Objective This study aims to systematically examine the application mechanisms, key obstacles, and countermeasures for the landing and promotion of innovative medical devices in Shanghai. Methods Utilizing expert consultation and qualitative research methods, in-depth interviews were conducted with 16 experts from hospital equipment, asset, and logistics management fields. This was combined with an analysis of internal hospital policy documents, and data were systematically organized and thematically refined using Colaizzi's seven-step phenomenological analysis method. Results T he findings indicate that the hospital admission of innovative medical devices faces multi-dimensional systematic obstacles. These primarily include: the preemptive constraints of platform listing rules (such as the complexity of the "first listing" process and the impact of the "first excess" rule on pricing strategy), lengthy and rigid internal approval processes, insufficient clinical awareness and acceptance, as well as economic pressures and market overlap issues. To address these barriers, hospitals have implemented a classified management and collaborative promotion mechanism. Specific measures include: simplifying processes and establishing fast-track channels, strengthening cross-departmental collaboration and forward planning, and implementing policy tilts and centralized procurement volume guarantees. Conclusion The landing and promotion of innovative medical devices is a systematic project requiring coordinated process optimization, departmental collaboration, clinical education, and policy support. Although the current mechanisms have improved admission efficiency, it is still necessary to continuously address deeper challenges such as the lag in changing clinical behaviors and balancing economic feasibility with policy compliance. Furthermore, efforts should be intensified to strengthen in-hospital promotion, improve higher-level support policies, and optimize equipment introduction models to foster the sustainable application of innovative technologies.

ObjectivesTo investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity.DesignCross- sectional survey design.SettingThis study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023.Participants1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods.MethodsThe survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours.ResultsThe study found significant associations between PTG and moral sensitivity (r=0.49, p<0.01), with both factors positively influencing HCWs’ service behaviours. Specifically, PTG had a direct effect on service behaviours (β=0.172, p<0.01) and an indirect effect through moral sensitivity (β=0.333, p<0.01), with moral sensitivity mediating 65.8% of PTG’s impact on service behaviours. The model explained 56.0% of the variance in service behaviours, indicating a substantial influence of these psychological factors on professional conduct.ConclusionsThe findings highlight the significant role of PTG and moral sensitivity in shaping the service behaviours of HCWs in the aftermath of the COVID-19 pandemic. The study suggests that enhancing PTG and moral sensitivity through targeted interventions could improve HCWs’ service delivery and resilience, emphasising the importance of incorporating psychological and ethical training into healthcare practices to prepare for future public health crises.

目的:分析上海市标准化残疾人辅助器具(以下简称"辅具")服务社建设现状及存在问题,为推进辅具服务社标准化建设提供参考建议.方法:根据服务社类型进行分层抽样,选取7家辅具服务社开展典型案例调查,并对35位关键知情人进行访谈,通过Nvivo法和鱼骨图法进行标准化建设现况分析.结果:截至2020年,上海市残疾人辅具服务社共计239家,服务社标准化综合评分最高为92分,最低为62分.Nvivo分析确定服务设施硬件、服务人员、满意度、标准规范及服务质量五个树状节点,服务设施硬件和服务人员参考点数分别为115及69.其中硬件不足主要与场地申请困难,辅具利用率不高、部分辅具价格较高有关.结论:辅具服务社标准化建设问题仍较突出,需进一步加强服务社硬件和服务水平标准化建设.

The study summarized the treatment experience of the Tenth People’s Hospital of Tongji University in supporting the treatment of COVID-19 patients. That was, according to the situation of COVID-19 patients in the supported wards, the human resources of doctors, nurses and pharmacists should be allocated reasonably, their respective responsibilities should be clarified, and the work flow should be continuously optimized on the basis of division of labor and cooperation, and the concept of hospital sense should be always implemented. The treatment of severe patients with COVID-19 was the key and difficult point in supporting treatment work, and multidisciplinary collaboration and psychological intervention should be adopted at the same time, and continuous strengthening of the development of critical care medicine was an important strategy to deal with major public health events in the future.

目的 建立住院患者医疗服务行风风险预警体系,加强对医疗服务行为的行风风险监管.方法 采用文献分析法、专家咨询与论证确定风险的预警指标体系及管理规范,并通过信息化技术手段,开发风险预警系统.结果 从合理住院、合理收费、合理治疗、合理检查、合理用药、合理用耗等6个层面构建了医疗服务的行风预警框架,明确了14个二级行风预警指标、相应的评分标准,规定了预警等级及处置方案,并实现信息化监管.结论 以住院患者为中心的行风风险预警体系可促进医疗服务行为规范化管理,保障患者的合法权益,并可作为临床医生、临床科室行风管理的重要手段.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.

目的 开发应用静脉血栓栓塞症(Venous Thrombo Embolism,VTE)智能评估与辅助决策系统,提升院内VTE防治能力.方法 基于自然语言处理对院内多元系统数据进行后结构化处理,通过机器学习方法,综合已有量表指标和专家意见,研制VTE风险评估模型;结合规则引擎、人工智能引擎,开发VTE智能评估和防治决策支持系统.结果 应用该系统后,院内VTE风险发生评估率由53.8％上升到98.8％,出血风险评估率由9.8％上升到56.7％,评估时间由3.2 min/患者缩减到0.5 min/患者,恰当预防率由12.2％提高到63.4％,每筛查1例阳性患者需要检查人数由11.6人下降为3.0人.结论 VTE智能评估与辅助决策系统可提升患者VTE风险预警能力,规范临床诊疗行为,对降低医院VTE发生风险、保障患者安全起到重要促进作用.

目的:开发单病种质控数据智能上报系统,提升数据上报效率和质量.方法:通过自然语言处理、知识图谱、机器学习等人工智能技术,对院内医疗数据进行治理和标准化处理,在此基础上进一步开发智能上报系统.结果:该系统具备"智能入组匹配、智能采集填充、高效审核上报"等3大功能;应用系统后,医院单病种入组的敏感度为100％,平均自动填充率达到80％以上,传至国家单病种质量管控平台的通过率为100％,上报时间由过去手动填报的每份20～30 min缩短至每份5 min以内.结论:单病种质控数据智能上报系统可辅助临床医生快速完成数据上报,减轻工作负担,同时可提高上报数据的准确性和完整性,进而提升整体上报质量.

利用医政APP实现对非计划二次手术的移动监管与闭环管理.使用医政APP后,非计划二次手术发生率从2016年的0.79％下降到2020年的0.13％,监管能力进一步加强.实践表明,医政APP应用于非计划二次手术监管,可提高二次手术监管的及时性,是智慧医务管理的有益探索.

综合考核出院患者微创手术、四级手术占比是三级医院疑难重症诊疗能力的体现,也是国家绩效考核的重点内容之一.在四级手术和微创手术编码统计填报中,有的医院自定义目录进行统计和填报,导致全国范围内的数据结果很难进行比较,甚至同一省市内医院之间的数据也不能进行比较.本文应用Excel对《三级公立医院绩效考核四级手术目录(2019版)》《三级公立医院绩效考核微创手术目录(2019版)》《上海市统一代码库(疾病手术)》,采取一对一的单向映射,进行VLOOKUP函数分析,对需人工映射的条目,组织临床和编码专家进行审核.从相同条目及需要映射方面对相关编码库进行比较和映射,使医院四级手术和微创手术目录达到高度统一,从而解决医院之间的数据监测问题,使同一省市内医院之间的数据能进行比较,保证四级手术和微创手术数据在国家绩效考核中的应用.

针对病种的复杂性和诊治手段的多样性,借鉴流程再造理论和权变理论,创新临床路径管理思路,包括细化分支路径、增设路径备选项、动态调整考核标准,建立了符合三级综合医院功能定位及病种特点的临床路径管理模式.自2018年第二季度以来,全院临床路径完成占比持续保持在50％以上.该模式推动了临床路径深入开展,可扩大三级综合医院临床路径管理覆盖面,为复杂病种临床路径管理提供了参考.

目的 了解医院静脉血栓栓塞症防治现状.方法 对同济大学附属第十人民医院医疗集团内45家二、三级医院开展问卷调查,运用描述性统计分析.结果 建立静脉血栓栓塞症管理团队或综合管理体系的医院占37.78％,开展宣教或知情同意告知的医院占77.78％,进行医护人员培训的医院达80％以上.对目前开展效果满意的医院占8.89％;医院管理者重视程度三级医院高于二级医院(P=0.028),救治能力高于二级医院(P<0.05).结论 集团内医院对静脉血栓栓塞症预防总体意识较高,但满意度不高.二级医院的静脉血栓栓塞症防治能力相对不足,需加强VTE防治工作监管,提升VTE防治效率;三级医院应细化VTE防控体系,开展VTE防治区域协作,促进VTE防治整体水平提升.

党的十八届三中全会提出推进分级诊疗,将康复医疗纳入医疗卫生体系基本的组成部分.上海拥有数量较多的高水平三级综合医院、康复医院和专科医院,患者康复医疗需求逐渐得到满足.通过对国内外和上海三级医院与康复疗养机构转诊现状进行分析,总结目前三级医院和康复疗养机构转诊的经验和不足.建议通过康复人才培养,建立医联体、区域医疗中心、学科联盟等载体,制订转诊标准,做好制度保障,发展智慧转诊,落实分级诊疗和分阶段康复,实现健康中国.

以自然语言处理、机器学习为核心的人工智能技术,可实现病案首页的智能填写.病案首页智能控制系统包含形式质控和内涵质控两大模块,拥有对病案首页的基本信息智能监测、诊断信息智能提示和预警、手术/操作信息智能推荐、编码员智能复核四大功能.应用后,在病案首页完成时间及内容的准确性、规范性、完整性方面,该系统相较于传统病案首页信息系统具有一定优势.病案首页智能控制系统可辅助医生和编码员快速、准确完成首页内容填写,有助于提高病案首页质量.

目的 对某三甲医院国临库、国标库及医保库的疾病、形态学及手术编码库进行比较分析,找出编码应用上存在差异,为管理层面充分整合编码库提供建议.方法 应用Microsoft Office Excel 2010对疾病编码库、手术编码库、形态学编码库中的编码和名称进行VLOOKUP函数分析,对实际需要映射的条目数,组织临床专家和编码专家,对每条需要映射的条目数进行审核.结果 国临版以国标版为基础,疾病、形态学及手术相同条目分别为21 253、1106及8738条;新增编码占39.3％、11.2％及34.5％;实际需要映射:疾病库583条、形态学库294条及手术库146条.国临版以医保版为基础,疾病、形态学及手术相同条目分别为31 129、1422及12 435条;新增编码占9.7％、0％及6.4％;实际需要映射:疾病库1756条、形态学库68条及手术库125条.结论 通过国临版对国标版的三种编码库条目以及国临版对医保版的三种编码库条目的比对分析,找出少数实际需要映射编码的明细,并组织专家的建议、审核映射编码库,从而使本院现有各个版本编码库达到高度统一,为管理层面充分整合编码库提供建议,同时减小支付技术障碍,节省行政和服务管理成本.

基于移动管理平台,对传统危急值管理进行改进,使手机移动端具备危急值管理功能,实现在手机移动端查看、提醒和监控危急值.平台应用后,临床科室在5 min内、10 min内、20 min内、30 min内危急值平均处置效率分别为31.43％、58.32％、70.05％、80.76％.运用移动管理平台,可提高对危急值处置和监管的及时性,提升危急值闭环管理能力,进一步保障患者安全.

目的 本研究基于临床电子病历与临床辅助决策系统构建机器学习模型(AI模型),并对机器学习模型与人工Caprini量表对深静脉血栓形成(Deep vein thrombosis,DVT)风险的预测效果进行对比.方法 回顾性收集与模型建立一致的住院患者的临床变量、金标准诊断结果以及Caprini评分,比较AI模型与Caprini的受试者特征曲线下面积(AUC)、敏感性与特异性.结果 AI模型对DVT的预测效果(AUC=0.894,95％CI:0.838,0.940)显著优于Caprini量表(AUC=0.716,95％CI:0.626,0.801),P＜0.001.机器学习模型的敏感性、特异性也高于Caprini评分.结论 机器学习模型预警工具对高危住院患者DVT的预测效果较人工Caprini评分具有明显的优势,或有助于DVT的风险管理,值得在临床上推广应用.

The purpose of this study is to establish a novel pulmonary embolism (PE) risk prediction model based on machine learning (ML) methods and to evaluate the predictive performance of the model and the contribution of variables to the predictive performance. We conducted a retrospective study at the Shanghai Tenth People's Hospital and collected the clinical data of in-patients that received pulmonary computed tomography imaging between January 1, 2014 and December 31, 2018. We trained several ML models, including logistic regression (LR), support vector machine (SVM), random forest (RF), and gradient boosting decision tree (GBDT), compared the models with representative baseline algorithms, and investigated their predictability and feature interpretation. A total of 3619 patients were included in the study. We discovered that the GBDT model demonstrated the best prediction with an area under the curve value of 0.799, whereas those of the RF, LR, and SVM models were 0.791, 0.716, and 0.743, respectively. The sensibilities of the GBDT, LR, RF, and SVM models were 63.9%, 68.1%, 71.5%, and 75%, respectively; the specificities were 81.1%, 66.1, 72.7%, and 65.1%, respectively; and the accuracies were 77.8%, 66.5%, 72.5%, and 67%, respectively. We discovered that the maximum D-dimer level contributed the most to the outcome prediction, followed by the extreme growth rate of the plasma fibrinogen level, in-hospital duration, and extreme growth rate of the D-dimer level. The study demonstrates the superiority of the GBDT model in predicting the risk of PE in hospitalized patients. However, in order to be applied in clinical practice and provide support for clinical decision-making, the predictive performance of the model needs to be prospectively verified.

The aim of this work is to explore the working conditions of logistics personnel in hospital and provide a new approach for improving the service quality of them in the post-COVID-19 era. Eighty-four logistics personnel in an upper first-class hospital were included in the study, and their working conditions were investigated and analyzed via self-designed questionnaire. 73.8% of all respondents think their work is significantly important to the brand building of the hospital, and 67.9% of them think they are closely related to a harmonious doctor–patient relationship. The compliant rate is higher in security personnel when compared with other personnel and the difference was statistically significant ([Formula: see text]). 94% of the logistics personnel indicate a higher intensity in their work, 39.3% of them constantly face the working pressure and 57.1% come from the risk of infection which accounts for the largest. The largest demand comes for the protective equipment, which is from 69 workers. It would be better for us to pay attention to the hospital culture training and strengthen the sense of identity among logistics personnel of the hospital continuously. Meanwhile we need to enrich the connotation of professional style construction in hospital and promote the efficiency of logistics service. Targeted training is necessary to improve the service capabilities of the security personnel since they receive more complaints. Diversified and personalized support to the logistics personnel based on the grasp of their special demand is also important.

目的 分析某三甲医院3年DRGs分组系统中未入组病例,找出存在的编码问题并采取相应措施,提高编码质量.方法 组织编码专家、临床专家对某三甲医院2017年1月1日-2019年12月31日DRGs分组系统中未入组病例,应用SH-DRGs系统对未入组病例进行分析,采用电子病历为主、纸质病历为辅的模式逐份核查,并将未入组原因做责任分析.结果 3年未入组病例总计1302例,DRGs系统未入组病例中涉及诊断与手术操作的主要问题为无效主要诊断(370例)、无效主要手术(201例)、非标准编码(664例)等.编码错误责任分析中有47.77％以上的责任来自医师的问题,如主要诊断、主要手术选择错误、诊断不规范等.结论 DRGs分组系统作为管理工具能反映医院病案首页编码问题,应加强临床医师、病案人员病案首页编码知识培训等管理手段,对提高病案首页数据质量有着重要意义.