本文選題：河北 + 北京��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:本研究旨在通過對2012—2015年河北省和北京市兩地三級醫(yī)院相關數(shù)據(jù)進行比較分析,找出兩地三級醫(yī)院的具體差異,精準定位河北省醫(yī)療服務缺點,從而有針對性地與北京市三級醫(yī)院進行合作,優(yōu)化衛(wèi)生資源的布局,了解河北籍患者赴京就醫(yī)人數(shù)和兩地發(fā)展差距的關系,為進一步轉變醫(yī)療衛(wèi)生發(fā)展的方式,創(chuàng)新區(qū)域醫(yī)療合作模式提供科學依據(jù)。方法:1數(shù)據(jù)收集方法:河北省三級醫(yī)院相關數(shù)據(jù)通過河北省衛(wèi)生網絡直報系統(tǒng)進行提取,北京市三級醫(yī)院相關數(shù)據(jù)通過北京市衛(wèi)生和計劃生育委員會公共衛(wèi)生信息中心配合提取。2對比分析方法:通過將2012—2015年度河北省和北京市三級醫(yī)院統(tǒng)計數(shù)據(jù)進行對比分析,得出結論。3統(tǒng)計學方法:采用統(tǒng)計描述的方法,其中計量資料采用均數(shù)和中位數(shù)進行描述;計數(shù)資料采用構成比進行描述。用平均增長量和平均增長速度對指標的增長情況進行描述,用平均減少量和平均減少速度對指標的減少情況進行描述。用多元線性相關系數(shù)對于兩地三級醫(yī)院發(fā)展差異和赴北京市就醫(yī)人數(shù)關系大小進行描述。結果:1京冀兩地三級醫(yī)院機構設置情況2012—2015年北京市與河北省三級醫(yī)院數(shù)量具體差值分別為16家、15家、12家和22家。北京市三級醫(yī)院數(shù)量平均每年增長5.33家,平均每年增長速度為7.21%,除2015年變化較大外其余年份相對穩(wěn)定總體呈上升趨勢;而河北省三級醫(yī)院數(shù)量平均每年增長3.33家,平均每年增長速度為5.75%,呈逐年增長態(tài)勢;2京冀兩地三級醫(yī)院發(fā)展差異2.1基礎建設2.1.1醫(yī)院床位配置情況2012—2015年北京市與河北省平均每家三級醫(yī)院開放床位數(shù)的具體差值分別為-281.38張、-262.86張、-225.83張和-325.95張。北京市每家三級醫(yī)院開放床位數(shù)平均每年增長21.44張,除2015年略有下降外整體呈上升趨勢;河北省平均每家三級醫(yī)院開放床位數(shù)平均每年增長36.30張,呈上升趨勢;2.1.2醫(yī)院萬元以上醫(yī)療設備配置情況2012—2015年北京市與河北省平均每家三級醫(yī)院萬元以上醫(yī)療設備總價值的具體差值分別為13843.9萬元、16291.55萬元、18212.31萬元和13355.25萬元。北京市平均每家三級醫(yī)院萬元以上醫(yī)療設備總價值平均每年增長3942.78萬元,呈上升趨勢;河北省平均每家三級醫(yī)院萬元以上醫(yī)療設備總價值平均每年增長4105.66萬元,呈上升趨勢;2.2人力資源分配2.2.1醫(yī)院衛(wèi)生技術人員配置2012—2015年北京市與河北省平均每家三級醫(yī)院衛(wèi)生技術人員數(shù)量的具體差值分別為-92人、-73人、2人和-102人,碩士及以上學歷衛(wèi)生技術人員數(shù)量的具體差值分別為64人、64人、58人和31人,碩士及以上學歷衛(wèi)生技術人員所占比例具體差值分別為7.88%、6.85%、4.86%和3.9%。北京市平均每家三級醫(yī)院衛(wèi)生技術人員數(shù)量數(shù)量平均每年增長68人,除2015年略有下降外整體呈上升趨勢;河北省平均每家三級醫(yī)院人員數(shù)量平均每年增長71.33人,呈上升趨勢。北京市平均每家三級醫(yī)院碩士及以上學歷衛(wèi)生技術人員數(shù)量平均每年增長8.67人,除2015年略有下降外總體呈上升趨勢;河北省平均每家三級醫(yī)院碩士及以上學歷衛(wèi)生技術人員數(shù)量平均每年增長19.67人,呈上升趨勢。北京市平均每家三級醫(yī)院碩士及以上學歷衛(wèi)生技術人員所占比例平均每年減少0.30%,呈下降趨勢;河北省平均每家醫(yī)院碩士及以上學歷衛(wèi)生技術人員所占比例平均每年增長1.02%,呈上升趨勢;2.2.2醫(yī)院執(zhí)業(yè)醫(yī)師配置2012—2015年北京市與河北省平均每家三級醫(yī)院執(zhí)業(yè)醫(yī)師數(shù)量的具體差值分別為-101人、-85人、-68人和-113人,碩士及以上學歷執(zhí)業(yè)醫(yī)師數(shù)量的具體差值分別為68人、68人、69人和36人,碩士及以上學歷執(zhí)業(yè)醫(yī)師所占比例具體差值分別為30.47%、26.91%、23.61%和20.72%。北京市平均每家三級醫(yī)院執(zhí)業(yè)醫(yī)師數(shù)量平均每年增長12.33人,除2015年略有下降外整體呈上升趨勢;河北省平均每家三級醫(yī)院執(zhí)業(yè)醫(yī)師數(shù)量平均每年增長16.33人,呈上升趨勢。北京市平均每家三級醫(yī)院碩士及以上學歷執(zhí)業(yè)醫(yī)師數(shù)量平均每年增長4人,除2015年略有下降外總體呈上升趨勢;河北省平均每家三級醫(yī)院碩士及以上學歷執(zhí)業(yè)醫(yī)師數(shù)量平均每年增長14.67人,呈上升趨勢。北京市平均每家三級醫(yī)院碩士及以上學歷執(zhí)業(yè)醫(yī)師所占比例平均每年減少0.72%,呈下降趨勢;河北省平均每家醫(yī)院碩士及以上學歷執(zhí)業(yè)醫(yī)師所占比例平均每年增長2.53%,呈上升趨勢;2.2.3醫(yī)院注冊護士數(shù)量2012—2015年北京市與河北省平均每家三級醫(yī)院注冊護士數(shù)量的具體差值分別為-15人、-1人、35人和-61人。北京市平均每家三級醫(yī)院注冊護士數(shù)量平均每年增長27.67人,除2015年略有下降外總體呈上升趨勢;河北省平均每家三級醫(yī)院注冊護士數(shù)量平均每年增長43人,呈上升趨勢;2.2.4醫(yī)院醫(yī)護比2012—2015年北京市與河北省平均每家三級醫(yī)院醫(yī)護比的具體差值分別為-0.19、-0.16、-0.16和-0.12。北京市平均每家三級醫(yī)院醫(yī)護比平均每年減少0.01,呈下降趨勢;河北省平均每家三級醫(yī)院醫(yī)護比平均每年減少0.03,呈下降趨勢;2.2.5醫(yī)院護床比2012—2015年北京市與河北省平均每家三級醫(yī)院護床比的具體差值分別為-0.54、-0.48、-0.48和-0.41。北京市平均每家三級醫(yī)院護床比平均每年增長0.02,呈上升趨勢;河北省平均每家三級醫(yī)院護床比平均每年增長0.02,呈上升趨勢;2.3收入支出情況2.3.1門急診費用2012—2015年北京市與河北省平均每家三級醫(yī)院門急診人次均費用的具體差值分別為179.64元、173.6元、177.14元和186.8元。北京市平均每家三級醫(yī)院門急診人次均費用平均每年增長13.27元,呈上升趨勢;河北省平均每家三級醫(yī)院門急診人次均費用平均每年增長10.89元,呈上升趨勢;2.3.2住院費用2012—2015年北京市與河北省平均每家三級醫(yī)院住院病人人均費用的具體差值分別為7707.71元、6552.12元、5912.93元和6623.16元。北京市平均每家三級醫(yī)院住院病人人均費用平均每年增長348.58元,2013和2014年略有下降,2015年略有上升;河北省平均每家三級醫(yī)院住院病人人均費用平均每年增長710.10元,呈上升趨勢;2.3.2百元醫(yī)療成本的醫(yī)療收入2012—2015年北京市與河北省平均每家三級醫(yī)院百元醫(yī)療成本的醫(yī)療收入的具體差值分別為-9.09元、-12.24元、-11.63元和-13.11元。北京市平均每家三級醫(yī)院百元醫(yī)療成本的醫(yī)療收入平均每年減少2.98元,呈下降趨勢;河北省平均每家三級醫(yī)院百元醫(yī)療成本的醫(yī)療收入平均每年減少1.64元,除2013年略有上升外總體呈下降趨勢;2.4醫(yī)療服務質量2012—2015年北京市與河北省平均每家三級醫(yī)院百元醫(yī)療成本的醫(yī)療收入的具體差值分別為-0.2日、-0.99日、-1.63日和-1.44日。北京市平均每家三級醫(yī)院平均住院日平均每年減少0.70日,呈下降趨勢;河北省平均每家三級醫(yī)院平均住院日平均每年減少0.28日,呈下降趨勢;2.5醫(yī)療服務效率2.5.1病床利用情況2012—2015年北京市與河北省平均每家三級醫(yī)院病床使用率的具體差值分別為-11.49%、-12.88%、-12.15%和-12.94%,病床周轉次數(shù)的具體差值分別為-2.29次、-0.33次、0.06次和0.07次。北京市平均每家三級醫(yī)院病床使用率平均每年減少0.84%,呈下降趨勢;河北省平均每家三級醫(yī)院病床使用率平均每年減少0.35%,呈下降趨勢。北京市平均每家三級醫(yī)院病床周轉次數(shù)平均每年增長1.30次,呈上升趨勢;河北省平均每家三級醫(yī)院病床周轉次數(shù)平均每年增長0.51次,呈上升趨勢;2.5.2醫(yī)師人均每日擔負診療人次和住院床日情況2012—2015年北京市與河北省平均每家三級醫(yī)院醫(yī)師人均每日擔負診療人次的具體差值分別為7.76人次/日、8.71人次/日、8.63人次/日和8.38人次/日,醫(yī)師人均每日擔負住院床日的具體差值分別為-0.47床日/日、-0.53床日/日、-0.56床日/日和-0.52床日/日。北京市平均每家三級醫(yī)院醫(yī)師人均每日擔負診療人次平均每年增長0.35人次/日,除2015年略有下降外總體呈上升趨勢;河北省平均每家三級醫(yī)院醫(yī)師人均每日擔負診療人次平均每年增長0.15人次/日,呈上升趨勢。北京市平均每家三級醫(yī)院醫(yī)師人均每日擔負住院床日平均每年減少0.03床日/日,除2013年外總體呈下降趨勢;河北省平均每家醫(yī)院醫(yī)師人均每日擔負住院床日平均每年減少0.02床日/日,呈下降趨勢;3河北籍患者赴北京市三級醫(yī)院就醫(yī)情況及其影響因素分析3.1河北籍患者赴北京市三級醫(yī)院就醫(yī)人數(shù)2012—2015年河北籍患者赴北京就醫(yī)人數(shù)中位數(shù)為291023人。河北籍患者赴北京市三級醫(yī)院就醫(yī)人數(shù)平均每年增長40210.67人,呈上升趨勢;3.2京冀兩地發(fā)展差異和河北籍患者赴北京市三級醫(yī)院就醫(yī)人數(shù)的關系2012—2015年河北籍患者赴北京就醫(yī)人數(shù)與碩士及以上學歷執(zhí)業(yè)醫(yī)師所占比例和百元醫(yī)療成本的醫(yī)療收入兩地差值呈負相關,與病床周轉次數(shù)兩地差值呈正相關。結論:1 2012—2015年北京市三級醫(yī)院在機構數(shù)量、基礎建設、人力資源、財務情況、醫(yī)療服務質量、醫(yī)療服務效率等各個方面均優(yōu)于河北省三級醫(yī)院。2河北省三級醫(yī)院在衛(wèi)技人員素質和執(zhí)業(yè)醫(yī)師素質、醫(yī)院公益性、醫(yī)療服務質量、病床利用水平這幾個方面與北京市三級醫(yī)院有較大的差距,可以在這幾個方面有針對性地與北京市三級醫(yī)院進行合作。3 2012—2015年河北籍患者赴京就醫(yī)人數(shù)逐年上升可能與京冀兩地三級醫(yī)院病床周轉次數(shù)、百元醫(yī)療成本的醫(yī)療收入、碩士及以上學歷執(zhí)業(yè)醫(yī)師所占比例的差距有關。
[Abstract]:Objective: the purpose of this study is to find out the specific differences between the three level hospitals in Hebei and Beijing from 2012 to 2015, to find out the specific differences between the three hospitals in the two places, and to accurately locate the shortcomings of the medical service in Hebei Province, so as to cooperate with the three level hospitals in Beijing to optimize the layout of the health resources and understand the Hebei nationality. The relationship between the number of medical personnel and the development gap between the two places in Beijing will provide a scientific basis for the further transformation of medical and health development and the mode of innovative regional medical cooperation. Methods: 1 data collection methods: the related data of the three level hospitals in Hebei province are extracted by the direct reporting system of the health network in Hebei Province, and the related data of the three level hospitals in Beijing are passed through The Beijing municipal health and family planning committee public health information center combined with the comparative analysis method of extracting.2: by comparing the statistical data of the three level hospitals of Hebei and Beijing in 2012 to 2015, we draw a conclusion of.3 statistical method: the statistical description method is used to describe the average number and the median of the data. The count data are described by the composition ratio. The growth of the index is described with the average growth rate and the average growth rate. The reduction of the index is described with the average reduction and the average reduction rate. The relationship between the difference of the development of the three level hospitals and the number of medical doctors in Beijing city is the size of the multiple linear correlation coefficient. Results: 1 in Beijing, Hebei, Hebei, Hebei, Hebei, Hebei, Hebei and two places, three hospitals set up from 2012 to 2015, Beijing and Hebei Province three level hospitals in the number of specific differences are respectively 16, 15, 12 and 22, the number of three hospitals in Beijing average annual growth 5.33, the average annual growth rate of 7.21%, except in 2015, the change is relatively stable and the rest of the rest years relatively stable in larger than the overall stability of the total number of years in 2015 relatively stable total The body is on the rise, and the average annual growth rate of the three level hospitals in Hebei province is 3.33, the average annual growth rate is 5.75%, it is increasing year by year, 2 the difference of the development difference of the three level hospitals in Beijing, Hebei, and the 2.1 basic construction of 2.1.1 hospital bed configuration is 2012 to 2015, the specific difference between the open bed digits of the average three hospitals of Hebei province and Hebei Province The values are -281.38, -262.86, -225.83 and -325.95. The average number of open bed digits in every three level hospitals in Beijing is increased by 21.44, except for a slight decrease in 2015. The average number of open bed digits in the average three level hospitals in Hebei province is up 36.30, showing an upward trend, and the medical setting of more than 10000 yuan in 2.1.2 hospital The total value of the total value of medical equipment in Beijing and Hebei province from 2012 to 2015 was 138 million 439 thousand yuan, 162 million 915 thousand and 500 yuan, 182 million 123 thousand and 100 yuan and 133 million 552 thousand and 500 yuan respectively. The average total value of medical equipment above 10000 yuan per family of three hospitals in Beijing was up 39 million 427 thousand and 800 yuan, showing an increase of 39 million 427 thousand and 800 yuan per year. Trend; the average total value of medical equipment over 10000 yuan per three level hospitals in Hebei province average annual increase of 41 million 56 thousand and 600 yuan, showing an upward trend; 2.2 human resources distribution 2.2.1 hospital health technicians allocation 2012 - 2015 Beijing and Hebei province average three level hospitals for each health technical personnel of the specific difference is -92, -73, 2 People and -102 people, the specific differences in the number of health technicians with master's degree and above were 64, 64, 58 and 31. The proportion of the proportion of health technicians with master's degree and above was 7.88%, 6.85%, 4.86% and 3.9%. in Beijing. The average number of health technicians in every three hospital was 68, except 201. A slight decrease in 5 years is on the rise. The average number of staff in three level hospitals in Hebei province average annual increase of 71.33 people, showing an upward trend. The average annual growth of 8.67 people per year of master and above education of every three level hospitals in Beijing, except for a slight decline in 2015, the average increase trend; the average of Hebei province per year. The average number of health technicians of master's degree and above in the three level hospital increased by 19.67, showing an upward trend. The average proportion of master and above in Beijing's three level hospitals was reduced by 0.30% per year, showing a decline trend, and the average degree of master's degree and above education in Hebei Province was accounted for by health technicians in each hospital. The average annual growth rate was 1.02%, showing an upward trend. The specific difference between the number of licensed practitioners in Beijing and Hebei province from 2012 to 2015 was -101, -85, -68 and -113, respectively. The specific difference between the number of licensed practitioners of master degree and above were 68, 68, 69 and 36, respectively. The proportion of professional doctors with master's degree and above was 30.47%, 26.91%, 23.61% and 20.72%., the average number of practicing physicians in three level hospitals in Beijing was increased by 12.33 per year, except in 2015. The average number of practitioners in the average three hospitals in Hebei province increased by an average of 16.33 people each year. The average number of practitioners of master's degree and above in the average three level hospitals in Beijing has increased by 4 people a year on average, except for a slight decrease in 2015. The average number of practitioners of master's degree and above in the average three hospitals in Hebei province is up 14.67, showing an upward trend. The average of each family in Beijing is three. The average proportion of master and higher education practitioners in grade hospitals is reduced by 0.72% per year, showing a downward trend. The average proportion of master and higher education practitioners in Hebei province average annual increase of 2.53%, showing an upward trend; the number of registered nurses in 2.2.3 hospital from 2012 to 2015 in Beijing and Hebei Province average three level hospital notes The specific differences between the number of nurses were -15, -1, 35 and -61. The average number of registered nurses in three grade hospitals in Beijing averaged 27.67 people a year, except for a slight decrease in 2015; the average number of registered nurses in the average three level hospitals in Hebei province increased by 43 people a year; the 2.2.4 hospital medicine was on the rise. The specific difference between Beijing and Hebei province from 2012 to 2015 in Hebei province and Hebei province was -0.19, -0.16, -0.16 and -0.12., and the average medical care of each three level hospitals in Beijing city decreased by 0.01 in average each year, showing a decline trend. The average number of hospitals and nurses in the average three hospitals in Hebei province decreased by 0.03, and the 2.2.5 hospital was declining. The specific difference between the nurse bed ratio in Beijing and Hebei province from 2012 to 2015 was -0.54, -0.48, -0.48 and -0.41., the average ratio of nurse bed ratio of three level hospitals in Beijing city increased by 0.02, showing an upward trend, and the average annual rate of nursing bed of three hospitals in Hebei province increased by 0.02, with an increase of 2.3 income. Expenditure situation 2.3.1 emergency cost from 2012 to 2015, the average cost difference between Beijing city and Hebei province and Hebei province was 179.64 yuan, 173.6 yuan, 177.14 yuan and 186.8 yuan respectively. The average annual cost increased by 13.27 yuan per year in three hospitals in Beijing City, and the average per year increased by 13.27 yuan, and the average of Hebei province was on the average. The average annual cost increased by 10.89 yuan per year in the three level hospital of the three level hospital, and the average cost of hospitalized patients in Beijing and Hebei province was 7707.71 yuan, 6552.12 yuan, 5912.93 yuan and 6623.16 yuan, respectively, from 2012 to 2015 in Hebei province. The average number of hospitalized patients in the three level hospital in Beijing city was respectively. The average per capita cost increased by 348.58 yuan per year, a slight decrease in 2013 and 2014 and a slight increase in 2015. The average per capita cost of hospitalized patients in Hebei province average three level hospitals increased by 710.10 yuan per year, showing an upward trend; the medical income of 2.3.2 100 yuan medical cost was 2012 to 2015 in Beijing and the average per family of three hospitals in Hebei province. The specific difference between the cost of medical income is -9.09 yuan, -12.24 yuan, -11.63 yuan and -13.11 yuan respectively. The average medical cost of 100 yuan medical cost per family in Beijing is reduced by 2.98 yuan per year in Beijing. The average medical cost of 100 yuan medical cost per family in Hebei province is reduced by an average of 1.64 yuan per year, except in 2013. There was a downward trend in total, and 2.4 medical service quality from 2012 to 2015 in Beijing and Hebei Province, the average medical cost of 100 yuan medical cost per three level hospitals in Hebei province was -0.2 day, -0.99 day, -1.63 day and -1.44 day. The average annual hospitalization day of each hospital in Beijing was reduced by 0.70 days on average, showing a decline trend. The average daily hospitalization day of each three level hospital in Hebei province was reduced by 0.28 days on average, showing a decline trend. 2.5 medical service efficiency 2.5.1 sick bed utilization from 2012 to 2015 in Beijing and Hebei Province, the specific difference between the average hospital bed use rate of each three hospital in Hebei province was -11.49%, -12.88%, -12.15% and -12.94%, and the specific difference between the number of sick bed turnover times -2.29 times, -0.33 times, 0.06 times and 0.07 times respectively. The average use rate of hospital beds in three grade hospitals in Beijing was reduced by 0.84% per year, showing a decline trend. The average annual rate of hospital bed use in Hebei province averaged 0.35%, showing a declining trend. The average annual rate of bed turnover in three grade hospitals in Beijing was 1.30 times a year. The average annual growth rate of hospital bed turnover in every three level hospitals in Hebei province averaged 0.51 times per year, showing an upward trend. 2.5.2 doctors per person took on daily diagnosis and treatment and bed days from 2012 to 2012 - 2015 in Beijing and Hebei Province, the average difference in daily medical treatment per person per person of three level hospitals was 7.76, respectively. 8.71 times per day, 8.71 person / day, 8.63 person person / day and 8.38 person / day, the doctor per capita daily bed day's difference was -0.47 bed day / day, -0.53 bed day / day, -0.56 bed day / day and -0.52 bed day / day. Average daily cost per person per capita of three hospitals in Beijing was 0.35 per day per day, except in 2015. The average daily burden of diagnosis and treatment per capita per family in Hebei province increased by 0.15 times per day per day in Hebei province. The average daily hospital bed day per capita of three hospitals in Beijing was reduced by 0.03 days per day per day, except for 2013. The average daily bed day per capita of doctors in each hospital was reduced by 0.02 beds per day per day, with a decline of 0.02 beds per day. 3 Hebei patients went to Beijing three hospitals for medical treatment and its influencing factors. 3.1 Hebei patients went to Beijing three hospitals for 2012 - 2015, the median of the number of Hebei patients to Beijing for medical treatment was 291023. People. The number of Hebei patients going to the three level hospital in Beijing has increased by 40210.67 people a year, showing an upward trend. 3.2 the difference between Beijing and Hebei Province and the relationship between Hebei patients and the number of medical doctors in the three grade hospital in Beijing City 2012 - in 2015, the proportion of medical doctors in Beijing and the percentage of licensed practitioners in Beijing and 100 yuan The medical cost of medical income is negatively correlated with the difference between the two places. Conclusion: 12012 - 2015 Beijing three level hospitals in the number of institutions, basic construction, human resources, financial situation, medical service quality, medical service efficiency and other aspects are superior to Hebei Province three level hospital.2 Hebei Province three level medical treatment. The hospital has a large gap with Beijing three level hospitals in several aspects, such as the quality of the medical staff, the quality of medical practitioners, the public welfare of the hospital, the quality of medical service and the level of the utilization of the sick bed. In these aspects, it is possible to cooperate with the three level hospitals in the city of Beijing for 2012 to 2015 and the number of Hebei patients to Beijing is increasing year by year. It can be related to the number of beds turnover times of the three hospitals in Beijing and Hebei, the medical income of 100 yuan medical cost, and the difference between the proportion of licensed doctors in master's degree or above.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.3

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