手术分级与病例分型管理的应用研究

手术分级与病例分型管理相结合能够科学、客观地反映医院实际诊疗水平和救治能力,合理评价工作绩效,极大地提升医院的医疗质量和管理水平,对医院的可持续发展和社会效益的提升具有重要的影响。通过实施·手术分级和病例分型管理,提高医院收治病种的含金量,引导医院保持正确发展方向,合理调配医疗资源,使分级医疗落到实处。     

全面质量管理在综合医院住院诊疗管理中的运用探讨

住院诊疗管理是指对住院病人诊断和治疗过程的组织、控制和协调等系统管理,其核心是病房管理。住院诊疗以三级医师负责制为基础,是发挥医院功能的中心环节,也是实现以病人为中心的优质医疗服务的保障。由于全面质量管理在医院管理中表现为医院所提供的医疗服务质量、医护人员的服务态度、患者及其家属的满意程度等,将TQM方法科学地运用到住院诊疗管理工作中,可以不断提高医院的医疗服务质量和水平,提升患者和家属的满意度及其对医院认可度,增强医院竞争力。     

医院绩效管理的二次转型

医药卫生体制改革对医院管理提出新的、更高的要求,需要构建有效的绩效管理体系,实现医院绩效管理的二次转型。绩效管理是将医院整体发展战略落实为医护人员个人具体工作和效果的有效手段,传统的绩效管理关注部门和科室整体绩效水平,二次转型的重要内容是医护人员个人效能的提高,特别是提升医院中效能较低人员的绩效。从严预算、流程优化、提升科室经济管理能力等有助于实现绩效管理的二次转型,提升医院深层次核心竞争力。     

价值工程在医院管理中的应用初探

简述了医院开展价值工程的意义,对价值工程这一工程技术理论如何在医院管理中应用进行了探索,总结了医院的做法和实施效果,为提高医院管理水平,提升核心竞争力提供了一种新的角度。     

探讨现代医院药剂管理的思路及意义

随着我国医疗体制的改革,医院也面临着新形势下自身管理体系和管理方式的改革和创新。现代医院的管理模式也发生很大变化,从传统经验管理型逐步转变为现代管理型。现代医院管理采用科学的管理方法和管理技术,广泛地运用现代自然科学和社会科学的研究成果使管理手段现代化、科学化。现代医院药剂管理是医院管理工作的重要组成部分,对医疗质量及用药安全起着重要的作用。医院药剂管理的现代化可以保证用药的安全性,提高医疗质量,提高医院的核心竞争力,促进现代市场经济体制下医疗水平的提升和医院的发展。现代医院药剂管理的关键在于如何实现新模式下的管理目标及如何提高新模式下的药剂管理水平。本文结合我院在医疗改革背景下逐渐创新各个环节的管理模式,完善管理体系,突破管理瓶颈而获得的实践体会,进一步探讨现代医院药剂管理的方法及意义,为医院药剂管理工作提供理论指导。     

探讨现代医院药剂管理的思路及意义

随着我国医疗体制的改革,医院也面临着新形势下自身管理体系和管理方式的改革和创新。现代医院的管理模式也发生很大变化,从传统经验管理型逐步转变为现代管理型。现代医院管理采用科学的管理方法和管理技术,广泛地运用现代自然科学和社会科学的研究成果使管理手段现代化、科学化。现代医院药剂管理是医院管理工作的重要组成部分,对医疗质量及用药安全起着重要的作用。医院药剂管理的现代化可以保证用药的安全性,提高医疗质量,提高医院的核心竞争力,促进现代市场经济体制下医疗水平的提升和医院的发展。现代医院药剂管理的关键在于如何实现新模式下的管理目标及如何提高新模式下的药剂管理水平。本文结合我院在医疗改革背景下逐渐创新各个环节的管理模式,完善管理体系,突破管理瓶颈而获得的实践体会,进一步探讨现代医院药剂管理的方法及意义,为医院药剂管理工作提供理论指导。     

新时期提升传染病区医院管理的有效策略

目的：探讨新时期提升传染病区医院管理水平的有效策略。方法：通过对传染病区医院感染因素进行探究,制定出适用于医院实际的感染预防策略。结果：制定和落实医院预防感染的规章制度,实施严格的职业防护培训,完善传染病区医院管理的诸项策略,能有效降低医院感染发生率。结论：传染病区是医院感染发生的高危地带,加强对传染病区的规范化管理,能起到良好的传染病预防效果。     

在住院处深入开展以人为本与和谐共存服务理念的探讨

目的：为构建和谐的医患关系,为病人提供优质服务,结合住院处的实际情况,探讨在医院住院处深入开展以人为本与和谐共存服务理念的重要性和必要性。方法：详细介绍以人为本与和谐共存服务理念,简要概括医院住院处的工作职责及其在医院系统中的作用和地位,将以人为本与和谐共存服务理念与医院住院处的职责相结合,探讨该理念在提升住院处的工作职能、促进与患者的沟通交流、提升医院信誉、维护医院形象中的作用。结果：以人为本与和谐共存服务理念在指导住院处各项工作中确实有一定的引导作用。结论：将以人为本与和谐共存服务理念在提升住院处的工作职能相结合,可以很好地促进医务人员与患者的沟通交流,提升医院信誉,提高医院竞争力。     

PDCA框架下公立医院战略管理的实施

公益性和可持续发展是公立医院改革的核心,医院战略管理是实现公立医院改革总体目标的基本途径。北京安贞医院在PDCA框架下实施医院战略管理,通过对医院发展环境的总体分析,结合医院自身实际,重点确立了医院发展的“两大能力建设”和“两个根本转变”,即以提高“整体服务能力”和“可持续发展能力”为重点,实现由“大专科、小综合”向“强专科、大综合”转变,由“规模效益型”向“学院型医院”转变。不断提升服务意识、加强学科管理、注重内涵建设,推进了医院管理创新和可持续发展。     

互联网时代的医院危机公关管理

在市场经济条件下,市场环境、顾客需求、技术创新不断变化,都会给医院发展带来风险,如果医院不能及时防范就会形成医院公关危机,给医院造成重大损失。以网络、信息特征为特点的互联网时代的到来,更是给医院公关危机管理带来了新的挑战。强调潜在风险防范,防止多米诺骨牌效应,对于提升医院竞争力,保持医院良性运转具有极其重要的意义。     

基于DRGs死亡风险分级在医疗质量评价中的应用

目的 基于DRGs探讨死亡风险分级评价医院医疗质量的方法。方法 以死亡风险分级方法评价医院整体医疗质量,进行科室间、专业间横向对比,并与总住院死亡指标进行比较。 结果 （1）总死亡率2015年0.137%低于2014年0.236%,低风险死亡率2015年0.008%高于2014年0,高风险死亡率2015年3.341%高于2014年1.773%;（2）非手术科室A和手术科室A在两类科室中总死亡率都是最高的,其中非手术科室A在中高风险和高风险死亡率是最高的,而手术科室A仅在中高风险死亡率是最高的。非手术科室B出现1例低风险死亡患者;（3）MDCR专业组总死亡率为0.15%居第六位,低风险和中低风险死亡率分别为0.01%和0.24%,其他专业组这两个死亡率都为0。 结论 基于DRGs死亡风险分级是评价医院医疗质量的有效方法。     

Evaluation of Gene Expression Classification Studies: Factors Associated with Classification Performance

Classification methods used in microarray studies for gene expression are diverse in the way they deal with the underlying complexity of the data, as well as in the technique used to build the classification model. The MAQC II study on cancer classification problems has found that performance was affected by factors such as the classification algorithm, cross validation method, number of genes, and gene selection method. In this paper, we study the hypothesis that the disease under study significantly determines which method is optimal, and that additionally sample size, class imbalance, type of medical question (diagnostic, prognostic or treatment response), and microarray platform are potentially influential. A systematic literature review was used to extract the information from 48 published articles on non-cancer microarray classification studies. The impact of the various factors on the reported classification accuracy was analyzed through random-intercept logistic regression. The type of medical question and method of cross validation dominated the explained variation in accuracy among studies, followed by disease category and microarray platform. In total, 42% of the between study variation was explained by all the study specific and problem specific factors that we studied together.     

Classification, disease, and diagnosis

Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.     

病例分型与医疗费用支付方式的相关性研究

近年我国医疗费用呈快速上升趋势。从实证研究的角度，采用逐步回归分析统计方法研究病例分型与医疗费用的相关性，探讨病例分型应用于医疗费用支付方式的科学性和可行性，并对现有医疗费用支付方式的优缺点和病例分型的意义进行了讨论。     

Applying Classification Trees to Hospital Administrative Data to Identify Patients with Lower Gastrointestinal Bleeding

Background

Lower gastrointestinal bleeding (LGIB) is a common cause of acute hospitalization. Currently, there is no accepted standard for identifying patients with LGIB in hospital administrative data. The objective of this study was to develop and validate a set of classification algorithms that use hospital administrative data to identify LGIB.

Methods

Our sample consists of patients admitted between July 1, 2001 and June 30, 2003 (derivation cohort) and July 1, 2003 and June 30, 2005 (validation cohort) to the general medicine inpatient service of the University of Chicago Hospital, a large urban academic medical center. Confirmed cases of LGIB in both cohorts were determined by reviewing the charts of those patients who had at least 1 of 36 principal or secondary International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) diagnosis codes associated with LGIB. Classification trees were used on the data of the derivation cohort to develop a set of decision rules for identifying patients with LGIB. These rules were then applied to the validation cohort to assess their performance.

Results

Three classification algorithms were identified and validated: a high specificity rule with 80.1% sensitivity and 95.8% specificity, a rule that balances sensitivity and specificity (87.8% sensitivity, 90.9% specificity), and a high sensitivity rule with 100% sensitivity and 91.0% specificity.

Conclusion

These classification algorithms can be used in future studies to evaluate resource utilization and assess outcomes associated with LGIB without the use of chart review.     

Direct and Indirect Classification in Clinical Research

We investigate if the use of a priori knowledge allows an improvement of medical decision making. We compare two frameworks of classification – direct and indirect classification – with respect to different classification errors: differential misclassification, observed misclassification and true misclassification. We analyze general behaviors of the classifiers in an artificial example and furthermore as being interested in the diagnosis of early glaucoma we adapt a simulation model of the optic nerve head. Indirect classifiers outperform direct classifiers in certain parameter situations of a Monte‐Carlo study. In summary, we demonstrate that indirect classification provides a flexible framework to improve diagnostic rules by using explicit a priori knowledge in clinical research.     

我院抗菌药物实行分级管理后使用情况分析

目的:分析抗菌药物分级管理干预措施的实施及效果。方法:选择2011年5月至2013年5月间我院全院出院患者6622例的病案资料。其中实施分级管理制度之前的患者3238例,实施分级管理制度之后的患者3384例,分析分级管理前后医院抗菌药物使用情况。结果:实施分级管理制度后抗菌药物使用率,人均使用频次及人均抗菌药物费用均明显降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理制度后一线抗菌药物使用率显著提高,二线、三线抗菌药物使用率降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理后三联用药比例显著降低(P0.05),送检标本及检出阳性率较实施分级管理前无统计学意义(P0.05)。结论:实施抗菌药物分级管理可以有效的限制抗菌药物滥用情况,对于临床抗菌药物合理应用有积极意义。     

One-Hot Vector Hybrid Associative Classifier for Medical Data Classification

Pattern recognition and classification are two of the key topics in computer science. In this paper a novel method for the task of pattern classification is presented. The proposed method combines a hybrid associative classifier (Clasificador Híbrido Asociativo con Traslación, CHAT, in Spanish), a coding technique for output patterns called one-hot vector and majority voting during the classification step. The method is termed as CHAT One-Hot Majority (CHAT-OHM). The performance of the method is validated by comparing the accuracy of CHAT-OHM with other well-known classification algorithms. During the experimental phase, the classifier was applied to four datasets related to the medical field. The results also show that the proposed method outperforms the original CHAT classification accuracy.     

Flying Insect Detection and Classification with Inexpensive Sensors

An inexpensive, noninvasive system that could accurately classify flying insects would have important implications for entomological research, and allow for the development of many useful applications in vector and pest control for both medical and agricultural entomology. Given this, the last sixty years have seen many research efforts devoted to this task. To date, however, none of this research has had a lasting impact. In this work, we show that pseudo-acoustic optical sensors can produce superior data; that additional features, both intrinsic and extrinsic to the insect’s flight behavior, can be exploited to improve insect classification; that a Bayesian classification approach allows to efficiently learn classification models that are very robust to over-fitting, and a general classification framework allows to easily incorporate arbitrary number of features. We demonstrate the findings with large-scale experiments that dwarf all previous works combined, as measured by the number of insects and the number of species considered.