加强科室医疗质量控制小组管理的做法与体会

医疗质量是医院提高医疗水平的重要保证,科室医疗质量控制小组是医院医疗质量管理最基础、最直接的管理机构。加强科室医疗质量控制小组管理,对加强医院医疗质量建设,提高医疗质量水平,促进医院全面发展具有重要意义。本文以科室质量控制小组为单元,简要阐述了科室质量控制小组在医院质量管理中存在的问题及改进医疗质量方面的体会。     

医疗质量全息管理中"四个紧贴"服务的探讨

在现代高科技加速向医疗领域渗透、医疗质量管理难度日益增大的情况下，军队医院要想实现医疗质量的不断改进和提高，就必须对影响医疗质量的各种因素实行全息管理。严格执行医疗法规制度，及时为病人实施正确的救治措施，提供良好的整体化服务，切实为科室一线工作人员进行及时到位的综合保障，确保为兵服务等，是军队医院医疗质量全息管理中的主要内容。因此，应当实施“紧贴法规、紧贴病人、紧贴一线、紧贴部队”的全方位优质服务。     

医疗质量综合管理的几点体会

医疗质量管理是医院管理的核心。质量管理的优劣,不仅仅反映医院科学管理的水平,也是医院等级评审的重要指标之一。我院近年来,始终把抓医疗质量管理作为医院的中心工作,“科技兴医、质量建院、内强素质、外树形象”是我们的建院宗旨,从抓基础质量入手,开展标准化建设,建立有效的质量保障系统,通过狠抓医疗质量管理,使医院医疗质量不断提高,为医院的全面振兴走出了一条新路子。1　建立健全医院质量管理机构　为了保证医疗质量管理的全面实施,我院成立了院科两级质量管理组织。医院医疗质量管理委员会、药学管理委员会、器械管理委员会、院内…     

实施医疗质量控制管理 构建医疗安全长效机制

为构建医疗安全管理长效机制,我院推出了以“十三大医疗质量控制管理”为核心的立体式医疗安全管理体系,通过全过程、全时段的医疗质量自控和互控,推进了医疗安全管理的科学化、规范化、系统化建设,较好的预防了医疗事故的发生,确保了医院健康、稳定、和谐发展,现将主要做法和体会报告如下。     

狠抓医疗质量管理实施质管工作新举措

医疗质量是医院生存和发展的基础。置身于市场经济不断健全、医疗卫生改革不断深入的大环境中的军队医院,医疗质量管理更是医院管理的重中之重。医疗质量的优劣除人才、技术、设备等因素外,管理也是至关重要的因素。为巩固发展“三甲”、“百佳”医院成果,进一步加强医院质量建设,提高医院的综合效益,我院从建立健全管理体系入手,狠抓医疗质量管理,取得可喜效果。     

以病人为中心 抓好医疗质量

近年来我院紧紧围绕争创“二级甲等”医院，巩固“二级甲等”医院这个目标，医疗工作充分体现“以病人为中心”，抓管理及基本功．规范医疗行为，提高医疗质量，树立良好的医德医风，建立良好的医患关系；不断加强医疗队伍的全面建设，依靠科学技术，坚持以质量求生存，以信誉促发展，取得了良好的社会效益和经济效益。我们做了下面几南面的工作．     

开展"分级教学"提高培养质量

随着生活水平的不断提高、医疗市场的严酷竞争 ,以及医疗保险的政策出台 ,要求医院进一步提高医疗服务质量。作为医疗后备保障的教学工作 ,也应适应时代要求 ,不断完善、提高。　　我院通过“分级教学” ,对教学工作进行系统、科学、全面的实施、评估和控制 ,提高了学生的毕业质量、教师的带教水平和科室的教学建设 ,收到了良好效果 ,达到了“以教学促科研、以科研固医疗、医教研工作全面发展”的最终目的。本文总结教学经验 ,结合同行见解 ,探讨了“分级教学”的具体实施方案 ,以及在提高教学质量中的重要意义。1　开展“分级教学”的必要…     

浅谈从深层次抓好医疗质量

为进一步提高医疗卫生机构的医疗质量，确保为部队服务的质量和水平，根据兰州军区卫生建设“十五”计划和每年度卫生工作安排，从2002年开始，开展了“卫生质量年”活动。在前两个“卫生质量年”的活动中，我们认真贯彻军区通知精神，坚持以军区卫生建设“十五”计划为依据，以加强医护基础质量为重点，以持续改进和提高医疗护理技术水平、管理质量和服务质量为主要内容．促进了医疗技术的发展，     

医院医疗质量管理的完善与实施

在实行现代科学方法管理中,为加强医院管理,保证医疗质量的不断提高。我院从1984年起,逐步把分散的质量管理方法,纳入统一的、强有力的质量管理体系,做到医疗质量管理工作制度化、规范化、系列化、程序化,从而使我院医疗质量在深化改革,确保为部队服务的新形势下稳中有升,现就医疗质量管理体系的完善与实施,探讨如下。1 健全组织体系,形成管理网络 我院近10年来,相继成立了院、科两级质量管理机构,医院医疗质量管理小组在业务副院长的领导下,由医务处主任、医疗助理员和各科室主任等20人组成,其任务是做出医疗质量决策,确定质量目标,定期和不定期进行医疗质量考评。科室医疗质量管理小组,     

加强医疗环节质量控制 保证医疗质量持续改进

医院质量管理是为了保证和不断提高医院各项工作质量,而对所有影响质量的因素和工作环节实施计划、决策、协调、指导主质量信息反馈和处理等以质量为目标的全部管理过程．而环节质量控制是全面质量管理中的关键．它强调全员参与、全过程质量控制,有问题消灭在萌芽状态,是主动质量管理办法。我院自2004年起把医疗质量检查重点由终末质量检查转为环节质量控制,在医疗环节质量上下功夫,取得良好效果。下面就我院医疗环节质量管理中存在的问题进行分析,并将我们的改进措施报道如下。     

子宫切除患者婚姻质量的调查

目的探讨子宫切除患者的婚姻质量。方法应用描述性及相关性的研究方法,对2007年1月-12月在北大深圳医院行子宫切除术后6个月的200名已婚、配偶健在、有性生活、无精神病及恶性疾病的患者于复查时进行问卷调查。应用婚姻质量问卷（ENRICH）调查子宫切除患者的婚姻质量。结果子宫切除患者婚姻质量的各因子分均低于常模,其中婚姻的满意度、夫妻交流、性生活3个因子的得分低于国内育龄健康妇女的研究结果。结论子宫切除患者的婚姻质量低于健康育龄妇女。     

潜水员睡眠质量的现状调查及分析

目的 了解潜水员的睡眠质量及相关的影响因素,为提高潜水员睡眠质量提供参考.方法 通过整群随机抽样,采用匹兹堡睡眠质量指数(PSQI)对296名潜水员与77名海勤人员进行调查.结果 227名潜水员(76.7％)有睡眠质量问题,与海勤人员相比,PQSI总分(t=101.068)、睡眠质量(t=5.475)、入睡时间(t=8.387)、睡眠效率(t=25.834)、催眠药物使用(t=4.254)、日间功能(t=120.604)差异均有统计学意义(P＜0.05或P＜0.01);≥46岁与36～45岁的潜水员相比,PQSI总分、睡眠质量、入睡时间、睡眠时间、睡眠障碍、催眠药物使用差异有统计学意义(P＜0.05),与16 ～25岁的潜水员相比日间功能差异有统计学意义(P＜0.05);大学及以上文化程度与高中及中专文化程度的潜水员相比,睡眠质量、入睡时间、睡眠时间、睡眠障碍差异有统计学意义(P＜0.05);吸烟者睡眠质量(t=12.475)、睡眠效率(t=15.929)、日间功能(t=5.039)与不吸烟者比较差异有统计学意义(P ＜0.05或P＜0.01);饮酒者睡眠时间(t=5.369)、睡眠效率(t=18.283)、睡眠障碍(t=4.364)与不饮酒者的差异有统计学意义(P＜0.05或P＜0.01).结论 潜水员的睡眠质量不高,有必要采取适当措施提高其睡眠质量.     

The effect of anticipation in the scoring of mammographic accreditation phantom images

Purpose: Some of the subjectivity in the scoring of mammographic phantom images may be due to reader anticipation of the pattern of structures in the phantom. The extent of this bias was investigated by scoring images in which the positions of the structures were randomized.Methods: Images of the American College of Radiographers (ACR) mammography phantom were acquired under different X-ray techniques, digitized and scored by a group of five readers. The 16 structures comprising each image were then randomized in position to form new images, which were re-scored by the readers using the same criteria for visibility.Results: The scores after randomization were significantly lower than before randomization, indicating that a priori knowledge of the positions of the structures within the phantom resulted in false-positive scoring of individual structures and elevated net scores for the non-randomized images.Conclusions: Biased scoring due to reader anticipation of the phantom pattern contributes to the inherent subjectivity of the assessment mechanism. Computerized analysis of the phantom images would remove this bias and replace the arbitrary scoring system currently employed with an image quality index better correlated to clinical diagnostic quality.     

国产酶联免疫吸附试验试剂盒包被质量分析

目的　探讨国产酶联试剂盒包被板重复使用的可能性 ,并以重复测定的方法作为基层实验室检测包被质量的辅助手段。方法　以ELISA法测定使用过的包被板。结果　 10个厂家 12种试剂盒中 ,7家质量过关 ,可以重复使用 ;而另外 3家不可以。结论　随着包被方法的改进 ,包被质量的提高 ,包被的重复使用可以成为现实     

住院抑郁症患者及其家属的生活质量调查

目的了解抑郁症患者及其家属的生活质量，探索影响抑郁症患者及其家属生活质量的主要因素。方法应用多种心理评定量表对60例抑郁症患者与60名家属进行评估。结果男、女患者的生活质量无明显差异；男性家属的生活质量比女性家属普遍高。SDSS总分低等因素对患者的生活质量的各个维度均有一定影响。结论加强社会支持及时改善情绪，可能会提高他们的生活质量。     

Evaluation of competence in the interpretation of chest radiographs

RATIONALE AND OBJECTIVES: The purpose of this study was to determine relative rates of missed diagnoses for radiologists as a measure of competence in interpreting chest radiographs. MATERIALS AND METHODS: Cases involving differing interpretations of chest radiographs were collected from January 1994 through December 1999 by faculty (chest and nonchest radiology specialists) in an academic radiology department. A quarterly peer-review process designated cases months after the fact, and anonymously, as no miss or as class I (nondiagnosable), class II (very difficult diagnosis), class III (should be diagnosed most of time), or class IV (should almost always be diagnosed) missed diagnoses. The rates and classes of missed diagnoses were compared among chest faculty and for the nonchest radiology specialists as a group. RESULTS: Chest radiologists read 184,977 studies, and nonchest radiologists read 300,684 studies. Of these, 243 missed diagnoses were classified (classes I and II, 184 cases; class III, 50; and class IV, nine). No difference was detected in the rate of class III and IV misses among chest faculty, but nonchest faculty had significantly more class III (P = .022) and class IV misses (P = .016). CONCLUSION: Random sampling of differing interpretations can yield a relative rate of missed diagnoses for radiologists. No difference was detected in clinically important misses (ie, classes III and IV) among chest radiologists, but a statistically significantly higher rate of seemingly obvious misdiagnoses was found for nonchest specialty radiologists. Potential biases may have influenced this analysis, including disease prevalence, sampling, clinical factors, observer variability, and truth-in-diagnosis.     

An assessment of the usefulness of screen-film speed classifications

Speed classifications of screen-film combinations are frequently quoted in the day-to-day functioning of X-ray departments. These values are utilised for a variety of functions by X-ray personnel. This study aimed to compare a range of commonly used screen-film combinations in order to establish the level of agreement between stated speed classifications and actual speed of systems. Relationships between system speed class and image quality were also investigated. Six commonly used screen-film systems were studied; three had a speed classification of 200 while the remaining systems had a classification of 400. Characteristic curves for each system were produced, from which relative speeds were calculated at four beam energies. Psychophysical tools and visual grading analyses were used to assess image quality. The sensitometric results demonstrated that at all energies the speed class quoted did not predict the actual relative speeds of the film-screen systems. The image quality study demonstrated disagreement with conventional assumptions regarding speed classifications with mean values for 400 speed systems being higher or at least equal to the 200-system scores. There is no evidence from this study to support the ongoing use of current screen-film classifications. Personnel within all X-ray departments should carry out rigorous speed measurements and image quality assessments of all systems within their department before nominal classifications are used.     

寒区集训新兵睡眠质量影响因素研究

目的探讨寒区新兵睡眠质量的影响因素。方法以匹兹堡睡眠质量指数(PSQ I)测试寒区集训期新兵1 000人并分析其影响因素。结果(1)有效问卷892份,吸烟、饮酒者PSQ I及除催眠药物使用外的其他各项因子分高于无烟酒饮用习惯者。(2)县城来源新兵入睡时间明显高于省城来源新兵,乡镇来源新兵PSQ I及多项因子分低于省城和县城来源新兵。(3)回归分析显示:寒区新兵睡眠质量的主要影响因素依次为吸烟、饮酒及家庭住址。结论寒区新兵睡眠质量的影响因素为吸烟、饮酒及家庭住址。     

Characterizing the Performance of the Nation’s Hospitals in the Hospital Outpatient Quality Reporting Program’s Imaging Efficiency Measures

PurposeTo describe the performance of the nation’s hospitals in terms of the Hospital Outpatient Quality Reporting Program’s imaging efficiency measures.MethodsData were obtained from the Hospital Compare website and reflect outpatient Medicare claims of 4,118 hospitals for 5 imaging efficiency metrics: (1) frequency of combination abdominal CT (performed with and without intravenous contrast); (2) combination chest CT (performed with and without intravenous contrast); (3) simultaneous brain/sinus CT; (4) mammography follow-up (diagnostic imaging after screening mammography); and (5) lumbar spine MRI for low back pain without prior conservative therapy. Metrics were summarized and compared with other hospital characteristics.ResultsMedian frequency was 36.7% for lumbar spine MRI for low back pain and ranged from 1.6% to 7.8% for the remaining measures; however, extreme outliers were observed (maximal frequencies of 79.2%-95.2% for mammography follow-up and combination chest and abdominal CT). Essentially no correlation was found among measures, aside from combination abdominal and chest CT. For some measures, relatively poor performance was more commonly observed among critical access hospitals and physician-owned/proprietary hospitals, and less commonly observed among U.S. News & World Report “best” hospitals and primary residency teaching sites. Frequencies for combination abdominal and chest CT improved from 2013 to 2014 among hospitals with relatively poorer performance.ConclusionsAlthough the imaging efficiency measures help identify individual hospitals and hospital categories with relatively inefficient imaging practices, they do not readily identify distinctly positively performing hospitals. Excess utilization was suggested for lumbar spine MRI. Frequency of combination abdominal and chest CT examinations improved over a short time interval.     

配偶认知行为教育对肠造口患者夫妻性生活质量的影响

目的探讨配偶认知行为的高低对肠造口患者夫妻性生活质量的影响。方法将年龄小于65岁大于18岁的已婚或固有定性伴侣的肠造口患者96例,按随机分组的方法分为实验组和对照组,两组患者在出院时由研究者进行相同的出院指导,实验组增加对患者配偶的认知行为教育。两组患者采用Olson婚姻质量问卷调查,对调查结果进行分析。结果实验组病员在进行性生活指导后,性生活质量有显著提高,对照组无明显变化。结论加强对肠造口患者配偶认知行为的教育可以较好地提高肠造口患者夫妻性生活质量。