某医院住院抗菌药物信息化管理系统及其实施效果分析

发布时间：2018-04-24 22:23

本文选题：抗菌药物 + 信息化　；参考：《复旦大学》2012年硕士论文

【摘要】：1.研究目的根据卫生部对抗菌药物使用规定的法规政策,针对传统的抗菌药管理的不足,采用信息化手段,在上海市某三甲医院的HIS信息平台上构建抗菌药物管理系统,使得医院抗菌药物管理服务卫生部标准,同时使得临床更加合理使用抗菌药物。分析该医院抗菌药物使用情况,判断综合的信息化管理手段是否对医院使用抗菌药物情况产生影响。总结医院抗菌药物管理系统的问题和获得的经验,为后续抗菌药物管理的进一步改进提供技术保障,增加项目实施的经验,总结相关知识,并为项目的推广提供依据。实施前后医院住院使用抗菌药物的情况对比：住院患者使用抗菌药物费用、住院患者使用抗菌药物的百分率、抗菌药物使用强度、住院用抗菌药物患者病原学检查百分比等指标进行对比分析,来了解此方法是否对医院使用抗菌药物产生影响。 2.研究内容 2.1分析传统抗菌药物管理流程及存在的问题,实施构建信息化抗菌药物管理系统。 2.2研究指标：包括抗菌药物使用率、抗菌药物强度、抗菌药物送检率以及抗菌药物费用。 2.3统计分析抗菌药物系统使用前3个月和时候后3个月数据。 2.3.1抗菌药物影响因素分析 2.3.2基础情况比较 2.3.3分析指标的比较 3.资料来源及方法 3.1文献查阅为了了解住院抗菌药物信息化管理国内外的研究情况,以及学习相关知识。课题组首先通过中国知网(CNKI)、万方数据、维普等数据库及互联网搜索引擎(如百度、谷歌、必应等)查阅相关文献,了解抗菌药物、抗菌药物相关政策、抗菌药物的管理、效果评价等相关理论、研究现状以及其他医院试点情况,做好前期准备工作,其次,通过卫生部、各级卫生局官方网站、卫生信息网络学术大会,搜集门诊自助服务相关材料,主要包括卫生政策、实施推广措施以及项目开展的相关材料。 3.2医院信息化基本情况调查医院信息化经过十多年的建设基本建立起贯穿全院的信息系统。从基本的财务核算系统,到全部药品管理和药品配送系统,再到覆盖全部临床科室的门诊医生站、住院医生站、护士工作站、临床检验系统。都已经在信息化完成,为抗菌药物管理系统的构建打下基础。 3.3资料来源上海某三甲医院使用抗菌药物管理系统前3个月和使用后3个月的病人疾病信息、抗菌药物使用情况等数据。主要内容包括：姓名、性别、年龄、疾病名称等情况。比较指标为：住院患者人均使用抗菌药物品种数、住院患者人均使用抗菌药物费用、住院患者使用抗菌药物的百分率、抗菌药物使用强度、住院用抗菌药物患者病原学检查百分率。 4.研究结果 4.1通过对未使用抗菌药物信息化管理系统签流程的住院抗菌药物管理情况分析,结合卫生部有关抗菌药物临床应用的文件精神,,构建信息化的抗菌药物管理系统。 4.2Logistic回归显示,构建系统后使用抗菌药物的概率是构建系统前的0.73倍,即OR值为0.73(P0.0001),在年龄研究因素中,18～40岁使用抗菌药物的概率最高,是1～6岁者的18.7倍,即OR值为18.7(P0.0001)。 4.3按是否构建了抗菌药物管理系统分组,即构建前为A组,构建后为B组。A组女性占总人数的50.36%,男性占49.64,；B组女性占50.01%,男性占49.99%；性别分别的组间差距无统计学意义(x2=0.3929,P=0.5308)。A组平均年龄为49.33±21.07岁,B组为49.56+21.10岁。年龄的组间差异无统计学意义(t=0.65,P=0.5163)。 4.4A组抗菌药物使用率为62.99%,B组为51.40%,抗菌药物使用率的组间差异具有统计学意义(x2=156.90,P0.0001)。为控制科室因素的影响,做CMH-x2检验,结果显示,在去除了科室的影响后,抗菌药物使用率的组间差异仍具有统计学意义(CMH-x2=1113-3170,P0.0001)。 4.5A组抗菌药物使用强度为74.82,B组抗菌药物使用强度为63.05。抗菌药物使用强度的组间差异有统计学意义(P=0.0495)。 4.6A组抗菌药物送检率为62.68%,B组抗菌药物送检率为73.79%。为了控制科室因素的干扰,做CMH-x2检验,结果显示控制了科室因素后,送检率的组问差异有统计学意义(CMH-x2=9.47,P=0.0021)。 4.7A组抗菌药物费用约为2313万元,B组抗菌药物费用约为2586万元。抗菌药物费用的组间差异无统计学意义(t=-2.21,P=0.0915)。 5.研究结论 5.1未使用抗菌药物管理系统前的抗菌药物管理方法过于依靠道德和医疗水平。抗菌药物管理效果难以达到卫生部规定的要求,特别是抗菌药物使用率,本次研究之前3个月统计显示医院的抗菌药物使用率达到了62.99%未达到卫生部的抗菌药物使用率标准。 5.2基于分析传统的抗菌药物管理方法控制的难点,结合卫生部的法定法规,我们完成了对抗菌药物管理系统设计思路,通过1一个月的实施成功在上海某三甲医院的信息平台上构建了抗菌药物管理系统,使得抗菌药物管理从事后评价管理走向全程信息化管理。 5.3通过构建抗菌药物管理系统前后的数据对比,发现构建后该院的抗菌药物使用率降到了卫生部规定值以下,抗菌药物使用强度也得到了有效地降低,而送检率得到了提高,有效改善抗菌药物管理。 5.4虽然抗菌药物管理系统取得了一定的效果,但是还有一些不足需要改进,如对抗菌药物费用的管理、特殊药品的管理等。将系统改进地更加完善就可以使得抗菌药物的使用更加合理。
[Abstract]:1. purpose of research
According to the regulations and policies of the Ministry of health on the use of antibacterials, in view of the shortage of traditional antibiotics management, the anti-bacterial drug management system is constructed on the HIS information platform of a three a hospital in Shanghai, which makes the hospital antibacterial drug management service to the Ministry of health and makes the clinical use of antibacterial drugs more reasonable. Analysis of the use of antibiotics in the hospital to determine whether the comprehensive information management means have an impact on the use of antibiotics in the hospital. Summarize the problems and experience gained in the hospital antibacterial drug management system, provide technical support for further improvement of the follow-up antibacterial drug management, increase the experience of the project implementation, and summarize the related aspects. Knowledge, and to provide the basis for the promotion of the project. In the hospital before and after the use of antibiotics in hospital, the use of antibacterial drugs in hospitalized patients, the percentage of inpatient use of antibiotics, the intensity of antibiotic use, and the percentage of pathogens in hospitalized patients with antibiotics were compared and analyzed to understand this. Whether the method has an impact on the use of antibiotics in hospitals.
2. research content
2.1 analyze the management process and existing problems of traditional antibiotics, and implement the information management system.
2.2 Research Indicators: including the utilization rate of antibiotics, the intensity of antibiotics, the rate of antibiotics and the cost of antibiotics.
2.3 statistical analysis was made on the data in the first 3 months and 3 months after the use of antimicrobial drugs.
Analysis of the influencing factors of 2.3.1 antibacterial drugs
2.3.2 basic situation comparison
Comparison of 2.3.3 analysis index
3. sources and methods of information
3.1 literature review
In order to understand the domestic and foreign research on the information management of hospitalized antibacterial drugs, and the learning related knowledge. First of all, the group through the CNKI, Wanfang Data, VIP database and Internet search engines (such as Baidu, Google, Bing, etc.) to consult relevant literature to understand antibacterial drugs, antibacterials related policies, antibiotics management Theory, effect evaluation and other related theories, research status and other hospitals pilot conditions, preparatory work well, secondly, through the Ministry of health, the official website of the health bureau at all levels, the health information network academic conference, the collection of outpatient service related materials, including health policy, the implementation of promotion measures and related materials to carry out the project.
Survey on basic information of 3.2 hospital information
After more than 10 years of construction, hospital information has basically established the information system that runs through the whole hospital. From the basic financial accounting system, to the whole drug management and drug delivery system, to the outpatient doctor station covering all the clinical departments, the inpatient station, the nurse workstation and the clinical inspection system have all been completed in the information system and are antiseptic drugs. The construction of management system lays the foundation.
3.3 source of information
A three a hospital in Shanghai used the data of the disease information and the use of antibiotics for the first 3 months of the antibiotic management system and 3 months after use. The main contents include: name, sex, age and name of the disease. The comparison index is the number of anti bacteria drugs used in inpatients and the use of antibiotics per person in inpatients. The cost of substances, the percentage of antibiotics used in inpatients, the intensity of use of antibiotics, and the percentage of pathogens tested in hospitalized antimicrobial agents.
4. research results
4.1 through the analysis of the management of antibiotics in inpatients who have not used the information management system of antibacterial drugs, and combining the spirit of the Ministry of health on the clinical application of antibacterial drugs, the information management system of the antibacterials is constructed.
4.2Logistic regression showed that the probability of using antibacterial drugs after building the system was 0.73 times that of the system before building the system, that is, the OR value was 0.73 (P0.0001). Among the age research factors, the probability of using antibiotics at 18~40 years was the highest, which was 18.7 times that of the 1~6 year olds, that is, the OR value was 18.7 (P0.0001).
4.3 groups of antibacterials management system were constructed, that is, group A before construction, 50.36% of the total number of women in group.A in group B, 49.64 for men, 50.01% in group B and 49.99% for men, and there is no statistically significant difference between groups of sex respectively (x2=0.3929, P=0.5308).A group is 49.33 + 21.07 years, B group is 49.56+21.10 years old There was no significant difference in age between groups (t=0.65, P=0.5163).
The use rate of Antibacterials in group 4.4A was 62.99%, group B was 51.40%, and the differences in the use rate of antimicrobial agents were statistically significant (x2=156.90, P0.0001). In order to control the influence of the Department factors, the CMH-x2 test was done. The results showed that after the removal of the influence of the Department, the differences in the rate of use of antimicrobial agents were still statistically significant (CMH-x2=1113-3170, P 0.0001).
The intensity of antibacterial use in group 4.5A was 74.82, and the intensity of antimicrobial use in group B was 63.05., and the difference in the intensity of antimicrobial use between the two groups was statistically significant (P=0.0495).
The rate of Antibacterials in group 4.6A was 62.68%, and the rate of antibiotic delivery in group B was 73.79%. in order to control the interference of department factors and CMH-x2 test. The results showed that after the control of the Department factors, there was a statistically significant difference between the groups (CMH-x2=9.47, P=0.0021).
The cost of Antibacterials in group 4.7A was about 23 million 130 thousand yuan, and the cost of antibiotics in group B was about 25 million 860 thousand yuan. There was no statistical difference between the groups of antibacterials (t=-2.21, P=0.0915).
5. research conclusions
5.1 the antibacterials management methods before the use of the antibacterials management system depend too much on the moral and medical levels. The effect of antimicrobial drug management is difficult to meet the requirements of the Ministry of health, especially the use of antimicrobial agents. 3 months before this study, the statistics showed that the use of antibiotics in hospitals reached 62.99% to the Ministry of health. The standard of use rate of bacteria drugs.
5.2 based on the analysis of the difficulties in the control of traditional antibacterial drug management methods, combined with the legal regulations of the Ministry of health, we have completed the design idea of the antibacterials management system. Through the implementation of 1 months' implementation, the antibacterial drug management system has been constructed on the information platform of a three a hospital in Shanghai, so that the management of antimicrobial drugs is engaged in the post evaluation management. The whole process information management.
5.3 through the comparison of the data before and after the construction of the antibacterials management system, it is found that the utilization rate of antibacterial drugs in the hospital has dropped below the prescribed value of the Ministry of health, and the use of antibacterial drugs has also been effectively reduced, and the rate of delivery has been improved, and the antibacterial drug management is effectively improved.
5.4 although the antibacterials management system has achieved a certain effect, there are still some shortcomings that need to be improved, such as the management of the cost of antibacterial drugs, the management of special drugs, and so on. The improvement of the system will make the use of antibiotics more reasonable.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R197.3

【参考文献】