某三甲医院院内POCT血糖检测质量管理策略研究

发布时间：2018-05-14 15:48

本文选题：Donabedian质量理论 + 即时检验　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景POCT(Point of Care Testing)作为临床检验领域新出现的一种检验手段,正日益受到人们的重视。美国国家临床生化科学院(NACB)在其制定的“POCT询证文件”草案中,将POCT定义为“在接近病人治疗处,由未接受临床实验室学科训练的临床人员或病人(自我检测)进行的临床检验,POCT是在传统、核心或中心实验室以外进行的一切检验”。POCT是一类极具潜力的检测技术,因其快捷方便的特点,已被临床医务工作者、患者广泛接受,在很大程度上缩短了患者检查诊疗时间。与西方发达国家相比,我国应用POCT的时间不长,缺乏相应的管理经验,且POCT检测易受到仪器性能、操作熟练程度等诸多因素的影响,POCT的质量管理显得越来越重要。目前,POCT被广泛运用于临床血糖检测,各临床科室每天都要进行大量的血糖检测操作,而血糖检测结果也将影响医生的诊疗结果,若处理不当,甚至会危及病人的健康。然而,临床POCT血糖检测质量管理仍存在较多问题。如:临床操作人员缺乏相关检验知识培训、血糖检测过程缺乏标准的操作规程、未重视临床操作人员回顾性考核与评价、临床操作人员持续改进意识欠缺等。因此,研究POCT血糖检测质量管理现状,探讨管理策略,对保障临床血糖检测质量,减少临床诊疗误诊率,保证医疗质量安全具有重要意义。研究目的本研究旨在构建一套符合临床实际需求,科学、可行、目的性强的,并能在各级医院参考应用乃至为卫生行政部门制定政策管理文件提供借鉴的院内POCT血糖检测质量管理指标体系,并探讨其管理策略。研究方法1、文献研究法本研究主要集中在以下两个方面进行文献检索:一是相关的POCT血糖检测管理政策法规,收集相关指标;二是通过中国知网、万方等多种数据库广泛检索,了解POCT血糖检测国内外现状,并将相关内容转换为指标条目。2、德尔菲专家咨询法本研究采用德尔菲专家咨询法,制定专家咨询问卷,并选择20名专家进行评定,通过两轮正式调查,确定各级指标的权重值。为保证指标体系的科学性和可靠性,在本次研究中以专家的积极系数、权威系数和专家意见的协调程度等来衡量专家咨询结果的可靠程度。3、统计分析法(1)描述性统计描述咨询专家的年龄结构、技术职称、学历结构、工作年限、管理职务等基本情况。(2)专家积极系数专家积极系数表示咨询专家对本研究的关注与重视程度,一般用咨询问卷的回收率来反映,问卷回收率越高,说明专家积极系数越高。其计算公式为:Cj=mj/m;式中,Cj为专家积极系数,mj为参与评价的专家,m为专家总人数。(3)专家权威程度专家权威程度,一般由专家对评价指标作出判断的依据和专家对该指标的熟悉程度两方面进行衡量,其计算公式为:Cr=(Ca+Cs)/2(Cr为专家的权威程度系数,Ca为专家判断系数,Cs为专家熟悉程度系数)。(4)专家意见的协调系数专家意见的一致性用Kendall's协调系数反映。用W表示Kendall's协调系数,W值在0～1之间,越接近1,表示所有专家对全部指标评分的协调程度越好。(5)变异系数变异系数为方差与均值的比,一般情况下,变异系数小于0.25,说明专家的意见相对集中。在本研究中,对于三级指标的筛选,变异系数取0.25为标准,大于0.25的指标予以删除。结果1、第一轮和第二轮的专家积极系数均为100%,有效率均为100%。2、专家权威系数在0.883～0.940之间,均值为0.911。3、第一轮专家咨询中专家对一、二级指标的总协调系数分别为0.466和0.561,第二轮专家咨询中专家对一、二级指标的总协调系数分别为0.684和0.636,经卡方检验,P0.000。4、第一轮专家咨询中,一级指标权重赋值的变异系数在0.1662～0.2359之间波动;二级指标权重赋值的变异系数在0.1932～0.4668之间波动,权重变异系数只有“患者满意”变异系数大于0.4,其余均小于0.4;三级指标权重赋值的变异系数在0.0567～0.2606之间波动,满分率分布在0.40～0.95之间,根据指标筛选原则,删除1条三级指标。5、第二轮专家咨询中,一级指标权重赋值的变异系数在0.0759～0.1497之间波动;二级指标权重赋值的变异系数在0.1776～0.4174之间波动;三级指标权重赋值变异系数在0.0789～0.2427之间波动,满分率分布在0.20～0.90之间,根据指标筛选原则,删除2条三级指标。第二轮专家咨询的变异系数总体上小于第一轮,说明专家意见趋于一致。本研究通过文献分析和征求专家意见,草拟出院内POCT血糖检测质量管理体系指标池,并通过两轮专家咨询,分别确定了各级指标的权重。最终,确定了 3个一级指标:组织管理(0.29)、检测过程(0.41)和监督监测(0.30),11个二级指标:组织结构(0.25)、人员培训(0.37)、质控管理(0.38)、仪器试纸(0.21)、操作人员(0.20)、患者准备(0.15)、标本采集(0.23)、结果报告(0.21)、医患满意(0.29)、档案管理(0.33)、持续改进(0.38)和37项三级指标。结论本研究围绕医院临床POCT血糖检测现实需要构建了院内POCT血糖检测质量管理指标体系,并提出一系列改进措施,具有较好的完整性、科学性和实用性,不仅能提高临床POCT血糖检测质量管理的能力与水平,同时能够为临床其它POCT检测项目的管理提供新的思路与借鉴,从而促进医院管理质量和医疗服务水平的提升,具有良好的经济效益与社会效益。
[Abstract]:The research background POCT (Point of Care Testing) is becoming more and more important as a new test in the field of clinical testing. The National Academy of clinical and Biochemical Sciences (NACB), in the draft of the "POCT certificate document", defines POCT as "near the sick person treatment place, trained by the unaccepted clinical laboratory subject." Clinical examination of clinical personnel or patients (self testing), POCT is all tests carried out in the traditional, core or central laboratory. ".POCT is a kind of highly potential testing technology. Because of its fast and convenient characteristics, it has been widely accepted by clinical medical workers and patients, and to a great extent shortens the patient's inspection and treatment time. Compared with the developed countries in the west, the application of POCT in China is not long, the management experience is lacking, and the POCT detection is easily affected by many factors such as instrument performance and operation proficiency. The quality management of POCT is becoming more and more important. At present, POCT is widely used in clinical blood glucose testing, and every clinical department should carry out a large number of clinical departments every day. The results of blood sugar detection will also affect the results of the doctor's diagnosis and treatment. If it is not handled properly, it will even jeopardize the patient's health. However, there are still many problems in the quality management of clinical POCT blood glucose detection. For example, the clinical operators lack the training of related knowledge, the lack of standard procedures for blood glucose detection and the lack of clinical practice. It is of great significance to study the current situation of the quality management of POCT blood glucose detection and explore the management strategy, which is of great significance to ensure the quality of clinical blood glucose detection, reduce the misdiagnosis rate of clinical diagnosis and treatment, and ensure the safety of medical quality. In order to meet the needs of clinical practice, scientific, feasible and purposeful, the quality management index system of POCT blood glucose detection can be provided for reference in hospitals at all levels and even for the health administration department to formulate policy management documents. And its management strategy is discussed. Research methods 1. The research method of literature research is mainly focused on the following two aspects Document retrieval: first, related POCT blood glucose monitoring and management policies and regulations, collect relevant indicators; two, through a wide range of databases, such as China know net, Wan Fang and other databases, to understand the status of POCT blood glucose testing at home and abroad, and convert the related content to the index item.2, and the Delphy expert consultation method is made by Delphy expert consultation method. The expert consultation questionnaire, and selected 20 experts to assess, through two rounds of formal investigation, determine the weight of the indicators at all levels to ensure the scientific and reliability of the index system. In this study, the reliability of the expert consultation results is measured by the positive coefficient of experts, the authority coefficient and the coordination degree of expert opinion in this study, and the statistical analysis is.3. Method (1) descriptive statistics describe the age structure of experts, technical titles, academic structure, work years, management posts and other basic conditions. (2) the positive coefficient of expert positive coefficient experts expressed the attention and importance of the experts to this study, generally reflected by the recovery rate of the questionnaire, the higher the recovery rate of the questionnaire, the experts were positive. The higher the coefficient is, the formula is as follows: Cj=mj/m; in the formula, Cj is the positive factor of expert, MJ is the expert to participate in the evaluation, and M is the total number of experts. (3) the expert authority degree of expert authority is generally measured by the experts' basis for judging the evaluation index and the familiarity of the experts on the index. The formula is Cr= (Ca+Cs) /2. Cr is the authority degree coefficient of the expert, Ca is the expert judgment coefficient, Cs is the expert familiar with the degree coefficient. (4) the consistency of expert opinion coordination coefficient expert opinion is reflected by the Kendall's coordination coefficient. The Kendall's coordination coefficient is expressed with W, the W value is between the 1, the better the coordination degree of all the experts to all the indexes is shown. (5) The coefficient of variation coefficient of variation is the ratio of variance to mean value. In general, the coefficient of variation is less than 0.25, indicating that the expert's opinion is relatively concentrated. In this study, the coefficient of variation is 0.25 is the standard for the selection of three level indicators and the index greater than 0.25 is deleted. Results 1, the positive coefficient of the first and second rounds is 100%, and the efficiency is effective. 100%.2, the expert authority coefficient between 0.883 and 0.940, the average value of 0.911.3, the first round of expert consultation experts to one, two level index of the total coordination coefficient of 0.466 and 0.561, second expert consultation experts to one, two level index of the total coordination coefficient of 0.684 and 0.636, through the chi square test, P0.000.4, first round of expert consultation The variation coefficients of the weight assignment of the first grade index fluctuate between 0.1662 and 0.2359, and the coefficient of variation of the weight assignment of the two level index fluctuates between 0.1932 and 0.4668. The coefficient of variation of the weight variation is only more than 0.4 and the rest is less than 0.4, and the coefficient of variation of the weight assignment of the three level index fluctuates between 0.0567 and 0.2606. The rate of full score is between 0.40 and 0.95. According to the principle of index selection, 1 three grade index.5 is deleted. In the second round of expert consultation, the coefficient of variation of the weight assignment of the first class index fluctuates between 0.0759 to 0.1497, the coefficient of variation of the weight assignment of the two level index fluctuates between 0.1776 and 0.4174, and the coefficient of variation of the weights of the three index is in 0.0789. 0.2427 fluctuation, the full score rate is between 0.20 and 0.90, according to the index screening principle, delete 2 three grade index. The variation coefficient of the second round expert consultation is less than the first round, indicating that the expert opinion tends to be consistent. This study drafts the index of the quality management system of POCT blood glucose detection in discharge through literature analysis and consultation. The pool, and through two rounds of expert consultation, identified the weights of the indicators at all levels. Finally, 3 first level indicators were identified: Organization Management (0.29), detection process (0.41) and supervision and monitoring (0.30), 11 two level indicators: organization structure (0.25), personnel training (0.37), quality control management (0.38), instrument test paper (0.21), operator (0.20), patient preparation (0.15), standard The results report (0.23), the results report (0.21), medical and patient satisfaction (0.29), file management (0.33), continuous improvement (0.38) and 37 three level indicators. Conclusion this study around the hospital clinical POCT blood glucose testing reality needs to build a hospital POCT blood glucose monitoring quality management index system, and put forward a series of improvement measures, with good integrity, scientific and Practicality can not only improve the ability and level of the quality management of clinical POCT blood glucose detection, but also provide new ideas and reference for the management of other clinical POCT detection projects, thus promoting the improvement of hospital management quality and the level of medical service, with good economic and social benefits.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446

【参考文献】