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【Objective】 To introduce the learning experience of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) in county-level hospitals. 【Methods】 The clinical data of 500 cases of BPH treated with HoLEP during May 2018 and Dec.2022 were retrospectively analyzed. The learning curve was divided into three stages: learning, maturity and proficiency stages. In each stage, the operation time, postoperative bladder irrigation time and rate of urinary incontinence of 20 patients were analyzed. 【Results】 All operations were performed by the same surgeon. During the learning stage, the operation time and bladder irrigation time were significantly longer, and the rate of urinary incontinence was significantly higher. At the proficiency stage, the operation time, bladder irrigation time, and rate of urinary incontinence were significantly improved. 【Conclusion】 HoLEP technique needs to be developed step by step with a certain learning curve. Continuous learning and mastery of key technical points are necessary for surgeons in county-level hospitals to avoid postoperative urinary incontinence.
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Objective:To explore the effect of scientific research group-based model on the improvement of nursing scientific research ability in a county-level hospital.Methods:A nursing research group was established, the composition of team members and work contents of the group were clarified, tiered focused scientific research training was implemented through progressive research content and flexible training methods, and individual and progressive research guidance was provided through research counseling application forms, while literature reading activities were conducted through article reports and literature debriefings. Retrospective analysis of the nursing research practice, the number of scientific research outputs, and research capacity were applied to evaluate the effect of the nursing research group-based model.Results:Within 2 years of the establishment of the nursing research group, 37 training programs were conducted, 33 scientific research materials were pushed to the WeChat public account, 23 scientific research projects were tutored, and 6 research projects were successfully declared. The scientific research ability score of nursing staff participating in literature reading debriefing increased from 44.24±19.12 to 53.57±13.86( P<0.001). Conclusions:The application of the nursing research group-based model can improve the nursing scientific research ability of the county-level hospital.
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Objective:To investigate the development of hypertension specialty and chronic disease management of county-level hospitals in China, for reference in improving the standardized chronic disease management level of hypertension in the counties.Methods:From September to November 2020, a questionnaire survey on 597 county-level hospitals in 24 provinces was conducted on a voluntary basis. The survey covered such areas as the setup of hypertension specialty, team building of professionals and the management regulations of chronic hypertension of the hospital. The survey data were analyzed by descriptive statistics.Results:Among the 597 county-level hospitals, 54(13.5%) hospitals had independent hypertension departments, 147(24.6%) had hypertension clinics, and 143(24.0%) hospitals had hypertension beds. 431(72.2%) hospitals had hypertension diagnosis and treatment process in outpatient clinics, 454(76.0%) hospitals had hypertension diagnosis and treatment process in wards, and 535(89.6%) hospitals had graded diagnosis and treatment process of hypertension. 473(79.2%) hospitals had established county medical alliance as the lead unit, including 167 compact medical alliances. 97.7% of the hospitals were equipped with basic hypertension risk stratification screening items, and 63.8% could carry out primary screening of secondary hypertension.Conclusions:The pattern of chronic diseases management of hypertension in county-level medical institutions has basically taken shape, but there is still room for improvement. In the future, we should focus on the construction of professional teams of hypertension, the standardized management of diagnosis and treatment of hypertension, and a smoother path of tiered medical service, so as to increase the health management level of hypertension in China.
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Severe trauma has the characteristics of complicated condition, multiple organs involved, limited auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to primary hospitals to receive treatments. But the traditional mode of separate discipline management can easily lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mortality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospitals (usually the top general hospital within the administrative region of a county), can establish a scientific and comprehensive trauma care system, the success rate of trauma rescue in this region can be greatly improved. On March 1st, 2013, Tiantai People's Hospital of Zhejiang Province, China set up a trauma care center, which integrated the pre-hospital and in-hospital trauma treatment procedures, and has achieved good economic and social benefits. Till March 1st, 2017, 1265 severe trauma patients (injury severity score >16) have been treated in this trauma center. The rescue success rate reached 95% and the delayed and/or missed diagnosis rate was less than 5%. Totally 86 severe cases of pelvic fractures with unstable hemodynamics were treated, and the success rate was 92%. The in-hospital emergency rescue response time is less than 3 min, and the time from definite diagnosis to surgery is within 35 min.
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Objective To investigate the status quo of Otolaryngology services in county-level hospitals in Ningxia,to know its developmentbottlenecks and shortcomings,and to provide suggestions for promotion of Otolaryngotogy medical service ability in county-level hospitals in Ningxia.Methods By cluster sampling method,and through questionaire survey,investigating and analyzing the actuality of Otorhinolaryngology in county-level hospitals in Ningxia.Results The current status of Otorhinolaryngology in county-level hospitals in Ningxia was lower than the standard of county-level hospitals.The number of personnel and equipment is seriously insufficient.Few medical technology can be carried out.The number of outpatients and discharged patients increases.The number of outgoing patients increases.Conclusion The medical service ability of Otorhinolaryngology in county-level hospitals in Ningxia is low.It is suggested to formulate development plans and to innovate development way;to develop human resources,and to upgrade technical level;to use information platform,and to joint construction of academic alliances.
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Starting from the reform result and influence of A County of public hospital reform,the reform experience and forming mechanism are analyzed to provide references for county level public hospital reform.Through taking controlling medical fees as the core,replacing policy break with mechanism break has a realistic meaning and applicable value.But the administrative type of passive controlling fees and squeezing the income of medical workers will produce a negative influence for the long-term development of health industry and for the future interest of local people.
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Objective To explore methods to develop a hospital quality of care index system of county level hospitals based on the homepage of inpatient medical records and examine the validity of this system. Methods By means of literature review, homepage data and panel discussion, along with theories and statistical methods, indexes were identified. The dimensions and indices of the index system were pinpointed. Confirmatory factor analysis and normalization methods were combined to calculate the weights and scores of such indices. Scores were adjusted by Charlson comorbidity index ( CCI) with multi-regression method. The hospitals were ranked by adjusted scores in each dimension. The validity was evaluated by comparing the application results to universally acknowledged standards, such as hospital level and economic level of the geographic areas. Results An index system with 6 dimensions and 25 indices was developed, and the application results proved valid to some extent. The adjustment of CCI also proved effective. The 6 dimensions were correlated yet their directions were not consistent. Conclusions The methods and data used to develop the system have demonstrated strong operability and availability. The application results can reflect medical care quality in different aspects making it applicable among homogeneous hospitals. It is meaningful to assess dimensions respectively.
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Objective:To reflect the training of basic-level medical stuff by investigating the doctor-patient cognition status of patients in a county-level hospital.Methods:The questionnaire of 180 patients collected from a county hospital in Shaanxi province was analyzed by Rank sum test and Descriptive analysis with SPSS17.0.ReSults:There were no statistically significant differences in the evaluation of current doctor-patient relationship from patients of different ages,occupations and degrees of education (P ＞ 0.05).82.2％ of the patients believed that the doctor-patient relationship is harmonious or somewhat harmonious.Moreover although the patient's trust in doctors is not high,there is a certain sense of recognition;and they put forward some expectation and requirements on doctor's professional skills,communication skills and professionalism.Conclusion:Considering the patients' feedback,local medical colleges and universities should reflect medical education ideas,play an active synergy model in the training of students' professional skills.In the meantime,they should strengthen the medical internship management,while paying equal attention to enhance students' responsibility and professionalism to serve the grassroots.
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OBJECTIVE: To study the effect of "cancel drug addition" policy in county public hospitals, and to provide reference for further improvement of relevant policies. METHODS: This paper compares the data of medical expenses control, hospital income and expenditure, compensation and so on before and after the policy of "canceling the drug addition" of a county public hospital to study the actual effect of policy implementation. RESULTS: The proportion of drugs after the implementation of the decline, from the policy before the implementation of 43.6% to the policy objectives (30%). The total cost of drug growth rate is lower than before the implementation of the policy, the slowdown in growth; outpatient average medical expenses, inpatient per capita reduction in drug costs, the difference was statistically significant. The average cost of medical care was increasing, and the growth rate dropped first and then rose, which was close to the level before the implementation of the policy. At the same time, the income structure of the county-level hospitals tends to be reasonable, but the balance of payments has dropped significantly. The increase in hospital investment and adjust the price of medical services increased hospital income is not enough to make up for the "cancellation of drug additions" brought about by the loss. CONCLUSION: "Cancellation of drug addition" policy in the county-level public hospitals since the implementation of the control of medical expenses have a certain role in the control of drug costs growth effect is obvious. Patient medical expenses are falling. In order to consolidate the effectiveness, but also the establishment of multi-share long-term compensation mechanism, while paying attention to the increase in medical staff income.
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The ongoing health reform features direct hosting of county-level hospitals by provincial level hospitals as an important means and effective attempt to improve comprehensive service capacity of the former.This paper introduces the“Hanchuan Model”,in which Hubei People’s Hospital has hosted Hanchuan city People’s Hospital,and analyzed the operation performance and hurdles found.Based on such studies,the authors recommend on the vertical integration of medical resources by means of hosting, and comprehensive reforms of county public hospitals.
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Medical insurance system plays a key role in China's social security system.In the social insurance system,medical insurance features the widest coverage and the most complex in mechanism,while China' s medical insurance system itself is found with many setbacks.This paper probed into such risks found in the county-level medical insurance system as excessive cost growth causing overpayment of the medical insurance fund and poor supervision of the fund.On such basis,the authors recommended such policy changes as payment reform,and enhanced supervision over the fund,the demand side,and the government,in an effort to optimize China' s medical insurance system for theoretical and decision reference of other county-level hospitals in their reforms.
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Objective: Through analyzing the level, construction and operation efficiency of revenue, to analyze the basic status and change trend of current economics operation of county-level hospitals in this area, provide former basic information for making comprehensive reform evaluation on public hospitals. Methods: To collect data of annual health financial report, collect and analysis the data. Results: The overall level of revenue and expenditure of couty-level hospitals in Hainan increased rapidly , but there were rapid fall in 2012, the balance gap increased obviously; the proportion of financial assistance increased in 2011, while the construction of income and expenditure remained relatively stable. Conclusion: The general economic operation efficiency of county-level hospitals improved, but the comprehensive reforms still has not appeared, which needs further implementation of compensation mechanism for ensuring the successful implementation of comprehensive reform.
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Objective: To summarize the experiences and problems in economic management of county-level hospitals in Yulin area, provide decision foundation for the further reform of the county health service system in China. Methods: Using descriptive study to analyze the economic operation condition of the 5 pilot county-level hospitals. Results: The effect and issues of the reform both exist in financial input, pharmacy income, asset utilization and operation capabilities in pilot county-level hospitals. Conclusion: It is needed to deepen the operation mechanism and compensation mechanism of public hospitals, reform the “using drug to compensate the medicine” mechanism, strengthen the hospital asset management and optimize liability structure.