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To improve the evaluation indicators of medical quality in TCM hospitals; To realize objective, fair, and accurate evaluation of the quality of TCM. Based on relevant literature on medical quality in traditional Chinese medicine hospitals research and thematic group discussions, 21 evaluation indicators for TCM characteristics were formed. A questionnaire survey was conducted among 40 experts, and 37 were effectively collected, with a positive coefficient of 92.50%. After two rounds of expert consultation, the evaluation indicators were determined to be: the intensity of outpatient use of TCM decoction pieces (utilization rate of TCM decoction pieces, prescription number of TCM decoction pieces, dosage of TCM decoction pieces, and service price of TCM decoction pieces), the intensity of the use of TCM technology (proportion of TCM technology, number of TCM projects, cost of TCM technology, and course of treatment). Case studies were conducted on relevant data from 10 departments using the operational decision support system (BI) platform of Yueyang Integrated Traditional Chinese and Western Medicine Hospital affiliated with Shanghai University of Traditional Chinese Medicine to verify the rationality of indicators. The 10 departments were analyzed and evaluated, and the results obtained were basically consistent with the actual medical quality situation of the hospital. The indicators used in this study can reflect the actual medical quality situation, and have a certain degree of scientificity, feasibility, and applicability, providing reference for improving the medical quality evaluation indicators of TCM hospitals.
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BACKGROUND:Clinical use of vascular stents involves high medical costs,but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients.Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE:To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS:The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science.The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume,institutions,countries,keywords,etc.Finally,the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION:(1)120 articles in English were finally included.In the past 10 years,the highest number of articles published in this field was in 2019,with 10 articles.The institution with the largest number of articles published was Harvard University in the United States with 20 articles,and the country with the largest number of articles published was the United States with 58 articles.(2)Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease,the cost-effectiveness analysis of angioplasty stent intervention,and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research.(3)In the context of medical quality management,the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows:long-term effect of vascular stents,safety,drug release mechanism research,personalized therapy,restenosis problems,and stent insertion technology.(4)The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis,and the restenosis rate is lower than that of bare metal stents,but the cost is usually higher.Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents,that is,avoiding long-term stent existence and reducing the risk of restenosis,but their cost may be higher,and there may be some complications in the short term,and they are not widely used at present.(5)In addition to the direct stent cost,factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention,the risk and cost of complications,the duration and cost of drug therapy,and the quality of life of patients.Therefore,while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents,they may lead to better clinical outcomes in the long term,resulting in a more favorable cost effect.(6)Future research directions should focus on making personalized vascular stent treatment decisions,observing the long-term effect of stent treatment,the impact of the stent on patients'quality of life,formulating health policies,rational allocation of medical resources,and the establishment of long-term follow-up mechanisms.
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Medical quality and safety are the foundation for the high-quality development of public hospitals.The concept of Multi-disciplinary Treatment(MDT)is of great value for functional departments of hospitals to collaborate in carrying out medi-cal quality management practices.Children's Hospital,Zhejiang University School of Medicine explored a new quality manage-ment model,constructed the MDT practice path for medical quality in administration,and formed a closed-loop management process where clinical departments actively initiate consultations,various administrative functional departments collaborate and in-teract in a two-way manner,accurately identify and solve clinical problems,and continuously track and feedback outcomes.After the inception of this path,the overall level of medical quality and safety in the hospital has been comprehensively improved,mainly manifested in the enhancement of quality control capabilities of clinical departments,optimization of core performance e-valuation indicators,and remarkable improvement in patient satisfaction,thereby holding profound significance for high-quality development of the hospital.
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Objective To explore and analyze the application effect of hospital quality monitoring system in medical quality management.Methods 800 patients from March 2021 to March 2022 were selected as the control group and routine medical quality management was adopted;and 800 patients from April 2022 to April 2023 were selected as the experimental group and the hospital quality monitoring system was adopted for medical quality management.Results The complication rate and re-admission rate after implementation were significantly lower than before implementation,with statistical significance(P＜0.05).The satisfaction of patients after implementation was significantly higher than before implementation,and the difference was statis-tically significant(P＜0.05).The score of medical service quality after implementation was significantly higher than before im-plementation,and the difference was statistically significant(P＜0.05).Conclusion The application effect of hospital quality monitoring system in medical quality management is remarkable,and it is worthy of promotion.
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Objective To establish an evaluation index system that can be used for medical quality assessment in clini-cal departments.Methods Based on literature analysis and key informant interview,the Delphi method was used to analyze the-importance and operability of the evaluation index system of medical quality in clinical departments.Results A clinical depart-ment medical quality assessment and evaluation system was established,consisting of 3 primary indicators,14 secondary indica-tors,and 24 tertiary indicators.Conclusion By building a medical quality assessment and evaluation index system in clinical departments,a simple,standardized,and highly operational management model is established for medical institutions to carry out medical quality management.It is conducive to directing clinical departments to focus on medical quality management,improving their medical quality awareness and management level,and promoting the high-quality development of public hospitals.
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Objective To analyze the implementation of day surgery in a public hospital in Tianjin,and to provide refer-ence for the quantity and quality of day surgery.Methods The implementation of day surgery in a public hospital in Tianjin from 2020 to 2022 was analyzed.Results From 2020-2022,the main types of daytime operations were secondary(43 kinds)and ter-tiary operations(28 kinds).In terms of the implementation of professional disciplines,anorectal surgery,urology surgery and orthopedics carried out the largest number of operations,among which anorectal surgery accounted for 70.76％(2 285/3 229).Conclusion It is necessary to further improve the development of professional disciplines,the management system of day surger-y,and the guarantee of medical services,strengthen the construction of weak links in the management path of day surgery and im-prove the coverage and accessibility of day service.
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This paper introduces the construction and application of the medical quality evaluation indicator system in clinical departments of a large general hospital.It describes the indicator system's constitution and score setting,summarize the characteristics and application practice of the assessment system,and proposes some ideas for the following improvement,which in order to provide some reference for other hospitals.
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Simulation-based medical education（SBME）is an important model in international medical education.With the development of SBME domestically,various forms such as in-situ simulation,team simulation,interdisciplinary simulation,and hybrid simulation are gradually emerging.While post-graduate education and competency receive more attention,SBME has shown its value in areas including education and training,clinical thinking,assessment,and evaluation,as well as improving medical quality and patients safety,especially in the management of emergency and critical care crisis resources.However,the progress of pediatric SBME has been slow despite attracting significant attention within the field of pediatric critical care.The establishment of pediatric critical care skills simulation,scenario simulation,in-situ simulation and other training methods can not only enable clinicians to achieve“standardized operation” and “team collaboration”,but also promote“system transformation”,greatly improving the medical quality of pediatric critical care while ensuring patients safety.
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Objective To evaluate the effect of centralized procurement of artificial joint consumables on total arthro-plasty placement surgery.Methods Through a retrospective study,t-test was conducted on the medical quality and effi-ciency,hospitalization cost per time structure through July-December,2021 to July-December,2022 centralized pro-curement of joint replacement surgery in a tertiary hospital in Shanghai.Results After centralized procurement,the amount of knee arthroplasty surgery decreased,and the time of hip replacement surgery was increased,and the difference was statistically significant(P＜0.05).The total cost,cost of consumables,arthrotomy fee of the two types of arthroplasty surgery were significantly decreased,and the difference was statistically significant(P＜0.05).In addition,the average cost of other consumables hospitalization of knee joint surgery patient increased,and the difference was statistically significant(P＜0.05).Conclusion After centralized procurement of artificial joint consumables,the cost of total knee arthroplasty and total hip arthroplasty has decreased significantly,and the quality and efficiency of medical care have not changed significantly.At the same time,hospital managers should pay more attention to the rational use of consumables after centralized procurement.In addition,it calls for increasing the price of surgery to reflect the value of physician services.
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Setting up branches of public hospital is one of the important ways to allocate high-quality medical re-sources.However,medical quality homogenization is the core problem of multi-campus hospitals.As a result of dif-ferent qualities of clinical departments setting,personnel,supervision,information technology,etc.,it is difficult for hospital branches to achieve medical homogenization as the main campus.It elaborated the implementation path of medical quality homogenization in the construction of one hospital with four campuses in a large public hospital di-rectly under the National Health Commission based on SPO theory.In the three dimensions of structure,process and result,it described the specific practice of resource allocation,comprehensive supervision,performance evalua-tion and improvement,etc,thus to discuss the medical management strategies of different types of branches of hospitals,which is expected to be helpful to the construction of public hospitals with multi-campus.
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Abstract@#Diagnosis-related groups (DRGs), designed to reflect the complexity of grouped cases and the consumption of medical resources, has been utilized for evaluating hospital specialty capabilities and assessing performance. A provincial tertiary hospital in Zhejiang Province has developed a management model based on DRGs performance evaluation with strengthening the medical record quality control, optimizing disease admission structures, and refining data analysis. This article introduced the application of DRGs performance evaluation in this hospital, and proposed suggestions for improvement, including leveraging artificial intelligence and big data and integrating clinical pathway management to further enhance medical care quality. These insights provided the reference for high quality development of hospitals.
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At present, the contradiction between the lack of pediatricians and the increasing demand for pediatric medical services has become more and more prominent. Taking pediatricians as the research object, this paper explored the needs and motivation of professional development of pediatricians in China by referring to a series of excellent foreign research results, so as to improve the professional development of pediatricians, reconstruct the ecology of pediatricians and patients, then improve medical experience, and alleviate the "shortage of pediatricians" and "difficulty in seeing a doctor" in pediatrics. Enhancing the work enthusiasm and professional motivation of pediatricians can not only improve the satisfaction of patients, but also enhance the quality of medical services, so as to promote the growth of the hospital’s own economic and social benefits.
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Patient safety is the cornerstone of medical quality and an important foundation for a healthy China.In May 2023,the National Health Commission and the National Administration of Traditional Chinese Medicine jointly is-suedthe Action Plan for Comprehensively Improving Medical Quality(2023-2025),which identified patient safety as an important task and special action.It introduces the concept of patient safety,the status quo of patient safety ac-tions at home and abroad,and the research trend of patient safety,and compares the work requirements of patient safety management and special actions in the Action Plan for Comprehensively Improving Medical Quality(2023-2025),and finally puts forward a series of suggestions for formulating the Implementation Plan of Special Ac-tions for Patient Safetywith Chinese characteristics.
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According to the current problems with hospital medical quality,through the study of the Action Plan for Comprehensive Improvement of Medical Quality(2023-2025),it elaborates on its key points."Breaking the Wall"action to improve the level of diagnosis and treatment for acute,critical,severe,and tumors;The quality of medical records has reached an unprecedented level,and specific requirements have been put forward for the digitization of outpatient medical records;Emphasize drug and device management in basic quality and safety management;For the first time,medical institutions are required to conduct medical quality management of traditional Chinese medicine.The implementation pathway to address the quality of care in hospitals includes the responsibility given to provincial health commissions to improve the quality of care across the board.The performance management mechanism of"quality first"ensures the internal medical quality and safety of hospitals,forming a national provincial health commission hospital department physician action plan system.
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Mortality review is an important way to identify deficiencies and gaps in the healthcare system and can effectively improve the quality and safety of healthcare delivery.It analyzes and summarizes the relevant domes-tic and international literature and review the current development,methods and characteristics of different applica-tion areas of death case review at home and abroad,with a view to guiding healthcare departments or institutions to establish a scientific and standardized mortality review system.
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Clinical pathway is an important quality management tool for regulating medical behavior both at home and abroad, and an important means of controlling medical costs in the reform of medical insurance payment methods.The author reviewed the current development status of clinical pathways both at home and abroad, focusing on summarizing the development experience of foreign countries, and analyzing the shortcomings in the development of clinical pathways in China from the perspectives of formulation, implementation, and evaluation. It is proposed that China should establish and improve the regulatory and incentive mechanisms for clinical pathways, accelerate the construction of supporting medical security systems, explore new incentive transmission models, attach importance to the role of patient participation in the formulation and implementation of clinical pathways, and so on, in order to provide reference for promoting the efficient development of clinical pathways in China.
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Objective:To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group (DRG), analyze the evaluation effect, for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods:This study extracted data such as the number of DRG groups, etc. of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform, and analyzed data on DRG performance evaluation indicators, as well as the average length of hospital stay and average cost of DRG enrolled cases. All data were analyzed using descriptive research methods, and inter group comparisons were conducted using the Mann Whitney U-test. Results:From 2018 to 2020, the average number of DRG groups in tertiary hospitals (28) was higher than that in secondary hospitals (10) ( P<0.05), and the average CMI values of both were the same(1.79); The average cost consumption index (1.15) of tertiary hospitals was higher than that of secondary hospitals (0.65) ( P<0.05), while the average time consumption index (1.11) was slightly lower than that of secondary hospitals (1.30); The mortality rate of the low-risk group in tertiary hospitals (0.01%) was generally lower than that in secondary hospitals (0.88%), and the average percentage of DRG admitted inpatients (82.8%) was significantly higher than that in secondary hospitals (27.3%) ( P>0.05). The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases ( P<0.05). Conclusions:The number of DRG groups, CMI value, and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals, but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services. DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients. The proportion of DRG enrolled cases might be a potential indicator for evaluating the service quality of psychiatric hospitals.
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Objective:To analyze the hot spots and frontiers of medical quality and safety management since the new medical reform, and to provide reference for the continuous improvement of medical quality and safety management.Methods:Chinese literatures related to medical quality and medical safety management in CNKI database from April 2009 to December 2022 were retrieved, and the included literatures were processed and analyzed by CiteSpace software and Excel software.Results:1 921 literatures related to medical quality management and 2 497 literatures related to medical safety management were included. The publication trend showed a " double peak", showing a downward trend. The research hotspots in literature related to medical quality and safety management in China since the new medical reform have focused on practice exploration and influencing factors. The trend of future research is to closely follow the background of the times in medical quality and safety management research and intelligent medical quality and safety management evaluation system research.Conclusions:In the future, research on medical quality and safety management should be more in line with the changes of medical reform policies, focus on high-quality development to deepen the research on micro issues, promote information construction to continuously improve the indicator evaluation system, so as to promote the sustainable and high-quality development of medical quality and safety management in China.
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Objective:To construct a theoretical model of medical quality and safety management based on the current situation of medical quality and safety management mode in China, providing reference for continuous improvement of medical quality and safety management.Methods:The CNKI database was used as the data source to search literature, with a high citation index H=38 as the judgment standard, the core literature related to the quality and safety management in China was selected. Based on the structure-process-outcome (SPO) model, Nvivo qualitative analysis software was used to code and analyze the included literature, sort out the relevant elements of China′s medical quality and safety management, and clarify the logical relationship between the elements, forming a generalized SPO model of China′s medical quality and safety management.Results:Through a systematic summary and review of relevant literature, a generalized SPO model for medical quality and safety management was proposed, including 5 structural elements (organizational structure, personnel management, resource management, informatization, management standards), 2 process elements (management methods, service processes), and 3 outcome elements (patient outcomes, employee outcomes, organizational results). The logical relationships between and within the three major elements were constructed.Conclusions:To improve the level of medical quality and safety management in China, the structural dimension should be focused on clarifying the responsibilities of the main body of quality management, establishing an independent and perfect quality control department, strengthening the investment and construction of information technology, and promoting the implementation of the medical quality management standard; the process dimension should be focused on promoting the rational application of quality management tools; and the outcome dimension should be focused on strengthening the management of patient safety and improving the individual satisfaction.
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Objective:To systematically construct the foreign medical quality and safety management model by searching the English literature related to medical quality and safety management, so as to provide reference for improving the level of medical quality and safety management in China.Methods:The Web of Science database was used as the data source, the English literature related to medical quality and safety management in foreign countries was screened following the PRISMA guidelines, and the content of the screened literature was analyzed using qualitative text analysis based on the Structure Process System Outcome (SPSO) theoretical model.Results:In this study, a total of 37 articles were screened, 5 first-level themes of structure, process, system, outcome and continuous quality improvement were identified, 16 second-level themes were found, and their functional relationships were established. A theoretical model of the SPSO-Extension (SPSO-E) for medical quality and safety management was constructed, added new elements of the external environment, organizational outcome and employee outcome, and refined the continuous quality improvement into three segments of quality checking, problem handling and quality consolidation.Conclusions:In order to improve medical quality and safety management in China, the internal management model of the hospital should be dynamically adjusted according to the changes of external environment, and the result dimension should pay attention to the improvement of organization′s operational effectiveness and the physiological and psychological aspects of the staff. The final management results have a feedback effect on the hospital′s resource allocation, service delivery, organizational arrangements and cultural construction, promoting continuous improvement and enhancement of the hospital′s quality.