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OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.
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Objective:To understand the cognition and training status of basic life support among medical staff in Linfen, Shanxi Province, and to provide reference for the development of targeted training strategies and programs.Methods:A questionnaire survey was conducted among medical staff in 12 county hospitals in Linfen, Shanxi Province by convenience sampling method. The survey included the general characteristics of departments and medical staff, previous basic life support training assessment and cognitive status.Results:A total of 839 medical staff were included, 756 (90.1%) completed the survey, 183 (24.2%) were doctors and 573 (75.8%) were nurses. Most personnel lacked awareness of environmental safety, emergency response system start-up, adequate compression, airway management, and electrical defibrillation.Conclusions:The cognitive status of basic life support of medical staff in Linfen county is not optimistic. It is necessary to construct an applicable precision training course and retraining assessment system to improve the cognitive level and practical operation ability.
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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 construct an evaluation index system of public health emergency preparedness capacity in county-level centers for disease control and prevention (CDC), so as to provide the evidence for improving the public health emergency preparedness capacity in county-level CDC.@*Methods@#An index system framework was created based on review of health emergency policies, laws and regulations released in China from 2003 to 2023. The importance, sensitivity and accessibility of indicators were scored and screened through two rounds of Delphi expert consultations, and the weights of indicators were calculated using precedence charts. The efficiency of Delphi expert consultations was evaluated using the active coefficient, authority coefficient and coordination coefficient. @*Results@#Eighteen experts participated in consultations, including 9 men, 15 with educational levels of master degree and higher, 12 with preventive medicine or public health as the specialty, and 12 with deputy senior professional titles and higher. The active coefficients of two rounds of consultations were 100.00% and 94.44%, and the authority coefficients were 0.83 and 0.84, respectively. The coordination coefficients of secondary and tertiary indicators during the second round consultation were 0.341 and 0.241, which were both higher than those during the first round (both P<0.05). The final evaluation index system included 8 primary indicators, 21 secondary indicators and 58 tertiary indicators. Among primary indicators, health emergency organization and management (0.203 1), health emergency team building (0.203 1) and financial support for health emergency (0.203 1) had the highest weights, and of secondary indicators, completion degree of health emergency administration regulations (initial weight/global weight: 0.750 0/0.152 3), health emergency team building (0.750 0/0.152 3) and financial support for emergency (0.750 0/0.152 3) had the highest weights, while among tertiary indicators, defining the duty of health emergency administration sectors had the highest weight (0.750 0/0.114 2). @*Conclusion@#The created evaluation index system is feasible for evaluation of the public health emergency preparedness capacity in county-level CDC.
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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 views of general practitioners (GPs) on developing special interests in the context of the county medical community.Methods:A survey was conducted using self-designed questionnaire from November and December 2019, among 49 general practice residents trained in the First Affiliated Hospital of Zhejiang University School of Medicine. Meanwhile, structured interviews were undertaken with 14 general practice residents.Results:Forty-nine valid questionnaires were collected with a response rate of 100.0%. All participants were from the county medical community units. The survey showed that 91.8% (45/49) of respondents were willing to develop special interests and 79.6% (39/45) chose one subject, and the top three subjects were endocrinology, gastroenterology and cardiology. The structured interviews demonstrated that most participants did not understand meaning of general practitioners with special interests (GPwSIs) clearly and were unable to distinguish GPwSIs from specialists; they were confused about the status, training mode, and assessment standards of GPwSIs. The interviews also showed that the demand for developing special interests for them was derived from the needs of patients for diagnosis and treatment, the target population of health care services, peer advice and personal interests.Conclusions:Most general practice residents are willing to develop special interests, and internal medicine is the first choice; however, their understanding of the GPwSIs is insufficient. The survey suggests that the position, training model, assessment and certification of GPwSI need to be further clarified.
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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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Objective:To build the evaluation index system of traditiond Chinese medicine(TCM) service capacity in county-level TCM hospitals, for references to improve the TCM service capability in China.Methods:Based on the " structure-process-result" evaluation model, a preliminary screening index system for the evaluation of TCM service capacity in county-level TCM hospitals was established by analyzing relevant literature and policies; Two rounds of Delphi expert consultation were made to screen the evaluation indexes; The combination weighting method based on both expert scoring method and entropy weight method was used to determine the index weight.Results:The evaluation index system of TCM service capacity of county-level TCM hospitals was finally incorporated into 3 first-level indicators, 9 second-level indicators and 33 third-level indicators. The top five third-level indicators in terms of comprehensive weight were the person time of TCM preventive care in the year(12.02%), the person time of manual reduction diagnosis and treatment(9.03%), the person time of acupuncture and moxibustion(6.55%), the proportion of income from inpatient TCM services in medical income(5.87%) and the person time of massage(5.34%).Conclusions:From the perspective of the whole process of TCM service, the evaluation index system of TCM service capacity of county-level TCM hospitals reflectd the health service capacity of county-level TCM hospitals, highlighted the characteristics of TCM.
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The construction of hospital administration talent echelon has become a " bottleneck" problem in the core competence construction of county-level public hospitals in ethnic regions. West China-Mabian Medical Alliance has made a preliminary exploration on the cultivation of hospital management talents in county-level public hospitals. The hospital carried out the working principle of " setting up a talent pool by post" , and gradually established a reserve talent pool with suitable scale and dynamic adjustment by providing part-time project management positions for young employees in the hospital. There were three kinds of part-time project management positions: part-time assistant to president, part-time project supervisor and part-time department management assistant. In addition, the hospital strengthened the ideological and political education, medical management theory training and practical training of the reserve talents in a planned way. The practical experience of hospital reserve management personnel training based on West China-Mabian Medical Alliance can be used for reference by other county-level hospitals.
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Objective:To evaluate the ophthalmic service ability of county hospitals in China based on the improved DS evidence theory.Methods:Convenient sampling method was used to select the data of ophthalmology department of 9 county hospitals in eastern, central and Western China in 2019. The improved DS evidence theory method based on Mahalanobis distance weight coefficient was applied to evaluate the medical service ability, and the evaluation results were compared with the classical evidence theory method.Results:The regional development of ophthalmic service capacity in counties of China was uneven, and there were regional differences in the evaluation results of some indicators. Hospitals in the eastern region were generally leading in the evaluation of a number of indicators related to the amount of medical services. The numbers of inpatient operations, outpatient operations, bed turnover times, bed utilization rate, number of inpatients, number of outpatients, number of patients in the eastern region were 3.25, 1.60, 1.81, 1.61, 2.64, 2.63 and 4.47 times of the numbers of hospitals in western region. Compared with the classical evidence theory method, the analysis results of the improved DS evidence theory method were consistent with the actual business development of each hospital, and the evaluation results were credible, which could more effectively reduce the uncertainty in the evaluation results.Conclusions:Ophthalmic service ability of county hospitals in China needs to be continuously improved. Improved DS evidence theory can be adopted to make continuous evaluation.
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OBJECTIVE：To e xplore the health economic burden of hypertension patients at county-level areas and its influential factors in China. METHODS ：A questionnaire survey was conducted on hypertension patients in 7 county-level public hospitals from 6 provinces as Hebei ，Shandong，Shanxi provinces by using a convenient sampling method. Catastrophic health expenditure was defined by the standard of “medical and health expenditure exceeding 10％ of household income ”. The incidence ， average gap and relative gap of catastrophic health expenditure were analyzed. A multi-factor Logistic regression model analysis was used to analyze the influential factors that lead to catastrophi c health expenditure. RESULTS ：A total of 1 378 questionnaires were sent out ，and 925 valid questionnaires were collected with effective rate of 67.13％ . The incidence of catastrophic health expenditure，average gap and relative gap among hypertension patients were 23.03％，19.37％ and 84.12％，respectively. At different income levels ，the incidence of catastrophic health expenditure，average gap and relative gap were 72.67％ ， 96.79％ and 133.18％ in the poorest household group ，and were 1.94％ ，0.47％ and 24.23％ in the richest household group. Among different types of medical insurance ，the incidence of catastrophic health expenditure in patients covered by “New Rural Cooperative Medical Scheme （NRCMS）”the highest （31.30％）. The household income ，complications and the type of health insurance had significant impacts on the incidence of catastrophic health expenditure in hypertension patients （P＜0.05）. CONCLUSIONS：The incidence of catastrophic health expenditure in hypertension patients with different income levels is different. As the income level raised ，the incidence of catastrophic health expenditures continued to decrease. But the protection of household health expenditure by NRCMS is weak. It is suggested that a certain policy preference should be given to families with low income and patients with chronic diseases ，so as to ensure the rights and interests of patients with hypertension .
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To accelerate the development of talent team construction is the urgent issue in the county level public hospital. Introduction of high-level talents in a flexible manner to work in county level public hospital can promote the sustainable development of the hospital. In view of the reality of Binhai county people's hospital, the author analyzes the flexible recruitment, training, encouragement and management of talents, which helps promote the cultivation of medical personnel, enhance research capacity and medical technology.
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Objective To provide reference for further promoting the development ability of county-level public hospitals by analyzing the influencing factors of the development ability of county-level public hospitals in Jiangsu Province from 2014 to 2016.Methods Different development indicators of 32 county-level public hospitals in Jiangsu Province were collected,and data were analyzed by Excel2007,and SPSS22.0 was used to analyze the comprehensive development ability of hospitals.Results Scale development factor,human resources development factor and medical service development factor have impacts on the development capacity of county public hospitals in Jiangsu Province.Different hospitals have different scores.on three factors,and their development ability is identical.Conclusion The scale of the hospital,the staff development and the medical service are important to the development of the count-level public hospitals.
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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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Objective To study the development of the first county-level key clinical specialized talent teams in Henan province. Methods Data on the first 30 county-level key clinical specialized talent teams were collected through questionnaire in 2014 and 2017 respectively, and signed rank sum test was conducted to analyze such facts as the changes of medical service volume, academic titles and scientific researches of discipline leaders before and after such construction. McNemar′s test and chi-square test were conducted to study the age structure, seniority, education and technical title makeup of these discipline leaders. Such tests were also conducted to study the age structure, seniority, education and technical title makeup of the talents. These efforts aim to discern the construction achievement of the key clinical specialties. Results The indexes of healthcare capacities of the first batch of clinical key specialties were observed as improved ( P <0. 05 ) in terms of the medical service volume. Of the discipline leaders′ age structure, the 51 -60 age groups accounted for 40. 0％ and 66. 7％ respectively, before and after the construction, scoring a difference of statistical significance ( P <0. 05 ); the number of senior physicians increased by 80 persons, the number of physicians having master or above titles increased by 40 persons;the number of physicians participating in continuing education held by these specialties grew from 146. 50 to 262. 50(P<0. 05). Conclusions The volume of medical service of the first batch of county-level clinical key specialties has been elevated, and a group of talents of high education and senior titles have been recruited. Whereas, the title structure needs to be improved, and more young academic leaders are expected, while more opportunities of further education and training are also expected for the physicians, in order to enhance their professional ability.
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Objective To learn the present development and comprehensive reform of county-level general hospitals in Fujian province.Methods Questionnaires were used to survey the development of 59 county-level general hospitals in 2013 and 2016 in the province. The study covered such aspects as basic profile, number of beds, human resources, service capacity, department setup and medical technology development among others. These data were replenished by information from the service capacity survey data collection system for county-level hospitals of the National Health and Family Planning Commission. The data so acquired were subject to descriptive statistics. Results 59 such hospitals had made developments and progress to various extents in terms of the number of beds, human resources, medical service capacity, department setup and medical technology development. Compared with those in 2013, their beds, employees, and number of inpatients and outpatients had grown by 3. 78% , 12. 24% and 7. 95% respectively. Conclusions These hospitals should, based on scientific planning, appropriately scale up, strengthen their high-caliber talent teams, focus on the development of key technologies and key weak disciplines. These efforts will help develop core competitiveness, and deepen their comprehensive reform.
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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 analyze the behavior choices of county-level doctors in county-level and township service collaboration based on game theory, and provide basis for promoting county-level and township service collaboration. Methods: It established a game model for county-level doctors’ treatment plan selection in county-level and township service collaboration, and analyzed the profits and losses of coun-ty-level hospitals, doctors and patients. Results: The patient in the service collaboration would benefit the most, only if county hospital doctors were willing to collaborate and there were enough policy supporting collaboration, would the county hospital collaboration. Conclusion: At present, there was a lack of institutional constraints on doctors’ behavior in county-level and township service collaboration. The system of grading diagnosis and treatment was unreasonable. The costs and benefits of doctors in service collaboration were not equal. Doctors lacked motivation for collaboration. Since the doctor at the county-level income mainly depended on the incention of policies and performance, doctors at the county level under the condition of no cooperative was the optimal solution. From the perspective of game theory, to encourage county-level doctors to cooperate in service better, it needed to strengthen its comprehensive recognition of two levels of service collaboration, change the income structure and reduce the cost of service collaboration.
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Objective To analyze the static and dynamic efficiency of the county-level public hospitals in Jiangsu province, and the influencing factors of efficiency. Methods The static and dynamic efficiency of 43 such hospitals was analyzed using the super-efficiency DEA and the Malmquist index method, and the influencing factors were studied using the Tobit regression model. Results Overall efficiency of the 43 county-level public hospitals varies significantly, mostly found in their technical efficiency. From 2014 to 2015, the total factor productivity index of some hospitals declined, mostly due to declining technical efficiency changing index. The efficiency is positively correlated to the location of the hospital, medical personnel, and the ratio of beds available. On the other hand, the efficiency is a negatively correlated to hospital grading, drug proportion per 100 yuan medical income. Conclusions Differential strategies are recommended to improve their operational efficiency, by optimizing hospital resource allocation, rationalizing hospital scale, and improving internal management system.
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ObjectiveTo encourage development of county-level hospitals by building a performance appraisal indicator system for such institutions. Methods Using the PATH model ( a performance appraisal tool for hospital ) quality improvement, an appraisal system was built for such institutions. Centering on patients, this system encompassed such dimensions as public benefits, quality of care and safety, staff and hospital development. Results This system consisted of six level-1 indicators, 21 level-2 indicators and 70 level-3 indicators, each given due weight. Conclusions This indicator system centers on patients, follows guidance of public benefits, and aims at continuous quality improvement, making it an effective in evaluating hospital performance and providing reference for the decision-makers to promote and adjust medical reform policies.