实施病例缺陷管理 提高医疗质量

对吉林省６５所医院的２１８０份病例进行了分析，结合实际，地对病例缺陷问题提出了中强质控，完善病例缺陷管理的对策；巩固医院分级管理及评审成果，防止评审后医疗质量滑坡，将病例缺陷管理纳入医院评审工作中、常抓不懈；平等行政部门要加强管理，使医院分级管理及评审工作落到实处；规范标准，切实抓好医疗质量；继续坚持“病人第一，质量第一”的原则。     

在实施医院分级管理中值得商榷的几个问题

在实施医院分级管理中值得商榷的几个问题胡登利，王宪国，黄茂辉，李明杰医院分级管理自１９９０年国家卫生部颁发《医院分级管理办法（试行草案）》以来，逐渐在全国范围内展开。目前，各地区正在对各级各类医院进行分级定等的评审工作，母庸置疑，医院分级管理的评审对...     

实施病例缺陷管理 提高医疗质量——对吉林省65所医院2180份病例缺陷情况分析

对吉林省65所医院的2180份病例进行了分析,结合实际,针对病例缺陷问题提出了加强质控,完善病例缺陷管理的对策:巩固医院分级管理及评审成果,防止评审后医疗质量滑坡;将病例缺陷管理纳入医院评审工作中,常抓不懈;卫生行政部门要加强管理,使医院分级管理及评审工作落到实处;规范标准,切实抓好医疗质量;继续坚持“病人第一,质量第一”的原则。     

对医院分级管理评审的思考

笔者曾有机会参与全国综合医院分级管理标准的起草工作,听到五省市关于试评工作经验的介绍,近来,又读了《中国医院管理》杂志上发表的关于医院分级管理和评审工作等方面的文章,思考了医院分级管理评审的有关问题。     

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。     

实施军队医院分级管理的思考

“八五”期间，我军医院依据总后卫生部制订的《军队医院分级管理办法》和《军队医院分级管理标准》，在驻军医院以上各级医院开展了分级管理工作。文章根据第一个评审周期工作的实践，在总结成绩和经验的基础上，从指导思想、《标准》修订、达标建设、评审工作等４个方面，就今后如何进一步搞好军队医院的分级管理与评审提出一些具体建议，与同行商榷。     

医院评审中存在的问题与对策

山东省医院分级管理与评审工作自１９９１年起，到１９９４年，第一周期已基本结束。根据３年来的医院评审实践，我们发现评审中出现了对标准内函领会不透，突出补资料等现象。     

医院分级管理及评审软件系统的研究与应用

医院分级管理及评审标准项目多，信息量大，手工操作较难，四川省采用电子计算机对医院分级管理及评审进行管理，实现了对评审资料进行快速查询、评审、统计、分析，并有效地保存资料，使宝贵的评审信息资料变成实用的信息系统，为医院分级管理及评审提供了一个全新的工作方法。     

刘战培：院长的烦恼？制度的烦恼!

我国医院等级评审工作始于1989年,到1998年告一段落。在医院评审第一周期工作推行的同时,制度设计者们还同时发布了《关于实施医院分级管理的通知》,文中特别强调,耍“防止和克服盲目攀比,不顾全局的局部观念。切实防止借分级管理之机盲目扩大医院规模和发展不适宜技术的现象发生”,要“防止和克服不顾基础质量,单纯片面追求扩大规模和高技术设备的不正确导向”。应该说,这一配套通知在保证医院等级评审工作的顺利开展,实现等级评审的导向性目标起到了非常重要的作用。然而,在卫生部医院等级评审工作暂停13年后,各地重启仅仅一年就暴露了当初制度设计者们预料的问题——医院的医疗质量没有得到提高,服务质量没有得到改善。     

坚持科学管理,巩固和发展医院评审成果

如何巩固和发展医院分级管理及其评审成果,这是医院分级管理评审后必须高度重视和认真解决的十分重要的课题。为此,我们进行了有益的探索。我们认为必须坚持科学管理,采取有力措施,方能巩固和发展医院分级管理评审的成果,进一步提高医院整体服务功能,使医院的全面工作再上新台阶。     

参加军队医院等级评审的做法与成效

目的总结介绍迎评经验做法,利用迎评促进医院建设发展。方法从组织领导、制度机制、策略方法、现场评审、评审后整改等方面回顾和介绍迎评的做法和经验。结果医院等级评审促进医院质量内涵建设水平提升。结论医院等级评审质量、安全、管理、服务、绩效的五大主题,明确了军队医院转型发展努力的方向。     

JCI标准下医院感染预防及控制质量持续改进的实践

目的了解某院JCI评审期间医院感染率与手卫生依从率情况,评价JCI标准下医院感染控制措施实施效果。方法按该院JCI标准实施前(评审前)、启动过程中(围评审期)、通过JCI国际认证后(评审后)三阶段分组,比较不同阶段医务人员手卫生依从率、医院感染率、手卫生用品消耗量等指标的差异。结果全院医护人员的手卫生依从率由JCI标准评审前的74. 99%,上升到围评审期的78. 61%,再到评审后的90. 95%,总体差异具有统计学意义(P 0. 001)。JCI评审后全院各病区洗手液、快速手消毒剂消耗量均有增加;评审后,心内科、肿瘤血液科及全院医院感染发病率较评审前下降(P 0. 05),医院感染发病率较评审前也呈下降的趋势(P 0. 05)。医护人员手卫生依从率与医院感染发病率呈负相关(r=-0. 99,P 0. 05)。结论参照JCI评审标准,实时改进,可有效提高医护人员的手卫生依从率,降低医院感染发病率。     

对浙江省医院评审第一周期运作的评价

结合浙江省医院评审工作实际,对浙江省医院审第一周期运作情况进行了评价,指出了当前医院评审中存在的问题,并对第二周期医院评审工作提出建议：制订全国统一的医院审标准和评审细则; 建立专业医院评审机构;建立医疗专业技术质量控制系统。     

抓住新一周期三级综合医院评审特点推动医院建设发展

通过对我国开展医院评审工作的重要意义和两周期医院评审的区别进行分析,提出应抓住新一周期三级综合医院评审的特点,抓住评审契机,全力投入医改;全力以赴完成政府指令性任务开展公益活动;坚持质量为本;服务中体现以人为本;注重日常数据收集;把评审常态化精细化等,全面推动医院的建设发展。     

Mapping oral health related quality of life to generic health state values

Background

Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted.

Methods/design

To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation.

Discussion

The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.     

The healthy afterschool activity and nutrition documentation instrument

Health department accreditation is one of the most important initiatives in the field of public health today. The Public Health Accreditation Board (PHAB) is establishing a voluntary accreditation system for more than 3000 state, tribal, territorial, and local health departments using domains, standards, and measures with which to evaluate public health department performance. In addition, public health department accreditation has a focus on continuous quality improvement to enhance capacity and performance of health departments in order to advance the health of the population. In the accreditation effort, a practice-based research agenda is essential to build the scientific base and advance public health department accreditation as well as health department effectiveness. This paper provides an overview of public health accreditation and identifies the research questions raised by this accreditation initiative, including how the research agenda will contribute to better understanding of processes underlying the delivery of services by public health departments and how voluntary accreditation may help improve performance of public health departments.     

Is accreditation in the public interest?

The relationship of accreditation to the public interest has been a topic of discussion in the media as well as in higher education circles as the topic has been politicized. This article examines the historical evolution of public involvement in the accreditation process as well as the reasons for public representation on accreditation bodies and in decision making. The links between accreditation and quality control are discussed and assessed.     

泰国医院评审历程及对我国的启示

医院评审是促进医疗质量持续改进的有效手段。对泰国医院评审认证的发展历程、核心理念和标准框架、评审员遴选和培训、评审流程与评审周期、评审结果等进行梳理,指出其具有注重持续改进和风险管理、评审的多元性、融入大爱理念、广泛开展评审标准细化项目等特点。在全面了解泰国医院评审认证体系的基础上,提出了对我国医院评审工作的思考,如:与医保支付体系对接,加强评审员体系建设,注重体现医院功能定位等     

“达标上等”对医疗工作影响的研究

在第一评审周期结束之际,适时地开展“达标上等”创建工作对医疗工作影响的评估,对促进我国医院分级管理和医院评审,加快医院实现标准化和目标化管理进程有着十分重要的意义。本文采用特菲尔法建立了医疗工作评价指标体系和权重;运用TOPSIS法和加权秩和比法对医院初审前(1990年～1991年)、初审与复审间(1992年～1995年)和复审以后(1996年～)3个时期的医疗工作进行纵向评价。结果表明:“达标上等”创建工作对医疗工作质量有明显促进作用,而对医疗工作效率的影响未能与质量同步达到最佳水平。由此,作者提出:第二评审周期,应把握“巩固成果、提高质量、注重效率”的指导思想,更加注重质量与效率的同步发展,促进医院走“优质、高效”的内涵建设之路。     

Attitude of laboratory personnel towards accreditation

A multiple choice questionnaire was submitted to medical technologists in three medical laboratories, at varying times after obtaining an EN 45001 accreditation. A large majority (85-90 per cent) considered that their workload was increased by the accreditation process. In two laboratories, the technologists did not think that the accreditation process had improved the quality of the results. The major advantages were the fact that everything was traceable, that the technologists felt more sure about the procedures to follow, received more responsibilities and had a better knowledge of the tests they performed. The major disadvantages were the increased paperwork, discrepancies between the procedures and the reality, the fact that more attention is paid to the formalities than to the quality of the results and that the accreditation process decreased the adaptability. The number of advantages mentioned seemed to increase with the interval since the accreditation. A small majority of the technologists preferred working in an accredited laboratory than in a non accredited one.