上海市医疗质量控制综合评分体系研究

目的 构建一套客观通用的医疗质量综合评分体系,从而加强对各医疗机构总体医疗质量的控制,促进医疗机构质量不断提升,为政府有关部门提供可操作性的政策建议。方法 在文献综述的基础上应用德尔菲法（Delphi Method）对医疗机构质量控制综合评分指标体系的重要性、评估难度以及理想评估次数进行评价,建立评价指标体系。结果 构建的指标体系包含三个层级结构,共32个指标,各级指标的重要性评价意见的协调系数均有统计学意义,专家们较一致的认为管理类别的评价指标评估难度较大,理想的评估频次是一年2次。结论 构建的评价指标体系符合上海市的实际情况,可以应用到实际质量控制综合评价工作中。     

基于循证评价的现代化综合性中医院医疗质量评价指标体系的建立

目的 建立一套科学合理、量化可比、简便易行的现代化综合性中医院医疗质量评价指标体系。方法 对我国现有的医疗质量评价的文献进行循证分析,按循证医学的标准和引用频率提取综合性医院的共性指标和中医院特有的非共性指标,从而拟定指标体系草案。运用德尔菲法,进行3轮专家咨询,采用相乘模型的综合指数法筛选指标,用层次分析法和比例分配法确定指标权重。结果 指标体系由5个一级指标、23个二级指标构成,其中反映中医院特色的二级指标6个,占26%。结论 整套指标体系既有医院的共性指标,又强调了综合性中医院的特性指标,既能突出中医医疗质量管理与质量控制的特色,又能结合中医医院现代化发展的需要。     

临床检验危急值运行质量综合评价指标体系构建初探

目的 尝试初步构建一套适用于临床检验危急值运行质量评价的科学、合理、可靠、可行的指标体系。方法 借鉴全面质量管理的思路,依托指标体系构建的理论,采用文献系统分析、规范的选题小组法、专家咨询等研究方法,结合案例实证分析,通过检验、临床、护理、管理、科研等多学科合作,全面地收集整理临床检验危急值运行质量相关指标,初步构建出一套临床检验危急值运行质量评价指标体系。结果 初步构建的临床检验危急值运行质量评价指标分三级：一级指标3个,二级指标9个,三级指标55个。结论（1）本研究初步构建的临床检验危急值运行质量评价指标的相关内容能全面反映临床检验危急值运行质量情况,适合临床检验危急值运行质量的综合评价。（2） 初步构建的评价指标需要继续通过德尔菲法、数理统计、文献法等方法进一步精选、量化及确定权重。     

基于患者体验的医疗服务质量关键指标体系构建

??????? 目的 初步构建基于“患者体验”的医疗服务质量关键指标体系。方法 通过检索国内外相关文献,构建指标体系框架和专家咨询表并进行2轮专家咨询,确定了基于“患者体验”的医疗服务质量关键指标体系。结果 构建基于“患者体验”的医疗服务质量关键指标体系,一级指标有有形性、可靠性、反应性、保证性、关怀性和连续性6个,二级指标28个,三级指标83个。结论 基于患者体验的医疗服务质量关键指标体系具有很强的实用性,为患者体验量表开发奠定基础。研究结果对于改进我国医疗服务质量评价手段和策略具有重要意义。     

军队中心医院基于平衡计分卡成本控制体系评价指标的建立

目的 为军队医院评价医疗成本运行现状和成本管理,提供一套科学、完整的评价指标体系。方法 基于平衡计分卡（BSC）原理和医院发展规律筛选指标,采用德尔菲法（Delphi）结合层次分析法(AHP) 确定各维度指标的权重。结果 从BSC的4个维度建立了一套完整反映医院成本控制战略目标的核心指标及权重,包括4个一级指标、11个二级指标以及42个三级指标。结论 指标体系设计科学、合理全面,权重系数的确定合理,可进一步用于军队医院的成本控制评价。     

三级医院医疗质量评价指标体系的构建及优化

目的 在原有医疗质量评价体系的基础上,建立一套科学合理、可操作性强的三级综合性医院医疗质量评价指标体系。方法 采用典型研究方法,通过文献研究筛选初始指标,通过知情人访谈法确定质量评价框架,运用德尔菲法并借鉴平衡积分卡的原理和思想优化并确定指标及权重系数。结果 确定了以医疗基础质量、环节质量和终末质量为基本结构的三级综合性医院质量评价框架和指标体系,由3个一级维度、8个二级维度、24个三级维度指标体系及其相应权重。结论 医疗质量评价指标体系关注医院质量管理中的难点和重点环节,能够满足上海市三级综合性医院医疗质量管理的实际需要。     

基于病种的精细化医疗管理模式研究与实践

目的 以肺部专科疾病为主要研究内容,探索基于病种的精细化医疗管理模式。方法 借鉴澳洲版DRGs体系,建立医院病种分类目录,并按病种目录进行绩效评价与考核。结果 实施病种管理以来,病例组合指数（CMI）呈明显升高趋势,从2013年0.94提高到2016年的1.04;医疗费用指标基本保持稳定;6个医疗质量指标有明显提高。结论 按病种管理有利于优化医院病种结构调整、控制医疗费用以及保证医疗质量。     

大型综合医院科研绩效评价指标体系的构建研究

目的 为大型综合医院构建较为科学合理的科研绩效评价指标体系。方法 采用德尔菲法获得大型综合医院科研绩效评价的指标体系,运用层次分析法对各级指标进行权重的确定。结果 建立了大型综合医院科研绩效评价指标体系,其中一级指标2个,二级指标12个,三级指标40个。结论 构建的医院科研评价指标体系具有科学性、可操作性,可以作为评估医院科研绩效的工具。     

急性缺血性脑卒中临床路径管理模式的优化及实践

目的 评价优化后急性缺血性脑卒中临床路径管理模式的优越性。方法 随机选取医院实施急性缺血性脑卒中治疗临床路径管理优化前后收治的急性脑梗死患者各200例,采用回顾性分析比较各组患者的相关指标。结果 路径优化管理后,患者诊疗等待时间缩短,疾病规范诊疗比率进一步提高,医护工作量大大减少,患者满意度进一步提高。结论 实施临床路径能够改善医疗质量,更好地利用医疗资源。临床路径优化后医疗质量进一步提高。     

ABC分类法在医院感染管理绩效考核中的应用

目的 探讨ABC分类法在医院感染管理绩效考核中的作用。方法 根据管理特点和工作性质将科室分为A、B、C 3类,分别制定绩效考核方案进行考核。结果 除重症监护室（ICU）外,A类科室中其他科室以及B、C类科室主要考核指标均有所改善。结论 分类管理绩效考核方法提高了管理效率,实现了医院感染管理质量的持续改进。     

基于德尔菲法的外科手术风险因素评价指标构建

目的 构建外科手术风险因素评价指标体系,为有效监管外科手术质量与安全提供参考依据。方法 运用文献分析法、德尔菲法、层次分析法进行外科手术风险因素评价体系的构建和指标权重的确定。结果 建立了一个由手术固有风险、医疗机构风险、医务人员风险、患者风险4 个一级指标和手术本身风险、医务人员专业技术水平、患者个体差异、医务人员责任心、医学科学的局限性、医院诊疗流程、医务人员团队协作,医院诊疗服务水平、工作负荷等等20 个二级指标组成的手术风险因素评价指标体系。结论 建立一套完善的外科手术风险因素评价指标体系,对于保障手术患者安全、有效进行外科手术质量与安全监管具有重要意义。     

通过ISO 15189认可实验室质量指标制定及监测情况调查

目的 了解目前我国通过ISO 15189认可的实验室质量指标制定及监测情况。 方法 设计质量指标制定及监测情况调查表并下发给185家认可实验室,要求在10月31日前以邮件形式回报结果,使用Microsoft Excel 2010软件进行统计分析。 结果 共85家（占45.95%）实验室回报结果,76家临床实验室,9家独立实验室。不同认可实验室制定的质量指标数量及分布差异较大。76家临床实验室共设置质量指标1105项,每家实验室平均14.5项。9家独立实验室设置质量指标195项,每家实验室平均21.7项。临床实验室制定了更多的检验前、检验中质量指标,独立实验室在设置质量指标时还包括了较多的检验后、支持性过程和其他质量指标。 结论 目前我国认可实验室质量指标制定及监测情况尚不理想。在推进质量指标一致化的同时,实验室应加强宣贯与教育,建议一套完整、科学和实用的质量指标体系。

     

Quality indicators for hyperthermia treatment: Italian survey analysis

AimNowadays, no Quality Indicators (QI) have been proposed for Hyperthermia treatments. Starting from radiotherapy experience, the aim of this work is to adapt radiotherapy indicators to Hyperthermia and to propose a new specific set of QI in Hyperthermia field.Material and methodsAt first, radiotherapy quality indicators published in literature have been adapted to hyperthermia setting. Moreover, new specific indicators for the treatment of hyperthermia have been defined. To obtain the standard reference values of quality indicators, a questionnaire was sent to 7 Italian hyperthermia Institutes with a list of questions on physical and clinical hyperthermia treatment in order to highlight the different therapeutic approaches.ResultsThree structure, five process and two outcome QI were selected. It has been possible to adapt seven indicators from radiotherapy, while three indicators have been defined as new specific indicators for hyperthermia. Average values used as standard reference values have been obtained and proposed.ConclusionThe survey performed on 7 Italian centres allowed to derive the standard reference value for each indicator. The proposed indicators are available to be investigated and applied by a larger number of Institutes in which hyperthermia treatment is performed in order to monitor the operational procedures and to confirm or modify the reference standard value derived for each indicator.     

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture

BackgroundThe Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process.ObjectivesTo (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators.MethodThe indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence.ResultsSeven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48 h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care.ConclusionThe indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.     

基于CIS的医疗质量安全监管系统应用效果

?????? 目的 探讨以临床信息系统（CIS）为基础构建医疗质量安全监管系统的实际应用效果。方法 对照分析应用CIS及医疗质量信息化监管系统前后的医疗服务效率与质量安全指标变化。结果 实施CIS及信息化医疗质量安全监管系统后医疗效率和质量安全指标均有显著性提升。结论 基于临床信息系统建立健全医疗质量安全监管系统,是深入挖掘利用CIS、充分发挥其持续改进医疗质量、保障患者安全、提升服务效能的重要支持和保证。     

Developing and Communicating a Taxonomy of Ecological Indicators: A Case Study from the Mid-Atlantic

To ensure indicators of ecosystem health are integrated into environmental decision-making, it is imperative to provide a comprehensive framework for indicator selection and use. The same framework can also be used to evaluate the utility of any given indicator. The Atlantic Slope Consortium (ASC) has developed such a framework, based upon three primary elements: 1) The specific questions to be answered (the type of indicator), recognizing the following types of questions/indicators: Condition assessment: snapshot of the current state of the system; Stressor diagnosis: identification of causative factors of condition; Communication to the public: encouraging comprehension of condition in its most elementary or integrated form; Futures assessment: estimating the probable trajectory of condition, or assessing the vulnerability of any system to a stochastic event; Evaluation: a subset of condition indicators that evaluate the effectiveness of management actions. 2) The spatial and/or temporal scale of the issue being addressed (the spatial/temporal scale over which the indicator is valid). 3) The context of the question, using categories of surrounding land use as surrogates for social choices. A Fish Community Index (FCI) developed for the ASC will provide an example of utilizing the framework to select an indicator, as well as using the framework to judge the utility of the indicator.     

医学院校附属医院科研能力评估指标体系构建

目的 构建医学院校附属医院科研能力评估指标体系。方法 运用德尔菲法筛选并确定各项评价指标。 结果 经过两轮德尔菲法专家咨询,构建出医学院校附属医院科研能力评估指标体系,包括一级指标3个,二级指标8个,三级指标25个。结论 所构建的指标体系具有较高的信度、效度,可以作为评估医院科研能力的工具。     

Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care

Background

The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators.

Objective

To present a conceptual framework to develop comprehensive, robust, and transparent composite indicators of pediatric care quality, and to highlight aspects specific to quality measurement in children.

Methods

We reviewed the scientific literature on composite indicator development, health systems, and quality measurement in the pediatric healthcare setting. Frameworks were selected for explicitness and applicability to a hospital-based measurement system.

Results

We synthesized various frameworks into a comprehensive model for the development of composite indicators of quality of care. Among its key premises, the model proposes identifying structural, process, and outcome metrics for each of the Institute of Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity) and presents a step-by-step framework for embedding the quality of care measurement model into composite indicator development.

Conclusions

The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals.