基于持续质量改进的三甲医院医疗质量管理探究

目的探讨持续质量改进模式对三甲医院医疗质量管理的影响。方法以某三甲医院2012年3月至2014年3月期间的患者作为研究对象,将持续质量改进理论应用于医院的医疗质量管理中。结果实施持续质量改进模式后,所有患者对护理的满意度评分均显著高于实施持续质量改进模式前,数据差异明显(P0.05)。结论在三甲医院中实施持续质量改进模式,能够有效改善医疗质量管理,从而提高患者的满意度。     

持续质量改进在医疗质量管理中的运用

本文针对持续质量改进的特点进行剖析,通过完善医疗质量管理制度、建立持续质量改进组织、构建医疗质量评价体系、监督改进措施实施效果、总结持续质量改进经验等运用方法。目的在于提高医疗质量管理水平,提高医院的综合服务水平。     

医疗质量持续改进警示制度的实施体会

医疗质量是医院管理的基础和核心,是医院管理永恒的主题。我院运用科学的质量管理手段,将持续质量改进理论引入到医疗质量管理中,制定并实施医疗质量持续改进警示制度。几年来,通过建立不断完善医疗质量管理体系,构建持续质量改进的组织机构。并且针对性下发医疗质量持续改进建议书等措施,不断提高医疗质量,确保患者安全。并在实践中体会到不断完善医疗质量持续改进系统,加强科室医疗质量管理小组作用,提高医务人员参与医疗质量管理积极性的重要性。     

过程方法在医疗质量管理中的应用

用过程方法进行质量管理，是国际上质量管理研究的成果。本文从识别医疗服务过程、制定医疗服务过程有效运作和控制所需要的准则和方法，监控医疗服务过程和实施持续改进等四个方面阐述了过程方法的应用，旨在提高医疗服务和医疗质量管理的效果。     

持续质量改进在医疗器械清洗质量管理中的应用

目的 探讨实施持续质量改进的方法,提高消毒供应室器械清洗的管理质量.方法 确定质量改进的问题,进行原因分析,制定改进措施.结果 提高了临床科室对消毒供应室的满意度,确保医疗质量安全.结论 医疗器械清洗质量管理需要人人参与,并要建立切实可行的管理措施,从而促进质量管理的持续改进.     

应用医院信息系统监管非计划再次手术的效果分析

目的：应用医院信息系统（HIS）实时监管非计划再次手术,从而有效降低非计划再次手术的发生率。方法：对照分析应用HIS监管前后非计划再次手术的相关指标变化。结果：实施HIS监管后非计划再次手术的发生率由1.12%降低至0.46%有统计学差异（P<0.001）。结论：基于临床信息系统建立健全医疗质量管理系统,是有效利用、充分发挥其持续改进医疗质量、提高效能的重要保证。     

建立和完善国家医疗质量保障与持续改进体系的探讨

在审视我国医疗卫生体系的现状和存在的问题,分析总结我国医疗卫生系统的经验教训,借鉴国际上医疗管理的有效做法的基础上,提出建立国家层面的医疗质量保障和持续改进体系.国家医疗质量保障和持续改进体系由准入体系、控制体系、评价体系、检查监督体系、信息监测预警体系和医疗风险保险制度(医疗责任保险制度)等构成.指出:提高医疗质量,保证医疗安全,是我国卫生政策目标之一,医疗质量和医疗安全是一个持续改进、不断追求完善的过程,要牢固树立医疗质量意识和医疗安全意识,医疗质量保障和持续改进体系应着眼于建立长效机制,体现长期效果,建立医疗质量保障与持续改进体系需要各方面的共同参与和努力.     

ISO9001质量管理的实践与成效

ISO9001质量管理体系对于确定医院的质量标准,加强医务人员的行为规范起到好的指导和规范作用。本文从组织架构、人员培训、过程管理、改进服务、严格制度以及改进建议等方面总结4年来的工作,在持续改进医疗服务质量方面取得的较好的效果。     

全科医疗慢性病管理质量评价研究进展

慢性病已成为影响我国乃至全球居民健康的重大问题，全科医疗服务质量的改进对提升基层医疗慢性病管理水平有重要意义。通过对全科医疗慢性病管理质量进行评价，进而发现目前存在的问题，是实现持续质量改进的重要途径。综述国内外研究现状，部分国家已建立较为完善的全科医疗慢性病管理质量评价体系，与国外相比，我国的全科医疗慢性病管理质量评价与改进实践仍处于探索阶段，虽然取得了一定进展，但也存在一些挑战：第一，慢性病管理质量评价主要集中在高血压和糖尿病两种疾病，对于其他慢性病的临床管理质量关注不足，且在临床指标细化程度上与国外相比仍须进一步加强；第二，在评价全科医疗慢性病管理实践过程方面存在局限，多数研究仅关注服务规范框架内的绩效考核指标，可借鉴国外经验，细化以循证为基础的质量评价和质量改进体系，具体化监测指标；第三，基层医疗信息系统建设仍存在很大改进空间，信息“碎片化”和信息缺失严重阻碍了慢性病管理质量的有效评价，应尽快完善信息系统建设；第四，质量评价结果侧重于在行政体系内反馈，卫生服务提供者缺乏对自身服务质量的认知，应探索更为公平、有效的评价与反馈机制，促进慢性病管理质量的持续改进。     

持续质量改进在护理风险防范管理中的应用

护理风险是指医院内患者在被护理过程中有可能发生的一切不安全事件。护理风险既可以是对患者的伤害,也可以是医疗行为为此付出的赔偿代价,甚至损失医院声誉。护理风险防范管理是指护理管理者有组织、有系统地尽可能减少护理风险的发生,消除或减少护理风险的危害和经济损失。持续质量改进是质量管理体系中的一个重要原则,它强调持续的、全程的质量管理。在注重终末质量的同时,更注重过程管理、环节控制的质量管理。持续质量改进的基本活动包括：测量分析现状、寻找解决办法、实施解决办法、测量实施结果。2008年我院将持续质量改进管理体系运用于护理风险的防范管理,取得了较明显的效果,现对于实施流程作一综述。     

Benchmarking Electronic Medical Records Initiatives in the US: a Conceptual Model

This article provides a conceptual model for benchmarking the use of clinical information systems within healthcare organizations. Additionally, it addresses the benefits of clinical information systems which include the reduction of errors, improvement in clinical decision-making and real time access to patient information. The literature suggests that clinical information systems provide financial benefits due to cost-savings from improved efficiency and reduction of errors. As a result, healthcare organizations should adopt such clinical information systems to improve quality of care and stay competitive in the marketplace. Our research clearly documents the increased adoption of electronic medical records in U.S. hospitals from 2005 to 2007. This is important because the electronic medical record provides an opportunity for integration of patient information and improvements in efficiency and quality of care across a wide range of patient populations. This was supported by recent federal initiatives such as the establishment of the Office of the National Coordinator of Health Information Technology (ONCHIT) to create an interoperable health information infrastructure. Potential barriers to the implementation of health information technology include cost, a lack of financial incentives for providers, and a need for interoperable systems. As a result, future government involvement and leadership may serve to accelerate widespread adoption of interoperable clinical information systems.     

Sharing Personal Health Information Via Service-Oriented Computing: A Case of Long-Term Care

Sharing personal health information among healthcare providers is a crucial business process not only for saving limited healthcare resources but also for increasing patient's healthcare quality. Building an effective personal health information sharing process from established healthcare systems is a challenge in terms of coordination different business operations among healthcare providers and restructuring technical details existed in different healthcare information systems. This study responds this challenge with a service-oriented approach and develops a business software application to describe how the challenge can be alleviated from both managerial and technical perspectives. The software application in this study depicts personal health information sharing process among different providers in a long-term care setting. The information sharing scenario is based on an industrial initiative, such as Integrating the Healthcare Enterprise (IHE) from healthcare domain and the technologies for implementing the scenario are Web Service technologies from Service-oriented computing paradigm. The implementation in this study can inform healthcare researchers and practitioners applying technologies from service-oriented computing to design and develop healthcare collaborative systems to meet the increasing need for personal health information sharing.     

Integration of Footprints Information Systems in Palliative Care: The Case of Medical Center of Central Georgia

Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information technology investment and development. A national initiative was long overdue. This report we show that advancements in both medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into the hospital’s palliative care service and existing EMR systems. The project provides evidence that there are a plethora of areas in healthcare in which innovative application of information systems could significantly enhance the care delivered to loved ones, and improve operations at the same time..     

面向医学信息交换的语义查询系统设计

医疗信息工作者通过制定医学数据交换标准，实现各种纷杂独立的异构医疗信息系统间的数据共享。但由于现实医疗环境的复杂性，存在如HIs、PACS、LIS和OS等异构系统，在这些异构系统中对相同含义的对象可能存在各种不同的语言表达方式，如何识别利用这些信息以提高医疗服务质量，成为备受关注且亟需解决的问题。提出面向医学信息交换的语义查询系统，引入本体的方法来解决语义信息缺乏问题，以更好地实现医疗系统的信息交换和共享。     

Can we understand population healthcare needs using electronic medical records?

INTRODUCTIONThe identification of population-level healthcare needs using hospital electronic medical records (EMRs) is a promising approach for the evaluation and development of tailored healthcare services. Population segmentation based on healthcare needs may be possible using information on health and social service needs from EMRs. However, it is currently unknown if EMRs from restructured hospitals in Singapore provide information of sufficient quality for this purpose. We compared the inter-rater reliability between a population segment that was assigned prospectively and one that was assigned retrospectively based on EMR review.METHODS200 non-critical patients aged ≥ 55 years were prospectively evaluated by clinicians for their healthcare needs in the emergency department at Singapore General Hospital, Singapore. Trained clinician raters with no prior knowledge of these patients subsequently accessed the EMR up to the prospective rating date. A similar healthcare needs evaluation was conducted using the EMR. The inter-rater reliability between the two rating sets was evaluated using Cohen’s Kappa and the incidence of missing information was tabulated.RESULTSThe inter-rater reliability for the medical ‘global impression’ rating was 0.37 for doctors and 0.35 for nurses. The inter-rater reliability for the same variable, retrospectively rated by two doctors, was 0.75. Variables with a higher incidence of missing EMR information such as ‘social support in case of need’ and ‘patient activation’ had poorer inter-rater reliability.CONCLUSIONPre-existing EMR systems may not capture sufficient information for reliable determination of healthcare needs. Thus, we should consider integrating policy-relevant healthcare need variables into EMRs.     

基于语义的区域医疗信息集成方法研究

区域医疗信息共享能有效促进区域内医学信息平台之间数据的有效互通,提高医护人员的工作效率,提升医疗质量。但由于区域医疗的业务内容繁多,标准和规范复杂,同时涉及的运行机构多,严重限制了区域医疗信息系统之间的信息共享。针对这一问题,引入语义网技术,提出基于物理层、语义层和应用层三层架构模型的区域医疗信息集成框架,采用混合本体方法将分散的数据源发布成关联数据,构建一张计算机能理解的语义数据网络。通过局部本体和上层本体的建立,在不改变原有数据结构的条件下实现区域异构系统之间的无缝连接,进而达到为医护人员、患者等随时随地提供个性化的医疗保健服务目的。     

医疗质量评价走近EMRs新时代

医疗质量评价是医院管理的重要手段,目前国内的医疗质量评价主要是以住院患者病案首页作为数据源。但在医院信息系统蓬勃发展的今天,电子病历系统应被开发成医疗质量评价更好的数据源,同日寸与数据采集相关的各类编码、数据库、知识库的开发与使用也应尽快开展。     

Improving the quality of cancer care in America through health information technology

A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient–clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation.     

A Provably Secure RFID Authentication Protocol Based on Elliptic Curve for Healthcare Environments

To enhance the quality of healthcare in the management of chronic disease, telecare medical information systems have increasingly been used. Very recently, Zhang and Qi (J. Med. Syst. 38(5):47, 32), and Zhao (J. Med. Syst. 38(5):46, 33) separately proposed two authentication schemes for telecare medical information systems using radio frequency identification (RFID) technology. They claimed that their protocols achieve all security requirements including forward secrecy. However, this paper demonstrates that both Zhang and Qi’s scheme, and Zhao’s scheme could not provide forward secrecy. To augment the security, we propose an efficient RFID authentication scheme using elliptic curves for healthcare environments. The proposed RFID scheme is secure under common random oracle model.