Objective To establish a performance appraisal system based on Diagnosis-Intervention Packet（DIP） for the main clinic group, in order to improve the quality of medical and efficiency. Methods The evaluation index system and weight were determined through two rounds of thematic discussion and analytic hierarchy process, and the performance of 4 main clinic groups in the Neurology Department of a tertiary integrated traditional Chinese and Western medicine hospital in Shanghai in December 2021 was assessed and evaluated according to the assessment rules. Results An evaluation index system was constructed, including four first-level indexes of quality and safety（33.70%）, DIP correlation（23.72%）, operation efficiency（18.25%）, TCM connotation（24.33%）, and 18 second-level indexes. CR value of consistency test of index weight was less than 0.1. The score rate of "quality and safety" index was the highest（93.18%）, while the score rate of "TCM connotation" and "DIP related index" was low. Conclusion The performance appraisal system with the introduction of DIP related indicators can objectively reflect the medical service situation of the main clinic group in the Neurology Department of integrated traditional Chinese and Western medicine hospital, guide the main clinic group to focus on quality connotation construction, and improve the ability to receive and treat superior diseases and specialized services.

目的 建立高效稳定的不良事件报告系统,夯实医疗安全管理体系.方法 通过对医院不良事件报告系统进行再造,增加随手拍系统,构建不良事件上报"双系统"操作模式,并在此基础上改进医疗安全管理模式.结果 通过对实施"双系统"操作前后数据进行分析,医院不良事件上报例数从每年上报513例上升至1 022例,医疗纠纷、行风投诉等数量上逐年下降.结论 不良事件"双系统"操作优化了不良事件上报流程,减轻了临床负担,提高了不良事件上报的数量,使管理者及时了解并掌控不良事件,采取干预措施,有效减少了恶性事件发生,夯实了医疗安全预警管理体系.

目的 根据上海市的国家三级公立医院绩效考核非监测指标数据,研究国家三级公立医院绩效考核29项非监测指标的权重系数,为提高三级公立医院绩效评价效果提供借鉴.方法 运用专家咨询法与熵权法分别对29项国家非监测指标进行赋权,最终以主客观赋值结合的方法得到权重系数.结果 两种赋权方法的指标对比,人才培养、学科建设等部分的权重系数存在较大差异.结论 根据上海市的绩效考核数据,通过主客观结合的方法建立国家三级公立医院绩效考核非监测指标权重系数有助于其他省市及其他医院开展相关绩效评价,能够更好地促进公立医院按照国家要求高质量发展.

目的 科学测算居家安宁疗护服务的医疗费用及直接成本,为完善居家安宁疗护服务、改革医疗保险支付激励机制提供科学依据.方法 结合文献研究和专家咨询,制定居家安宁疗护服务费用及成本核算数据收集表.采用典型抽样调查法,选取上海市已开展居家安宁疗护服务的43家典型社区卫生服务中心,收集并分析其2018—2019年实际发生的居家安宁疗护服务医疗费用和直接成本数据.结果 2018—2019年社区卫生服务中心累计建立居家安宁疗护病床868张,累计开展居家安宁疗护服务7321人次.核算费用及成本发现:每诊次居家安宁疗护服务的医疗费用为224.12元,其中,药品费和建床/查床费分别占53.06％和27.68％;直接成本为571.52元,其中,人力成本、药品成本及交通成本分别占67.65％、20.81％和5.49％.结论 居家安宁疗护服务的总体医疗费用不高,每诊次居家安宁疗护的直接成本高于每诊次的医疗费用.居家安宁疗护服务应将积极评估、心理疏导等未纳入收费项目的常规服务项目计入成本,以体现医务人员的技术劳务价值.应探索对居家安宁疗护服务采用按诊次付费的支付方式,提高医疗机构和医务人员开展居家服务的积极性,促进居家安宁疗护事业的可持续发展.