.方法 采用Delphi专家咨询建立评价模型和进行指标筛选以及确定权重.结果 运用关键绩效指标法构建了三甲医院绩效评价指标体系.结论 从战略的视角构建了三甲医院绩效评价指标体系,为三甲医院改善绩效管理提供参考,有助于三甲医院战略目标的实现,为医院的可持续、健康的发展奠定了坚实的基础.     

综合医院绩效评价指标体系的设计

目的为卫生主管部门准确评价医院经营绩效、医院加强科学管理提供一套科学、完整的医院绩效评价指标体系。方莹用多种统计学方法筛选指标,用层次分析法确定各层次指标的权重系数,用综合指数法评价医院绩效大小,并比较排序．数据分析用PEMS3．Oforwindows统计软件。结果从资源配置等8个方面共50余项指标中选出46个基本指标,再从中筛选出24个指标组成医院绩效评价指标体系：用层次分析法确定了各层次指标的权重系数：用综合指数法评价了医院绩效大小。结论指标体系设计科学全面、权重系数的确定合理,评价结果符合实际,可适用于综合医院的绩效评价。     

医院感染防控绩效评价体系构建研究

目的建立契合医院感染防控实际的绩效评价体系,用于科学评价医院感染防控工作。方法应用头脑风暴法、文献荟萃法等建立指标池,通过咨询专家组完成指标的筛选、层次构建、评价和权重计算。结果成功构建医院感染防控绩效评价体系,包含一级指标3个、二级指标17个、三级指标27个。咨询信度Cronbach's α系数为0.901,内容效度指数为 0.800～1.000。结论构建的医院感染防控绩效评价体系可对医院感染管理工作进行科学、客观地评价。     

医院绩效评价指标设定探讨

目的 设定医院绩效评价指标.方法 在文献研究的基础上,以关键业绩指标法作为构建评价指标体系的基本方法,对文献资料比较分析进行定性研究.结果 根据指标需要满足的特点,归纳并设定包含物力资源、发展能力、医疗质量、工作效率、经济状况、社会效益、服务质量、病人负担情况、教育指标、预防指标、组织管理和医护定位等12个一级指标的医院绩效评价指标.结论设定适当指标,客观、公正地评价医院的整体绩效,有利于了解医院面临的机遇和挑战,从而提高医院的工作效率,增强医院的综合竞争力.     

基于平衡计分卡构建军队医院绩效评价指标体系

目的：构建一套合理、有效的军队医院绩效评价指标体系。方法：本文主要采用层次分析法（AHP）和Saaty’s权重法,确定医院绩效评价的三级指标及其权重。结果：构建了一套军队医院BSC绩效评价指标体系,该体系包括4个一级指标,12个二级指标,41个三级指标。结论：平衡计分卡从多个维度评价军队医院管理状况,有利于医院进行持续的质量改进,提高管理水平和服务能力。     

综合指数法在广西某三甲医院科研绩效评价中的应用分析

目的 运用综合指数法对广西某三甲医院科研绩效进行评价,探讨该方法在医院科研绩效评价中的合理性和实用性.方法 选择5个常用的科研绩效评价指标,通过专家咨询打分赋予各层指标相应权重,各项指标按照权重系数最低的分指标进行折算,采用综合指数法对该院2007-2012年科研绩效进行综合评价.结果 通过综合指数法计算,得到最终排序结果,该院2012年度的科研绩效综合指数为2.413,综合评价最优;2007年度的科研绩效综合指数为0.138,综合评价最劣.结论 综合指数法评价结果切合实际,具有一定的合理性和实用性,能综合评价医院科研绩效.     

基于网络环境建立的医院绩效评价体系与评价方法

目的探讨基于网络环境下的医院绩效评价体系与评价方法。方法采用系统综合集成法建立绩效评价体系,将专家体系、统计数据和信息资料、计算机技术三者有机结合,建立医院绩效评价计算机管理系统。结果引入平衡记分卡的考核技术,对常州市第二人民医院9个评价对象2005年度医院绩效数据进行了模拟评价。结论 ＂基于网络环境建立的绩效评价体系与评价方法＂适用于各级医院,并适合不同考核技术的应用,但需结合各医院的实际情况,在指标选定、指标权重和考核体系上进行必要调整。     

国外医院绩效评价的比较分析与对我国的启示

医院绩效评价已在各国的卫生系统得到普遍认可.许多国家都建立了医院绩效评价指标,开展了绩效评价工作.但因国情与制度不同,各国的绩效评价方案也有所不同.通过从评价维度、结果反馈与应用方面对英国、美国、澳大利亚、荷兰的医院绩效评价方案和WHO在欧洲实施的绩效评价项目进行归纳与分析,总结其医院绩效评价方面的特点,为我国医院绩效评价提供可供借鉴的经验.     

An evidence-based evaluation of quality and efficiency indicators

The goal of this study was to identify and appraise quality and efficiency indicators relevant to hospitals or physicians' practices by performing a systematic literature search. Process indicators were limited to 11 diagnoses and treatments. To appraise the indicators identified, a framework for grading health care recommendations was expanded to categorize evidence on cost-effectiveness. Seven indicators of structural quality and 34 indicators of process quality were identified and appraised. The set of performance indicators could serve as a state-of-the-art system of measurement for governments and organizations evaluating the quality and efficiency of health care.     

军队医院信息化水平评价与实证分析

本研究采用专家咨询和层次分析法构建了6个一级指标、24个二级指标和74个三级指标的军队医院信息化发展水平评价指标体系。并对某区6所军队医院进行实证研究,研究表明军队医院的信息化总体发展良好,医院间水平存在较大差距,信息化建设发展也不平衡。测算结果与实际情况基本相符,对军队医院信息化的测评工作有较强的参考价值。     

转型期县级医院竞争力提升（一）——县级医院竞争力定量测评体系

新医改进入攻坚阶段之后,2010年,16个城市作为国家试点开启了公立医院改革的大幕。在2010年底,卫生部明确宣布建立重点联系县医院工作机制,年初,卫生部又在2011年卫生工作要点中指出,今年要优先发展县级医院,可见,作为农村三级医疗卫生服务网络的龙头,数量众多的县级医院的生存与发展成为影响医改成败的重要因素。     

Novel indicator for the assessment of hospital bed occupancy

In the past decades the bed occupancy of hospitals in Hungary has been calculated from the average of in-patient days and the number of beds during a given period of time. This is the only measure being currently looked at when evaluating the performance of hospitals and changing their bed capacity. The author outlines how limited is the use of this indicator and what other statistical indicators may characterize the occupancy of hospital beds. Since adjustment of capacity to patient needs becomes increasingly important, it is essential to find indicator(s) that can be easily applied in practice and can assist medical personal and funders who do not work with statistics. Author recommends the use of daily bed occupancy as a base for all these statistical indicators.     

军队大型综合医院研究型医师选拔评价体系构建

目的：探讨科学合理的军队大型综合医院研究型医师的选拔评价体系。方法采用德尔菲法组织两轮专家函询,汇总专家意见,确定指标命名、权重及最低标准说明等。结果建立由个人情况、医疗特色和水平、教学工作、科研工作等4项一级指标、10项二级指标和20项三级指标构成的军队大型综合医院研究型医师的选拔评价体系。结论军队大型综合医院研究型医师的选拔和评价体系,是选拔和评价研究型医师及推进医院人才队伍建设的基础和保证。     

Measuring the Performance of Critical Access Hospitals in Missouri Using Data Envelopment Analysis

Purpose: Rural hospitals are critical for access to health care, and for their contributions to local economies. However, many rural hospitals, especially critical access hospitals (CAHs) need to strive for more efficiency for continued viability. Routinely evaluating their performance, and providing feedback to management and policy makers, is therefore important. Method: Three measures of relative efficiency are estimated for CAHs in Missouri using an Input‐oriented Data Envelopment Analysis with a variable returns to scale assumption and compared with the efficiency of other rural hospitals in Missouri using Banker's F‐test. Using 30‐day readmission rate as a measure of quality, CAHs are evaluated against efficiency‐quality dimensions. Findings: CAHs in Missouri had a slight decline in average technical efficiency, but they had a slight gain in average cost efficiency in 2009 compared to 2006. More than half of the CAHs were neither economically nor technically efficient in both years. The relative efficiency of other rural hospitals was statistically higher than that of CAHs in Missouri. Conclusions: This study validates the finding of relative inefficiency of CAHs compared to other hospitals paid under the Prospective Payment System at a state level (Missouri). However, with considerable variation in socioeconomic as well as health care access indicators across states, a relative efficiency frontier may not be the only relevant indicator of value for the evaluation of the performance of CAHs. Access to health care and the impact on the local economy provided by these CAHs to the community are also critical indicators for more comprehensive performance evaluation.     

医院无形资产评估指标体系的构建

运用系统论、专家咨询法、统计学等方法及理论对无形资产进行评估,初步建立了一套较为科学、完整、简便易行、适用于我国医院无形资产现状的评估指标体系。经过6所医院实际测评,评估结果较符合实际情况,从而进一步证实了医院无形资产评估指标体系的科学性和可行性。     

Comparing a multivariate response Bayesian random effects logistic regression model with a latent variable item response theory model for provider profiling on multiple binary indicators simultaneously

Provider profiling entails comparing the performance of hospitals on indicators of quality of care. Many common indicators of healthcare quality are binary (eg, short-term mortality, use of appropriate medications). Typically, provider profiling examines the variation in each indicator in isolation across hospitals. We developed Bayesian multivariate response random effects logistic regression models that allow one to simultaneously examine variation and covariation in multiple binary indicators across hospitals. Use of this model allows for (i) determining the probability that a hospital has poor performance on a single indicator; (ii) determining the probability that a hospital has poor performance on multiple indicators simultaneously; (iii) determining, by using the Mahalanobis distance, how far the performance of a given hospital is from that of an average hospital. We illustrate the utility of the method by applying it to 10 881 patients hospitalized with acute myocardial infarction at 102 hospitals. We considered six binary patient-level indicators of quality of care: use of reperfusion, assessment of left ventricular ejection fraction, measurement of cardiac troponins, use of acetylsalicylic acid within 6 hours of hospital arrival, use of beta-blockers within 12 hours of hospital arrival, and survival to 30 days after hospital admission. When considering the five measures evaluating processes of care, we found that there was a strong correlation between a hospital's performance on one indicator and its performance on a second indicator for five of the 10 possible comparisons. We compared inferences made using this approach with those obtained using a latent variable item response theory model.     

Quality indicators of hospital care: evaluation of patient care in acute myocardial infarction]

In the international hospital accreditation programs there is an increasing emphasis on involving performance indicators. The inpatient mortality rate of AMI patients and the usage of thrombolytic therapy are very common, evidence based indicators of these programs. The authors goal was to analyze the applicability of these indicators in the evaluation of the Hungarian hospital care. In Hungary, there is a data collection system on every inpatient case. This database was used to determine the above mentioned two indicators for 1997 and 1998. They calculated by hospital group level, by institutions and by geographic areas crude rates and rates adjusted for age and gender, and for severity using the different DRGs of AMI patients. In these two years the inpatient mortality rates of AMI patients were 20.4% and 21.7%, and the usage of thrombolytic therapy were 9.9% and 11.8%, respectively. Using indirect standardization methodology in the usage of thrombolytic therapy, they found high differences among the counties compared to the national average, the range was 51-199%, and among the institutions 0-306%, respectively. It is clear, that there are huge differences in the curative processes and in the inpatient mortality rates of AMI patients among the hospitals. The differences are developed by chance, there are no close connections either to hospital groups, or to geographical locations. Because of the difficulties of risk adjustment, they suggested that indicators were suitable for benchmarking. It is necessary to implement in the national quality criteria system different indicators for evaluating the patient care, to develop programs for auditing the best and worst hospitals and to introduce standards for assuring the validity of the basic data.     

Variability in hospital care. Nasosinus surgery in Spain.

Objectives: To describe variations in the management of nasosinus disorders among the Autonomous Communities and hospitals of Spain. Methods: We analyzed the Minimum Basic Data Set of the public health system from 1998-2000 for the diagnoses of nasosinus polyps and chronic sinusitis. We studied the distribution by regions of the rate of hospitalizations and of 4 indicators of quality of care and efficiency: mean length of stay, percentage of discharges without surgery, percentage of functional endoscopic sinus surgery and surgical complications. A cluster analysis was performed to classify hospitals according to the values of these indicators. Results: We analyzed 13061 discharges from 263 hospitals. Marked differences were found in age-adjusted hospitalization rates by regions. Cluster analysis classified the centers with more than 10 annual discharges in 3 categories: a) 32 hospitals in which the 4 quality indicators were above average; b) 35 hospitals in which 3 of the indicators were below average, and c) 74 hospitals in which 2 indicators were above average and 2 indicators were below average. Conclusions: Marked interregional variations were found in hospitalization rates, as well as in the characteristics of management of nasosinus disorders in Spanish hospitals. The centers examined could be grouped into three clearly defined patterns according to indicators of quality of care and efficiency.