Public hospitals stand in need of strengthening cost control and improving operational efficiency to balance public welfare and economic benefits.Taking practice and exploration of ultrasound department as an exam-ple,it integrates the advantages of TDABC with cost management.Take the merits of time driver and activity driver,realizes direct cost accounting under the clinical pathway,strengthen capacity management capabilities un-der the integration of industry and finance,with a view to providing a powerful cost control tool for public hospitals to sensibly respond to pricing reform and reasonably make operational decisions.
The achievements of the national health informatization of China have been remarkable while still facing various challenges,including infrastructure,overall coordination,technical specifications,network security,and public health risks.By conducting a comparative study of the information management of the top 5 best hospitals in the world in 2021,it identifies that for the future of hospital information construction,there is a need for deepening the application of core scenarios such as electronic medical records,mobile medical care,and telemedicine.Further-more,there is a need to expand technology development at the terminal layer,network layer and platform layer.The key to accelerating the construction of national health information is closely integrating the application require-ments of hospital information management with the development trend of intelligent technology.
Objective To analyze the change of healthcare quality after the Diagnosis-Intervention Packet(DIP)payment system reform and provide evidence for improving payment system reform in China.Methods It collected discharge records of hospitalized patients with employee basic medical insurance scheme in first DIP pilot hospitals of a city from July 2017 to June 2021.It included three death-related measures and two readmission-related mea-sures,which were all risk-adjusted considering the patient mix.It used t test to compare their differences before and after the DIP reform in July 2019.Results After the risk-adjustment,mortality rate of surgical patients,mortality rate of patients in low-risk DIP groups,all-cause readmission rate within 30 days after discharge and readmission rate with the same principal diagnosis within 30 days after discharge declined 0.06 percentage points(P=0.031),0.15 percentage points(P=0.001),0.47 percentage points(P＜0.001)and 0.72 percentage points(P＜0.001),respectively.Conclusion No current evidences indicated negative impacts of the DIP payment reform on the quality of healthcare in the city.Case-based payment pilot cities should closely monitor the change of healthcare quality after the reform.
The Department of Radilogy of Peking University Cancer Hospital collaborated with the AI technology team to carry out top-level design and establish an AI based medical imaging management optimization path system during 2021-2022;This system can meet the needs of intelligent diagnosis and treatment,scientific research man-agement,teaching management,operation management,and assessment warning.It preliminarily demonstrates the value and role of this system in quickly providing homogeneous and high-quality diagnosis and treatment services,improving management service efficiency and quality,and improving clinical research and teaching capabilities.It is of great significance for areas with scarce high-quality medical resources and underdeveloped grassroots areas with weak medical diagnosis and treatment capabilities.The establishment of this AI based medical imaging management optimization path system provides a high-quality tool for the expansion and sinking of high-quality medical resources and regional balanced layout work,and has good prospects for promotion and application.
Mortality review is an important way to identify deficiencies and gaps in the healthcare system and can effectively improve the quality and safety of healthcare delivery.It analyzes and summarizes the relevant domes-tic and international literature and review the current development,methods and characteristics of different applica-tion areas of death case review at home and abroad,with a view to guiding healthcare departments or institutions to establish a scientific and standardized mortality review system.
Patient safety is the cornerstone of medical quality and an important foundation for a healthy China.In May 2023,the National Health Commission and the National Administration of Traditional Chinese Medicine jointly is-suedthe Action Plan for Comprehensively Improving Medical Quality(2023-2025),which identified patient safety as an important task and special action.It introduces the concept of patient safety,the status quo of patient safety ac-tions at home and abroad,and the research trend of patient safety,and compares the work requirements of patient safety management and special actions in the Action Plan for Comprehensively Improving Medical Quality(2023-2025),and finally puts forward a series of suggestions for formulating the Implementation Plan of Special Ac-tions for Patient Safetywith Chinese characteristics.
In recent years,with the rise of concepts such as translational medicine,precision medicine and medi-cal artificial intelligence,the relationship between clinical departments and basic medicine in university affiliated hospi-tals has become closer and closer,and the interdisciplinary integration between clinical medicine and basic medi-cine,natural science,engineering and other disciplines has become normal.It focuses on the strategy of building basic research and translational medicine institute in affiliated hospital of medical schools.The construction experi-ence of the internal research institute of the affiliated hospital of Shanghai Jiao Tong University School of Medicine was introduced,and systematically summarizes the construction experience in the establishment conditions,func-tional positioning,organizational structure,operation and management of the internal research institutes in the affili-ated hospitals of medical schools.It has reference significance for the development of clinical medicine in medical schools and the construction of research-oriented hospitals in affiliated hospitals in China.
The unique professionalism of the medical industry,the complexity of diseases,and the lag of medical insurance supervision and other factors bring challenges to the supervision of medical insurance funds.Taking the practice of a tertiary public hospital in Weifang City,Shandong Province in the construction of a full-process,multi-dimensional and three-dimensional medical insurance intelligent monitoring system as an example,it retrospectively analyzed the construction and operation of the hospital's medical insurance intelligent monitoring system since 2020,summarized the achievements,and put forward constructive suggestions on further improving the medical insurance intelligent monitoring system.
Objective To understand students'satisfaction with the"order-type"training of pre-hospital first aid professionals and their professional identification,and provide countermeasures and suggestions for further improving the training system of pre-hospital first aid professionals.Methods A questionnaire survey was conducted among the students of pre-hospital first-aid major in Shanghai Health Medical College.Results Among the respondents,91(93.8%)were men,78(80.4%)were three-yearjunior college students,and 77(79.4%)were in the same dis-trict as the registered residence location.The awareness of the"order based"talent training policy for pre hospital emergency care is good(69.1%),and the evaluation of talent training is good(83.5%).The student satisfaction evaluation is relatively high,and the average score of each item is greater than 4 points;having a good willingness to work at the emergency center after graduation.Conclusion The practice of"order type"training of former emer-gency doctors is good.It can further adheres to the"order-type"training mode,promotes the two-level"or-der-type"talent training.
The medical big data platform for mental illness was constructed by analyzing the clinical characteris-tics and application needs of mental disorders,which was built on the Hadoop ecological construction and used com-mon data model and standard data element dictionary.The construction of the medical big data platform distributes computing framework which provides real-time and full-scale computing,machine learning,and map computing ca-pabilities of medical data,provides efficient inquiries,multi-dimensional statistics and analysis,and supports for scientific research,medical service quality management and operation management.
The key measure to effectively alleviate the risks and economic burden of chronic diseases is to pro-mote the integration of medical and preventive measures in the management of chronic diseases.As the top of medi-cal service technology,public hospitals play an indispensable role in chronic disease management.Analyzing the problems of public hospitals participating in the integration of chronic disease management and medical prevention,it is believed that the main reason restricting public hospitals'participation in the integration of medical prevention is the lack of endogenous motivation caused by the imperfect compensation mechanism.Exploring the compensation mechanism for chronic disease management suitable for the development environment of public hospitals from the perspective of medical prevention integration.
The construction of national regional medical centers is an important initiative for the reform of the na-tional medical service system,and 125 national regional medical centers have been approved nationwide.As one of the first batch of 10 national regional medical center projects approved,the Chongli Branch of Peking University Third Hospital,in accordance with the positioning of"Ice and Snow Sports Medical Center",features the treatment of sports trauma diseases,adopts the model of"large specialty,small comprehensive",and takes the principle of homogeneous development,utilizing the brand,technology and talent advantages of the Peking University Third Hospital,has rapidly improved the medical service capacity of the Chongli Branch,and successfully completed the medical security tasks of the Beijing 2022 Winter Olympic Games and Winter Paralympic Games.Peking University Third Hospital Headquarters and Chongli Branch were awarded the title of"Outstanding Contribution to the Beijing Winter Olympics and Winter Paralympics"by the State Council of the CPC Central Committee respectively.
Objective Focusing on the evaluation system of senior health professional titles in Shanghai,it discusses the rationality of the existing policies from the perspective of clinicians who plan to participate in the promotion,and put forward suggestions for optimizing the content and form of the evaluation.Methods Online questionnaire surveys had been conducted for all clinicians who participated in the application for Shanghai's senior health professional titles in 2020 to collect the personal information and their attitudes towards the professional title review system.R 4.0.2 soft-ware was used to conduct statistical description,cluster analysis,chi-square test,non-parametric test,etc.Results A to-tal of 1,674 people from 32 clinical specialties were surveyed.According to the two factors of growth space and growth speed,the participating subjects are divided into four different categories of groups,which are named according to the sample characteristics:Stars,Mainstay and Veteran.There are no differences among the three groups in the familiarity,and difficulty evaluation of clinical indicators for the senior health professional title evaluation system.The proportion of Veteran considered unreasonable is relatively high.There are differences among the three groups in overall difficulty level,scientific research difficulty and qualification difficulty.Conclusion The incentive attribute of the health technical person-nel senior title evaluation system should be continuously strengthened,and the differentiated characteristics of the de-velopment of health talents should be paid attention to.Big data can be used to highlight the quantification and differen-tiation of clinical competency evaluation indicators,which can effectively improve the scientific level of professional title evaluation.
The shortage of emergency and critical care resources has become increasingly prominent,seriously reducing the quality and safety of care.How to improve the efficiency of the emergency and critical care platform is an urgent problem to be solved.Since 2020,the emergency department of Peking University Third Hospital has achieved an increase of 10%-20%in the annual visits of emergency and critically ill patients,the reduction of the emergency department length of stay and the improvement of survival rate using Objectives and Key Results(OKR)as an advanced management tool.It provides a new paradigm for improving efficiency of emergency department in large general hospitals.
Objective It combines medical big data and machine learning techniques to explore clinical outcomes based clinical physician performance evaluation method.Methods The non-negative principal component analysis(NPCA)was used in cases.Based on the non-negative sparse principal component analysis(NSPCA),a comprehen-sive index fitting was performed on 11 clinical performance indicators of 170 clinicians treating cardiovascular diseases.At the same time,confidence intervals were constructed based on root cause assessment techniques to calculate the range of indicators for each clinician.Results The coincidence rate of outpatient discharge diagnosis,the rate of grade A healing of surgical incision,the proportion of surgical patients,the rate of 3-day diagnosis,the proportion of third-grade and fourth-grade surgery,the completion of surgery and the number of operations were significant in dis-tinguishing the work performance of clinicians.However,the average length of hospital stays before surgery,the rate of unplanned readmission within 30 days,the average length of hospital stays of discharged patients,the main diag-nosis and cure/improvement,and the number of patients admitted were not significant in distinguishing the clinical work performance of clinicians.The overall work performance of all clinicians can be ranked through comprehensive index fitting,and the further evaluation of high,middle and low performance of each specific index can reveal the potential reconstruction dimensions of each clinician.Conclusion It utilizes machine learning techniques to achieve a comprehensive evaluation of clinical performance,utilizing medical big data as the foundation.It holds the potential to provide important support for a more scientific and objective assessment of clinical performance.
The assessment of physicians'clinical competence is pivotal for fostering their professional growth and enhancing the quality of healthcare services.Despite this,a universally recognized and standardized system for as-sessing physicians'clinical competence remains to be established in China.Drawing on international practices in clini-cal competence assessment,provided a summary of the commonly utilized tools and methods for evaluating physi-cians'clinical competence.It also proposed recommendations for the development of a clinical competence assess-ment system in China.In the current practice of assessing physicians'clinical competence in China.It advocated for the establishment of a unified framework for clinical competence assessment,encouraging graded and classified as-sessments and a patient-centered,quality-improvement-oriented system for evaluating clinical competence.The uti-lization of big data will bring new opportunities for the assessment of healthcare personnel and the overall quality of medical services in China.
Objective Establishing an integrated assessment index system in order to strengthen the multi-dimen-sional evaluation for scientific research performance of medical staff in tertiary general hospital.Methods The method of documentary and Delphi are used in filtering the indexes of medical personnel's scientific research performance evaluation and the method of analytic hierarchy process is used in ascribing different weights for each index that the consistency is tested.Results There are two evaluation index systems in the Evaluation System of medical research performance in tertiary general hospital.The first one is Medical Staff's Scientific Research Ability Evaluation System.There are 51 indexes in the system,including 2 first-level indexes,1 second-level indexes and 38 third-level indexes.The second system is Scientific Research Performance Evaluation Index System,which have 70 indicators,including 4 first-level indicators,15 second-level indicators,51 third-level indicators.Conclusion The index system of scientific research performance evaluation has a high credibility,and can be popularized as an index of scientific research performance evaluation for medical staff in hospital based on the practice evaluation.The system could provide data support for hospital to implement more accurate scientific research management policy.
Objective To construct a systematic evaluation model of the operation and management capacity of pub-lic hospitals,and to objectively and realistically assess the current status of the operation and management capacity of public hospitals.Methods The"input-process-output"framework was used to construct a systematic evaluation model for operation management capability.56 public hospitals at or above the secondary level were sampled to con-duct empirical research.Results The results showed that,operation management in current stage emphasized a"re-sult oriented"approach,with insufficient basic investment and unclear core activities.Increasing funding investment,strengthening hospital marketing,and improving output quality were the core tasks of operation management.The operation management were generally in the initial stage,and the overall ability was not strong.The ability advantages of tertiary hospitals were relatively prominent.Conclusion It recommended that public hospitals should focus on the five major elements of human resources,finance,information,systems and decision-making mechanisms to com-prehensively optimize operation management investment;precise core activities,and promote the modernization of the economic system by improving the efficiency of resource allocation;stimulate the potential of hospitals,medi-cal staff,and disciplines to improve the quality of comprehensive outputs.
At present,some medical personnel have problems in professional resilience,such as post competence,psychological resilience,self-efficacy and decreased professional identity.In order to strengthen the training of medical personnel professional resilience,starting with the mechanisms of professional resilience training,management guaran-tee,hospital culture construction and self-construction,it puts forward that the government and society should build the training system of multiple subjects,improve the occupational safety and welfare guarantee,and optimize the psy-chological environment of medical personnel;medical institutions should create a good hospital culture atmosphere,strengthen the material support of occupational resilience training,and establish the vocational resilience training pro-gram;medical personnel should enhance their professional quality,enhance professional identity,and establish a harmo-nious interpersonal relationship.
According to the current problems with hospital medical quality,through the study of the Action Plan for Comprehensive Improvement of Medical Quality(2023-2025),it elaborates on its key points."Breaking the Wall"action to improve the level of diagnosis and treatment for acute,critical,severe,and tumors;The quality of medical records has reached an unprecedented level,and specific requirements have been put forward for the digitization of outpatient medical records;Emphasize drug and device management in basic quality and safety management;For the first time,medical institutions are required to conduct medical quality management of traditional Chinese medicine.The implementation pathway to address the quality of care in hospitals includes the responsibility given to provincial health commissions to improve the quality of care across the board.The performance management mechanism of"quality first"ensures the internal medical quality and safety of hospitals,forming a national provincial health commission hospital department physician action plan system.
