本文選題：三級(jí)綜合醫(yī)院評(píng)審標(biāo)準(zhǔn) + 評(píng)審辦法��； 參考：《新疆醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:本文主要通過(guò)比較JCI國(guó)際醫(yī)療機(jī)構(gòu)評(píng)審條例、ISO9001醫(yī)療質(zhì)量管理辦法與我國(guó)《三級(jí)甲等醫(yī)院評(píng)審辦法(2011版)》的指標(biāo)標(biāo)準(zhǔn)和特點(diǎn),來(lái)分析評(píng)審辦法的不同對(duì)所選樣本醫(yī)院的綜合服務(wù)效率、管理水平的影響,又通過(guò)對(duì)評(píng)審辦法的內(nèi)容對(duì)比分析,找出我國(guó)等級(jí)醫(yī)院評(píng)審標(biāo)準(zhǔn)中存在的缺陷或問(wèn)題,提出進(jìn)一步完善評(píng)審辦法,促進(jìn)評(píng)審政策的完善,對(duì)我區(qū)醫(yī)療機(jī)構(gòu)的等級(jí)醫(yī)院評(píng)審政策進(jìn)行探討并提出規(guī)范化的建議。方法:本文研究主要采用文獻(xiàn)查閱、比較研究、綜合指數(shù)法等對(duì)新疆烏魯木齊某五所綜合三級(jí)甲等醫(yī)院運(yùn)行情況和綜合服務(wù)能力進(jìn)行統(tǒng)計(jì)分析;其次,通過(guò)相關(guān)渠道獲得樣本醫(yī)院反應(yīng)醫(yī)療機(jī)構(gòu)衛(wèi)生服務(wù)能力等情況的數(shù)據(jù),利用Epidata3.1軟件建立數(shù)據(jù)庫(kù),Excel2007軟件進(jìn)行數(shù)據(jù)整理,SPSS17.0統(tǒng)計(jì)軟件對(duì)得到的數(shù)據(jù)進(jìn)行整理和分析,設(shè)立6個(gè)維度19個(gè)指標(biāo),并且判定指標(biāo)的好于壞,最終使用綜合指數(shù)法對(duì)五所醫(yī)院指標(biāo)指數(shù)化并得出結(jié)果與維度指標(biāo)的對(duì)比得到結(jié)論。第三、對(duì)得到的標(biāo)準(zhǔn)數(shù)據(jù)使用T檢驗(yàn)和卡方檢驗(yàn)試驗(yàn)出所參考指標(biāo)有無(wú)統(tǒng)計(jì)學(xué)意義,并進(jìn)行效益分析比較研究,最終比較出三種績(jī)效評(píng)審辦法視角下對(duì)所選樣本醫(yī)院有何影響,在哪一維度指標(biāo)中影響較為明顯,我國(guó)等級(jí)醫(yī)院評(píng)審指標(biāo)標(biāo)準(zhǔn)哪部分需要加強(qiáng)和完善。結(jié)果:1)通過(guò)對(duì)五所醫(yī)療機(jī)構(gòu)衛(wèi)生人力資源的組成分析,就衛(wèi)生技術(shù)人員、執(zhí)業(yè)(助理)醫(yī)師、注冊(cè)護(hù)士占衛(wèi)生人員比例來(lái)看,作為使用JCI國(guó)際醫(yī)療機(jī)構(gòu)評(píng)審條例A醫(yī)院在碩士、博士比較其他醫(yī)院高為3.86%和24.1%,達(dá)到了JCI國(guó)際醫(yī)療機(jī)構(gòu)評(píng)審條例中衛(wèi)生人員的管理部分的指標(biāo)標(biāo)準(zhǔn);其次為B醫(yī)院,B醫(yī)院使用ISO9001醫(yī)療質(zhì)量管理辦法,在衛(wèi)生人員的管理上使用的是PDCA模式,對(duì)衛(wèi)生人員起始質(zhì)量-中間質(zhì)量-終末質(zhì)量進(jìn)行考核,在碩士、博士比中緊跟A醫(yī)院,占比為1.66%和23%;C、D、E醫(yī)院均使用我國(guó)頒布的等級(jí)醫(yī)院評(píng)審辦法,其中在衛(wèi)生人員結(jié)構(gòu)中與A、B醫(yī)院相比相差較為明顯,碩博人員所占比例偏低,醫(yī)院總收入和人均創(chuàng)造價(jià)值均偏低;2)五所三級(jí)甲等醫(yī)院經(jīng)濟(jì)支出情況中,對(duì)人員支出、后勤保障支出分析顯示,人員支出D醫(yī)院C醫(yī)院A醫(yī)院B醫(yī)院E醫(yī)院,后勤保障支出B醫(yī)院D醫(yī)院C醫(yī)院E醫(yī)院A醫(yī)院;3)病床服務(wù)效用分析中看出,A醫(yī)院病床周轉(zhuǎn)次數(shù)、病床使用率、平均住院日在五所醫(yī)院中效率比值較為高,其次是B醫(yī)院,但是B醫(yī)院病床使用率高,而病床周轉(zhuǎn)次數(shù)與使用率未成比例來(lái)看,B醫(yī)院的患者的構(gòu)成有所不同。C、D、E醫(yī)院病床周轉(zhuǎn)次數(shù)平均在28.72%,明顯較低,使用率平均在87.43%,病床服務(wù)情況比較中顯示衛(wèi)生人員的閑置現(xiàn)象嚴(yán)重;4)對(duì)五所三級(jí)綜合醫(yī)院提供的整體服務(wù)能力效率情況來(lái)看,使用綜合指數(shù)法對(duì)19項(xiàng)指標(biāo)標(biāo)準(zhǔn)的對(duì)比分析顯示A、B、C、E四所綜合醫(yī)院提供服務(wù)能力效率均達(dá)標(biāo),而D綜合醫(yī)院未達(dá)標(biāo)。從綜合指數(shù)排序來(lái)看,I_AI_BI_CI_EI_D,說(shuō)明A醫(yī)院效率好于B醫(yī)院,B醫(yī)院好于C醫(yī)院,C醫(yī)院好于E醫(yī)院,E醫(yī)院好于D醫(yī)院。結(jié)論:根據(jù)新疆烏魯木齊市某五所三級(jí)甲等醫(yī)院使用的評(píng)審辦法對(duì)醫(yī)院綜合效益的影響可以看出現(xiàn)行的評(píng)價(jià)體系指標(biāo)的特點(diǎn)和優(yōu)缺點(diǎn)。JCI國(guó)際標(biāo)準(zhǔn)指標(biāo)最全面,對(duì)醫(yī)院質(zhì)量管理評(píng)審體系的促進(jìn)最強(qiáng),更是適用于醫(yī)生對(duì)病人的診治等無(wú)法標(biāo)準(zhǔn)化的工作,但是此標(biāo)準(zhǔn)職責(zé)過(guò)分繁多,評(píng)審指標(biāo)細(xì)致和繁瑣,操作性較差,一般以咨詢(xún)、管理和教育集于一身,造成了成本的過(guò)分升高;ISO9001醫(yī)療質(zhì)量管理辦法則突出強(qiáng)調(diào)了領(lǐng)導(dǎo)的管理作用,關(guān)注醫(yī)護(hù)人員在工作中對(duì)各項(xiàng)技術(shù)程序的認(rèn)真程度,相比JCI國(guó)際標(biāo)準(zhǔn),它更關(guān)注于過(guò)程的管理,避免醫(yī)療差錯(cuò),提高醫(yī)療質(zhì)量,但是由于此標(biāo)準(zhǔn)最初是為企業(yè)而誕生,對(duì)醫(yī)療機(jī)構(gòu)針對(duì)性較差,缺少醫(yī)療活動(dòng)的標(biāo)準(zhǔn);三級(jí)甲等醫(yī)院評(píng)審體系分析來(lái)看,我國(guó)的評(píng)審一直由政府主導(dǎo),但是任然存在醫(yī)療機(jī)構(gòu)被動(dòng)參與、評(píng)審與評(píng)級(jí)合為一體帶來(lái)的弄虛作假,評(píng)審的目標(biāo)過(guò)于全面、指標(biāo)標(biāo)準(zhǔn)過(guò)于細(xì)致、不適宜操作等問(wèn)題對(duì)醫(yī)療機(jī)構(gòu)帶來(lái)許多不利影響。從醫(yī)院總體的效益的比較來(lái)分析,使用JCI國(guó)際標(biāo)準(zhǔn)和ISO9001評(píng)審辦法的醫(yī)院總體效益較好,與通過(guò)等級(jí)醫(yī)院評(píng)審體系的醫(yī)療機(jī)構(gòu)相比較有明顯差異,從而可以在適合我區(qū)區(qū)情,借鑒國(guó)際上先進(jìn)的評(píng)審體系標(biāo)準(zhǔn),完善我國(guó)等級(jí)醫(yī)院評(píng)審體系。
[Abstract]:Objective: through comparing the JCI international medical institution evaluation regulations, the ISO9001 medical quality management method and the index standard and characteristics of the evaluation method of three grade a hospital (2011 Edition) in China, this paper analyzes the different evaluation methods on the comprehensive service efficiency and the management level of the selected sample hospitals, and through the content of the evaluation methods. To find out the defects or problems in the evaluation standards of grade hospitals in our country, this paper proposes to further improve the evaluation methods, promote the improvement of the evaluation policy, and discuss the evaluation policy of the grade hospital in the medical institutions of our district and put forward the standardized suggestions. The operation situation and comprehensive service ability of five comprehensive three grade first class hospitals in Urumqi, Xinjiang were analyzed. Secondly, the data of the health service ability of the hospital reaction medical institutions were obtained through the related channels, and the database was established by Epidata3.1 software, the Excel2007 software was compiled, and the SPSS17.0 statistical software was used. The obtained data are arranged and analyzed, 6 dimensions and 19 indexes are set up, and the indexes are better than bad. Finally, the comprehensive index method is used to index the index of five hospitals and get the conclusion of the comparison between the result and the dimension index. Third. The standard data obtained by the T test and the chi square test show the reference index. Statistical significance, and carry on the comparative study of benefit analysis, and finally compare the influence of three kinds of performance evaluation methods on the selected sample hospital, which is more obvious in which dimension index, which part of the grade hospital evaluation index standard of our country needs to be strengthened and perfected. 1) through the health manpower resources of five medical institutions As regards the proportion of health technicians, practicing (Assistant) doctors and registered nurses in the proportion of health personnel, the A hospital is used as the JCI international medical institution, and the doctorate is 3.86% and 24.1% higher than other hospitals. B hospital, B hospital use ISO9001 medical quality management method, in the management of health personnel is the use of PDCA model, the initial quality of health personnel - the quality of the intermediate quality - the quality of the assessment, in the master, the doctor's ratio is closely followed by the A hospital, accounting for 1.66% and 23%; C, D, E hospitals all use our country's hierarchical hospital evaluation method, among them, in the Wei Compared with A, B hospital, the proportion of raw personnel is relatively obvious, the proportion of the huge personnel is low, the total income of the hospital and the per capita creation value are low; 2) in the economic expenditure of the five three grade A hospitals, the analysis of the personnel expenditure and the logistic support expenditure shows that the personnel expenditure is the B Hospital of A Hospital of D hospital, E Hospital of B hospital, and the logistics support expenditure B medicine. The hospital D hospital C hospital E hospital A Hospital; 3) the hospital bed service utility analysis showed that the ratio of bed turnover in A hospital, the rate of sick bed use, the ratio of average hospitalization days in five hospitals was higher, followed by B hospital, but the use rate of B hospital bed was high, but the proportion of sick bed turnover and utilization rate was not proportional to the proportion of patients in B hospital. The average turnover of hospital beds in different.C, D and E hospitals was 28.72%, significantly lower, the average use rate was 87.43%, and the health workers' idle phenomenon was serious in the bed service comparison; 4) the comprehensive index method of the comprehensive index method showed A, B, C with the comprehensive index method. The efficiency of the E four general hospitals provided the standard of service ability, while the D general hospital did not reach the standard. From the comprehensive index ranking, I_AI_BI_CI_EI_D showed that the efficiency of A hospital was better than that of B hospital, B hospital was better than C hospital, C hospital was better than E hospital, and E hospital was better than D hospital. Conclusion: according to the Evaluation Office of the three grade A hospitals in Urumqi, Xinjiang The influence of the method on the comprehensive benefit of the hospital can be seen that the characteristics and advantages and disadvantages of the current evaluation system index.JCI international standard index are the most comprehensive, the promotion of the evaluation system of hospital quality management is the strongest, and it is applicable to the doctor's work on the diagnosis and treatment of the patients, but the standard is too numerous and the evaluation index is meticulous and complicated. The ISO9001 medical quality management approach emphasizes the management role of the leaders and pays more attention to the seriousness of the technical procedures in the work of the medical and nursing staff. Compared with the JCI international standard, it pays more attention to the management of the process and avoids the medical treatment. Error, improve the quality of medical treatment, but because this standard is originally for the enterprise, it is poor in medical institutions and lacks the standard of medical activities. In the analysis of the evaluation system of the three grade a hospital, the evaluation of our country has been dominated by the government, but there is a lack of passive participation in medical construction and the combination of evaluation and rating. The objectives of the evaluation are too comprehensive, the standard of the index is too careful and the unsuitable operation has many adverse effects on the medical institutions. From the comparison of the overall benefit of the hospital, the overall benefit of the hospital using the JCI international standard and the ISO9001 evaluation method is better, compared with the medical institutions which have passed the grade hospital evaluation system. Obviously, it can improve the evaluation system of our grade hospitals in the light of our regional conditions and the international advanced evaluation system standards.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R197.3

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