部分医学检验结果纵向互认的可行性分析研究

发布时间：2018-04-16 23:05

本文选题：医疗服务供应链 + 检验结果互认　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究以检验结果互认为切入点,调查医疗服务链中横向和纵向信息流的现状,提出完善横向和纵向信息流的对策建议,为实现分级诊疗提供依据。以期通过不同级别医疗机构医学检验结果互认打破“医疗信息孤岛化”现象,为山西省分级诊疗实施提供依据。方法:历史文献法:运用历史文献法,对医疗服务供应链、分级诊疗、检查结果的历史沿革进行梳理与分析,了解目前关于检查结果互认的研究现状。配对实验与统计分析。采用随机抽样法,随机抽取100人作为研究对象,将研究对象血样分为两份分别送至县级医院所测的血常规指标与某三级医院。运用相关检验设备以及统计分析方法,对100份血液样品从RBC、WBC等8个方面进行比较,分析不同级别医疗机构之间检查结果互认的可行性。对比分析与归纳总结。根据上述探讨与分析的结论,结合医疗服务链理论,分析在分级诊疗背景下,如何实现纵向信息流的构建,为山西省分级诊疗实施提供依据。结果:通过测试,白细胞、红细胞、血红蛋白、血小板等各个浓度区间均通过检测,说明测试仪器与基准仪器在本研究的各个指标方面的相对偏差值符合《临床血液学检验常规项目的分析质量要求》(行业标准)要求。其中红细胞、血红蛋白、血小板在测试的过程中,均出现未在相对偏差范围内的样本,血红蛋白与血小板的通过率均80%,红细胞的通过率为96%,高于行业限值,而其他指标通过率也很高,基准与测试测试仪器具有良好的稳定性,可以认为能在二级和三级医疗机构之间开展互认工作。结论:从硬件设备上来说,山西省二级医疗机构和三级医疗机构之间能够开展某些检验结果互认工作。从实际开展工作来看,只有硬件设施完善是远远不够的,差级医疗机构检验结果互认还面临着诸多问题与不足。建议政府积极发挥行政指导作用,制定相关政策并提供便利,做好多方面辅助工作;加强基层医疗机构的监督管理,确保检验结果的质量水平;接诊医师要对患者报告进行严格审查,要与患者或其委托人严格履行知情同意与选择权。媒体应正确引导和宣传,患者要正确理解和认知。
[Abstract]:Objective: to investigate the current situation of horizontal and longitudinal information flow in the medical service chain, and put forward the countermeasures and suggestions to improve the horizontal and longitudinal information flow, so as to provide the basis for the realization of classified diagnosis and treatment.In order to break the phenomenon of "medical information insularity" through medical examination results of different levels of medical institutions, this paper provides the basis for the implementation of classified diagnosis and treatment in Shanxi Province.Methods: historical literature method was used to sort out and analyze the history of medical service supply chain, grading diagnosis and treatment, examination results, and to understand the current research status of mutual recognition of examination results.Pairing experiment and statistical analysis.Using random sampling method, 100 people were randomly selected, and the blood samples were divided into two parts, which were sent to the county level hospital and a third class hospital respectively.By using the relevant testing equipment and statistical analysis method, 100 blood samples were compared from eight aspects such as RBCU WBC and so on, and the feasibility of mutual recognition of examination results among different levels of medical institutions was analyzed.Comparative analysis and summary.According to the conclusion of the above discussion and analysis, combined with the theory of medical service chain, this paper analyzes how to realize the construction of longitudinal information flow under the background of classified diagnosis and treatment, and provides the basis for the implementation of classified diagnosis and treatment in Shanxi Province.Results: the concentrations of white blood cells, red blood cells, hemoglobin and platelets were measured.The results show that the relative deviation between the test instrument and the reference instrument in each index of this study is in line with the requirements for the analysis quality of the routine items of clinical hematological examination (industry standard).Among them, red blood cells, hemoglobin, and platelets all showed samples that were not in the range of relative deviation during the testing process. The passing rates of hemoglobin and platelets were 80% and 96% respectively, which was higher than the industry limit.The passing rate of other indicators is also very high, the benchmark and the test instrument have good stability, it can be considered to be able to carry out mutual recognition between the secondary and tertiary medical institutions.Conclusion: from the hardware point of view, the level 2 medical institutions and the third level medical institutions in Shanxi Province can carry out some mutual recognition of test results.From the point of view of the actual work, it is far from enough to improve the hardware facilities only, and there are many problems and deficiencies in the mutual recognition of the inspection results of the poor medical institutions.It is suggested that the government should give full play to the role of administrative guidance, formulate relevant policies and provide convenience, do a lot of auxiliary work, strengthen the supervision and management of primary medical institutions, and ensure the quality of inspection results.The attending physician must strictly examine the patient's report and execute the informed consent and option strictly with the patient or his client.The media should be guided and propagandized correctly, and the patients should understand and recognize correctly.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.1

【参考文献】