目的 目前我国各地区均已形成符合当地特色的家庭医生签约服务模式,但尚缺乏科学、可行的效果评价工具.为此,本研究构建我国家庭医生签约服务模式效果评价指标体系,旨在进一步推动家庭医生签约服务优质、高效发展.方法 通过文献回顾分析并经小组讨论形成初步效果评价指标体系及专家咨询表.于2021年9月—2021年12月,采用德尔菲法,以Better Together模型为理论基础,"结果框架"为指导,经过两轮专家咨询,确定最终家庭医生签约服务模式效果评价指标体系,并通过专家咨询和层次分析法,确立各指标权重.结果 专家积极性和权威程度较高,两轮专家咨询表的有效回收率分别为100％和75％,权威程度系数分别为0.898和0.877;专家意见趋于一致,两轮肯德尔系数分别为0.245(X2=393.205,P＜0.001)和0.252(X2=453.417,P＜0.001).通过两轮专家咨询,最终构建以人群健康、服务质量、服务效率、成本控制、居民认可、亲密度为主要内容的家庭医生签约服务模式效果评价指标体系,其具体有5个一级指标、15个二级指标、48个三级指标,权重系数分别为0.217、0.217、0.196、0.181、0.188.结论 本研究专家积极性、权威性、协调程度均较高,最终构建出的家庭医生签约服务模式效果评价指标体系结果可靠,从而为国内各地区家庭医生签约服务模式提供科学、客观的效果评价工具.

Objective:To develop an evaluation index system for the management ability of general practice team leaders in community health service centers.Methods:Based on literature review, key insider interviews and other methods, the framework and indicator pool for management capability of general practice team leaders were formed. Two rounds of Delphi consultations with 15 experts were conducted from July to October 2021, and the evaluation index system of general practice team leaders' management ability established.Results:All 15 experts had at least 5 years of work experience, including 10 engaging in clinical general practice, 3 in public health and 2 in community management. The response rates for the two rounds of expert consultation was 15/15, and the expert authority coefficient was 0.84, with Kendall's W coefficient of 0.35 ( P<0.001) and 0.46 ( P<0.001), respectively. Finally, the evaluation index system of the management ability of general practice team leaders was established, which consisted of 5 primary indicators (personal quality, special business management, organizational management, teaching and research management, strategy and culture building), 11 secondary indicators and 37 tertiary indicators. Conclusions:The management capability evaluation index system general practitioner team leaders of the community health centers has been established in this stu, which may be used for the training and selection of general practice team leaders in the community health centers.

PURPOSE:The purpose of this study was to use the hospital information system to analyze the cancer profile and compare demographics, hospitalization, status of surgery and treatment cost of various cancer categories based on the electronic health record (EHR) of outpatient children with tumors in Shanghai, China.PATIENTS AND METHODS:Information was collected from 3834 inpatients aged 0-18 who were diagnosed with malignant tumors in all 17 hospitals with pediatric wards in the Pudong New District of Shanghai from 2011 to 2016. All patients were classified according to the International Classification of Childhood Cancer-3 (ICCC-3). The chi-squared test was used to compare demographics, hospitalization information, status of surgery and treatment cost according to inpatients' cancer category.RESULTS:In both the malignant non-solid tumor and solid tumor groups, males and those aged 0-4 years were the dominant groups. Lymphocytic leukemia was the most common cancer in all inpatients (n=994, 25.93%), and the acute myeloid leukemia had the longest length of stay of inpatients (median=26.00 days). In both the non-solid and solid tumor groups, patients who received only one type of surgery had an advantage. The highest proportion of patients who had undergone surgery was found in non-Hodgkin lymphoma patients. In terms of total cost, surgical cost and medicine cost, the expenditure of central nervous system tumor patients was the highest. Astrocytoma had the highest total cost.CONCLUSION:Leukemia is common in children with cancer in Pudong and should be given attention. Because the highest financial burden falls on patients with central nervous system tumors and acute myeloid leukemias, the government should take immediate and targeted measures for these cancers in particular.

目的 探寻构建临床手术科室风险系数并客观评价其风险等级的方法.方法 结合Ridit法与RSR法,对临床手术科室风险系数进行分档评级.结果 手术科室风险系数(Ki)=各科室平均Ridit值+三四级手术占比+复杂病人占用床日比.后期通过运用RSR法和最佳分档准则,将Ki值分为3档,即临床手术科室风险分为3个等级:第一级为低风险科室,第二级为一般风险科室,第三级为高风险科室.结论 利用临床手术科室风险系数Ki值反映各科承担的手术风险,能相对客观公正地表现临床医生的工作量和工作强度,有利于优化医院内部运营绩效考核与分配等工作.

科学有效的临床手术及手术科室的风险评估,有利于促进公立医院提高疑难复杂疾病的诊治能力,深化绩效管理和评价,符合国家现代医院管理制度改革要求.通过阐述手术风险的存在类型和评估过程、我国手术分级等管理现状,总结了我国当前手术科室风险系数的相关评价方法及其优缺点.介绍了用非参数检验Ridit分析方法在临床科室的风险系数评估中的应用及不足,并提出了相应的建议和对策.

中国日渐严峻的慢性病蔓延趋势正在对既有医疗保健体系和慢性病防控管理的运营模式提出严峻挑战.在深入探讨这一问题的基础上,指出慢性病管理的运营模式创新必须与疾病演化阶段和疾病类型匹配,慢性病防治要加强全过程健康管理,并重视借助数字技术赋能与激励机制创新.

Objective To study the perceptions of the safetyeffectivenesseconomy and ethics of physicians and managers in Orthopedics on the application of 3D printings.Methods Questionnaire surveys were conducted among all orthopedic physicians and some related hospital administrators in 4 tertiary hospitals in Shanghaiand qualitative interviews were adopted in 4 orthopedic experts.Results 3 hospitals have applied 3D printing technology in Orthopedicsbut the number of operations is limited.The advantages perceived by the surveyed physicians and managers are 3D printing in Orthopedics has shorter operation durationmakes operation convenience and has higher operation success rate.While the disadvantages include high cost and pricelack of standards and professional normsand process complexity and time consuming.Conclusion Clinical evaluation on safety and effectiveness of 3D printing in Orthopedics needs long term follow up.The regulation needs to be built up for rational use of 3D printing in Orthopedics.

目的 了解上海市三级综合医院临床医生工作幸福感现状,分析影响临床医生工作幸福感的多维因素,探索和实践具有实效性和可操作性的改善方法和途径,建立常态长效机制,不断提高临床医生工作幸福感.方法 以上海市隶属于4个不同系统的8家具有代表性的地方三级综合医院的临床医生为调查对象进行抽样调查,调查结果使用SPSS19.0软件进行统计,在统计分析过程中运用描述性统计分析和多元逐步线性回归分析等分析方法.结果 上海市三级综合医院临床医生的积极情感多于消极情感.临床医生的工作幸福感认知处于中等偏上水平,其中对人际关系的幸福感认知较高,对福利报酬的幸福感认知较低.消极情感体验与上海市三级综合医院临床医生工作幸福感呈负相关,积极情感体验与上海市三级综合医院临床医生工作幸福感呈较强的正相关.结论 心理健康状况、收入水平、职业发展是影响上海市三级综合医院临床医生工作幸福感的主要因素.

Improving the performance of clinical departments is not only the significant content of the healthcare system reform in China, but also the essential approach to better satisfying the Chinese growing demand for medical services. Performance management is vital and meaningful to public hospitals in China. Several studies are conducted in hospital internal performance management, but almost none of them consider the effects of informational tools. Therefore, we carried out an empirical study on effects of using performance management information system in Shanghai Ninth People's Hospital. The main feature of the system is that it provides a real-time query platform for users to analyze and dynamically monitor the key performance indexes, timely detect problems and make adjustments. We collected pivotal medical data on 35 clinical departments of this hospital from January 2013 until December 2014, 1 year before and after applying the performance management information system. Comparative analysis was conducted by statistical methods. The results show that the system is beneficial to improve performance scores of clinical departments and lower the proportion of drug expenses, meanwhile, shorten the average hospitalized days and increase the bed turnover rate. That is to say, with the increasing medical services, the quality and efficiency is greatly improved. In a word, application of the performance management information system has a positive effect on improving performance of clinical departments.

The scientific construction and optimization of performance assessment of physicians,focusing on technical services reflecting the value of the medical staff,and paying attention to the connotation of medical services have important significance for effectively mobilizing the enthusiasm for work,and improving public hospital operation efficiency and management level.Through extensive literature research,the paper systematically analyzes the current situation and existing problems of the performance allocation model of public hospitals in China,and puts forward some corresponding suggestions and countermeasures according to the main existing problems.

Objective To evaluate the application effect of the RBRVS based clinician performance evaluation model:(hereinafter referred to as RBRVS allocation model) in a operation department of the tertiary hospital in Shanghai.Method Descriptive statistical analysis,t test and bivariate correlation analysis were used to collect the research data by SPSS19.0 statistical software.Result The distribution of the value points of each item in the two allocation patterns was larger,and the difference was significant between the two groups.There was a positive correlation between the RBRVS distribution model and the three and four stage operation.Conclusion RBRVS distribution model is better than the original simple basic point method (hereinafter referred to as basic point method) based on parity,and itisa more scientific measurement of the diagnosis and treatment project resources,to promote the three and four level operation,and difficult and complicated diseases,and to constantly optimize the business structure of public hospitals.

Objective To establish a scientific performance allocation model for clinicians,and to focus on the value of clinician technical services.Method Through using literature research method,expert consultation method and key performance index method,the evaluation index system was constructed,and the nonparametric test expert evaluation data was statistically analyzed.Result A performance evaluation model based on Resource Based Relative Value Scale is constructed,which is focused on the value of medical service.Conclusion The index system can effectively evaluate the resource input in the medical treatment program,and can effectively measure the labor pay of doctors in the medical service process,which is of great significance to the formation of a scientific performance distribution mechanism.

Objective This study was to make a multi-dimensional analysis of the present situation of the staff of the authors'hospital, by focusing on the bottleneck problems, exploring and practicing the ways that were effective and viable for the promotion of the welfare of the staff, in order to build up a regular system for the rein-forcement of the unity of the staff.Methods Literature review and Delphi method were used to design the ques-tionnaire.A total of 3000 questionnaires were issued among hospital staff, 2492 questionnaires were recovered, and the recovery rate was 83.1%.SPSS17.0 statistical software was used for analysis.Results Overall employee sat-isfaction reached 7.82 points ( out of 10 points);the lowest satisfaction was the welfare treatment, the highest was the hospital cultural emotion.Physicians'satisfaction was lower than other positions, and the administrative staff satisfaction was relatively high.Conclusion The compensation and benefits were the great factors that affect the satisfaction degree, but not the decisive factor.Self career development plan, a more equitable policy system envi-ronment and humanized management process were important points to improve employee satisfaction.The cohesion of employees would be effectively enhanced by strengthening the system construction, innovating the carrier for em-ployee service, and solving the bottleneck problem.

构建科学、合理的绩效考核与薪酬分配制度,符合公立医院改革和医院内部精细化管理的需要.介绍了以资源消耗为基础的相对价值比率(Resource based relative value scale,RBRVS)评估系统及其在医院绩效考核分配中的应用,分析了我国现有医务人员考核分配存在的问题,并提出了相应的建议和对策.

The effective implementation of the performance appraisal is strongly dependent upon the support of information. Establishing a performance appraisal management information system which is based on the large clinical data integrated platform will be helpful for improving accuracy and timeliness of the performance appraisal data, improving performance appraisal information real-time analysis and dynamic supervision, improving the service performance's positive incentive and guiding role,to effectively make performance appraisal and distribution scientificness,informatization and intelligentization,and to achieve leap development of the hospital internal performance appraisal management.

Based on Service Oriented Architecture,and through using HL7,CDA and IHE,one tertiary hospital in Shanghai has built a large-scale data integrated platform with clinical data repository(CDR) as the core component,thus achieved data integration,information sharing and process coordination of the information systems of the hospital. It can satisfy the needs of clinical service,hospital management and scientific research,meanwhile improve the precise management level,raise competitive advantage and promote sustainable development of the hospital.

PURPOSE:An optimal sequence algorithm model of divided period appointment consultation service was built through optimal sequence algorithm.METHODS:Re-visiting patients in the department of stomatology in a tertiary hospital were enrolled as the research objects in this study. Information about the diagnose term of common diseases, tooth positions treated, doctor's consultation hours were collected. After calculating the mean consultation hours of each disease based on the statistical analysis, the appointment consultation service sequence of re-visiting patients in the department of stomatology was optimized in accordance with the rule of "providing priority service to those requiring short consultation hours" by referencing to the theoretical model of parallel machine.RESULTS:The total waiting hours of patients after optimizing the appointment consultation sequence was decreased by 35.1%.CONCLUSIONS:Optimal sequence algorithm can optimize divided period consultation sequence, effectively shorten waiting hours and improve patients' medical experience.

Objective To evaluate the effect on application of information technology in the hospital performance appraisal.Method Analyzing 35 clinical departments' performance appraisal scores,clinical service data before and after applying intelligent performance appraisal information system by comparative analysis,statistics description and repeated measurement,and using SPSS20.0 statistical software. Result The scores increased which has a statistically significant difference after using the intelligent performance appraisal information system. Under the circumstance of improving medical services and efficiency,cost and medical expense are controlled effectively. Conclusion Application of information technology in the hospital performance appraisal has an important significance to insist on the commonwealth,keep the high efficiency and arouse the initiative of medical workers. It can effectively promote sustainable development of public hospital and better satisfy the people's growing demand of medical services.

Objective To build a performance appraisal index system guided by public interest and motivation. Method According to the spirits of the central and local government documents,using BSC and KPI methods to build the performance appraisal index system,and using AHP method to determine the index weight. Result A performance appraisal index system in which core contents are patients' satisfaction,work and service quality,disease,cost control and medical cost control,and medical ethics is constructed. Conclusion Intensifying the public interest nature of the public hospital and transforming the tent towards interest has a far-reaching influence to perfect public hospital performance appraisal and distribution system reform and deepening the reform of internal system mechanism.

PURPOSE To optimize visiting sequence and time-interval appointment mode to reduce waiting time of re-visiting patients in department of stomatology based on clinical data repository. METHODS Waiting time data of re-visiting patients in department of stomatology was collected and divided into 2 groups. A total of 70897 patients from July 2014 to September 2014 were enrolled as experimental group (group year-2014), while 63960 patients from July 2013 to September 2013 were used as control group (group year-2013).Measurement data was compared with two-tailed independent-samples t test using SPSS 22.0 software package. RESULTS The waiting time of group year-2014 was 73.65 minutes while it was 106 minutes for group year-2013. P value was 0,which meant the waiting time of group year-2014 was significantly less than group year-2013. CONCLUSIONS Optimizing visiting sequence and time-interval appointment mode can reduce the waiting time of re-visiting patients in department of stomatology greatly. Supported by Innovation Research Training Project of Humanities and Social Sciences from Shanghai Jiao Tong University School of Medicine(wz1214).