新疆乌鲁木齐某五所三甲医院三种绩效评审方法评价医院综合效益研究

发布时间：2018-05-21 01:35

  本文选题：三级综合医院评审标准 + 评审办法　； 参考：《新疆医科大学》2016年硕士论文

【摘要】：目的:本文主要通过比较JCI国际医疗机构评审条例、ISO9001医疗质量管理办法与我国《三级甲等医院评审办法(2011版)》的指标标准和特点,来分析评审办法的不同对所选样本医院的综合服务效率、管理水平的影响,又通过对评审办法的内容对比分析,找出我国等级医院评审标准中存在的缺陷或问题,提出进一步完善评审办法,促进评审政策的完善,对我区医疗机构的等级医院评审政策进行探讨并提出规范化的建议。方法:本文研究主要采用文献查阅、比较研究、综合指数法等对新疆乌鲁木齐某五所综合三级甲等医院运行情况和综合服务能力进行统计分析;其次,通过相关渠道获得样本医院反应医疗机构卫生服务能力等情况的数据,利用Epidata3.1软件建立数据库,Excel2007软件进行数据整理,SPSS17.0统计软件对得到的数据进行整理和分析,设立6个维度19个指标,并且判定指标的好于坏,最终使用综合指数法对五所医院指标指数化并得出结果与维度指标的对比得到结论。第三、对得到的标准数据使用T检验和卡方检验试验出所参考指标有无统计学意义,并进行效益分析比较研究,最终比较出三种绩效评审办法视角下对所选样本医院有何影响,在哪一维度指标中影响较为明显,我国等级医院评审指标标准哪部分需要加强和完善。结果:1)通过对五所医疗机构卫生人力资源的组成分析,就卫生技术人员、执业(助理)医师、注册护士占卫生人员比例来看,作为使用JCI国际医疗机构评审条例A医院在硕士、博士比较其他医院高为3.86%和24.1%,达到了JCI国际医疗机构评审条例中卫生人员的管理部分的指标标准;其次为B医院,B医院使用ISO9001医疗质量管理办法,在卫生人员的管理上使用的是PDCA模式,对卫生人员起始质量-中间质量-终末质量进行考核,在硕士、博士比中紧跟A医院,占比为1.66%和23%;C、D、E医院均使用我国颁布的等级医院评审办法,其中在卫生人员结构中与A、B医院相比相差较为明显,硕博人员所占比例偏低,医院总收入和人均创造价值均偏低;2)五所三级甲等医院经济支出情况中,对人员支出、后勤保障支出分析显示,人员支出D医院C医院A医院B医院E医院,后勤保障支出B医院D医院C医院E医院A医院;3)病床服务效用分析中看出,A医院病床周转次数、病床使用率、平均住院日在五所医院中效率比值较为高,其次是B医院,但是B医院病床使用率高,而病床周转次数与使用率未成比例来看,B医院的患者的构成有所不同。C、D、E医院病床周转次数平均在28.72%,明显较低,使用率平均在87.43%,病床服务情况比较中显示卫生人员的闲置现象严重;4)对五所三级综合医院提供的整体服务能力效率情况来看,使用综合指数法对19项指标标准的对比分析显示A、B、C、E四所综合医院提供服务能力效率均达标,而D综合医院未达标。从综合指数排序来看,I_AI_BI_CI_EI_D,说明A医院效率好于B医院,B医院好于C医院,C医院好于E医院,E医院好于D医院。结论:根据新疆乌鲁木齐市某五所三级甲等医院使用的评审办法对医院综合效益的影响可以看出现行的评价体系指标的特点和优缺点。JCI国际标准指标最全面,对医院质量管理评审体系的促进最强,更是适用于医生对病人的诊治等无法标准化的工作,但是此标准职责过分繁多,评审指标细致和繁琐,操作性较差,一般以咨询、管理和教育集于一身,造成了成本的过分升高;ISO9001医疗质量管理办法则突出强调了领导的管理作用,关注医护人员在工作中对各项技术程序的认真程度,相比JCI国际标准,它更关注于过程的管理,避免医疗差错,提高医疗质量,但是由于此标准最初是为企业而诞生,对医疗机构针对性较差,缺少医疗活动的标准;三级甲等医院评审体系分析来看,我国的评审一直由政府主导,但是任然存在医疗机构被动参与、评审与评级合为一体带来的弄虚作假,评审的目标过于全面、指标标准过于细致、不适宜操作等问题对医疗机构带来许多不利影响。从医院总体的效益的比较来分析,使用JCI国际标准和ISO9001评审办法的医院总体效益较好,与通过等级医院评审体系的医疗机构相比较有明显差异,从而可以在适合我区区情,借鉴国际上先进的评审体系标准,完善我国等级医院评审体系。
[Abstract]:Objective: through comparing the JCI international medical institution evaluation regulations, the ISO9001 medical quality management method and the index standard and characteristics of the evaluation method of three grade a hospital (2011 Edition) in China, this paper analyzes the different evaluation methods on the comprehensive service efficiency and the management level of the selected sample hospitals, and through the content of the evaluation methods. To find out the defects or problems in the evaluation standards of grade hospitals in our country, this paper proposes to further improve the evaluation methods, promote the improvement of the evaluation policy, and discuss the evaluation policy of the grade hospital in the medical institutions of our district and put forward the standardized suggestions. The operation situation and comprehensive service ability of five comprehensive three grade first class hospitals in Urumqi, Xinjiang were analyzed. Secondly, the data of the health service ability of the hospital reaction medical institutions were obtained through the related channels, and the database was established by Epidata3.1 software, the Excel2007 software was compiled, and the SPSS17.0 statistical software was used. The obtained data are arranged and analyzed, 6 dimensions and 19 indexes are set up, and the indexes are better than bad. Finally, the comprehensive index method is used to index the index of five hospitals and get the conclusion of the comparison between the result and the dimension index. Third. The standard data obtained by the T test and the chi square test show the reference index. Statistical significance, and carry on the comparative study of benefit analysis, and finally compare the influence of three kinds of performance evaluation methods on the selected sample hospital, which is more obvious in which dimension index, which part of the grade hospital evaluation index standard of our country needs to be strengthened and perfected. 1) through the health manpower resources of five medical institutions As regards the proportion of health technicians, practicing (Assistant) doctors and registered nurses in the proportion of health personnel, the A hospital is used as the JCI international medical institution, and the doctorate is 3.86% and 24.1% higher than other hospitals. B hospital, B hospital use ISO9001 medical quality management method, in the management of health personnel is the use of PDCA model, the initial quality of health personnel - the quality of the intermediate quality - the quality of the assessment, in the master, the doctor's ratio is closely followed by the A hospital, accounting for 1.66% and 23%; C, D, E hospitals all use our country's hierarchical hospital evaluation method, among them, in the Wei Compared with A, B hospital, the proportion of raw personnel is relatively obvious, the proportion of the huge personnel is low, the total income of the hospital and the per capita creation value are low; 2) in the economic expenditure of the five three grade A hospitals, the analysis of the personnel expenditure and the logistic support expenditure shows that the personnel expenditure is the B Hospital of A Hospital of D hospital, E Hospital of B hospital, and the logistics support expenditure B medicine. The hospital D hospital C hospital E hospital A Hospital; 3) the hospital bed service utility analysis showed that the ratio of bed turnover in A hospital, the rate of sick bed use, the ratio of average hospitalization days in five hospitals was higher, followed by B hospital, but the use rate of B hospital bed was high, but the proportion of sick bed turnover and utilization rate was not proportional to the proportion of patients in B hospital. The average turnover of hospital beds in different.C, D and E hospitals was 28.72%, significantly lower, the average use rate was 87.43%, and the health workers' idle phenomenon was serious in the bed service comparison; 4) the comprehensive index method of the comprehensive index method showed A, B, C with the comprehensive index method. The efficiency of the E four general hospitals provided the standard of service ability, while the D general hospital did not reach the standard. From the comprehensive index ranking, I_AI_BI_CI_EI_D showed that the efficiency of A hospital was better than that of B hospital, B hospital was better than C hospital, C hospital was better than E hospital, and E hospital was better than D hospital. Conclusion: according to the Evaluation Office of the three grade A hospitals in Urumqi, Xinjiang The influence of the method on the comprehensive benefit of the hospital can be seen that the characteristics and advantages and disadvantages of the current evaluation system index.JCI international standard index are the most comprehensive, the promotion of the evaluation system of hospital quality management is the strongest, and it is applicable to the doctor's work on the diagnosis and treatment of the patients, but the standard is too numerous and the evaluation index is meticulous and complicated. The ISO9001 medical quality management approach emphasizes the management role of the leaders and pays more attention to the seriousness of the technical procedures in the work of the medical and nursing staff. Compared with the JCI international standard, it pays more attention to the management of the process and avoids the medical treatment. Error, improve the quality of medical treatment, but because this standard is originally for the enterprise, it is poor in medical institutions and lacks the standard of medical activities. In the analysis of the evaluation system of the three grade a hospital, the evaluation of our country has been dominated by the government, but there is a lack of passive participation in medical construction and the combination of evaluation and rating. The objectives of the evaluation are too comprehensive, the standard of the index is too careful and the unsuitable operation has many adverse effects on the medical institutions. From the comparison of the overall benefit of the hospital, the overall benefit of the hospital using the JCI international standard and the ISO9001 evaluation method is better, compared with the medical institutions which have passed the grade hospital evaluation system. Obviously, it can improve the evaluation system of our grade hospitals in the light of our regional conditions and the international advanced evaluation system standards.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.3

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