从单病种控制分析医疗质量管理

医疗质量管理是医院管理的核心。因此 ,我院依照卫生部颁布的 1992年《病种质量控制标准》和 1995年《山西省 36种病种平均住院日、平均费用标准》 ,对 1998年出院的 8981例病人中的 12种疾病进行了病种统计与质量分析。一、资料与方法(一 )资料来源 :所用的病种质量标准资料均来源于科室呈送的病人出入院卡。(二 )统计方法 :所有病人出入院均按国际疾病分类标准(ＩＣＤ 9)进行 ,所有出入院卡都经逐级医师质量控制 ,统计人员逐一检查核对校正录入计算机统计 ,实查率 10 0 %。二、结果与分析(一 )在 8981例出院病人中 ,属于规定病种质量控制…     

急性心肌梗死单病种质量管理实施前后效果评价与分析

目的通过分析急性心肌梗死单病种质量管理的实施效果,探讨单病种质量管理的目的和意义。方法对比分析我院急性心肌梗死病例实施单病种质量管理前后的平均住院日、住院费用、药费、药费所占比例和病死率。结果单病种质量控制并未降低平均住院日、住院费用和药费,但降低了反映医疗工作质量的病死率和管理质量的药费所占比例。结论如果对病种管理仅仅是为了控制医疗费用,而忽略医院的利益,就可能降低医疗质量,应建立以病种过程质量指标为核心指标的医疗质量评价指标体系。     

临床路径管理对改进医疗质量的作用分析

目的分析临床路径管理对医疗质量的影响。方法将595例实施临床路径管理的7个病种病例作为路径组,将2009年入院采用传统方法治疗的7个病种1284例作为对照组,对两组进行比较。结果7个病种实施临床路径管理后,组平均住院日、平均术前住院日缩短,外科围手术期抗生素使用天数和内科抗生素费用比显著降低,其中6个病种的药占比降低,平均住院费用有下降趋势,患者满意度提高。结论临床路径管理能缩短平均住院日,提高床位周转率,规范抗生素使用,控制医疗费用的增长,提高医疗质量水平。     

病种费用控制标准实验研究

目的 制定合理的病种费用控制标准,加强病种质量管理和病种费用控制。方法 调查了某医院1999年全年出院病人病案,对667个病种、1518个病型、26668份病案,进行了病例分型可行性试验、正态性分布检验和建立标准的统计方法选择等多层次分析。结果 实验研究表明,由于病人病情差异等因素,同种疾病的平均住院日与医疗费用均呈偏态分布。讨论 通过算术均数和中位数2种方法比较,认为采用中位数作为病种质量费用控制的标准参考值以及上、下界限控制值为妥。     

用秩和比法对某院2007年收治的病种医疗质量进行综合评价

目的综合评价某院2007年所收治病种的医疗质量。方法选取收治人数、治愈好转率、病死率、平均住院日、总费用、中药费占药费的比例共6个指标作为综合评价的指标，用秩和比（RSR）法作出综合评价。结果把某院所收治的70个病种分为5个医疗质量档次，按优，次优……的顺序排列。（完全性）自然流产、功能（障碍）性子宫出血2个病种质量为最好（1档），泌尿道感染、输卵管阻塞性不孕等23个病种质量为次优（2档），膝十字韧带断裂、膝关节内侧副韧带扭伤等28个病种质量为3档，女性生殖器官恶性肿瘤、缺血性心脏病等15个病种质量为4档，循环系统畸形、心力衰竭2个病种质量为最差（5档）。结论可用秩和比法综合评价收治病种之间的医疗质量高低，为管理部门决策提供依据。     

病种质量控制管理系统的开发与应用

抓医疗质量是医院管理工作永恒的主题.病种质量管理是提高医疗质量、促进医疗质量建设规范化、标准化和科学化进程的有效途径,也是医院建设的长期任务之一.20世纪80年代以来,医疗服务质量的评价与控制已进入到了病种阶段.由于同病种的病人医疗需求和资源消耗相似,以病种为单位的质量评价更具精确性和可比性[1].我院于1992年制订了40个病种的质控标准,基本上覆盖了全院各主要临床科室,要求各科室每月登记这些病种的病例,并计算这些病种的治疗效果、住院费用、住院日等指标,与事先制定的标准进行分析、比较,进行质量控制,对于提高医疗质量发挥了应有的作用.     

病种质量管理方法在医院管理中的应用

病种质量管理是以病种为管理单元的一种监控评价方法。本从病种筛选、质控指标的选择和评价标准的制定、病种质量管理的研究方法及应用等方面对病种医疗质量管理的主要内容及评价方法进行了论述。病种医疗质量管理是适应医院科学管理的需要而产生的,它能使医疗质量的监控和评价更加科学和合理。     

实施单病种质量管理对医院医疗质量的影响分析

目的：分析单病种质量管理对医院医疗质量的干预效果。方法：统计石河子大学第一附属医院2019年至2022年实施单病种质量管理的病例，并收集单病种管理前后的急性心肌梗死、心力衰竭、脑梗死、社区获得性肺炎（儿童，首次住院）、感染性休克早期治疗、髋关节置换术、膝关节置换术和剖宫产共8个病种住院病例资料，分析单病种管理对平均住院日、次均费用和次均药费的影响。结果：自2021年实行单病种质量管理后，8个病种次均费用较实施前均有减少；除感染性休克早期治疗外，其余7个病种平均住院日均小于实施前；对于次均药费，除社区获得性肺炎（儿童，首次住院）外，其余病种实施后次均药费均小于实施前。结论：开展单病种管理有助于提高医院医疗质量水平，提高医疗资源利用效率，降低医疗成本。     

病种质量控制系统

文章从病种质量控制的必要性;病种质量控制的概念;病种质量控制系统问题的提出;病种质量控制系统的程序结构、功能特点及病种质量控制系统的应用体会,5个方面阐述。旨在通过计算机参与病种质量控制,及时准确反映临床工作质量,以加强医疗卫生服务质量的宏观管理和微观管理,提高医院的社会效益和经济效益。     

临床路径实施效果分析与探讨

目的 评价实施病种临床路径的获益情况。方法 比较实施病种临床路径前(2007年)、后(2009年)全院住院天数、住院费用、医疗质量的变化,及心肌梗塞、尿道修补、骨盆骨折、髋关节置换等疾病的费用分项变化。结果 实施病种临床路径后,全院住院平均住院天数下降,住院费用下降,医疗安全上升。结论 病种临床路径可以提高医院管理水平,节省医疗成本。     

Bacteriological quality of foods and water sold by vendors and in restaurants in Nsukka, Enugu State, Nigeria: a comparative study of three microbiological methods

Bacterial count in prepared food or water is a key factor in assessing the quality and safety of food. It also reveals the level of hygiene adopted by food handlers in the course of preparation of such foods. This comparative study evaluated the bacteriological quality of food and water consumed in Nsukka, Enugu state, Nigeria, using three bacteria enumeration methods. Data obtained are assumed to reflect the level of personal and environmental hygiene in the study population. Ten types of foods--beans, yam, abacha, okpa, moimoi, pear, cassava foofoo, rice, agidi, and garri--and 10 water samples were evaluated for bacteriological quality, precisely determining the level of coliform contamination, using the most probable number (MPN), lactose fermentation count (LFC), and Escherichia coli count (ECC) methods. Bacterial counts differed significantly (p < 0.05) among the various food samples. However, this did not differ significantly in the three methods used for the enumeration of coliforms, suggesting that any of the three methods could be validly used for such studies with confidence. Escherichia coli and Klebsiella pneumoniae were the two major coliforms identified among 98 coliform isolates obtained from the various food samples, of which 78 (79.6%) were assumed to be of human origin on account of their ability to grow at 44 degrees C. The level of coliform contamination in the food samples from vendors and restaurants (geometric mean count 7.64-9.21; MPN > or = 50) were above the accepted 10(4) colony-forming unit/g or MPN < or = 10 limits. The results of the study, therefore, call for stringent supervision and implementation of food-safety practices and regular education on food and personal hygiene among food vendors.     

Measuring functional service quality using SERVQUAL in a high-dependence health service relationship

Although there is a growing concern about health care quality, little research has focused on how to measure quality in long-term care settings. In this article, we make the following observations: (1) most users of the SERVQUAL instrument reassess customers' expectations each time they measure quality perceptions; (2) long-term care relationships are likely to be ongoing, dependent relationships; (3) because of this dependence, customers in the long-term care setting are likely to reduce their expectations when faced with poor service quality; (4) by using this "settled" expectations level, service providers may make biased conclusions of quality improvements. We recommend various methods for overcoming or minimizing this "settling" effect and propose modifications to the SERVQUAL gap 5 measure to assess quality in a long-term care setting.     

Professional expectations about quality assurance: a review-based taxonomy of usability criteria in prevention,health promotion and education

Usability criteria sum up cognitions and perceptions of professional methods and problem solutions such as quality assurance in health care. They are important for the dissemination and implementation of innovations and the effectivity and efficiency of systems. In order to extract such criteria in an explorative structured review, publications from five fields were examined: (a) quality assurance in health care, (b) health promotion and education, (c) psychological methodology, (d) evaluation studies, and (e) comparative policy assessment. One hundred thirty-eight English and German basic and applied research contributions were selected. Usability criteria and comments on their interference were extracted. The review provided a two-dimensional taxonomy of the concept of usability. The first dimension is defined by five functional aspects of quality assurance instruments: (1) easy and efficient handling, (2) scope of practical functions and options for usage, (3) completeness of information, (4) users’ compliance and motivation, and (5) scientific quality of results and data. Between these usability areas some characteristic antagonisms are perceived. The second dimension is defined by four levels of increasing precision of professional cognitions: The usability area constitutes level 1. Each consists of several main criteria (level 2). Twenty-one main criteria of usability were found that were each specified by alternative sub-criteria (level 3) and their empirical indicators (level 4). This taxonomy offers an approach to the empirical exploration of users’ expectations concerning quality assurance. It may contribute to the transparency of stakeholders’ perspectives, to the preparation of consensus procedures in QA and to systematical comparison of quality assurance systems.     

Concepts and methods for assessing the quality of essential obstetric care

Approaches to reducing maternal mortality and morbidity have attracted much attention in the last decade. It is recognized that availability and use of essential obstetric care (EOC) of sound quality by women in labor would reduce the burden of illness and death resulting from pregnancy. However, the literature on methods for defining, assessing and improving the quality of EOC at the point of service delivery in developing countries is quite weak. Drawing upon fundamental concepts of quality assurance, statistics, clinical practices and health service management, this article presents unifying concepts and methods for defining, assessing and improving the quality of EOC in developing country settings. It argues that any intervention that would improve the quality of EOC must act through at least one of three mechanisms: improve the clinical management of uncomplicated labor; improve the detection of complications of labor; or, improve the clinical management of complications of labor. The text presents the basis for using quantitative and qualitative methods to assess the quality of EOC. It concludes that any method to assess the quality of EOC, as a basis for improvement at the health center level, must satisfy the following seven criteria: (i) be derived from scientifically sound and locally defined guidelines for what constitutes care of good quality; (ii) enable objectively verifiable measurements of the performance of critical tasks; (iii) be sufficiently discriminating to detect variations in quality among health centers, thereby enabling managers to focus on improving care in those health centers providing care of lower quality; (iv) facilitate production of visual aids within each health center, thereby enabling midwives, doctors and their supervisors to use information for improving their work on a daily basis; (v) include qualitative assessments to facilitate interpretation of quantitative information; (vi) be reasonably simple to use without unsustainable foreign technical assistance; and, (vii) be affordable within the limited resources of public health facilities and District Health Management Teams.     

Geographic disparities in Healthy Eating Index scores (HEI–2005 and 2010) by residential property values: Findings from Seattle Obesity Study (SOS)

BackgroundHigher socioeconomic status (SES) has been linked with higher-quality diets. New GIS methods allow for geographic mapping of diet quality at a very granular level.ObjectiveTo examine the geographic distribution of two measures of diet quality: Healthy Eating Index (HEI 2005 and HEI 2010) in relation to residential property values in Seattle-King County.MethodsThe Seattle Obesity Study (SOS) collected data from a population-based sample of King County adults in 2008–09. Socio-demographic data were obtained by 20-min telephone survey. Dietary data were obtained from food frequency questionnaires (FFQs). Home addresses were geocoded to the tax parcel and residential property values were obtained from the King County tax assessor. Multivariable regression analyses using 1116 adults tested associations between SES variables and diet quality measured (HEI scores).ResultsResidential property values, education, and incomes were associated with higher HEI scores in bivariate analyses. Property values were not collinear with either education or income. In adjusted multivariable models, education and residential property were better associated with HEI, compared to than income. Mapping of HEI–2005 and HEI–2010 at the census block level illustrated the geographic distribution of diet quality across Seattle-King County.ConclusionThe use of residential property values, an objective measure of SES, allowed for the first visual exploration of diet quality at high spatial resolution: the census block level.     

北京市城区学龄儿童自我意识与主观生活质量的相关性研究

目的 了解北京市城区学龄儿童自我意识及主观生活质量现状,并分析两者间的相关性。方法 采用团体施测方式,采用Piers-Harris儿童自我意识量表和儿少主观生活量表对北京市城区210名学龄儿童进行测评。采用线性相关分析学龄儿童自我意识与主观生活质量之间的关系。结果 北京市城区学龄儿童在自我意识的6个维度上的得分以及总分均高于全国城市常模的水平,差异具有统计学意义(P<0.05);主观生活质量总体水平高于常模水平,差异有统计学意义(P<0.05),主观生活质量中认知成分高于常模水平,情感成分与常模水平相当。自我意识水平与主观生活质量呈线性正相关。结论 北京市城区学龄儿童的自我意识水平与主观生活质量总体高于常模水平。自我意识越高的儿童其主观生活质量也越好。     

阜阳市医疗机构消毒工作质量监测结果分析

1993— 1999年对辖区医疗机构消毒质量监测 ,采样检测合格率 ,市级高于县级 ,县级高于乡镇级 ,差别显著 (P <0 .0 5 )。对县以上医疗机构加强消毒管理前后 ,消毒质量明显提高 (P <0 .0 5 )。各县市 (区 )近年监测结果表明 ,不同地区、级别医疗机构消毒质量参差不齐。一些县、市仍存在较多消毒问题。提出了加强消毒知识培训、健全消毒规章制度、改善更新消毒设备和方法、加强消毒工作监测管理是预防和减少医源性感染的有效手段     

Measuring the value of air quality: application of the spatial hedonic model

This study applies a hedonic model to assess the economic benefits of air quality improvement following the 1990 Clean Air Act Amendment at the county level in the lower 48 United States. An instrumental variable approach that combines geographically weighted regression and spatial autoregression methods (GWR-SEM) is adopted to simultaneously account for spatial heterogeneity and spatial autocorrelation. SEM mitigates spatial dependency while GWR addresses spatial heterogeneity by allowing response coefficients to vary across observations. Positive amenity values of improved air quality are found in four major clusters: (1) in East Kentucky and most of Georgia around the Southern Appalachian area; (2) in a few counties in Illinois; (3) on the border of Oklahoma and Kansas, on the border of Kansas and Nebraska, and in east Texas; and (4) in a few counties in Montana. Clusters of significant positive amenity values may exist because of a combination of intense air pollution and consumer awareness of diminishing air quality.     

Assessment of level of care: implications of interrater reliability on health policy.

In Wisconsin, level-of-care assessments are used to set Medicaid reimbursement and determine nursing home eligibility. This study examined three methods of assessing level of care: 1) the Wisconsin quality assurance project (QAP) method, based on observations of patients, patient records, and staff interviews; 2) the Wisconsin standard (STD) method, based primarily on a clinical record review; and, 3) an adaptation of New York's "DMS-I," a checklist with numerical weights used to set level of care. Results address interrater reliability, the agreement between assessments by research teams and actual levels of care set by the State, and the implications that agreement has for reimbursement.