潍坊市医疗机构执业许可量化评审标准的实践与思考

目的回顾我国医疗机构评审的历史,分析第一周期医疗机构评审存在的问题,制订医疗机构执业许可量化评审标准,建立评审专家库并实施量化评价,核定医疗机构执业许可范围,规范医疗机构执业行为,强化卫生行政部门的监督管理。方法主要采用了专家咨询法、政策文献复习法、试验性研究等方法制订医疗机构执业许可量化评审标准,建立评审专家库并实施量化评价。结果第一周期医疗机构评审存在的问题主要包括：医院歪曲了部分评审标准和指标,盲目增加基础设施建设;政府主导的医院评审模式缺乏公平性和公正性;评审标准、评审方法缺乏规范化和科学性。通过实施量化评审,在我局登记注册的二级综合医院的内、外、妇、儿、检验以及医学影像等科目全部核定到二级,累计撤销179个诊疗科目,取缔非法从业人员34人。结论该量化评审标准以医疗机构基本功能为核心,强调医疗机构的医疗质量与安全评价;需要进一步完善医疗机构评审体系,建立第三方中介评价机构;需要借鉴国外医院评价标准,完善和实施绩效评价。     

试论建立我国医疗机构评审制度

建立我国的医疗机构评审制度是医疗机构宏观管理的一项重要措施。本文回顾了我国医院评审活动的历史经验,讨论了建立我国医疗机构评审制度的必要性和可行性,介绍了现行医疗机构评审制度的组成与特点,提出了下一阶段医疗机构评审工作的对策。     

JCI国际医院认证与中国医院评审标准比较研究

为加强对医疗机构的管理,我国自1989年11月卫生部发布《关于实施医院分级管理的通知》和《综合医院分级管理标准(试行草案)》至1998年8月发布《关于医院评审工作的通知》10年间,对医院评审工作的理论与实践进行了积极、有益的探索。实践表明,第一周期评审,在一定程度上促进了医疗机构的建设与发展,提高了科学管理水平,推动了医疗质量的改进与提高,积累了宝贵的经验。但是,也存在着一些不足和亟待解决的问题[1,2]。1 JC I国际医院认证标准的特点JCI编纂的《医院评审标准》是集中了75年来,美国医疗机构联合评审委员会和其前身机构一直致力…     

各地

北京民办医院职称评审将看齐公立医疗机构 北京市日前发布了《北京市社会资本举办医疗机构卫生专业技术人员职称考试与评审暂行办法》,指出凡在北京地区民办医院内工作的医务专业技术人员,只要符合条件,均可自主参加职称考试与评审。此举破除了民办医院医务人员参评职称的准入障碍,打破户籍、单位职务数额和结构比例限制,打通了民办医院医务人员参加职称评审的渠道,使民办医院中医务人员均可在北京市参加职称评审,且职称评价标准条件与公立医疗机构水平相当、评价标准一致。     

日本医疗机构评审概述及启示

评审评价工作是医院提高管理水平和服务能力的重要抓手。日本医疗机构评审于2013年获得国际认证。公益财团法人日本医疗机能评价机构是专业的第三方评审机构,有专职人员负责具体事务,并面向全国招聘评审专家,评审内容及评审支援项目明确,以学术的、中立的观点评价医疗机构,为民众了解医疗机构水平提供了途径。我国医院评审近年来成效显著,但也存在诸如条款多、评审员培训不足、患者参与度不高、医务人员工作压力大等问题。据此提出,应建立我国等级医院评审官方网站,应明确医院区域功能需求,应成立完全独立的第三方评审组织,应大力开展评     

医院等级，医疗质量说了算!

近日,天津市卫生部门对全市60所二级西医医疗机构进行了校验审查。根据评审结果,天津市干部疗养院等38所医疗机构基本符合二级医疗机构标准,予以保留二级资格;河西区柳林医院等8所医疗机构被亮“黄牌”,限期整改;河东区中山门医院等14所医疗机构因不符合二级医疗标准被降级。     

建立健全医院评审系统保证《条例》贯彻执行

自１９８９年在全国开展医院评审以来，对于促进我国医疗事业的发展，保障病人的权益起到了重要作用，但医院评审过程中存在着医院评审系统不健全，标准和评审细则不完善，缺乏评审后监督等问题，为了使医院评审能正常运行，急需建立包括全国统一的标准和评审细则，建立具有法人资格的医院评审机构和对医院决策实施不间断监督的专业中心的医院评审系统，保证国家《医疗机构管理条件》的贯彻执行。     

我国医疗机构评审工作的发展设想

借鉴国外的成功经验，结合我国第一轮医疗机构评审工作存在的问题，对我国第二轮医疗机构评审工作提出三个方面的发展设想：在总体思路上，保持医疗机构三级评审体系的连贯性，逐步引入委托第三方评审的模式，提高评审结果的激励效用；在评审标准上，明确评审标准的定位，强化医疗质量和病人安全等内涵指标；在评审方式上，要求评审机构与医疗机构良性互动，加大日常监督检查的力度。     

对我国医院评审标准的再认识

为探讨医院实施持续质量改进的思路与途径,建立一个具有中国特色的医院评审指导原则框架,回顾了医院评审的历史.对美国医疗机构国际联合委员会(JCI)与中国医院评审2个标准体系的背景与内容进行了比较.分析了两者的特色和存在的问题,以及在关注的侧重点、范围、内涵,行业特征上的差异.认为医院评审标准具有巨大的导向作用,必须立足于我国医院现状,将2个标准有机地结合起来,强调建立中国医院评审标准的落脚点是质量与效益.     

湖南省老年友善医疗机构建设评审与分析

目的 老年友善医疗机构创建工作是全面推进健康中国建设,积极应对人口老龄化国家战略的一项具体举措。方法 按照《湖南省老年友善医疗机构标准(试行)》对湖南省提供老年服务的不同类型、不同等级的共113家老年友善医疗机构进行评审,从老年友善文化、管理、服务、环境四个方面进行评审。结果 总平均分88.72分,文化方面平均分13.44分,管理方面平均分12.76分,服务方面平均分37分(总分45),环境方面平均分24.17分。结论 虽然老年友善医院建设取得了长足的进展,但仍存在一些不足,评审结果可为医疗机构开展老年友善医疗机构建设工作提供参考。     

医院分级管理与区域医疗技术关系的研究

通过专家咨询法选择了部分体现医疗技术进步的指标,对四川省某区域内8所1995年通过医院分级管理评审委员会评审达标的二级乙等医院进行了专题调查,调查的指标有:医院的一般情况、医疗设备配置现状、新技术开展状况、科研成果与学术论文(发表)产出、卫生专业技术人员的培训、重点专科建设、学术与学科带头人的培养等8项。通过对8项指标的系统分析认为,我国医院分级管理工作,在第一个评审周期促进了医院的技术进步。但同时还存在有:①医院之间发展不平衡;②卫生资源配置不合理;③学术与学科带头人老化;④重点专科的功能发挥受限;⑤技术标准有待调整等问题。并针对存在的问题及进一步完善我国医院分级管理工作,在第二个评审周期如何促进医院技术进步,以适应医院服务社区人群的医疗需求等阐述了作者的看法。     

以等级医院评审为契机提高临床输血管理水平

目的探讨等级医院评审对临床输血管理工作的持续改进成效。方法收集等级医院评审前后相关输血相关资料,分别从输血申请单、输血病历、临床用血情况进行回顾性分析。结果等级医院评审后,输血申请单填写不合格率由59.7%降低到9.7%,输血病历不合格率由79.0%下降到23.7%。在住院患者与手术患者增长的情况下,用血人次与用血总量均减少。结论等级医院评审可有效提高临床输血管理质量。通过建立规范化、标准化的输血管理体系,可以促进临床用血更加科学、合理、安全、有效     

Occupational health and safety in hospitals accreditation system: the case of Lebanon

Introduction: Hospital accreditation can be an incentive to improve occupational health and safety (OHS) performance.

Objective: This study assesses the relationship between status of accreditation among private Lebanese hospitals and compliance with OHS accreditation standards.

Methods: A survey was administered to 68 private Lebanese hospitals to assess accreditation status and specific indicators related to each of the 9 OHS codes in the Lebanese accreditation manual. Chi-square, Fisher’s exact test, and independent sample t-tests compared the OHS standards between accredited and non-accredited hospitals.

Results: Fifty-six percent of participating private hospitals were accredited. Accredited hospitals reported statistically better OHS performance than non-accredited hospitals based on the standards outlined in the accreditation manual. However, there was inconsistent performance on numerous OHS indicators among participating hospitals.

Conclusion: The gaps in OHS performance suggest the need for strengthened OHS guidelines in the national accreditation process to safeguard workers’ health. Strategies to fortify OHS performance include tying service reimbursement to OHS compliance and linking OHS standards with national labor legislation.     

武汉市实施一级医院分级管理与医院评审的做法与体会

自1992年武汉市开展医院分级管理一级医院试点工作以来,全市176所基层医院中已有23所被评为一级甲等医院。其基本做法:1.精心设计.周密布置,充分做好试点准备工作;2.坚持正确的舆论导向,加强交流指导,推动医院分级管理工作健康发展。     

Changing hospitals: the role of hospital accreditation

Participation in the Australian Council on Hospital Standards' accreditation program provides one of the important stimuli for change in Australian hospitals. This article analyses the impact of the accreditation program upon a random sample of 23 Australian hospitals which were monitored for two years. At the conclusion of the study, those hospitals which had applied for accreditation were compared and contrasted with those hospitals which had not applied. It was found that those hospitals which applied could be differentiated from those hospitals which had not by significant changes in six areas. The areas which showed the least change were those most directly associated with the medical staff. 'Nursing Organisation' and 'Physical Facilities and Safety' were the areas most affected by accreditation.     

四川省医院分级管理评审方法研究及实践

目的回顾和总结四川省医院分级管理评审工作,研究医院分级管理评审的发展,探讨医院分级管理评审的新方法。方法对四川省开展医院分级管理评审工作以来的资料进行统计和分析,并对相关资料采用EXCEL软件建立数据库,进行统计和归纳,作回顾性描述分析和总结。结果四川省在医院分级管理评审工作中坚持标准、兼顾现实、全面考核、突出重点,采用统一数学模型、统一评审程序、统一考核检查程序、统一检查方法和公开评审标准、公开评审程序、公开检查方法的评审方法。有力地推动了四川省医院分级管理评审工作的开展,促进了各级医院的发展,取得了良好的效果。结论实践证明,四川省采取的＂四统一＂和＂三公开＂及坚持＂两原则＂的评审方法是可行、有效的。     

Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

ObjectiveThis study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes.Materials and methodsThis was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards’ Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003–2006 (Time 1) and 2007–2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2.ResultsContinuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time.ConclusionsAn accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.     

Towards an accreditation system for the Dutch hospitals

The development of the Netherlands system for accreditation of hospitals started in 1989 in the Pilotproject Accreditation (PACE). This resulted in the establishment of the Netherlands Institute for Accreditation of Hospitals (NAIH) early 1999, by the Dutch Association of Hospitals, the Dutch Association of University Hospitals, the Dutch Organisation of Medical Specialists and the PACE foundation. Dutch hospitals may request (voluntary) for an accredition for their whole organisation or for parts of it, independent of the used quality system. An accreditation assesses whether organizational requirements are available for quality assurance. Accreditation is not primarily aimed to account for organizational quality, but rather to find points for improvement. The survey is carried out by peers: experts from other Dutch hospitals. The frame of reference used in accreditation is composed of 35 departmentwise standards and a hospitalwide standard 'Quality system'. All standards are developed by people in Dutch hospitals. NIAH can accept certificates for parts of the hospital (e.g. laboratoria) issues by organisations. The system is complementary to the 'visitities' which are organized by the medical specialist societies in the Netherlands. From 1996-1998 trial accreditations were carried out in 19 Dutch hospitals. These showed that the accreditation system has an added value for Dutch hospitals.     

JCAHO accreditation and quality of care for acute myocardial infarction

We examined the association between JCAHO accreditation of hospitals, those hospitals' quality of care, and survival among Medicare patients hospitalized for acute myocardial infarction. Hospitals not surveyed by JCAHO had, on average, lower quality (less likely to use aspirin, beta-blockers, and reperfusion therapy) and higher thirty-day mortality rates than did surveyed hospitals. However, there was considerable variation within accreditation categories in quality of care and mortality among surveyed hospitals, which indicates that JCAHO accreditation levels have limited usefulness in distinguishing individual performance among accredited hospitals. These findings support current efforts to incorporate quality of care in accreditation decisions.