广州市区级妇幼保健院儿科医疗服务能力评价研究

发布时间：2018-05-11 03:40

本文选题：区级妇幼保健院 + 儿科　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:在了解广州市儿科医疗服务概况和区级妇幼保健院儿科医疗服务现状的基础上,构建广州市区级妇幼保健院儿科医疗服务能力评价指标体系,基于构建的评价指标体系对广州市区级妇幼保健院儿科医疗服务能力进行综合评价,分析广州市区级妇幼保健院儿科医疗服务能力建设中存在的问题,并提出提升广州市区级妇幼保健院儿科医疗服务能力的建议,为卫生行政管理部门的决策提供参考依据。方法:采用问卷调查法收集广州市儿科和区级妇幼保健院儿科的相关数据,采用文献研究法、德尔菲法构建广州市区级妇幼保健院儿科医疗服务能力的评价指标体系;采用AHP层次分析法测算各级指标权重;采用Topsis法对广州市区级妇幼保健院进行综合评价。结果:1.广州市儿科医疗服务总体情况:共110家医疗机构开展儿科业务,医护比为1:1.26,高学历高职称儿科医生多集中在三级医疗机构,儿科医务人员收入低于全院平均水平,儿科医生平均工作量高于全院。2.广州市区级妇幼保健院儿科医疗服务现状:医生数从2013年的147人降为2015年的140人,护士数则先从2013年的272人增长为2014年的281人,到2015年下降为271人;以2015年为例,医生:高级职称以上占比20%,硕士学历占比8%,护士:中级职称以上占比约10%,本科以上学历占比22%;2013到2015年,广州市区级妇幼保健院儿科平均住院日下降,病床使用率增加,病床周转次数下降。3.广州市区级妇幼保健院儿科医疗服务能力评价指标体系的构建:采用专家咨询法构建了三级评价指标体系,包括人力、物力、财力、医疗服务4个一级指标,人员数量、人员构成、床位数等10个二级指标,科室医护人员总数、每千人儿童医生数、医护比、本科以上医生比例等24个三级指标。4.广州市区级妇幼保健院儿科医疗服务能力各级评价指标权重的确定:基于构建的指标体系,采用AHP法测算了各级指标的权重,权重最大的前三指标为人力(0.4550)、人员构成(0.3640)、财力(0.2627)。5.广州市区级妇幼保健院儿科医疗服务能力的综合评价结果:基于构建的评价指标体系和调查数据,经Topsis法排序,区级妇幼保健院中服务能力最好的是H3医院,Ci值为0.7046,最差的是H1医院,Ci值为0.1768。结论:1.儿科医护人员总数不足,素质有待提升;儿科医护人员工作压力大,流动性高;儿科床位资源不能满足患者需求;儿科医护人员收入和付出比例失衡;儿科财政补偿不足。2.建立了广州市区级妇幼保健院儿科医疗服务能力三级评价指标体系;采用AHP层次分析法测算了各级指标权重;采用Topsis法对广州市区级妇幼保健院儿科服务能力进行综合评价,验证了评价指标体系的可操作性。3.从政府、医院、医护人员、患者四方面提出提升广州市区级妇幼保健院儿科医疗服务能力的对策:政府要重视儿童医疗卫生事业的发展,增加对儿童医疗卫生事业的投入,在区级妇幼保健院的基础上加强儿童专科医院建设;区级妇幼保健院医院要重视儿科的发展,改革绩效薪酬体系,建立儿科患者转诊机制;儿科医护人员培养职业自信,提高自身服务能力,重视医患沟通;患儿家长要理性就医,给予儿科医护人员更多的宽容和理解。
[Abstract]:Objective: on the basis of understanding the general situation of Guangzhou paediatric medical service and the current situation of pediatric medical service in the district level maternal and child health care hospital, the evaluation index system of the pediatrics medical service ability of the Guangzhou urban maternal and child health care hospital was constructed. Based on the evaluation index system, the pediatrics medical service ability of the urban maternal and child health care hospital of Guangzhou was evaluated comprehensively. This paper analyzes the existing problems in the capacity construction of Pediatrics medical service in Guangzhou urban maternal and child health care hospital, and puts forward some suggestions to improve the ability of pediatric medical service in Guangzhou urban maternal and child health care hospital, and provides a reference for the decision-making of the health administration department. Method: using the questionnaire survey method to collect the pediatrics of the pediatrics and the district level maternity and child health care hospital of Guangzhou Related data, using the literature research method, Delphi method to construct the evaluation index system of the pediatrics medical service ability of Guangzhou urban maternal and child health care hospital; use the AHP analytic hierarchy process to measure the index weight at all levels and the comprehensive evaluation of Guangzhou urban maternal and child health care hospital in Guangzhou. Results: 1. the general situation of the pediatrics medical service in Guangzhou City: A total of 110 medical institutions carried out pediatric operations. The medical care ratio was 1:1.26. The high academic and high professional pediatrician concentrated in the three level medical institutions. The income of paediatric medical staff was lower than the average level of the hospital. The average workload of pediatricians was higher than that of the hospital of.2. Guangzhou urban maternal and child health care hospital: the number of doctors dropped from 147 in 2013. For the 140 people in 2015, the number of nurses increased from 272 in 2013 to 281 in 2014, to 271 in 2015; in 2015, for example, doctors: higher professional titles and above 20%, master degree accounted for 8%, nurses: Higher Vocational titles than about 10%, undergraduate education and above 22%; 2013 to 2015, Guangzhou urban maternal and child health care hospital, Er Keping The decline of the hospitalization day, the increase of hospital bed use rate, the decrease of the number of bed turnover,.3. Guangzhou urban maternal and child health care hospital pediatric medical service evaluation index system construction: using the expert consultation method to construct the three grade evaluation index system, including manpower, material resources, financial resources, medical service 4 first level indicators, the number of personnel, personnel composition, bed number and so on 10 two level indicators, the total number of medical and nursing staff in the Department, the number of doctors and nurses per thousand, the ratio of medical care and nursing, and the proportion of doctors and children above the undergraduate level, 24 three level indicators.4., the weight of the evaluation index weight of the Department of Pediatrics medical service at Guangzhou city level maternal and child health care hospital: Based on the construction index system, the weight of the indexes at all levels is measured with the AHP method and the weight is the largest The first three indexes were human (0.4550), personnel composition (0.3640), financial (0.2627).5. Guangzhou urban maternal and child health care hospital comprehensive evaluation of the pediatrics medical service ability. Based on the evaluation index system and survey data, the best service ability in the district level maternal and child health care hospital was the H3 hospital, the Ci value was 0.7046, the worst was H1. The hospital, Ci value is 0.1768. conclusion: 1. the total number of paediatric medical staff is insufficient, the quality needs to be improved; paediatric medical staff work pressure and high mobility; paediatric bed resources can not meet the needs of the patients; the income and payment ratio of paediatric medical staff are unbalance; paediatric financial compensation is not sufficient.2. to establish the Guangzhou urban maternal and child health care hospital paediatric medical suits. The three level evaluation index system is used to measure the index weight of the three levels, and the Topsis method is used to evaluate the paediatric service ability of the Guangzhou urban maternal and child health care hospital, and the operability of the evaluation index system is verified by the four aspects of the government, hospital, medical staff and patients to improve the maternal and child health care in Guangzhou. The Countermeasures of the pediatric medical service ability of the hospital: the government should attach importance to the development of children's medical and health services, increase the investment in children's medical and health services, strengthen the construction of children's specialized hospitals on the basis of the district level maternal and child health care hospital; the district level maternal and child health care hospital should attach importance to the development of paediatrics, reform the performance compensation system and establish pediatric patients. The pediatrics and nursing staff cultivate professional self-confidence, improve their own service ability, and attach importance to the communication between doctors and patients. The parents of children should make rational medical treatment and give more tolerance and understanding to the paediatric medical staff.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.5

【参考文献】