基于国际医疗质量指标体系的医院医疗质量评价

国际医疗质量指标体系(International Quality Indicator Project,IQIP)在北京市5家三级甲等医院实施了3年。通过收集5家医院3年的病案首页数据,并挑选出IQIP中适合我国医院使用的指标,对医院的医疗质量进行统计分析及评价,通过医院间的横向比较和医院自身的纵向比较,为医院改进医疗质量提供数据支持。通过统计分析3年的病案首页数据发现5家医院的医疗质量均有改善,医疗水平逐年提高。     

基于国际医疗质量指标体系构建ICU护理质量评价体系

目的?基于国际医疗质量指标体系,为IcU护理质量管理提供评价工具.方法?采用“专家对比排序法”.结果?6项一级指标的权重依次为0.241、0.132、0.085、0.074、0.240、0.238,24项二级指标的权重为0.031~0.462.结论?IcU护理质量评价体系,可作为IcU护理质量的评价工具     

疾病质量与医疗质量指标的关系

本讨论疾病质量与医疗工作，医疗质量指标之间的内部关系和规律，提出通过疾病质量的量化评估这一标准化方法，达成对质量指标中疾病必然性成分与技术质量成分的分离，提纯，促成质量指标的跨地域，跨时空直观统计比较，提高质量指标的科学性，实用性。     

国际主要医疗质量评价体系选择的临床指标及其共性

医疗质量指标是评估医疗机构的基础,很多国际机构和组织都制定了临床指标体系。通过分析国际5个主要的医疗质量评价体系（世界卫生组织、经济合作与发展组织、美国卫生服务与质量研究所、美国绩效科学研究中心、澳大利亚卫生服务标准委员会）所选择的临床指标,发现其共性在于：在选择临床指标时均高度重视临床服务的结果,高度重视临床指标的科学性和临床指标的可行性,其选择的临床指标中均包括住院死亡类指标、非计划重返类指标以及患者安全类指标。     

医疗质量指标统计软件的介绍

本介绍一个实用统计软件。它利用病案管理中产生的病案首页库；BLKPKI．DBF和两个辅助库ZKMCKDBF，DIAGDICT.DBF。输出一份医皖管理感兴趣的、各临床科室全部单病种治疗质量的统计表．现已在上海长海医院和上海东方肝胆外科医院运行。     

医疗质量指标填写中存在的问题及改进对策

医疗质量指标是评价医疗质量的主要依据 ,也是等级医院检查的重要项目 ,它对加强医院的管理 ,促进医疗质量的提高发挥着重要作用。现将我院在病历检查中发现的医疗质量指标统计中存在的问题 ,作一分析 ,并提出改进对策。1　存在问题1 1　诊断质量指标填写失真这组指标为 :门诊与出院诊断符合率、入院与出院诊断符合率、手术前与手术后诊断符合率、临床诊断与病理诊断符合率、入院 3日确诊率。填写失真现象 :为使门诊诊断与出院诊断符合 ,门诊诊断不填住院证上的诊断或修改住院证上不符的诊断 ;为使入院与出院诊断符合 ,把修正后诊断作为入院…     

医院医疗质量指标数据库平台设计与实现

目的：建立一套完整的指标体系,并通过数据库平台进行采集,在信息平台上予以呈现。方法采用数据库技术,抓取并转换医院管理系统、MHIS系统、LIS系统、PACS系统中的数据,整合“三甲”复审指标、医院质量监测指标、卫生网络直报指标、科室管理指标,架构、设计数据库平台。结果数据库平台使医疗质量指标采集更加规范有序,指标集中呈现,在平台内可进行综合查询与分析。结论数据库平台的应用既提高了统计工作效率,又保证了数据的完整性与准确性,还能为管理层提供科学决策支持。     

国内外儿科医疗质量指标对比分析

对美国、澳大利亚儿科医疗质量指标,欧洲儿科医疗质量指标,国际医疗质量指标体系中的儿科指标,美国《医疗质量与患儿安全年报》中的儿科指标等进行介绍,并与我国的儿科医疗质量指标进行对比分析,探讨国内外儿科医疗质量指标的共性,从医疗质量指标的可行性、客观准确性以及数据的收集与分析等方面分析了对我国的启示。     

医院综合医疗质量指标管理

为探讨综合医疗质量指标管理,本阐述了我院按照三特医院的标准要求,进行了质量检控,建立了医疗质量提高的保障系统,形成了完整的医疗管理体系,促进了各项综合医疗质量指标的达标,使医护工作质量不断提高。     

县医院质量指标体系及考评办法探讨

健全医院质量指标体系及考评办法,是当前深化医院改革,加强医院管理的一个重要内容。本文就此作点探讨。 一、主要评价指标 县医院质量指标体系的建立,应本着全面、精简、可行的原则。基于目前多数县医院的技术和质量水平,县医院拟采用综合评价指标体系。据抚州地区的实践,县医院质量主要评价指标可以分为以下六个方面:     

我国评价医疗质量指标中存在的主要问题剖析

以国际医疗质量评价指标体系为基准，对国内目前所使用的医疗质量评价指标进行分析．发现国内目前评价医疗质量所使用的指标存在着如下主要问题：（1）现行指标与现代医疗服务质量概念和指标设计原则之间存在较大差距：（2）现行评价医疗质量的指标没有形成完整的体系；（3）现行指标在科学性、客观性和准确性方面存在较大问题：（4）过多使用“间接指标”。     

Incidence and Risk Factors for Unplanned Transfers to Acute General Hospitals From an Intermediate Care and Rehabilitation Geriatric Facility

ObjectiveUnplanned acute hospital transfers (AT) from post-acute or long-term care facilities represent critical transitions, which expose patients to negative health outcomes and increase the burden of the emergency departments that receive these patients. We aim at determining incidence and risk factors for AT during the first 30 days of admission at an intermediate care and rehabilitation geriatric facility (ICGF).Design and SettingProspective cohort study conducted in an ICGF of Barcelona, Spain. Sociodemographics, main diagnostics, and variables of the comprehensive geriatric assessment were recorded at admission. At the moment of AT, suspected diagnostic motivating the transfer was recorded. Multivariable Cox proportional hazard models were used to evaluate the association between admission characteristics and AT.ResultsWe included 1505 patients (mean age + standard deviation = 81.31 ± 7.06, 65.7% women). AT were 217 (14.4%, 5.64/1000 days of stay) resulting in only 81 final hospitalizations (37% of AT), whereas 136 patients returned to ICGF after visiting the emergency department. Principal triggers of AT were cardiovascular, falls/orthopedic, and gastrointestinal problems. Being admitted to ICGF after a general surgery [hazard ratio (HR) 1.88; 95% confidence interval (CI) 1.21–2.94; P < .001], taking 8 or more drugs at admission (HR 1.98; 95% CI 1.37–2.86; P < .001) and living with a partner (HR 1.35; 95% CI 1.01–1.81; P = .05) were independently associated with a higher risk of AT.ConclusionsIn our sample, clinical and social characteristics at admission to an ICGF are associated with a higher risk of AT. A relevant proportion of AT is not admitted to the acute hospital, suggesting perhaps some avoidable AT. Identification of risk factors might be relevant to design strategies to reduce AT.     

止血合剂治疗急性上消化道出血的临床观察及护理

目的探讨止血合剂及针对性护理措施对急性上消化道出血的临床疗效。方法将84例急性上消化道出血患者随机分为治疗组和对照组,在常规西药治疗的基础上,治疗组给予止血合剂口服或胃管注入,对照组予正肾冰盐水口服或胃管注入,并同时给予两组针对性护理措施,观察两组患者止血时间和大便潜血转阴时间,对比二者对急性上消化道出血的临床疗效。结果止血合剂治疗组在止血时间和大便潜血转阴时间方面治疗组明显优于正肾冰盐水对照组(P<0.05);止血合剂对急性上消化道出血的总体疗效明显优于正肾冰盐水(P<0.05),且两组予针对性护理措施可明显提高临床疗效。结论止血合剂治疗急性上消化道出血疗效确切,针对性护理措施可提高治疗效果,值得临床进一步推广应用。     

止血合剂治疗急性上消化道出血的临床观察及护理

目的探讨止血合剂及针对性护理措施对急性上消化道出血的临床疗效。方法将84例急性上消化道出血患者随机分为治疗组和对照组,在常规西药治疗的基础上。治疗组给予止血合剂口服或胃管注入,对照组予正肾冰盐水口服或胃管注入,并同时给予两组针对性护理措施,观察两组患者止血时间和大便潜血转阴时间,对比二者对急性上消化道出血的临床疗效。结果止血合剂治疗组在止血时间和大便潜血转阴时间方面治疗组明显优于正肾冰盐水对照组（P〈O．05）;止血合剂对急性上消化道出血的总体疗效明显优于正肾冰盐水（P〈0．05）,且两组予针对性护理措施可明显提高临床疗效。结论止血合剂治疗急性上消化道出血疗效确切,针对性护理措施可提高治疗效果,值得临床进一步推广应用。     

Maternal Near Miss: An Indicator for Maternal Health and Maternal Care

Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.     

Health Resource Utilization and Medical Care Cost of Acute Care Elderly Unit Patients

OBJECTIVE: In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. METHODS: Retrospective case-control design was used. Patients admitted to ACE unit (n = 680) between 1999 and 2002 with primary admitting diagnosis of pneumonia, congestive heart failure, or urinary tract infection were randomly selected from the health-care system's administrative database. Equal number controls (n = 680) were selected from usual medical care services and were matched by DRG, age, ethnicity, and Charlson comorbidity score. Data on HRU, annual number of admissions before and after index admission, length of stay (LOS), and medical care cost were obtained. Bootstrap, t-test, and Wilcoxon test were used to compare cost, LOS, and number of readmissions between ACE and non-ACE unit. Multivariate log-linear and Poisson regressions were used to assess the impact of ACE unit on incremental cost and number of readmissions, respectively. RESULTS: Mean LOS was 1 day shorter for ACE unit (4.9 vs. 5.9 P = 0.01). Mean cost of ACE unit was 9.7% lower than that of non-ACE unit (Dollars 13,586 vs. Dollars 15,040, P = 0.012). Both groups had similar costs of pharmacy, diagnostic and therapeutic procedures. Multiple log-linear and Poisson regression models indicated that ACE unit patients had 21% lower cost and 11% lower annual readmissions. CONCLUSIONS: Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.