医院综合效益评价指标的构建与选择

本文作为《沈阳市综合医院综合效益评价研究》的基础研究报告之一，从对医院综合效益概念的具体界定入手，阐述了设计评价指标的基本原则，最后提出了医院综合效益评价指标体系的内容，并从总体把握和内部联系两个方面对所选择的指标体系进行说明。     

广东省医院综合效益评价研究

根据广东省医院的特点，应用德尔菲法和层次分析法，选择和建立了医院综合效益评价指标体系。采用加权秩和比法对广东省东、西、中部的１０所医院进行横向和纵向评价，评价结果符合医院的实际情况。     

用DEA方法对医院作综合效益评价

用数据包络分析法对南京地区４０所医院进行综合效益评价。共列出投入与产出各五项指标，代入用计算的Ｃ＾２Ｒ模型利用计算机计算出各医院的综合效益，得出其中１２所医院的综合效益及规模效益是好的。     

关于医院综合效益评价的探讨

评价一个医院某一时期工作效益如何，不仅反映了医院该时期的实力，更重要地是验证医院在该阶段所采取的政策、措施是否成功。目前，沈阳市、西南地区、广州市及军队系统对医院综合效益评价体系及标准都做了较系统的探索研究，但在医院综合效益指标体系，指标选定、标准值确定评价标准以及统计方法等方面观点各异，有的评价项目多达56项。     

我国医院综合效益评价方法的探讨

本文探讨了医院综合效益评价的必要性，医院综合效益评价的现状及常用评价方法的优点和不足，评价体系的确定，评价方法选择中应注意的问题。医院的综合效益评价应促进医院管理效能的提高，推动医院的改革、发展和建设。     

新时期医院综合效益评价指标体系构建初探

本文在深入分析现有医院综合效益评价指标体系的基础上，提出了构建新时期医院综合效益评价指标体系的构建原则、步骤和设想，并初步构建了新时期医院综合效益评价指标体系框架。     

灰色多层次综合评判法在医院综合效益评价中的应用

本文根据医院综合效益评价的模糊性和灰性,运用改进的灰色多层次综合评判法对安徽省1所医院临床科室的综合效益进行了评价,结果经有关人员论证,令人满意,认为该方法在医院综合效益评价中有较大的应用价值。     

关于"医院综合效益评价"方法有待完善

关于“医院综合效益评价”方法有待完善贾秀萍石玉琴作者单位：１１６０２７大连医科大学卫生管理系（贾秀萍）；附属二院（石玉琴）为探讨较完善、准确的评价医院综合效益方法，就卫生部组织的西南地区“医院综合效益评价”课题组研究的方法在我市某所医院进行实际应用和...     

医院院长应重视的四项效益指标

浙江省医院综合效益评价指标共有19项，包括医疗质量指标5项、医疗效益指标3项、医院效益指标11项。开展综合评价对于提高医疗质量和医院效益有很好的促进作用。作为医院院长必须及时分析医院效益指标和质量指标的动态变化，针对薄弱环节，及时采取必要措施。     

综合医院综合效益评价的病例组合模型研究

目的建立一种考虑病人病例组合的医院综合效益评价模型,以控制传统评价模型中各医院救治病人疾病复杂程度不同所致的偏倚。方法各医院病人疾病复杂程度由根据信息理论计算的病例组合指数(CMI)进行测量。采用病例组合指数对综合效益传统评价模型中指标进行调整(标化)得到新的病例组合评价模型。分别采用传统评价模型与病例组合评价模型评价2003年南充地区9所综合医院综合效益,比较两种模型得到的各医院综合效益排序情况。评价主要步骤包括从投入和产出角度构建评价指标体系,采用层次分析法确定各评价指标权重,根据投入产出比构建综合评价指数。结果9所医院的CMI值不同,其中有6所医院的CMI<1,3所医院的CMI值>1。9所医院中有7所医院采用病例组合模型得到的综合效益位次与采用传统评价模型得到的一致,另2所医院采用病例组合模型得到的位次与传统评价模型得到的位次不同。结论相对于传统评价模型,病例组合评价模型考虑了医院病人疾病复杂程度的影响,得出的结论更为客观真实。     

Cross-sectional survey of hospital HIV/AIDS care in Catalonia, 1990

In 1991, a survey of 42 acute-care hospitals was carried outin Catalonia to obtain information related to hospital carefor HIV/AIDS patients during 1990. Thirty-eight hospitals responded;the mean length of stay of the 1,527 patients admitted withAIDS was 21 days. The six largest hospitals of the metropolitanarea of Barcelona treated 67% of them. Overall there were 179(12%) ‘terminal’ AIDS patients. Six per cent ofinternal medicine beds overall were occupied by AIDS patients,but this figure rose to 22% in large hospitals. The estimatedcost for AIDS in-patient care during 1990 was nearly £26 million. The major concentration of AIDS patients in fewinstitutions and the demand on beds for HIV/AIDS patients ishaving an impact on the acute hospital care system. If presentHIV/AIDS care demands prevail, we conclude that some unnecessaryacute hospital care might be mitigated if comprehensive, coordinatedhealth and social programmes are developed.     

拓宽思路增强乡镇卫生院活力

分析了南汇县乡镇卫生院门急诊和住院病人减少的原因，提出在社会主义市场经济迅速发展的新形势下，乡镇院必须拓宽思路，树立战略观念，切实搞好“初保”，结合卫生事业和人事制度改革，扶植和装备重点卫生院，加强软硬伯建设，多方集资改善基本医疗服务设备，放大服务项目、形成特色科目和开展特需医疗服务等综合措施，增强乡镇卫生院活力，使医疗服务质量、医德医风、社会效益和经济效益均踏上一个新的台阶。     

Applying a framework for assessing the quality of maternal health services in urban India

This paper presents findings from the application of a framework for assessing the quality of care of institutional maternity services in an urban slum in India. The framework divides quality into two parts: the quality of users' experience of care and the quality of the provision of care. Data from public and private hospitals were collected via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women in the immediate vicinity of the case study hospitals. Findings provide evidence that quality is far from optimal in both public and private facilities. Problems identified included a lack of essential drugs, women being left unsupported, evidence of physical and verbal abuse, and births occurring in hospitals without a health professional in attendance. The paper concludes that while many governments have explicit targets to increase institutional deliveries, many do not have explicit targets or even a commitment to assess and improve the quality of institutional services for childbirth.     

中国医院感染管理组织建设30年调查

目的了解我国医院感染管理组织建设30年的发展情况。方法对全国12个省（直辖市、自治区）医院感染管理组织建设进行调查。结果共调查166所医院,其中三级医院96所（57.83%）;164所有建立医院感染管理科年份的医院中,1995年之前建科的医院46所（28.05%）,1995—2005年建科的医院63所（38.41%）,2005—2015年建科的医院55所（33.54%）。165所医院每千床专职人员数从1995年的4.80名下降至2015年的4.09名,1995—2015年医院感染管理科专职人员类别构成比较,差异有统计学意义（χ2=26.22,P＜0.01）。1995—2015年各省份医院感染管理科专职人员学历、专业构成比较,差异有统计学意义（χ2值分别为242.91、47.10,均P＜0.01）。1995、2005年专职人员学历均以大专及以下学历为主,所占比率分别为70.81%、53.30%;2015年以本科学历（53.79%）为主,博士、硕士所占比率分别为2.45%、22.86%。专职人员专业均以护理为主,所占比率由1995年的58.38%下降至2015年的45.96%。结论我国医院感染管理组织建设经历了30年,取得了一定成绩,但仍存在一些问题,需要继续提高专职人员比例,优化人员结构。     

1994年全国卫生部门综合医院运营情况分析

对1994年全国卫生部门综合医院运营情况进行了分析,结果是:医疗服务量有所减少,病床使用率继续下降,平均住院日略有缩短,医院业务收入增长过快,医疗费用增长辐度下降。对此目前需要引起各级卫生部门重视并努力解决的问题是:扩大医疗服务,提高卫生人力、物力的服务程度,提高医疗服务质量和效率。逐步实现医疗服务按成本收费,控制药费开支,遏制医疗费用急剧增长。     

Regionalization and Local Hospital Closure in Norwegian Maternity Care—The Effect on Neonatal and Infant Mortality

Objective

To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out.

Data

The Medical Birth Registry of Norway provided detailed medical information for all births in Norway.

Study Design

Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated.

Principal Finding

Neonatal and infant mortality were not affected by the type of hospital where the delivery took place.

Conclusion

A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries.     

军队中小医院在“双向转诊”中的机遇与对策

目的：分析军队中小医院的生存现状，提出在“双向转诊”中相应的对策；方法：采用实地调研和专家咨询的方法，了解各所军队中小医院及所在地的地方大医院在医疗质量、技术水平等方面存在的差距及原因，根据调研结果制定军队中小医院在“双向转诊”中的对策，经过专家咨询，确定对策内容；结果：通过实地调查和专家访谈得知，各地军队中小医院的总体实力较地方大医院有一定差距，生存的压力比较大，“双向转诊”给军队中小医院的发展带来了新的契机；结论：通过专家咨询，确定四条对策。     

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study

Objective

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.

Data Sources

EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021).

Study Design

We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.

Data Extraction

We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.

Principal Findings

In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.

Conclusions

Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.     

广东省各级医院就诊病人疾病构成分析

目的 为比较各等级医院收治病人的病种构成,探讨病人就诊流向的合理性。方法 随机抽取广东省各地级市的各级医院,收集门诊和住院病人的诊断及年龄、性别、医疗保障形式等资料。结果 门诊和住院病人以呼吸系统疾病最常见。各等级医院收治病人的严重程度呈现一定梯度,但差异并不明显。结论 病人就诊流向仍存在较大的不合理性,高等级医院的特点和优势没有充分体现,导致卫生资源浪费。     

成都市民患病首选就诊医院原因分析

目的了解成都市民就医选择医院的行为模式,为加强医院管理提供依据。方法按照分层随机起点等距辐射抽样法原则,在成都市主城区抽选调查户,共完成1300个居民家庭的入户调查,对其患病就诊时首选医院以及选择医院的原因进行调查。结果（1）选择到医院就医者595人（45．77％）,药店买药546人（42．00％）,到社区卫生服务中心等118人（9．08％）,其他41人（3．15％）;（2）在选择到医院就医的595名市民中,选择市级医院314人（52．77％）,选择省级以上医院214人（35．97％）,选择区级医院67人（11．26％）;（3）成都市民患病时首选不同级别医院就医主要选择原因的差异显著（P〈0．05）。首选到高级别医院就医主要考虑的是其医术好、设施好、名气大;首选到较低级别医院就医主要考虑的是其价格合理、看病简便、服务好。结论患者就医行为模式是影响医疗市场的重要因素之一,应根据患者选择就医的需求,有针对性的加强医院管理,满足群众医疗服务需求。