ObjectiveBased on the localization of resource-based relative value scale (RBRVS) in H Hospital, to implement a surgical performance management model reform with the main surgery as the core, and to construct a more scientific and fair surgical performance distribution system. MethodsA surgical performance management model with the main surgery as the core was constructed. Relevant data such as RBRVS, diagnosis related groups (DRG), case mixed index (CMI), and surgical time of 65 915 inpatient elective surgeries in H Hospital in 2023 were collected and organized. Large sample historical data analysis was conducted using SPSS software, and the rationality of the optimized surgical performance management model was verified through key indicators. ResultsThe total coefficient of multiple orders for surgery in the 22 departments included in the study was highly correlated with the main surgery coefficient (γ>0.85), and the matching coefficients for each specialty were significantly different (P<0.001). The surgical performance management model with the main surgery as the core showed a significant improvement in the key indicators (doctor’s time resource investment and surgical risk and difficulty). ConclusionBy implementing a surgical performance management model with the main surgery as the core, we aim to strengthen the performance orientation that reflects the risks and difficulty of diagnosis and treatment, as well as the value of doctor services. This will guide clinical practice to return to the essence of medicine, support the development of discipline construction, and further stimulate the vitality and motivation of clinical work.
Regarding the working hours generated by clinical trial project services under the guidance of good clinical practice (GCP), taking the standard process of a cancer project screening period as an example, and relying on a standardized management model, this paper uses standard time measurement methods to calculate the standard time of the 12 regular tasks in the GCP project. On this basis, it analyzes the GCP project process in detail to find out the reasons for wasted performance hours, and proposes a series of improvement methods and suggestions, such as formulating and implementing a target assessment mechanism, developing standard format cards, using double-line operations research to carry out parallel operations, using quadrant method to divide tasks, using site management organization and resources of hospital departments to reduce coordination loss, and introducing big data management systems, so as to make the work process of clinical research coordinators more refined and professional.
Objective To assess the performance of post-disaster reconstruction of Yushu earthquake at the first anniversary, so as to summarize the Yushu modes of post-disaster reconstruction and provide references for reconstruction work after extreme natural disasters at home and abroad. Methods All the materials seen during the first year after Yushu Earthquake were collected, such as all documents, information notifications and work reports issued by the Central Government and the Ministry of Health, and all the information from the website of News Office of the State Council, the Ministry of Health, Qinghai Provincial People’s Government, and Xinhuanet. The literatures about Yushu Earthquake were also searched from CNKI. All the data were retrospectively analyzed to describe the reconstruction tasks and summarize the effectiveness. Results?a) The reconstruction faced upon special difficulties, including short construction time, cold climate and hypoxia, poor transport, lack of construction resources, economic backwardness, weak logistics and higher cost of reconstruction; b) The performance was significant, e.g., the government completed an investment of 5.01 billion yuan. The goal of urban and rural housing construction was fully completed. Public and municipal infrastructure construction made an important breakthrough. The projects related to livelihood were rapidly implemented. The counterpart’s education at remote was basically completed. Conclusion?As the largest reconstruction in the highest altitude area after a magnitude 7.0 earthquake, Yushu’s reconstruction learns from the experience in Wenchuan, keeps the foothold of its own features and conditions, challenges the limits of high altitude with cold and hypoxia climate, forms a post-disaster reconstruction mode with Chinese characteristics, demonstrates the speed and quality of reconstruction, and provides the valuable experience for domestic and foreign counterparts.
ObjectiveTo investigate the distribution of human resources in primary healthcare system of Xinjin county in Chengdu in 2010, so as to provide the evidence for appropriate allocation of health manpower. MethodsWe collected the data of human resources in the regional health information and management platform, and the list of health workers and their registration information. Microsoft Excel 2003 and SPSS 13.0 software were used to analyze data. Resultsa) A total of 1 551 health workers were in Xinjin primary healthcare system in 2010, including 1 124 in tenure position (accounting for 72.5%) and 427 in contract (accounting for 27.5%). b) In county-level hospital (CLH) or community healthcare centre (CHC) or township hospital (TH), the proportion of health professionals were 83.2%, 79.0% and 80.0% respectively; and 28.8%, 27.2% and 28.7% for registered & assistant doctors; 39.3%, 22.7% and 16.2% for registered nurses; 6.7%, 8.3% and 4.7% for technicians; and 5.9%, 6.8% and 6.9% for pharmacists, respectively. c) Health personnel per 1 000 population in CLH, CHC, and TH were 3.10, 1.98, and 1.92, respectively; health professionals per 1 000 population were 2.58, 1.58, and 1.54, respectively; registered & assistant doctors per 1 000 population were 0.89, 0.54, 0.55, respectively; and registered nurses were 1.22, 0.45, 0.31, respectively. The nurse-to-doctor ratios were 1.36, 0.83, and 0.56 nurses per doctor in CLH, CHC, and TH, respectively. The bed-to-nurse ratios were 0.59, 0.38, and 0.19 nurses per bed respectively. d) Most health professionals were junior professionals (about 60%), in college-level education (about 50%), between 25 to 44 years old (20%-70%), work experience between 5 to 19 years (40%-63%). e) Temporary employees in TH accounted for 46.4%, among which 86.6% younger than 35 years old, 23.4% in internship, and 64.1% at clinical position. Conclusiona) The shortage of health personnel is very obvious in Xinjin county with inappropriate proportions of health professionals; b) The stability of health personnel is challenging due to the large proportion of temporary employees in THs; c) health professionals in Xinjin county features a younger population, and in lower professional positions; d)Therefore, the related policies should be adjusted and innovated to enhance the education and training, to maintain the stability of health personnel and to promote the healthy and sustainable development of primary healthcare services.
ObjectiveTo investigate the essential healthcare system performance in Xinjin county of Chengdu city from 2009 to 2010, so as to provide baseline data for further study. MethodsThe general information of the essential healthcare, such as the numbers of out and in-patients, service and profits were collected and then analyzed using the software of Microsoft Excel 2003 and SPSS 13.0. Resultsa) The results showed that the numbers of out and in-patients were in the rank of the county, township and community hospital. The numbers of out and emergency patients has been decreased 31.0% and 25.3% in the community hospital from 2009 to 2010, while patients in the county and township hospital has been increased. The numbers of in-patients has been increased by year; b) hospital bed occupancy has been increased by year, and the hospital bed occupancy of county hospitals was 8% lower than national level in 2009, 33.5% higher in 2010, the hospital bed occupancy of township hospitals from 2009 to 2010 was higher than national level, the ones of community hospital was lower than national level; c) there is an annual decreasing tendency for average days for hospitalization in county and community hospital, which were higher than national level; d) it was lower than national average rate; e) the inpatient fee per time was lower than national average rate; f) in the components of the in-patients expense, drug expense, operation expense and diagnose expense were constituted more than 86% in all eight costs; and g) the receipts and expenditure of Xinjin hospital throughout the year increased by years, the income and expenses showed 39.3% and 37.7%. ConclusionThe hospital bed occupancy, average hospitalization days and the inpatient fee per time in Xinjin county of Chengdu city during 2009-2010, were higher than national level. The overall health performance of hospitals in Xinjin county was satisfied. However, there was significant difference between the best and the worst. In order to distribute health resources, both benefit and efficient should be emphasized.
ObjectiveTo systematically review the comprehensive evaluation methods applied to estimate the medical service performance based on diagnosis-related groups (DRGs) in China and to provide suggestions for the promotion of methods in further studies.MethodsLiterature published before May 2019 were searched in China National Knowledge Infrastructure, WanFang Data, CQVIP and PubMed for studies about DRGs-based comprehensive evaluation. After literature screening and information extracting by two reviewers independently, qualitative approaches were used to describe the application of DRGs-based comprehensive evaluation methods in the performance evaluation of medical services.ResultsA total of 24 articles were included in the systematic review. Different indexes were used to evaluate the medical service performance. Delphi Method, expert discussion, Saaty’s Method and some other means were applied to determine the weights of indexes in 8 articles. Rank-sum ratio method, Technique for Order Preference by Similarity to an Ideal Solution and synthetic index method were proposed for the comprehensive evaluation in 9, 7 and 9 articles, respectively; besides, analytic hierarchy process and combination evaluation were also used.ConclusionsBased on DRGs, the choose of indicators, weighting approaches, and calculation methods of comprehensive values vary richly in different studies. More attention should be paid to weight using and combination of comprehensive evaluation methods in further studies. Meanwhile, the quality of information source used for estimation and the rationality of results application are supposed to be emphasized.
ObjectiveTo improve the comprehensive service ability of the hospital, improve the satisfaction of medical care, implement the requirements of fine management, and enrich the connotation of hospital internal performance improvement.MethodsIn July 2017, based on the concept of approach-deployment-learning-integration, the internal performance improvement model of Children’s Hospital Affiliated to Fudan University was constructed to form a management closed loop.ResultsFrom 2016 to 2019, the average length of hospital stay was reduced from 6.90 d to 6.47 d, the patient satisfaction was elevated from 92.89% to 93.80%, the proportion of drugs was reduced from 35.25% to 30.44%, the proportion of materials was reduced from 23.35% to 18.55%, and the proportion of difficult operations of grade Ⅲ and Ⅳ was elevated from 66.98% to 67.68%.ConclusionThe improvement of key performance indicators depends on the implementation of external policies, the integration of scientific management elements, the cooperation of multiple subjects, and the construction of information system.
ObjectiveTo explore the new hospital management method about diagnosis-related groups (DRGs), and put forward some strategic suggestions.MethodsIn March 2019, using literature research method, relevant documents were consulted to understand the research policy and background. In April 2019, the DRGs data and first pages of medical records of a tertiary grade A hospital in 2018 were obtained through field survey. The DRG with the largest quantity of patients was selected, and then the top two treatment centers ranked by the quantity of patients were selected for analysis.ResultsA total of 11 936 patients’ face sheets for medical records were investigated, covering 18 major disease categories (MDCs) and 93 DRGs. Treatment center A and B were the top two treatment centers ranked by the quantity of patients, covering 8 MDCs and 34 DRGs. There were 1 116 patients in treatment center A and 470 patients in treatment center B, with the same case-mix index (0.820). There was no statistically significant difference in the average length of hospital stay between the two treatment centers (t=−1.926, P=0.054). The average hospitalization expenses [(45 902.64±30 028.22) vs. (40 763.34±25 141.12) yuan, t=−3.260, P=0.001], drug expenses [21 481.43 (10 663.16, 34 251.64) vs. 11 740.36 (5 818.37, 21 572.09) yuan, Z=−9.812, P<0.001], and other expenses [138.00 (84.00, 178.00) vs. 120.00 (72.00,155.28) yuan, Z=−3.573, P<0.001] in treatment center B were higher than those in treatment center A. But the medical technology expenses [(7 319.11±3 781.52) vs. (10 995.61±4 784.55) yuan, t=12.324, P<0.001] and nursing expenses [(578.42±226.82) vs. (882.99±781.63) yuan, t=8.187, P<0.001] in treatment center B were lower than those in treatment center A.ConclusionsThe disease diagnosis and treatment specifications need to be strengthened and the process needs to be optimized. In the next hospital management, we should pay attention to key indicators to improve performance appraisal, standardize the diagnosis and treatment process to promote clinical path, and mine deep data to make performance management detailed.
Objective To systematically review and conclude the healthcare reform policy in rural China throughout the past 62 years. Methods This study was applied with PICOS structure to formulate research issues. National/ministry policies and documents on healthcare reform in rural China were systematically collected. The primary healthcare issues and healthcare reform measures carried out at each stage were studied, and, the criteria as population healthcare indicators, indicators for healthcare workforce and infrastructure in rural areas, healthcare expenditure indicators, and the results of national surveys for healthcare service were used to evaluate the reform performance achieved at each stage. Results A total 396 national policies on healthcare reform in rural China were included through comprehensive search. In accordance with the results of quantitative analysis on literatures, characteristics of economy system reform at each stage as well as actual advancement on healthcare reform, the reform courses of healthcare system in rural China in this study were divided into six periods as follows: national economy recovery and adjustment period, cultural revolution period, early stage of economy system transition, initial stage of healthcare reform, middle stage of healthcare reform, and implement stage for new rural cooperative medical system (NRCMS). The average policies of each period increased year by year, which generally showed as features as laying more emphasis on medical services than medicine, and thinking little of medical insurance. The population health indicators, sickbeds per thousand rural population and medical practitioners kept improving gradually. Yet the import of market mechanism and influence of international economy condition led to the decline in public welfare of healthcare system, increase of personal expenditure proportion among general healthcare cost, and duplicate content among some polices.Conclusion Commonwealth orientation is the fundamental principal to fulfill healthcare service system, thus performance on policies should be concluded in combination with the present national conditions, future requirements as well as evidence-based policy-making, and additionally, such performance should be improved during implementation.
Objective To evaluate the performance of emergency medical rescue (EMR) within 1 month after Lushan earthquake, and to prove and enrich the experience from Wenchuan earthquake, so as to provide useful references for global earthquake EMR with regard to decreasing death and disability rates. Methods All the following date published within 1 month after 4.20 Lushan earthquake were collected and analyzed, including official information, public documents, news release, relevant information from websites and victims’ medical records in the West China Hospital, then the relevant domestic and foreign literature about EMR (including EMR of Wenchuan earthquake). And then comparative analysis was conducted to evaluate the performance of EMR in Lushan earthquake. Results a) Being 87 km apart from each other, the main seismic zones of Lushan and Wenchuan located in the south west and middle north of Longmenshan fault zone, respectively. Although only 1 earthquake magnitude differed between them, the disaster area, and the number of affected population, deaths, disappearances, injured, severe injured and migration population in Wenchuan earthquake were 40, 23, 353, 853, 27, 14 and 51 times higher than those in Lushan earthquake, respectively. b) Learned from Wenchuan experience, the manpower scheduling in Lushan earthquake was quicker: the assembled medical personnel peak of Lushan vs. Wenchuan was 87.62% vs. 56.06 % in golden 72 hours post-quake. c) Supplies scheduling was more rational: the utilization rate was higher under the guidance of accurate information of demand. d) Medical treatment was more rational and efficient: the critical injured were treated following “Four concentration treatment principles”; saving life and restoring function at the same time; treatment and physical-mental rehabilitation at the same time; treatment and evidence production and implementation at the same time. e) Medical institutions and service returned to normal in time: 96.7% (440/455) of government owned township medical institutions in 21 affected towns returned to normal and provided medical services at their original sites. Conclusion By learning form Wenchuan experience, the following performance is implemented in Lushan earthquake: medical rescue guided by the accurate information; supplies scheduling guided by the accurate demand; both critical injured treatment,and physical-mental rehabilitation guided by the accurate assessment of injuries. So the medical rescue within 1 month after Lushan earthquake is quicker, more rational and efficient. After 20 days post quake zero death of critical injured was achieved. The early physical-mental rehabilitation fastens the functional reconstruction of the injured and helps them return to the society. So it suggests that the Lushan EMR enriches and develops the reference value of EMR experience of Wenchuan earthquake.