本文旨在探索建立科学的临床保健护理人员绩效考核指标体系,运用指标体系对临床护士进行考核,帮助护士提高专业素质和工作效率,实现自我提升和发展,使临床保健护理工作能够高质高效运行.通过两轮德尔菲专家函询,本文构建了 一套完整的临床保健护理人员绩效考核指标体系,包括一级指标4个,二级指标27个,采用层次分析法确定了各级指标的权重和组合权重,并对指标体系进行了分析与展望.

目的 针对非计划取消手术因素,应用"手术服务标准"进行管控,降低发生率,提高医疗质量和工作效率.方法 根据非计划取消手术原因,对照中国医院协会"手术服务标准"中术前标准条款,制定术前准备落实清单.结果 提取2017年-2019年度非计划取消手术数据,对发生原因进行比较分析.其中,病情因素降低0.40％,管理因素降低0.98％,患者因素降低0.25％,未说明原因降低0.18％.结论 通过术前要素清单和信息化的标准监测,有效降低了非计划取消手术发生率.

通过文献回顾法,编制专家函询问卷.采用德尔菲法,确定军队保健医生能力素质指标体系,运用层次分析法计算各指标权重.构建军队保健医生能力素质指标体系,为军队保健医生的选拔、培养、评价提供数据化客观标准.

目的 分析北京市某三甲医院恶性肿瘤住院患者信息,了解前10位恶性肿瘤的构成、性别及年龄的分布情况,为医院床位、人力等资源配置提供数据依据.方法 对2015年1月1日-2019年12月31日恶性肿瘤患者疾病顺位、性别、年龄进行描述性分析,使用Excel 2010和SAS 9.2进行数据整理,对平均住院日、次均费用年均增长率进行统计分析.结果 前10位恶性肿瘤较稳定,为支气管和肺(12.94％)、甲状腺(10.68％)、肝和肝内胆管(10.37％)、结直肠(8.13％)、胃(7.36％)、肾(除外肾盂)(5.73％)、乳房(4.65％)、呼吸和消化器官的继发(3.51％)、胰腺(3.36％)、胆道其他和未特指部位恶性肿瘤(3.05％).历年恶性肿瘤在性别、年龄、平均住院日、次均费用方面存在差异.结论 前10位恶性肿瘤随时间位次有所变化,应结合其收治量、平均住院日、次均费用等适时调整资源配置,提高管理效率.

目的 探讨某综合型医院住院患者呼吸系统死亡疾病的分布特点,为医院合理安排救治与预防保健工作提供科学依据.方法 利用统计工具从医院信息管理系统(HIS)中提取2010～2019年10年间北京市海淀区某医院呼吸系统死亡病例,回顾性分析死亡病例的性别、年龄、疾病病种等.结果 10年间呼吸系统死亡993例,病死率2.84％,其中男性2.97％,女性2.58％,男性病死率明显高于女性,差异有统计学意义(P＜0.05);各年龄段病死率随着年龄的增加而增加,病死率从0.09％上升到30.77％;呼吸系统疾病死亡有明显季节性,一季度死亡人数最多,占30.01％;死亡前3位疾病依次肺炎(病原体未特指),占37.97％,细菌性肺炎占27.59％,慢性阻塞性肺疾病占14.80％.结论 死亡患者中99.90％为下呼吸道感染患者,60岁以上的老年人是呼吸系统死亡的高危人群,应加强对呼吸系统死亡疾病及其相关危险因素的监测.

宫颈癌在女性恶性肿瘤中的发病率和死亡率均位于全球第4位,是严重威胁女性生命健康的恶性肿瘤之一[1].尽管随着宫颈癌脱落细胞学筛查、HPV(人乳头瘤病毒)检查和HPV疫苗等项目的应用,可以在全球范围内降低宫颈癌的高病死率[2],但我国的宫颈癌发病率和死亡率仍呈逐年上升趋势,在中国女性死亡前10位的恶性肿瘤中排名第8[3].早期宫颈癌首选手术治疗,以往认为腹腔镜手术的远期预后与传统开腹手术无异,同时因具有较少的围手术期并发症等优点而被广泛应用.笔者整理了相关文献,对微创与开腹手术治疗宫颈癌患者预后比较作一综述.

目的 研究2015～2019年北京市某大型综合性医院住院患者疾病谱特征及变化趋势,为重点疾病防治和医疗资源合理配置提供参考依据.方法 提取北京地区某医院2015～2019年138 470例住院患者的病案首页信息,按照《国际疾病与相关健康问题统计分类第十版》(ICD-10)对系统疾病和病种分类统计,应用Excel 2016和SAS 9.4软件对数据统计分析,利用帕累托图描述本地住院患者系统疾病构成.结果 系统疾病中影响健康状况和保健机构接触的因素、循环系统疾病、肿瘤、消化系统疾病、泌尿生殖系统疾病、妊娠、分娩和产褥期、肌肉骨骼系统和结缔组织疾病累计构成比为78.34％;病种前5位分别为心绞痛、老年性白内障、胆石症、原发性高血压、慢性缺血性心脏病.结论 5年来该院因肿瘤及其相关治疗住院的患者数量居首位,其次为循环系统疾病,应合理配置各项医疗资源,针对疾病谱特点做好重点疾病防治工作.

军队保健工作是集医疗、心理、预防、保健、急救、康复等综合性保障服务,军队保健医生作为保健工作的“主力军”,工作性质与临床医生有很大差别.在大保健、大健康观的统领下,保健学科日趋发展,保健模式创新改革,军队保健队伍必须符合新时代强军卫生战略要求.构建军队保健医生能力素质指标体系,为各级单位客观、准确评聘保健医生人才提供标准,数据化指标作为军队保健医生业绩考核主要评估途径,激励军队保健医生综合能力提升.文章将主要就军队保健医生评估体系进行系统性概括.

目的 通过对同种手术植(置)人材料在临床使用中的差异分析,探索其存在的主要问题,为建立医院植(置)人材料全过程规范化管理系统提供依据.方法 选取某大型综合性医院HIS系统2018年全年行“白内障囊外摘除+人工晶状体植入术”患者资料,参照《全国医疗服务价格项目规范(2012年版)》中对植(置)人材料的使用规范,应用方差分析法对不同医师、不同患者人工晶体使用情况进行差异分析.结果 ①人工晶体规格型号多,国别、供应商各异,价格差异大;②相同诊断、手术操作患者间人工晶体临床使用费用存在差异(P＜0.05);③不同医师主要使用的人工晶体规格不同,次均费用存在差异(P＜0.05).结论 从医师、患者等角度分析植(置)人材料在临床中的使用差异,植(置)人材料的使用与医疗质量、医疗成本紧密关联,因此建立规范化、精细化、信息化的医院植(置)人材料管理体系尤为重要.

目的 研究CCHI与ICD-9-CM-3对接过程中发现的问题,总结对接经验,梳理对接方法 .方法按照CCHI与ICD-9-CM-3各自的名称 、内涵及操作流程,以及耗材投入量 、手术技巧及手法等对接顺序和对接节点,进行对接相关研究.结果 总结出对接的基本原则及操作方法,建立了电子对接平台,根据医院HIS系统设置了输入及输出接口,达到了对接目的.结论 CCHI与ICD-9-CM-3分类对接过程中,需考虑对准率 、ICD-9-CM-3项目内涵标准控制 、CCHI的同类型对接 、一对多情况下的主次手术系数 、对接体系标准的制定等问题.

目的 探讨某医院入院时患感染性疾病的趋势,为医院感染性疾病收治准备提供参考.方法 通过医院HIS系统,提取某医院2014-2016年70岁以上患者收治及入院患感染性疾病的全部病例,通过趋势模型法预测2017年入院感染趋势,并对历年入院感染疾病构成进行了分析.结果 收治7612例患者中,感染性病例1782人次,占比23.41％,历年占比未见统计学差异(χ2=3.43,P=0.1803);通过各季度患感染性疾病分析发现,总体上呈逐年下降趋势,具有明显的季节波动规律,一季度感染数最高,四季度次之,二 、三季度较低.从疾病构成看,肺炎所占比例呈逐年上升趋势,2016年占所有感染性疾病的61.50％,是第二位上呼吸道感染的10倍以上.结论 尽管入院患感染性疾病总例数呈下降趋势,但肺炎例数没有减少,其占比逐年上升,是日常收治防控重点.

目的 探讨健康体检人群血清尿酸水平对外周血常规各指标的影响.方法 以2015年1～12月在中国人民解放军总医院健康管理研究院国际部进行健康体检且资料完整的9167例体检人员作为研究对象,回顾总结研究对象的年龄、性别、体质量指数(BMI)、腰臀围比(WHR)、血常规、尿常规等指标.结果 9167例体检者中男性6171例,女性2996例,年龄16～87岁,平均(49.41±8.98)岁,其中男性平均年龄(49.21±8.52)岁,女性(49.81±9.84)岁;人群总的高尿酸血症患病率为20.66％(1894/9167);男性尿酸浓度为121～796μmol/L,平均(379.51±77.69)μmol/L,女性为84～576μmol/L,平均(270.13±57.88)μmol/L;男性高尿酸血症患病率为27.50％,明显高于女性的6.58％,差异有统计学意义(P<0.05);男性组随年龄增加高尿酸血症患病率逐渐下降(P<0.05),女性组随年龄增加高尿酸血症患病率增加(P<0.05);男性高尿酸血症组的尿酸水平明显高于女性高尿酸组,正常尿酸组男女间比较差异也具有统计学意义(P<0.05);BMI和WHR超标、尿液pH值较低的人群中,高尿酸血症患病率均明显高于正常指标范围内人群,差异均有统计学意义(P<0.05);相关分析表明,血尿酸与血常规指标之间存在相关性,其中男性高尿酸组白细胞计数(r=0.064,P<0.05)、红细胞计数(r=0.063,P<0.05)、血小板计数(r=0.053,P<0.05)和血红蛋白(r=0.049,P<0.05)明显高于尿酸正常组并呈正相关,而尿酸水平与年龄呈负相关(r=-0.154,P<0.05);女性组除中性粒细胞外,高尿酸组的年龄(r=0.151,P<0.05)和白细胞计数(r=0.13,P<0.05)、红细胞计数(r=0.126,P<0.05)、红细胞比积(r=0.137,P<0.05)、血红蛋白(r=0.158,P<0.05)和血小板计数(r=0.073,P<0.05)均高于正常尿酸组并呈正相关.结论 男性高尿酸血症患病率明显高于女性;BMI和WHR超标以及尿液pH值下降与高尿酸血症的发生有关;高尿酸血症引起外周血常规指标的一系列改变,血常规指标可作为观察高尿酸血症的生物学指标之一.

目的 对比分析病例组合指数(CMI)在不同地区、不同类型的大型综合医院临床医疗服务绩效评价中的适用性及其调整方法.方法 分别以主要诊断类别(MDC)的病例构成、医院所在地区医疗服务空间价格指数(SPI)对样本医院CMI进行单独和联合标化调整,并结合卫生机关医院管理人员的感性评价,对CMI及其调整结果进行对比分析.结果 教学医院较其他类型医院的诊疗范围更广、临床产出更高,各医院病组数、MDC构成及CMI值都存在一定差异.基于MDC构成的CMI标化可降低各医院收治疾病结构不同对CMI值的影响,通过MDC构成与SPI联合调整的医院顺位与感性评价结果更为接近.结论 经标化调整的CMI值能更客观地反映不同地域、不同类型大型综合医院临床诊疗服务技术水平,为跨地域的医院临床绩效对比提供支撑.

Objective To explore the monitoring indexes and methods of rational use of Chinese traditional patent medicine after the separation fo prescribing from dispensing.Methods 185200 prescriptions at an outpatient pharmacy of the HIS system were retrieved,and 57 400 prescriptions of Chinese traditional patent medicine were classified,summarized and analyzed statistically.Results The cost of non-TCM departments accounted for more than 85 ％ of the total expenses on Chinese traditional patent medicine the cost of ten types of Chinese traditional patent medicine accounted for 28.55％ of the total expenses on Chinese traditional patent medicine.Prescriptions in which there were more than one drug of the subclass accounted for 27.35％,and high-ten types of priced Chinese patent medicines accounted for 10.96％ of the total.Conclusion We should exercise strict control over doctors right to prescribe Chinese traditional patent medicine and enhance the training of "syndrome differentiation and treatment" in Chinese medicine,and integrate the whole-process management of Chinese traditional patent medicine into the hospital information management system to improve the rational use level of Chinese traditional patent medicines.

Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China.Objective.— We conducted a one‐year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study.Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18‐65 years were invited to a face‐to‐face interview.Results.— The one‐year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region.Conclusion.— Migraine prevalence was higher in the lower‐income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower‐income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.

目的 探讨老年男性体检人群血脂异常和相关心血管危险因素(cardiovascular risk factor,CRF)聚集时与主要心血管疾病(cardiovascular disease,CVD)的关系.方法 收集2013年4—7月在医院例行体检的28385例老年男性离退休人群数据,年龄60~108(70.87±8.51)岁.计算血脂异常与心血管危险因素(高血压、糖尿病和肥胖)聚集状况,并使用Logistic回归分析其与冠心病和缺血性卒中的关联.结果 总的血脂异常患病率为40.0%,随年龄增长患病率逐渐降低(P<0.001);CRF聚集明显,血脂异常人群中同时具有≥2项危险因素的比例是无异常人群的1.59倍.多因素结果显示,患冠心病和缺血性卒中风险随血脂异常聚集的危险因素项数增多而明显增加.血脂异常无伴随、伴1项和伴≥2项危险因素时患CVD的比值比和95%置信区间(confidence interval,CI)分别为1.22(95%CI:1.11~1.35)、1.85(95%CI:1.68~2.02)和2.28(95%CI:2.04~2.56).结论 老年男性血脂异常与CRF聚集明显增加患冠心病和缺血性卒中的风险,亟待临床关注.

Context Previous studies about the relationship between nonalcoholic fatty liver disease (NAFLD) and diabetes are limited by inconsistent conclusions, mainly being cross-sectional and having a small sample size, no elderly people, or a lack of prediabetes. Objective This study sought to examine the relationship between NAFLD and diabetes and prediabetes in a large cohort based on Chinese male elderly. Design This was a retrospective cohort study that was followed up for ∼5 years. Setting This study was conducted in Beijing, China. Participants Chinese male elderly (n = 18,507). Participants with diabetes/prediabetes at baseline were excluded. Main Outcome Measures Ultrasound was used for diagnosis of NAFLD. Results Mean age of the 18,507 participants was 71.38 ± 14.15 years. The prevalence of NAFLD was 18.77% (3474/18,503), and participants with NAFLD had higher body mass index (BMI), blood pressure levels, blood lipid levels, and also higher alanine aminotransferase levels (P < 0.001). The total 5-year incidence was 2.448% for diabetes and 10.628% for prediabetes. Participants with NAFLD at baseline had a higher incidence of both diabetes and prediabetes. The adjusted relative risks (RRs) were 1.672 [95% confidence interval (CI), 1.361 to 2.052] and 1.336 (95% CI, 1.205 to 1.481). The RRs were closely related to BMI changes. The adjusted RRs for diabetes according to three BMI change groups (<-1.00 kg/m2, -1.00 to 1.00 kg/m2, >1.00 kg/m2) were 1.599 (95% CI, 1.054 to 2.426), 1.640 (95% CI, 1.241 to 2.167), and 1.918 (95% CI, 1.239 to 2.969), respectively. Similar results were obtained when prediabetes was used as the dependent variable. Conclusions There was a strong and independent association between NAFLD and both diabetes and prediabetes among Chinese male elderly, and this relationship was closely related to BMI changes.

Objective Identification of patients with miscellaneous complicated disorders and critical diseases has always been the focus of hospital administrators.Due to the difficulty in collecting and quantifying the characteristics of patients with miscellaneous complicated disorders and critical diseases, there is still a lack of convincing solutions.Methods A checklist was set up to link the diagnosis and treatment projects of CCHI to the doctor`s advice projects from the price table of hospital HIS.The technical difficulties and the degree of risk of CCHI were assigned values based on the definitions in CCHI and taken as the indirect parameters to evaluate the difficult and critical diseases.The parameters were calculated to find the methods to identify the difficult and critical diseases.Results Several methods were used for calculation.The scores of the miscellaneous complicated disorders and critical diseases in the internal medicine department and surgical department were calculated by the max score method, The overall scores of the cardiovascular department of internal medicine and the neurosurgery department were 95.6 and 89.9 on average and the degrees of miscellaneous complicated disorders and critical diseases were higher.Neurology department averaged 56.8 with a relatively lower degree of miscellaneous complicated disorders and critical diseases.Conclusion The recognition rate obtained by the max score method is slightly higher, and the comprehensive score of miscellaneous complicated disorders and critical diseases presents obvious regularity in its distribution.It can be used as a method to identify the miscellaneous complicated disorders and critical diseases.The difficulties in comparing the diagnosis and treatment projects of CCHI and HIS may, to some extent, affect the application of this method.

Objective To monitor medical quality process indicators with informatization technologies,and apply the monitoring results to the hospital internal performance evaluation system.Methods According to the "Specific,Measurable,Attainable,Relevant,Time-base" (SMART) principle,the hospital quality management indicators were screened,and the evaluation method was set.Results A medical quality process evaluation indicator system was established,which achieved real-time monitoring through informatization technology.Conclusion The informatization monitoring and assessment of medical quality indicators can achieve timely and accurate access to medical quality data,which improves the quality of medical care.

This paper analyzed a series of indicators including the patients ’number of applied checkup items, reservation and report time, number of patients’round -trips to the hospital as well as the subsequent prob -lems based on the medical records of outpatient departments collected by HIS system of a large hospital .It dis-cussed the feasibility of establishing the concentrated reservation system for outpatients ’checkups based on big data and pushed forward the implementation pattern and target , which was of significant importance for enhancing medi -cal service quality, improving the patients’experience of medical treatment and promoting resource utilization effi -ciency of the hospitals.