医院科室病床使用情况综合评价及分析

目的 对医院部分科室2006-2008年病床使用情况进行综合评价,得出科学的合理床位区间,进而指导医院的病床分配. 方法 选取反映病床使用情况的统计指标,应用秩和比法进行评价,同时对这3年的数据进行对比分析. 结果 部分科室床位使用比较好,根据开放床位区间,少数科室需要进行床位调整. 结论 科学进行病床的综合评价、合理分配床位,有利于提高科室工作效率.     

风险评估在医院感染管理中的应用研究

目的对某三级甲等教学医院临床科室进行医院感染管理风险评估,明确医院感染高风险科室和医院感染控制的薄弱环节,为进一步制定针对性的防控措施提供循证依据。方法采用专家头脑风暴法并结合该院实际情况进行风险识别,由医院感染管理委员会成员评分确定权重系数,再设计风险评估表,根据2016年该院监测和检查数据进行风险估计,最后采用百分位数法进行风险评价,统计分析采用SPSS19.0软件进行。结果最终确定19个风险指标,总风险极高的科室为创伤外科、综合ICU、神经内科和心胸外科;不同类型的风险指标中其高风险科室的分布不同,其中管理风险指标中风险极高的科室为胆胰外科、普胸外科、肝脏外科和眼科,过程指标中风险极高的科室为创伤外科、综合ICU、神经内科和消化系统肿瘤科,结果指标中风险极高的科室为综合ICU、神经内科、心胸外科和神经外科。结论风险评估方法可以为医院感染管理防控工作明确重点,指明方向,提高防控效能。     

临床科室综合效益的TOPSIS法评价

目的探讨医院临床科室综合效益评价方法。方法采用TOPSIS法对某院临床科室2001-2005年的指标进行综合评价。结果该院几年来一直处于不断向前发展的态势,综合实力逐渐增强,脑外、神内、肛肠3大科室综合效益始终位于前列。以妇产科发展最快。结论利用TOPSIS法进行综合评价,结果客观、可信,能为管理层决策提供参考依据。     

基于加权TOPSIS法的临床科室医疗质量综合评价

目的研究加权TOPSIS法在临床科室的医疗质量综合评价中的应用,为综合考核和科学管理临床科室提供参考依据。方法选取8项指标运用加权TOPSIS法对某三级医院22个临床科室的2017年医疗质量进行综合评价。结果儿科病房、妇产科二病房、妇产科一病房、泌尿外科病房的综合指数Ci靠前,骨科病房、神经外科病房、胸心外科病房、血液科病房的综合指数Ci靠后。结论此次加权TOPSIS法综合评价结果与某三级医院的实际运行情况基本吻合,适用于对临床科室医疗质量情况的评价。     

基于系统聚类与密切值法的临床科室综合效益评价

目的应用系统聚类和密切值法评价临床科室效益,为医院管理临床科室综合评价问题提供方法。方法用系统聚类法将各临床科室分类、密切值法对各临床科室综合效益进行评价并排序。结果系统聚类为4类,结合密切值排序依次为:1类儿科;2类妇产科、消化内科、呼吸内科、神经内科、普外科、肾病内科、心血管内科、眼科、耳鼻咽喉科;3类骨科、感染疾病科、神经外科、肝胆外科、胸外科、ICU;4类康复科。结论系统聚类法和密切值法的结合运用可以准确对医院临床科室综合效益进行分类和评价,结果直观、可靠。     

TOPSIS法与密切值法对湖南省某医院医院感染监测的综合评价

目的采用TOPSIS法与密切值法对湖南省某医院2006-2010年医院感染监测管理质量进行综合评价,探索医院感染监测管理的适宜综合评价方法。方法资料来源于2006-2010年湖南省某医院的医院感染监测管理数据。以年度为评价对象,评价指标包括医院感染率、漏报率、环境卫生监测情况指标合格率等9个指标,应用TOPSIS法和密切值法对医院感染监测管理质量进行综合评价。结果 2006-2010年医院感染率和漏报率的平均增长速度分别为-12.4%和-11.6%;医院环境卫生监测合格率逐年增加。TOPSIS法、密切值法评价分析结果显示,在该院2006-2010年度医院感染监测情况中,监测管理质量最好年份为2009年,最差的年份为2006年;TOPSIS法与密切值法的排序结果分析完全一致。结论该医院2006-2010年医院感染感染率和漏报率均低于国家规定的控制标准。医院监测管理质量最好年份为2009年,TOPSIS法、密切值法均可作为评价医院感染监测管理质量的常规方法。     

基于床位效能评价优化综合医院床位配置的应用研究

目的 运用疾病诊断相关组（diagnosis related groups） DRG指标作为医院医疗服务能力评价指标,结合病床运行效率综合评价单位病床利用效能,为医院床位合理配置提供决策依据。方法 以某三级甲等医院2019年运行数据及DRG数据为基础,以病床周转次数及病床占用率绘制科室病床运行效率散点图;以单床年DRG权重为产出指标,结合科室病例组合指数（case mix index）CMI值绘制病床产出效能散点图; 结合运行效率及产出效率综合评价科室病床利用效能并将其分为A、B、C、D、E五类。分别利用病床工作效率指标及病床产出效率指标95%CI计算各科室病床数的合理区间。结果 39个临床科室中,病床利用效能综合评价为A类有5个科室、B类科室14个、C类科室3个、D类科室10个、E类科室7 个。 有6个科室实际开放床位较为合理,病床工作效率与病床产出效率判定结果均为合适,14个科室的判定结果均为偏多,5个科室的判定结果均为偏少,余14个科室的床位配置判定结果发生了变化。 结论 结合DRG指标与传统运行效率指标对医院科室床位利用效能进行综合评价兼顾了效率和质量,其结果更为全面、客观;可为医院调整内部结构,优化床位配置提供科学依据,助力医院精细化管理。     

医院临床科室综合评价方法探讨

本文对医院临床科室综合评价指标的选择原则，消除科室之间由于收治病种不同导致指标值的差异和确定标准值的方法进行探讨。应用ＲＳＲ法以某医院资料为例进行综合评价计算。     

床位利用模型与工作效率指标在床位管理中的应用北大核心CSCD

目的对某院床位合理使用情况和床位工作效率进行综合评价,进而指导医院的床位分配。方法根据2014年年度医疗统计数据,绘制2014年某院各科室床位利用模型静态评价分析图;采用床位工作效率指标测算出各科室开放床位数的合理区间。结果 17个科室为床位效率型科室,7个科室为床位周转型科室,1个科室为床位闲置型科室,没有科室为压床型科室。全院需要增加床位的科室有7个,需要减少床位的科室有9个,不需要调整的科室有9个。全院总计需要减少床位16张。结论科学进行床位的综合评价,合理分配床位,可以优化医疗资源配置,提高医院的社会效益和经济效益。     

用综合指数法评价临床科医疗质量

综合指数法是指以各指标的实际值和计划值为基础,通过计算两者比率,将各指标值的综合值作为评价的尺度,进行衡量评价的一种方法,本文采用综合指数法对临床科医院质量进行综合评价。     

Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission.

We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher risk of death. Across the six conditions, the R-squared values for predicting death using admission scores ranged from 0.01 to 0.16; R-squared values using mid-stay scores ranged from 0.03 to 0.34; and R-squared values from combining admission and mid-stay scores ranged from 0.05 to 0.41. Admission MedisGroups score was thus only modestly predictive of 30-day mortality. While the mid-stay score was more powerful, it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care.     

JCI标准下管理模式改变医院环境卫生管理过程的成效分析

目的探究JCI标准下管理模式改变在医院环境卫生管理过程中的效果。方法我院按照JCI标准2018年1月开始实施物体表面合格率考评方案,统计2018年1月-2018年12月我院物体表面合格率和环境清洁质量评分情况。结果按照JCI标准实施物体表面合格率考评方案后,我院2018年1月-2018年12月的环境清洁质量评分依次是(80.26±4.32)分、(82.35±4.56)分、(84.98±5.12)分、(86.26±4.86)分、(88.78±4.85)分、(90.25±4.26)分、(91.35±4.05)分、(92.78±3.87)分、(94.15±3.62)分、(95.37±3.32)分、(96.28±3.05)分、(97.12±2.85)分,物体表面合格率依次是43.25%、50.43%、51.34%、52.39%、56.48%、58.40%、59.51%、60.52%、62.16%、71.30%、75.47%、76.47%,随月份增加不断提高,差异对比有统计学意义,P<0.05。结论在JCI标准下实施物体表面合格率考评方案能提高物体表面合格率和医院环境清洁质量,确保医疗安全。     

Some determinants of work performance in foodservice systems. Job satisfaction and work values of school foodservice personnel

Job performance, job satisfaction, and work orientation of 304 women foodservice employees in twenty-four schools in seven districts were examined. Work values and job satisfaction of school and hospital foodservice employees were also compared. Work values varied little between the two groups. The school employees, however, were more satisfied with their work, supervision, and co-workers than were the hospital employees. School employees were divided into high- and low-performance groups through supervisory ratings of six dimensions of performance. The high-performance group had significantly higher satisfaction scores than the low-performance group. The former group had been employed longer and worked more hours per day than the latter.     

Comparison of emergency department crowding scores: a discrete-event simulation approach

According to American College of Emergency Physicians, emergency department (ED) crowding occurs when the identified need for emergency services exceeds available resources for patient care in the ED, hospital, or both. ED crowding is a widely reported problem and several crowding scores are proposed to quantify crowding using hospital and patient data as inputs for assisting healthcare professionals in anticipating imminent crowding problems. Using data from a large academic hospital in North Carolina, we evaluate three crowding scores, namely, EDWIN, NEDOCS, and READI by assessing strengths and weaknesses of each score, particularly their predictive power. We perform these evaluations by first building a discrete-event simulation model of the ED, validating the results of the simulation model against observations at the ED under consideration, and utilizing the model results to investigate each of the three ED crowding scores under normal operating conditions and under two simulated outbreak scenarios in the ED. We conclude that, for this hospital, both EDWIN and NEDOCS prove to be helpful measures of current ED crowdedness, and both scores demonstrate the ability to anticipate impending crowdedness. Utilizing both EDWIN and NEDOCS scores in combination with the threshold values proposed in this work could provide a real-time alert for clinicians to anticipate impending crowding, which could lead to better preparation and eventually better patient care outcomes.     

Developing a 'consultation quality index' (CQI) for use in general practice

BACKGROUND: The core values of general practice include holism and patient-centredness. None of the measures of quality of care in general practice presently capture the expression of these values at routine consultations. OBJECTIVES: The aim of the present study was to construct a 'consultation quality index' (CQI) which reflects the core values of general practice, using as proxies 'consultation length' and how well patients 'know the doctor' as process measures and 'patient enablement' as an outcome measure. METHODS: The CQI was constructed from data collected from 23 799 adult English-speaking patients consulting 221 doctors in four demographically contrasting areas of the UK during 2 weeks of March/April 1998. A total of 171 doctors who entered 50 qualifying consultations were allocated scores for the three component variables, and a total CQI was calculated. RESULTS: CQI scores were in the range 4-18. Validity was examined by looking at high and low scorers in greater detail and by searching for correlates with case mix, patient age and gender, and the deprivation scores of the practices concerned. Particular attention was paid to how registrars and doctors new to their practices scored. The scores of different doctors in the same practice were also noted. The results had strong face validity and were independent of case mix and deprivation. Reliability was gauged by examining similar work from a previous study which had collected information on consultation length and enablement over three time periods. High CQI scores were associated with smaller overall practice list sizes. CONCLUSIONS: We have outlined possible uses for the CQI as part of the packages assessing quality of care by doctors and practices. The measure may also have a part to play in recognizing poorly performing doctors. We suggest how CQI scores could contribute to an incentive scheme to reward good consulting practice. Further work is in hand to compare doctors' CQI scores with scores based on performance indicators constructed from routine NHS data on prescribing and preventive medicine.     

超声弹性成像参数及CT值与妇科术后下肢深静脉血栓形成临床分期的相关性及疗效预测价值

目的:探究超声弹性成像参数及CT值与妇科术后下肢深静脉血栓形成(deep-vein thrombosis,DVT)临床分期的相关性及疗效预测价值。方法:选取2018年1月至2019年12月某院妇科术后下肢DVT患者(73例)作为研究对象进行回顾性分析,所有患者均经超声造影检查确诊,均行超声弹性成像检查、CT检查及凝血功能检测。比较不同疾病分期(急性期、亚急性期和慢性期)患者的超声弹性成像参数(超声弹性评分、应变值)、CT值和凝血功能指标[纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)],分析超声弹性成像参数及CT值与下肢DVT、疾病分期、凝血功能指标的相关性,比较不同疗效患者超声弹性成像参数及CT值,探讨其对疗效的预测价值。采用SPSS 22.0进行统计学分析。结果:急性期患者的超声弹性评分及应变值<亚急性期患者<慢性期患者,CT值及Fib、APTT、PT>亚急性期患者>慢性期患者,差异有统计学意义(P<0.05);超声弹性评分及应变值、CT值与下肢DVT的相关性显著(P<0.05);下肢DVT患者疾病分期及APTT、PT、Fib与超声弹性评分、应变值间存在负相关关系,与CT值间存在正相关关系(P<0.05);疗效良好者的超声弹性评分及应变值高于疗效不佳者,CT值低于疗效不佳者(P<0.05);超声弹性评分、应变值及CT值联合预测下肢DVT患者疗效的AUC为0.913,大于各指标单独预测,联合预测的敏感度为90.00%、特异度为85.71%。结论:超声弹性成像参数及CT值与妇科术后下肢DVT临床分期、凝血功能均具有相关性,且在预测下肢DVT患者疗效方面具有较高的应用价值,可为临床评估患者病情、制订措施提供指导。     

区域医疗中心综合评价模型的构建及应用研究

目的 通过构建综合评价模型,对四川省区域医疗中心发展状况进行评价研究。方法 调查2013 - 2015年区域医疗中心相关指标数据,采用综合评分法构建综合评价模型。运用Microsoft Excel 2010和SPSS 17.0软件处理数据。结果 对各指标数据进行集中化处理,建立区域医疗中心综合评价模型,以加权求和的方式计算评分。区域医疗中心在三级、二级、一级指标和总评分间存在一定的差异。总评分结果显示:3年平均A医院排名第一,B医院排名第二,C医院排名第三,G医院和F医院排名最后。结论 地区间医疗水平发展不平衡,对于相对落后地区行政部门在分配卫生资源时应予以考虑。区域医疗中心各有所长,相互间应取长补短,不断提升医院自身及区域整体医疗水平,为患者提供更优质的服务。     

协同护理管理在肾内科科室护理中的效果分析

目的对肾内科科室护理中的协同护理管理应用效果进行探究。方法该院肾内科在2016年11月-2018年12月间收治的患者,从中选取84例患者作为研究对象,对照组患者采用的是常规的护理方案,观察组则需要采用协同护理管理的方案,对两组患者的住院时间、满意度、以及质量评分等指标进行对比。结果从该次研究的结果来看,观察组患者在进行协同护理管理之后,患者的住院时间、满意度以及质量评分等都得到了显著的改善,明显优于对照组(P<0.05),同时在不良反应方面,观察组患者的改善程度也要明显优于对照组。结论在当前的肾内科科室护理中,通过采用协同护理管理的方案,能够显著地改善整个科室的护理工作质量,同时实现患者满意度的提升,降低护患纠纷的发生几率,提升护理质量。     

肿瘤科专科护士培训临床护理路径的临床应用分析

目的了解肿瘤科专科护士培训临床护理路径的临床应用。方法将该院2018年1月-2019年1月的20名肿瘤科专科护士,随机分组每组10名。常规护理培训组对该院的肿瘤科专科护士予以常规管理模式培训,临床护理路径培训组对该院肿瘤科专科护士以临床护理路径培训。比较两组满意测评值;肿瘤科专科护士对待肿瘤科患者知识的认知以及技能的掌握评分;培训前后肿瘤科专科护士的理论成绩和实践操作成绩。结果临床护理路径培训组的满意测评值更高,差异有统计学意义(P<0.05)。培训后临床护理路径培训组肿瘤科专科护士的理论成绩和实践操作成绩优于常规护理培训组,差异有统计学意义(P<0.05)。临床护理路径培训组肿瘤科专科护士对待肿瘤科患者知识的认知以及技能的掌握评分优于常规护理培训组,差异有统计学意义(P<0.05)。结论肿瘤科专科护士实施临床护理路径培训可获得较好的效果,可提高肿瘤科专科护士对相关知识和技能的掌握度,是一种值得推广的培训模式。     

Out-of-hospital births, U.S., 1978: birth weight and Apgar scores as measures of outcome

An examination of 1978 natality data for the United States disclosed that low birth weight was less common among 30,819 infants born out of hospital than among 3,294,101 infants born in hospital in that year. When controls were applied for birth attendant, infants' race, and mothers' education, age, nativity, and parity, the data revealed that white, well-educated women between 25 and 39 years of age, who were having their second babies and were attended by midwives out of hospital, were at least risk of bearing low birth weight infants. The incidence rate of low birth weight babies was lower for midwife-attended births in every category examined. For college-educated white women, for example, the incidence rate was 2.0 percent among those attended by midwives, 4.6 percent among those giving birth in hospital, and 3.6 percent among those whose out-of-hospital deliveries were attended by physicians. Apgar scores for babies born both in and out of hospital were also studied but, because of inconsistent reporting, were given less attention. Excellent (9-10) Apgar scores were more common among babies born out of hospital than among those born in hospital (63 percent compared with 49 percent), particularly for out-of-hospital births attended by physicians. At least with respect to birth weight and Apgar scores, the claim that out-of-hospital births are inherently more dangerous than hospital births receives no support from these data. The findings also suggest the need for further refinement of vital statistics categories to permit the analysis of distinctions between births attended by certified nurse-midwives and those attended by lay midwives, as well as differences between births at home and those in alternative birth centers.