目的 对主诊医师的医疗服务能力进行科学合理的评价.方法 采用CRITIC-TOPSIS和CRITIC-RSR法对天津市某三甲医院2020年度乳腺肿瘤外科专业20名主诊医师的医疗服务能力进行评价.结果 CRITIC-TOPSIS法评价主诊医师服务能力排名前5位的是M、E、D、H、O,排名后5位的是N、T、Q、L、F;CRITIC-RSR法评价主诊医师服务能力排名前5位的是H、D、E、J、C,排名后5位的是T、N、Q、L、A.2种评价方法结果不完全相同,多数主诊医师评价排名相近,M和O主诊医师排名差异较大.结论 应用CRITIC-TOPSIS和CRITIC-RSR两者相结合的方法,能够克服主观性强、评价方法单一等局限性,能够更为直观、准确地对主诊医师的服务能力进行综合评价.

目的:本文以某三级医疗机构DRG付费改革实施情况为研究对象,探讨DRG付费在公立医疗机构的实施路径,为DRG付费改革顺利开展提供建议.方法:根据DRG付费改革的实践情况,利用Visio 2003流程建模方法构建DRG付费管理模型.结果:通过对DRG付费各环节的分析与汇总,构建医院各部门职责与分工管理模型图和基于关键要素的DRG实施路径模型图.结论:医院应加强各部门协调联动,明确职责与分工,对关键环节进行流程再造,加强成本效益管理,规范诊疗行为,抑制过度医疗.

目的:分析恶性肿瘤住院患者费用构成差异及个人负担情况,为医疗机构深入推进DRG付费和加强精细化管理提供建议.方法:利用SPSS19.0软件对费用构成差异性、患者个人负担等数据进行方差分析.结果:不同医师的费用构成存在差异,药品费和卫生材料费差异显著,组间差异有统计学意义(P＜0.05).患者个人负担构成中,医保支付范围以外的费用所占比例较大.结论:定点医疗机构应加强对DRG病组管理,控制医疗费用不合理增长.

通过对国内外价值医疗的探索和经验的总结,阐明以价值医疗为导向推动支付方式改革的必要性和具体路径,明确了公立医院面临支付方式改革新时期下,公立医院应重点从提升患者就医体验、建立价值医疗考评框架、强化医疗数据支持作用等维度入手,改革管理模式,提升管理效能.

目的 确定DRG评价体系指标的综合权重系数,提高DRG绩效管理评价的客观准确程度.方法 利用层次分析法和熵值法分别对构建的评价指标体系进行赋权,在层次分析法中应用Hadamard权重合成对专家权重作出综合集结,采用综合权重合成得到基于层次分析法和熵值法组合的DRG评价指标体系权重.结果 研究结果表明,基于两种赋权方法中的指标B11、B12、B13、B14、B15的权重系数存在较大差异.结论 从主客观两个层面明确了DRG评价指标体系的综合权重系数,确保评价体系应用于结果评价更为准确.

Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.

Based on the data of the first page of medical records of a hospital in Tianjin in 2015 and 2016,the proportion of the major diagnostic category (MDC) was analyzed.The statistical analysis was made on the indexes of casemix index (CMI),total weight,average length of stay and reference average length of stay,with management discussion,which can better reflect the status of the key department of hepatobiliary surgery.DRGs can provide accurate and scientific data support for hospital management in the new situation.

目的:对普外科导管护理操作过程中不良事件发生的原因进行分析,提出有效、规范的导管安全标识措施以提高导管护理安全.方法:以湖州市中心医院2011年2月～2013年2月收治的2500普外科患者为研究对象,将2011年2月～2012年2月期间的1200例患者设为对照组.将该期间导管护理操作发生不良事件的原因进行系统的分析,提出规范的导管安全标识措施.这些措施主要包括加强护理人员的培训、对患者进行安全宣教、对导管安全标识的内容和分类进行规范,将2012年2月～2013年2月期间采取措施后的1300例患者设为实验组.对两组患者的导管护理操作不良事件发生的几率进行比较分析.结果:研究发现对照组患者发生导管护理不良事件18例,发生率1.5％.实验组发生不良事件5例,发生率0.38％.对照组患者发生导管护理操作不良事件的几率显著高于实验组,两组差异显著具有统计学意义(P＜0.05).结论:规范导管安全标识能够有效地降低普外科导管护理操作不良事件发生的几率,有效地促进导管护理安全提高护理质量.

OBJECTIVE To synthetically evaluate the quality of antimicrobial drugs in a hospital from 2007 to 2011 with TOPSIS method so as to provide evidence for decision-making,and to explore a feasible method on assessment of the quality of antimicrobial drugs.METHODS The data were collected from management index which reflected the level of rational use of antibacterial drugs in the hospital from 2007 to 2011.An annual report was served as the evaluation unit,and the evaluation included 10 indexes,such as the per capita of antimicrobial drug costs,the rate of antimicrobial drugs usage,the average length of stay,the rate of antibacterial drug costs to total drug costs and so on.TOPSIS method was used in the comprehensive evaluation of related indicators of the quality of antimicrobial drugs.RESULTS Over the past few years,the quality of antimicrobial drugs has been gradually enhanced,of which the poorest was in 2007,the best in 2011.The relative proximities to the optimal value were 0.5028 and 0.4496.CONCLUSION The results of comprehensive evaluation of the quality of antimicrobial drugs with TOPSIS method is objective and credible,which can provide a scientific basis for the management and monitoring of antimicrobial drugs.

ObjectiveTo evaluate a hospital from 2003 to 2012, the quality of medical work for the hospital administration to provide the scientific basis for decision making.MethodsTOPSIS method in a hospital with the trends in health care quality data and normalized.ResultsThe quality of medical care generally increased year by year, in 2003 less, in 2012 the best evaluation Results broadly in line with the actual situation.Conclusion The evaluation of medical quality TOPSIS method for small sample size and flexible, feasible, accurate quantitative Results with high practical value.