变异系数赋权的功效系数法在医院医疗质量综合评价中的应用

目的：客观、科学地评价某医院各临床科室的医疗质量。方法选取14个有代表性的指标组成医疗质量综合评价指标体系,运用变异系数赋权与功效系数法,对各指标进行综合评价。首先运用Excel求出各个指标的标准差及变异系数,根据指标包含的信息确定其权重,计算各科功效系数,然后采用加权几何平均法计算出总功效系数,得出各临床科室的医疗质量综合排序结果。结果评价指标中病死率的权重最大,满意度的最小。各科室总功效系数分别为：内一科79．65、内二科83．56、内三科77．57、儿科95．39、外一科87．57、外二科82．51、外三科74．27、五官科83．6、妇产科91．48、老年科66．28。从总功效系数排序表可看出,各科医疗质量排序从高到低为儿科、妇产科、外一科、内二科、内一科、外二科、五官科、内三科、外三科、老年科。结论依据样本数据变异程度来确定权重的变异系数法,能有效消除主观因素的干扰。功效系数法用加权几何平均法对指标值进行综合,原理简单,灵敏度高,指标处理保持方向一致。应用变异系数赋权与功效系数法相结合对临床科室进行综合评价,提高了评价的准确性、科学性,客观、合理地反映了医院实际的医疗质量。     

应用功效系数法综合评价医院医疗工作质量

目的 全面客观地评价医院医疗质量,为医院制订合理的工作计划提供科学的决策依据.方法 运用功效系数法,选取9项医疗工作指标,对某医院2005-2010年的医疗工作质量进行综合评价.结果 从总体看,医院的医疗质量呈逐年上升趋势.结论 功效系数法具有原理简单,易于理解的特点,在医疗工作质量综合评价中具有较好的应用价值.     

基于功效系数法的医疗质量综合评价

在阐述功效系数法理论的基础上,运用其对某三级医院的医疗质量进行综合评价。实践表明,功效系数法原理简单,评价结果精确、直观,具有科学性和可操作性。     

功效系数法在医疗质量综合评价中的应用

对医疗质量综合评价的方法很多 ,如ＴＯＰＳＩＳ法 ,ＲＳＲ法、模糊综合评价法〔1～ 3〕等。本文应用经济统计领域中常使用的功效系数法〔4〕对我院 1996～ 2 0 0 1年医疗工作质量进行综合评价。原理与模型功效系数法根据多目标规划的原理 ,对每一评价指标分别确定一个满意值与不允许值 ,以满意值为标准上限 ,不允许值为标准下限 ,按线性正相关的方法将不同的评价指标无量纲化转化为相应的评价分数 ,经加权几何平均得出综合评价分数 ,对评价对象的综合状况作出评估。综合功效分数越大 ,表明评价对象其综合状况越佳。其数学模型 :ｄｉ =Ｘｉ-…     

黑龙江省县级医院医疗质量评价指标体系构建研究

目的:建立一套科学合理、可操作性强的县级医院医疗质量评价指标体系。方法:通过文献研究比较国内外医院质量评价模型并筛选初始指标库,通过专题小组法确定质量评价框架,运用专家咨询法并结合直接评分法与变异系数法筛选指标及确定权重系数。结果:确定了以医疗结构质量、过程质量和结果质量为基本结构的县级医院质量评价框架和指标体系,它由3个一级维度、7个二级维度、31个三级维度指标及其相应的指标权重构成。结论:该评价指标体系将关键政策指标以及医院质量管理中的重点和难点环节评价指标有机结合,可操作性强,能够满足黑龙江省县级医院医疗质量管理的实际需要。     

基于熵权的灰色综合评判法在医疗质量评价中的应用

目的 综合评价我院近五年来的医疗质量,掌握其变化规律,为医院管理决策提供科学参考与依据.方法 应用熵权法确定评价指标的权重值,采用灰色综合评判法对我院2007 ～ 2011年的医疗质量进行综合评价.结果 2011年的医疗质量最佳,2009年较差.评价结果与我院的实际情况大致相符.结论 将熵权法赋权应用于灰色综合评判法中评价医院医疗质量,其计算简便、直观,结果客观、科学,可以为医院管理提供决策参考.     

多种赋权方法联合应用制定科技实力评价指标权重

目的 制定评价科技实力指标权重.方法 采用主观赋权(专家打分法、对比排序法、Saaty’s权重法)和客观赋权(标准离差法、熵权法、CRITIC法)相结合的方法制定科技实力指标权重.结果 主观赋权法得到的指标权重之间相关系数均大于0.7,客观赋权方法中,熵权法和标准离差法及CRITIC法得到的权重之间存在负相关；主观赋权方法中排序法和Satty,s权重法均与熵权法得到的权重存在正相关.权重较大的指标为科学著作总数、装备定型总数、军用标准总数、SCI/EI/ISTP数、第一等级科技获奖数等.结论 多种赋权方法联合应用制定评价指标权重较单一方法赋权更具有合理性.     

分层标准差权重系数法在临床护理过程质量评价中的应用

目的 为了研究护理过程质量评价中指标权重系数的确定,及其指标合成运算的科学可行方法.方法 通过对四个科室的120位住院患者的问卷调查,将所得结果,运用本文提出的标准差权重系数法进行运算.结果 不仅确定了各个层次指标的权重系数,而且得到各个科室的评分值,对各科室的优劣进行了比较.结论通过实际运算结果的分析,以及与层次分析法、模糊数学法的比较分析,表明该方法具有一定的科学性、新颖性和可行性,值得研究和推广应用.     

应用多种综合评价方法对医疗质量组合评价

目的对医院10年的医疗质量进行组合评价。方法分别应用功效系数法、TOPSIS法、灰色关联度法评价医疗质量，同时将此3种方法进行组合评价。结果一致性检验：相关系数形=0．9731，组合评价得分2005年（20．3428），2004年（18．6811），……。结论组合评价较单一评价方法更全面、客观，10年医疗质量取得较大进步。     

基于功效系数法的医疗效率综合评价分析

目的对某医院医疗效率情况进行多指标综合评价分析,为医院管理决策提供科学依据。方法基于功效系数法对医院2004—2008年度反映医疗效率的8项指标进行综合评价。结果综合评价分析结果客观地反映出医院各个年度的医疗效率。结论运用功效系数法对反映医疗效率的多项指标进行综合评价,能客观地反映不同时期医院医疗效率的综合状况,是医院管理决策的重要依据。     

基于变异系数赋权与功效系数的医院综合评价

目的 为了解湛江市二级综合医院的医疗质量状况,对9家医院综合水平进行排序,找出某院与同行的差距,以及需要改进之处,为该院的发展提供决策依据.方法 从国家卫生统计信息网络直报系统提取2009年湛江市九家二级医院的直报数据,根据广东省卫生厅采用的指标公式整理并提取病床使用率、病床周转次数、平均住院日、病床工作日、有效率、病死率、住院危重病人抢救成功率、急诊抢救成功率、三日确诊率、入出诊断符合率、药品比例、平均每医生收治住院病人数、平均每医生负担诊疗人次、平均每诊疗人次医疗费、出院者平均每天住院医疗费等15个有代表性的医疗质量、效率指标.使用变异系数赋权与功效系数法,对这九家医院的上述指标进行综合评价.首先运用Excel求出标准差及变异系数,根据指标包含的信息确定权重,再计算功效系数,然后采用加权几何平均法计算出总功效系数,对结果进行排序.结果 A～I代表的九家医院医疗质量总功效系数分别为68.7、79.1、71.9、86.5、86.0、79.5、87.6、83.3、90.3.I单位平均住院日等4个指标排名第1,2个指标排第2,综合水平名列前茅;G单位病死率等3个指标排第1,平均住院日排第2,3个指标排第3,综合水平第2;A单位虽然出院者平均每天住院医疗费排第1,有效率排第2,但是病床使用率等权重较大的8个指标排在第8或9,综合水平排名最后.结论 A单位在医疗技术培训、抢救水平、外科及儿科建设、宣传等方面要加大力度,提升医疗质量.     

白蚁防治药剂的应用系数模型

为解决白蚁防治单位在白蚁防治制剂选择上难以抉择的困难,设计了土壤化学屏障白蚁预防药剂的应用系数模型、装修白蚁预防药剂的应用系数模型、灭治粉剂的应用系数模型和灭治液剂的应用系数模型,以便对市场上常见的白蚁防治制剂进行综合评估和比较,为白蚁防治单位在进行白蚁防治药剂的选择时提供一个简易的判断方法。     

A reappraisal of the kappa coefficient

Kappa is frequently used in epidemiology as an index of the quality of measurement for binary characteristics. The authors discuss the strong dependence of kappa on true prevalence, and they examine the relationship of the value of kappa to the degree of attenuation of the odds ratio that results from non-differential misclassification. It is concluded that under certain circumstances kappa can be interpreted as an indicator of validity, i.e. unbiasedness of the odds ratio, rather than simply as one of reliability. Cautions are stressed regarding (1) possible variation in the quality of measurement and (2) possible lack of independence of errors for the paired measurements from which kappa is calculated. An important implication for the design of reliability studies is that they should be conducted in populations where the distribution of the factor of interest is similar to that for the settings in which the measurement technique will ultimately be applied.     

A repeated measures concordance correlation coefficient

The concordance correlation coefficient is commonly used to assess agreement between two raters or two methods of measuring a response when the data are measured on a continuous scale. However, the situation may arise in which repeated measurements are taken for each rater or method, e.g. longitudinal studies in clinical trials or bioassay data with subsamples. This paper proposes a coefficient for measuring agreement between two raters or two methods of measuring a response in the presence of repeated measurements. We illustrate the methodology with examples comparing (1) 1-hr versus 2-hr blood draws for measuring cortisol in an asthma clinical trial and (2) two measurements of percentage body fat, from skinfold calipers and dual energy X-ray absorptiometry.     

Inferences on the within-subject coefficient of variation

The within-subject coefficient of variation (WCV) is widely used as a measure of precision and reproducibility of data in medical and biological science. In this paper, generalized confidence intervals and tests for a single WCV is developed using the concept of generalized pivots under the assumption of one-way random effect model. This approach is further extended to two-sample cases. The resulting procedures are easy to compute and have good properties in term of coverage probabilities and type-I error control at small sample sizes. The proposed methods are illustrated by a real life example.     

Inferences on the common coefficient of variation

The coefficient of variation is often used as a measure of precision and reproducibility of data in medical and biological science. This paper considers the problem of making inference about the common population coefficient of variation when it is a priori suspected that several independent samples are from populations with a common coefficient of variation. The procedures for confidence interval estimation and hypothesis testing are developed based on the concepts of generalized variables. The coverage properties of the proposed confidence intervals and type-I errors of the proposed tests are evaluated by simulation. The proposed methods are illustrated by a real life example.     

Concordance correlation coefficient applied to discrete data

In any field in which decisions are subject to measurements, interchangeability between the methods used to obtain these measurements is essential. To consider methods as interchangeable, a certain degree of agreement is needed between the measurements they provide. The concordance correlation coefficient is an index that assesses the strength of agreement and it has been widely applied in situations in which measurements are made on a continuous scale. Recently the concordance correlation coefficient has been defined as a specific intraclass correlation coefficient estimated by the variance components of a Normal-Normal mixed linear model. Although this coefficient was defined for the continuous scale case, it may also be used with a discrete scale. In this case the data are often transformed and normalized, and the concordance correlation is applied. This study discusses the expression of the concordance correlation coefficient for discrete Poisson data by means of the Poisson-Normal generalized linear mixed model. The behaviour of the concordance correlation coefficient estimate is assessed by means of a simulation study, in which the estimates were compared using four models: three Normal-Normal mixed models with raw data, log-transformed data and square-root transformed data, and the Poisson-Normal generalized linear mixed model. An example is provided in which two different methods are used to measure CD34+ cells.