某三甲医院病种收支模型构建及实施效果评价

目的 探寻有效评价规范临床路径、控制医疗成本的方法。方法 以某三甲医院2021年各科室疾病谱为例,通过对病种次均费用、收入结构、平均住院日、成本等项目进行分析,测算次均毛利润。结合临床路径,对药占比、耗占比和平均住院日等指标进行优化,并与科室进行探讨,在结合临床实际的基础上对该病种相关运营管理指标提出合理化建议,形成病种收支模型。结果 病种收支模型应用于临床以来,有效降低了药占比和耗占比,缩短了平均住院日,科室收入结构优化,病种次均毛利润增长,科室经济效益显著提升。结论 将合理的病种收支模型与临床路径的诊疗行为相结合,有助于医院临床路径的管理及医疗成本的管控,实现医疗质量与效益的同步推进。     

医用统计在质量管理中的应用

为了全面实施质量管理,提高工作效率和医疗质量,充分发挥统计工作在质量管理中的作用,我院从1984年开始,以兰后卫生部颁发的《临床科室工作质量标准》《辅诊科室工作质量标准》(讨论稿)为依据,结合本院实际制定出63种医疗控制指标,为医院由定性管理逐步走上定量管理打下了基础。具体做法:     

医学影像信息系统整合临床应用探讨

目的 探讨我院PACS 与军字一号工程(HIS系统)的集成与临床应用.方法 通过DICOM 3.0标准接口将影像科数字化成像设备CR、DR、CT、B超、DSA、MRI与影像储存与传输系统(picture archiving and communications system,PACS)、军字一号系统相连接,构建全院医疗信息网.结果 在PACS-HIS统筹规划标准下,集成PACS-HIS工作站42个,HIS独立工作站67个(医师工作站35个,护士工作站32个),共计109个工作站点覆盖全院各科室,实现医疗信息资源共享.结论 PACS-HIS系统整合提高了医学影像综合管理水平,降低了医院整体运营成本,它将在影像科室、临床科室、医学教育、远程会诊方面发挥重要作用.     

TOPSIS法在临床科室医疗质量综合评价中的应用

TOPSIS法是系统工程中有限方案多且目标决策分析常用的一种决策方法…。它将原始数据进行归一化处理,清除了不同指标量纲的影响,排序结果直观、可靠。本研究应用TOPSIS法对我院2012年医院临床科室的医疗质量进行综合评价,旨在从多方位对各病区的工作进行分析,综合评价,以宏观掌握医院各临床科室全年医疗任务完成情况。     

临床医学本科毕业生质量评价指标的构建

本文针对当前我国医学教育质量缺乏科学的评估体系,为提高我国临床医学本科毕业生质量,结合世界医学教育联合会(WFME)提出的医学教育标准,对我国临床本科毕业生质量主要构成要素进行分析,通过专家咨询法(Delphi法)建立评价指标,并以层次分析法(AHP法)确定指标的权重系数,建立了一套临床本科毕业生质量评价指标体系。     

医疗质量控制的效果和评价方法

我院从1987年起,把目标转向质量管理,以提高医疗质量为重点,以实施医疗技术标准为手段,以总后卫生部颁发的《军队医院医疗质量主要评价指标》为依据,制订了工作效率、工作质量和共同管理质量及相应的各项标准,在全院各科实施,并对8个主要临床科的医疗质量进行检查考核.为观察效果,医院医疗质控机构设计了《医疗质量信息表》,此表由各科自查后每月按时填报交医院医疗质控机构评价核准,下月初的院周会上将质控效果和评价分析结果进行讲评,这样做对科室的医疗质量起到了明显促进和推动作用.现将8个主要临床科的3项指标评价效果报告如下:资料来源和方法:一、资料来源(三项指标)(一)工作效率:①收容指标;②床位利用指数;③出院者平均住院日.(二)工作质量1.外科系:①临床初诊符合率;②入院3日确诊率;③临床与病理诊断符合率;④床位疗效指数;⑤住院者平均住院数;⑥住院抢救成功率;⑦医疗差错     

大型医院医技科室医疗质量评价体系的研究

为科学、准确的考评医技科室的医疗质量状况，为医院管理者实施横向比较提供依据，笔者运用德尔菲法，分两轮请医技科室主任和医院管理专家，对Ⅰ类和Ⅱ类指标存在的合理性和权重提出意见，以确定最后的指标并测算出相应的权重。从而研究并构建出医技科室医疗质量评价体系。     

新时期加强医疗质量管理的措施

1注重建章立制 1．1建立质量管理考评体系一是运用以病例为质量单元的管理评价方式，建立具有选择性、实用性、即时性、可操作性的病例分型指标模式，将效果和过程、质量和费用有机结合起来，对医疗质量进行综合评价；二是实行“临床医师综合评价”法，评价指标包括医德医风、工作态度、工作数量、工作质量、业务能力和技术水平等内容，根据每位医师的综合得分，在科室内部和全院相同职务范围内进行排序，使人人了解自己的“定位”。     

应用层次分析加权法综合评价临床科室工作

目的　用于综合评价医院工作的方法众多 ,但每一种方法均有其利弊。为了顺应医院管理的需要 ,我们对临床科室工作综合评价进行了研究。方法　采用层次分析加权法将临床科室月工作的 17项指标进行了综合分析。结果　通过实例证明本方法具有简明、客观、准确的特点。结论　结合层次分析加权法评价医院工作有一定的应用价值     

军队大型医院医技科室医疗质量指标评价体系的构建

目的：为科学、准确的考评医技科室的医疗质量状况，为医院管理者实施横向比较提供依据。方法：运用Delphi法，分两轮请医技科室主任和医院管理专家，对Ⅰ类和Ⅱ类指标存在的合理性和权重提出意见，以确定最后的指标并测算出相应的权重。结果和结论：成功的构建了医技科室医疗质量指标评价体系，同时该指标体系还具有较强的实用性和可操作性的特点。     

建立重大呼吸道传染病医用救治物资二级库的体会

 目的 实现突发呼吸道传染病救治过程医用物资精细化管理。方法 针对突发呼吸道传染病救治政策及药品耗材供应特点,依据临床科室人员配比情况,制定医疗物资库存基数,建立适合临床科室管理维护的医疗物资二级库。结果 临床科室医疗物资二级库能降低科室医疗物资请领频次,减轻中心药站药师药品调配强度及其他医护人员工作量,提高计价医嘱正确率。结论 医疗物资二级库的建立,可降低医护人员体能消耗,提高疫情防治的精准化管理。     

Effiziente IT-Lösungen in der Radiologie

For hospitals and radiology departments an efficient hospital information system (HIS), a radiology information system (RIS) and a picture archiving system (PACS) with high availability, reliability, flexibility and simple operation are necessary for survival. Besides the networking of patients and pictures data IT systems must also be capable of continuous process optimization in the dimensions of medical quality, service quality and profitability. What is not measurable is not improvable. A successful management demands current, medium-term and long-term indicators for the control. These performance and cost data are also available for benchmarking with other departments or for analysis for manpower requirements. In contrast to the past indicators must now concentrate on the use of resources by interdepartmental process treatment (clinical pathways and imaging pathways). The monitoring of image pathways is a future task. Without qualified IT personnel, optimal IT systems cannot be successful. In the complex treatment processes in hospitals high medical (radiological) quality is only possible in connection with optimal IT systems and excellent IT specialists.     

The PACS model plan at the Freiburg University Clinic. A first step toward a radiologic picture archiving and communication system

In a study performed at several clinical departments of the University of Freiburg, West Germany, it was found that approximately 180,000 patient examinations based on computed tomography, magnetic resonance, nuclear medicine, ultrasound as well as digital and conventional radiography, produce over 1,000,000 pictures. It was assumed that modern technologies can greatly facilitate the handling of such a quantity of images. This applies to diagnosis and therapy planning as well as to communication and archiving of this large amount of data. The study also assumes that the technologies to be considered, e.g. fiber optical networks, optical archives and medical work stations, which represent the main components of PACS, should be introduced in a stepwise manner following a clear overall conception. As the first step the implementation of a local area network (LAN) in the departments of radiology and general surgery is planned. Important criteria for the selection of these particular departments are improvements in health care for a maximum number of patients and in the working profiles for the greatest possible number of physicians and assistant personnel. A cost reduction as compared to the present system through more efficient communication and archiving of the digital images is expected. New perspectives for medical research as well as for medico-technical developments are also expected. Examples are the 3-D representations of human anatomy and the manufacturing of custom-designed prothetic devices. Scheduling and budgetary plans for equipment and manpower are further study results for the Freiburg PACS-Project.     

基于功效系数法的医院绩效分配评价

 目的 综合评价医院各科室间绩效分配,为合理分配医院绩效,提高公平和公正性,解决现行方案缺陷,达到充分利用薪酬提高人员激励效果提供依据。方法 采用功效系数法对某医院2016-2018年10个内科科室的10项绩效评价指标计算总功效系数并进行排序,评价指标权重采用德尔菲专家咨询法确定,科室实际绩效分配按照成本核算法为主导的综合绩效评价体系完成。结果 对成本核算指标过度重视的康复科和重视不足的肝中心总功效系数排序与实际分配结果有偏差,其他八个科室评价结果与实际分配结果一致或基本一致。结论 采用功效系数法可以对以成本核算为主的医院综合绩效分配结果进行评价,评价结果有实际意义,能够对绩效分配方案进一步调整产生指导作用。     

Project planning, training, measurement and sustainment: the successful implementation of voice recognition

Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.     

基于OA协同办公系统实现院内跨专科联合会诊的全流程闭环管理实践

 目的 梳理院内科室间的协作工作流程,保障临床医疗质量,提高医疗安全水平。方法 基于OA协同办公系统的设计实践,将跨专科联合会诊流程,融入项目管理的思路,从前期跨专科科室沟通,到协作诊疗的方案讨论,再回溯跟踪进行质量评估,形成整体标准化的院内跨专科联合会诊工作流程。结果 实现了全流程的闭环管理和质量监控。结论 该系统完善了院内跨专科的联合会诊业务流程和监管手段,有效提高了临床医疗质量,也为管理者提供了数字化管理依据。     

数字化影像工作站的开发与使用价值

目的：总结开发与使用数字化影像工作站的经验，提出今后的改进与发展方向。方法：通过在普通微机上使用MEDASYS公司的DxMM软件及自行开发的放射信息系统(RIS)软件实现了与旧型号MR机的数字化连接，构建了科室水平的简易网络化工作环境。通过对4a来应用工作的总结，验证了本项工作的临床价值及经济效益，获得了有益的经验。结果：本套系统运行稳定，使用简单、方便，显加快了检查及诊断的速度，提高了患满意度。同时简化了日常工作流程，提高工作效率约25％，每年节约成本约25万元，取得了社会效益与经济效益的双丰收。结论：医疗工作的数字化是当代最前沿的一项实用技术．对提高工作效率、改善服务质量及提高经济效益有着极其重要的作用，是今后医学界需要加大投入人力、财力来尽快全面实施的关键项目。     

提高预约挂号精度改善门诊就医秩序

目的 为预约挂号平台提供患者错峰就诊的准确预约时间,以改善门诊就医秩序.方法 分析预约挂号的特点及存在的问题,利用医院信息系统（HIS）中各专科的门诊时间信息,测算医师对每名患者的平均接诊时间.结果 准确预约时间,使患者有计划就诊,节省时间和医疗外费用,有利于实现错峰就诊,改善门诊就医环境.结论 预约挂号增强工作计划性,提高医院工作效率,缓解患者＂看病难＂的矛盾.     

The Walter Reed Army Medical Center Nephrology Service website: a tool for military-wide provider and patient education

OBJECTIVES: Military medical subspecialists consult with referring physicians, direct patient care and education, support isolated subspecialists, and maintain cohesive readiness plans. The World Wide Web appears promising in fulfilling these roles. METHODS: A website providing directed resources, the Walter Reed Army Medical Center Nephrology Service website (http:@www.wramc.amedd.army. mil/departments/medicine/nephro/NEPHROLOGY/index.htm!), is described in the context of its role in military medicine and online publishing. RESULTS: The Walter Reed Army Medical Center Nephrology Service website provides educational resources for both patients and physicians worldwide. It remains the only Army internal medicine website to offer online category I continuing medical education credits free to military physicians, and it also allows online graduate medical education. CONCLUSIONS: Military medical subspecialty programs can use the World Wide Web to provide consultation and education to distant and isolated patients and providers in a practical, feasible manner. This process can be expanded to education in operational medicine and other military-specific medical topics.     

临床护理路径在子宫切除患者中的应用效果

目的探讨临床护理路径在子宫切除患者的应用效果。方法选择2012年9月-2013年6月住院手术治疗子宫肌瘤患者152例,随机分为路径组和对照组各76例,两组患者均以整体护理为基础,对照组采用常规子宫切除术护理,路径组采用子宫切除术临床护理路径进行。对两组患者的住院时间、费用、满意度及健康知识掌握程度等进行比较。结果路径组患者的住院天数及费用低于对照组（P〈0．05）;患者满意度和健康知识掌握程度高于对照组（P〈0．05）。结论实施临床护理路径缩短了住院时间,降低了费用,提高了医护质量,保证了医疗安全,同时提高了患者对医疗护理工作的满意度和健康知识掌握程度。