2022年度国家康复医疗服务与质量安全报告

目的 从医疗机构康复医疗服务结构、环节和结局质量等方面,分析2021年全国综合医院康复医学科和康复医院的医疗服务和质量安全情况。方法 本报告数据来源于国家医疗质量管理与控制信息系统。2022年度调查共纳入全国9 328家医疗机构的康复医疗质量相关数据,涵盖全部二级以上综合医院、康复医院,也包含中医和中西医结合综合医院。数据清洗后实际纳入2 513家配置康复医学科病房的医院数据,对其进行康复医疗服务质量分析。结果 在2022年度纳入调查的9 328家综合医院中,仅2 713家设置有康复医学科病房。综合医院中,56.77%医院的平均每床配置医师数、80.36%医院的平均每床配置康复治疗师数、53.53%医院的平均每床配置护士数未达到国家要求,且各地区康复医学科每床平均配置康复医务人员数差距较大。综合医院骨科、神经内科和重症医学科病房早期康复介入率分别为13.45%、20.67%和29.74%。综合医院康复医学科出院患者平均日常生活活动能力改善率为77.87%,康复医院为69.01%。结论 2021年我国康复医疗服务和质量安全整体稳中有升,但全国多数综合医院仍未配置康复医学科病房,且康复医务...     

《国家医疗服务与质量安全报告》康复医学专业指标解读CSCD

自2016年北京大学第三医院受国家卫生健康委员会委托承担国家康复医学专业医疗质量控制中心工作,连续5年编制了《国家医疗服务与质量安全报告》(康复医学专业部分)(以下简称《报告》),弥补了我国康复医学相关数据的空白。本文旨在对《报告》所提取和分析的指标进行解读,以期不断提高康复医疗服务与质量安全调查的完整率和准确率,促进我国康复医疗质量的持续改进。指标由质量控制指标和资源消耗指标2类指标构成,其中质量控制指标包括结构指标、过程质量指标和结果质量指标,共16个大项149个分项。《报告》经由国家医疗质量管理与控制信息系统(NCIS)进行数据收集,数据报告质量、准确性和完整度将作为医院评审评价、重点专科设置等工作的参考依据。在NCIS指标中,数据采集形式分以下4种:首页自动提取、医疗相关记录提取、病历人工读取和相关部门提供。本文着重对早期康复介入率、ADL改善率、并发症等重点指标,结构指标和其他过程质量指标进行了解读。国家康复医学专业医疗质量控制中心近几年来的工作发现,康复医学科是否建立信息化系统是决定质控数据提取准确、便捷与否的重要因素。康复医疗和质控信息化系统正由"信息化"向"智能化"转变,信息化管理将结合人工智能自然语言分析等新兴技术,可以简化和精确化质控数据的提取过程,不断提升康复医学质控的效率。     

2016—2020年我国综合医院康复医学科医疗服务与质量安全趋势分析——基于国家医疗质量管理与控制信息系统数据

目的：自2017年起,国家康复医学专业医疗质量控制中心通过国家医疗质量管理与控制信息系统（National Clinical Improvement System,NCIS）进行康复医学专业数据调查,本文对2016—2020年我国综合医院康复医学科医疗服务与质量安全趋势分析。方法：本文选取2016—2020年全国范围均设置康复医学科病房且数据质量较高的616家综合医院数据进行分析,从结构、环节、结局质量等方面对我国医疗服务与质量安全进行描述。结果：康复医学科平均床位数、设备数、专业人才队伍逐年扩大,各重点病种的早期康复介入率逐年提升,病房门诊周转指标逐年向好,住院患者日常生活活动能力改善率逐年提升。然而,全国综合医院的康复医学科病房配置率约为30%,情况五年来无明显改善;平均每床配置医师数、治疗师数、护士数均不满足国家要求,治疗师数据要求差距大;各重点科室和各重点病种的早期康复介入率均小于30%。结论：我国综合医院康复医学医疗服务与质量安全不断提升,但目前还存在病房设置数量不足、医务人员数量不足、早期康复介入不足等问题,需持续改进。     

2013—2018年国家三级医院康复医学科住院患者医疗服务与质量安全报告：基于医院质量监测系统病案首页数据

目的:从医院运行管理类指标、结局指标等方面,对5年来三级医院康复医学科医务人员工作负荷、工作效率、患者负担、重点疾病谱、异地就诊、早期康复介入率等的变化情况进行描述性分析,以期为我国康复医学发展提供数据支持。方法:医院质量监测系统(Hospital Quality Monitoring System,HQMS)是国家卫生健康委员会(原国家卫生部)医政医管局指导下建立的全国性医疗服务信息监测网络。国家康复医学质控中心以HQMS中459家医院为样本,截取出院时间为2013年1月1日—2018年12月31日的155 2248个病案首页数据为分析样本,进行了上述指标分析。结果:2013—2018年,具有康复医学病房的三级医院数、年均出院人数逐年提升,平均住院日逐年下降,压疮等并发症的发生率逐年下降,早期康复介入率逐年提升。各省市区异地就诊率及康复早期介入率分布不均衡。康复医学收治病种复杂,且疾病诊断、功能诊断及治疗相关诊断混杂。结论:三级医院康复医学服务量、效率及服务能力逐年提升;康复医学地方资源配置不甚均衡;康复医学专业首页主要诊断名称及编码规范亟待统一。     

2016年度全国脊髓损伤康复医疗质量控制调查报告

摘要 目的：调查我国脊髓损伤康复医疗质量控制情况,了解脊髓损伤康复治疗的现状。 方法：对2016年度国家康复医学质控中心全国质控哨点医院的脊髓损伤康复治疗10项质量控制指标进行调查、统计分析。 结果：纳入全国30个省市自治区的综合医院共117家,2016年度脊髓损伤康复住院患者6831人次,男女比例为3.15∶1。脊髓损伤高发年龄为46—60岁,占34.75%。脊髓损伤常见损伤原因为跌落/跌倒和交通事故,分别占33.60%和32.85%。损伤部位：四肢瘫患者占40.33%,截瘫患者占58.44%。损伤程度：完全性脊髓损伤患者占32.97%,不完全性脊髓损伤患者占63.54%。对不同类型级别医院进行比较,委属委管医院年住院患者中位数是75人次,三级公立医院30人次,二级公立14人次,民营综合8人次;平均住院日：委属委管医院脊髓损伤康复患者23.74天,三级公立医院33.36天,二级公立医院61.21天,民营综合医院76.19天。按照不同地区比较,东部地区医院年住院患者中位数35人次,中部地区37人次,西部地区21人次;东部地区医院患者平均住院日38.42天,中部地区32.29天,西部地区44.7天。2016年脊髓损伤康复患者医嘱转院和医嘱转社区卫生服务机构比例为6.31%。 结论：各地区、各级医疗机构脊髓损伤康复医疗服务能力及资源分布不均,转诊不顺畅,应争取尽快建立康复医学专业医联体,完善三级康复医疗网络。     

综合医院康复医疗的特点和设想

目前康复医学在世界各国不断发展。各国都在努力探索符合本国国情的康复医学的模式，在人类健康医学体系中，保健、预防、医疗和康复医学，四者紧密结合，互相渗透，为人类提供全面的服务，由于早期康复越来越受到人们的重视，综合医院建立康复科已是一种趋势。综合医院的康复病房与普通病房有许多不同之处，它不仅要对病人进行继续治疗，而且要给病人早期康复介入。     

加强医学生康复医学观念的几个问题

为加强医学生的康复医学观念，改善康复医学教育现状，提高康复医学教学效果，作者总结了多年的康复医学教学经验，提出了关于康复医学教育的几点思考。     

浅谈康复治疗师在医疗服务中的语言艺术

康复治疗师的工作很平凡,但言行举止关系到患者的健康和生命,关系到很多家庭的稳定和和谐,而语言是沟通的纽带,治疗师要正确运用好语言,特别要注意语言艺术性修养,用有利于患者疾病治疗和康复的语言鼓励患者树立战胜疾病的信心和勇气,使他们早日康复,重返工作岗位,真正体现救死扶伤的高尚品德。同时,康复治疗师要合理使用语言,学会避免医患纠纷的语言技巧。     

康复医学对丰富援非医疗队内涵的探索(上)

在援非医疗队中开展康复医学项目,应立足根本点,找准着力点,抓住关键点,培育转折点,使康复医学成为“派得出,站得稳,吃得开,挤不走”的专业。.     

八年制医学生物理医学与康复医学方向医工交叉课程改革效果

目的 观察物理医学与康复医学方向医工交叉课程改革对八年制医学生的学习效果。方法 选择2018年至2019年清华大学学习物理医学与康复医学课程的八年制医学实验班的医学生为研究对象,2018年入对照组(n = 20),2019年入观察组(n = 18)。对照组采用常规课程和康复医学专业教师,观察组课程增加神经科学理论和新进展、功能磁共振发展和康复医学领域应用、医学工程新技术和进展,并增加清华大学电子工程系、机械工程系和医学院教师。两组考核均分为理论考核、操作考核和平时考核,观察组在平时考核中增加综述成绩。另设计调查问卷,在观察组开课前和考核后进行调查。结果 观察组理论考核、平时考核和总成绩均明显高于对照组(t > 2.694, P < 0.01),两组操作考核成绩无显著性差异( P > 0.05)。观察组对物理医学与康复医学课程的了解程度、对医工交叉/医工转化进展了解程度及设置医工转化课程必要性的评分在课程结束后增加(| Z| > 2.304, P< 0.05)。对康复医学医工交叉和医工转化研究比较感兴趣和非常感兴趣的学生比例从77.78%增加到94.44% (P= 0.222),表示比较可能和非常可能从事康复医学领域医工交叉和医工转化学生比例从61.11%增加到83.33% (P= 0.043)。结论 物理医学与康复医学方向医工交叉课程改革能一定程度提高八年制医学生对物理医学与康复医学的学习兴趣,并提高学习成绩。     

非洲康复医学发展与中国援非医疗队

非洲约有1.33 亿残疾人,多由感染性疾病、战争创伤事故、单器官功能障碍、屈光不正等引起。非洲的医学康复与社区康复只能满足其康复需求的5%~55%,基础设施薄弱、贫穷及资金匮乏、工作不落实、人文环境单调等是制约康复医学发展的因素。中国康复医学模式适合非洲,医疗队在接诊康复患者、改善硬件条件、培训专业人员、开展新技术、制定新流程及扩大康复医学的影响上可以做很多工作。     

The Epidemiology of Emergency Medical Services Use by Children: An Analysis of the National Hospital Ambulatory Medical Care Survey

Objective. There is an absence of nationally representative data describing pediatric patients who use emergency medical services (EMS) andthe factors associated with EMS use by children. This study characterizes pediatric emergency department (ED) visits for which the patient arrived by EMS andidentifies factors associated with those visits using a nationally representative database. Methods. A secondary analysis of the ED component of the 1997–2000 National Hospital Ambulatory Medical Care Survey was performed. The dependent variable was the mode of arrival to the ED (EMS vs. not EMS), andindependent variables were grouped into four domains: demographic, clinical, system, andservice characteristics. Bivariate analyses andmultivariate logistic regression analyses were conducted. Results. There were 110.9 million ED visits by children aged <19 years between 1997 and2000. Pediatric patients constituted 27.3% of all ED visits during this time, and7.9 million (7.1%) of these patients arrived via EMS. Pediatric patients represented 13% of all EMS transports. The annual EMS utilization rate by children was 26 per 1,000, compared with 66 per 1,000 in the adult population (p < 0.001). Sixteen percent of children transported by EMS were admitted to the hospital. Sixty-two percent of pediatric patients arriving at the ED by EMS were transported as a result of injury or poisoning. Characteristics significantly associated with arrival by EMS in the final multivariate model included demographic (age, African American race, urban residence), clinical (need for greater immediacy of care, illnesses associated with certain diagnoses), andservice (greater number of diagnostic services) variables. Conclusions. Pediatric patients transported by EMS are more likely to have injuries andpoisoning, andhave higher-acuity illness than those arriving at the ED by other means. The epidemiology of pediatric EMS use may have important operational, training, andpublic health implications andrequires further study.     

National Assessment of Quality Programs in Emergency Medical Services

Objective: This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. Methods: A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©. A convenience sample of respondents was enrolled between August and November, 2015. Univariate, bivariate and multiple logistic regression analyses were conducted to describe demographics and relationships between outcomes of interest and their covariates using SAS 9.3©. Results: A total of 1,733 surveys were initiated and 1,060 surveys had complete or near-complete responses. This includes agencies from 45 states representing over 6.23 million 9-1-1 responses annually. Totals of 70.5% (747) agencies reported dedicated QI personnel, 62.5% (663) follow clinical metrics and 33.3% (353) participate in outside quality or research program. Medical director hours varied, notably, 61.5% (649) of EMS agencies had <5 hours of medical director time per month. Presence of medical director time was correlated with tracking of QI measures. Air medical [OR 9.64 (1.13, 82.16)] and hospital-based EMS agencies [OR 2.49 (1.36, 4.59)] were more likely to track quality measures compared to fire-based agencies. Agencies in rural only environments were less likely to follow clinical quality metrics. (OR 0.47 CI 0.31 ?0.72 p < 0.0004). For those that track QI measures, the most common are; Response Time (Emergency) (68.3%), On-Scene Time (66.4%), prehospital stroke screen (64.6%), aspirin administration (64.5%), and 12 lead ECG in chest pain patients (63.0%). Conclusions: EMS agencies in the United States have significant practice variability with regard to quality improvement resources, medical direction and specific clinical quality measures. More research is needed to understand the impact of this variation on patient care outcomes.     

The Epidemiology of Emergency Medical Services Use by Older Adults: An Analysis of the National Hospital Ambulatory Medical Care Survey

Objectives To characterize older adult emergency department (ED) visits arriving by emergency medical services (EMS) and to identify factors associated with those patient visits.
Methods A secondary analysis of the ED component of the 1997–2000 National Hospital Ambulatory Medical Care Survey using logistic regression analyses was conducted. The dependent variable was the modes of arrival (EMS vs. not EMS) to the ED. Independent variables were grouped into four domains: demographic, clinical, system, and service characteristics.
Results Between 1997 and 2000, 38% of EMS responses were for patients aged 65 years and older. During that period, 62.2 million older adult ED patient visits occurred; 38% arrived via EMS. The average rate of EMS utilization by older adults was 167/1,000 population per year, more than four times the rate for younger patients (39/1,000 population). Fifty-three percent of EMS responses with transport to an ED for older adults resulted in hospital admission. Factors found to be associated with EMS mode of arrival included demographic (older age and urban residence), clinical (need for more rapid care and circulatory system illnesses), and service (need for procedures).
Conclusions Older adults account for a large proportion of EMS responses and use EMS at a disproportionately high rate. As the older adult population grows, EMS systems must prepare for the increased volume of older adults by making changes in training, operations, and equipment.