本文選題：醫(yī)療服務(wù)供應(yīng)鏈 + 檢驗(yàn)結(jié)果互認(rèn)��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究以檢驗(yàn)結(jié)果互認(rèn)為切入點(diǎn),調(diào)查醫(yī)療服務(wù)鏈中橫向和縱向信息流的現(xiàn)狀,提出完善橫向和縱向信息流的對策建議,為實(shí)現(xiàn)分級診療提供依據(jù)。以期通過不同級別醫(yī)療機(jī)構(gòu)醫(yī)學(xué)檢驗(yàn)結(jié)果互認(rèn)打破“醫(yī)療信息孤島化”現(xiàn)象,為山西省分級診療實(shí)施提供依據(jù)。方法:歷史文獻(xiàn)法:運(yùn)用歷史文獻(xiàn)法,對醫(yī)療服務(wù)供應(yīng)鏈、分級診療、檢查結(jié)果的歷史沿革進(jìn)行梳理與分析,了解目前關(guān)于檢查結(jié)果互認(rèn)的研究現(xiàn)狀。配對實(shí)驗(yàn)與統(tǒng)計(jì)分析。采用隨機(jī)抽樣法,隨機(jī)抽取100人作為研究對象,將研究對象血樣分為兩份分別送至縣級醫(yī)院所測的血常規(guī)指標(biāo)與某三級醫(yī)院。運(yùn)用相關(guān)檢驗(yàn)設(shè)備以及統(tǒng)計(jì)分析方法,對100份血液樣品從RBC、WBC等8個(gè)方面進(jìn)行比較,分析不同級別醫(yī)療機(jī)構(gòu)之間檢查結(jié)果互認(rèn)的可行性。對比分析與歸納總結(jié)。根據(jù)上述探討與分析的結(jié)論,結(jié)合醫(yī)療服務(wù)鏈理論,分析在分級診療背景下,如何實(shí)現(xiàn)縱向信息流的構(gòu)建,為山西省分級診療實(shí)施提供依據(jù)。結(jié)果:通過測試,白細(xì)胞、紅細(xì)胞、血紅蛋白、血小板等各個(gè)濃度區(qū)間均通過檢測,說明測試儀器與基準(zhǔn)儀器在本研究的各個(gè)指標(biāo)方面的相對偏差值符合《臨床血液學(xué)檢驗(yàn)常規(guī)項(xiàng)目的分析質(zhì)量要求》(行業(yè)標(biāo)準(zhǔn))要求。其中紅細(xì)胞、血紅蛋白、血小板在測試的過程中,均出現(xiàn)未在相對偏差范圍內(nèi)的樣本,血紅蛋白與血小板的通過率均80%,紅細(xì)胞的通過率為96%,高于行業(yè)限值,而其他指標(biāo)通過率也很高,基準(zhǔn)與測試測試儀器具有良好的穩(wěn)定性,可以認(rèn)為能在二級和三級醫(yī)療機(jī)構(gòu)之間開展互認(rèn)工作。結(jié)論:從硬件設(shè)備上來說,山西省二級醫(yī)療機(jī)構(gòu)和三級醫(yī)療機(jī)構(gòu)之間能夠開展某些檢驗(yàn)結(jié)果互認(rèn)工作。從實(shí)際開展工作來看,只有硬件設(shè)施完善是遠(yuǎn)遠(yuǎn)不夠的,差級醫(yī)療機(jī)構(gòu)檢驗(yàn)結(jié)果互認(rèn)還面臨著諸多問題與不足。建議政府積極發(fā)揮行政指導(dǎo)作用,制定相關(guān)政策并提供便利,做好多方面輔助工作;加強(qiáng)基層醫(yī)療機(jī)構(gòu)的監(jiān)督管理,確保檢驗(yàn)結(jié)果的質(zhì)量水平;接診醫(yī)師要對患者報(bào)告進(jìn)行嚴(yán)格審查,要與患者或其委托人嚴(yán)格履行知情同意與選擇權(quán)。媒體應(yīng)正確引導(dǎo)和宣傳,患者要正確理解和認(rèn)知。
[Abstract]:Objective: to investigate the current situation of horizontal and longitudinal information flow in the medical service chain, and put forward the countermeasures and suggestions to improve the horizontal and longitudinal information flow, so as to provide the basis for the realization of classified diagnosis and treatment.In order to break the phenomenon of "medical information insularity" through medical examination results of different levels of medical institutions, this paper provides the basis for the implementation of classified diagnosis and treatment in Shanxi Province.Methods: historical literature method was used to sort out and analyze the history of medical service supply chain, grading diagnosis and treatment, examination results, and to understand the current research status of mutual recognition of examination results.Pairing experiment and statistical analysis.Using random sampling method, 100 people were randomly selected, and the blood samples were divided into two parts, which were sent to the county level hospital and a third class hospital respectively.By using the relevant testing equipment and statistical analysis method, 100 blood samples were compared from eight aspects such as RBCU WBC and so on, and the feasibility of mutual recognition of examination results among different levels of medical institutions was analyzed.Comparative analysis and summary.According to the conclusion of the above discussion and analysis, combined with the theory of medical service chain, this paper analyzes how to realize the construction of longitudinal information flow under the background of classified diagnosis and treatment, and provides the basis for the implementation of classified diagnosis and treatment in Shanxi Province.Results: the concentrations of white blood cells, red blood cells, hemoglobin and platelets were measured.The results show that the relative deviation between the test instrument and the reference instrument in each index of this study is in line with the requirements for the analysis quality of the routine items of clinical hematological examination (industry standard).Among them, red blood cells, hemoglobin, and platelets all showed samples that were not in the range of relative deviation during the testing process. The passing rates of hemoglobin and platelets were 80% and 96% respectively, which was higher than the industry limit.The passing rate of other indicators is also very high, the benchmark and the test instrument have good stability, it can be considered to be able to carry out mutual recognition between the secondary and tertiary medical institutions.Conclusion: from the hardware point of view, the level 2 medical institutions and the third level medical institutions in Shanxi Province can carry out some mutual recognition of test results.From the point of view of the actual work, it is far from enough to improve the hardware facilities only, and there are many problems and deficiencies in the mutual recognition of the inspection results of the poor medical institutions.It is suggested that the government should give full play to the role of administrative guidance, formulate relevant policies and provide convenience, do a lot of auxiliary work, strengthen the supervision and management of primary medical institutions, and ensure the quality of inspection results.The attending physician must strictly examine the patient's report and execute the informed consent and option strictly with the patient or his client.The media should be guided and propagandized correctly, and the patients should understand and recognize correctly.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R446.1

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