提高医疗服务质量、确保病人安全是当前医学教育及培训面临的巨大挑战。今天的医生及医务工作者 应具备良好的沟通能力,掌握如何在临床实践中鉴别、预防和处理不良事件及接近过失事件(near misses),如何使 用当前获得的证据及相关信息,如何安全有效地在团队中工作,如何在实践中教授和学习病人安全知识,如何根据 认可的伦理原则服务公众。
The operation process of a hospital is a process of resource consumption. In order to compensate the cost of consumption, it is necessary to develop a reasonable pricing mechanism of medical services. This paper discusses the pricing mechanism of medical service from the aspects of researches on the pricing mechanism of medical service in Chinese mainland, the enlightenment of the application of the pricing mechanism of medical service in Hong Kong and Taiwan, China, as well as foreign countries, and the practice of hospital price management, so as to make suggestions on the reasonable formulation of the pricing mechanism of medical service.
The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
Objective To summarize and analyze the experience of Canadian hospital report, including report contents, indicators system and result application, so as to provide basis for improving Chinese hospital information report and enhancing healthcare regulation. Methods Official networks and databases in Canada were searched, and relative policies, documents, research reports and information reports were included. Results Canadian Hospital Report Project carried out by Canadian Institute for Health Information was effective for gathering and comparing hospitals’ information, and regulating healthcare service. Ontario Hospital Report Project, as a local policy based on national hospital report project, was a good example of local government to improve healthcare service regulation. Conclusion Canadian Hospital Report and Ontario Hospital Report enlighten us that, carrying out the comparison of hospitals in the same type, ensuring the comparability of data, setting comprehensive and scientific report contents and indicators, and emphasizing the self-evaluation function and self-improvement function of the hospital performance evaluation.
The paper summarizes three revolution trends of medical service mode in the age of 5th generation mobile networks (5G), including artificial intelligence & intelligent medical service, internet of things & internet hospital, and intelligent hospital. Artificial intelligence & intelligent medical service mainly covers artificial-intelligence-assisted diagnosis, artificial-intelligence medical decision-making, and artificial-intelligence-assisted new drug research & development. Internet of things & internet hospital mainly covers internet hospitals, internet care, cloud pharmacies, and medical imaging clouds. Intelligent hospitals mainly cover intelligent clinics, intelligent wards, and intelligent management. The revolution trends count on not only techniques such as 5G, but also the support and cooperation of the government and society. The risk of information and data leak needs attention.
Medical behaviors involve multi level and multi subject legal relations. In the process of medical and nursing care, there are two categories of legal relations concerning medical behaviors. They are external and internal legal relations. External legal relations involve legal relations between hospitals, between physicians and patients and between major medical accidents and penalties; internal legal relations involve physicians, nurses and hospital authorities.
Objective To analyze the impact of removing medicine makeups and two rounds of medical service price adjustment reform on inpatient expenses, and to provide reference for policy-making and adjustment of hospital management strategy. Methods Select the front page data of medical records of the case hospital medical record management system from 2016 to 2018. According to the time of cancellation of drug addition and two rounds of medical service price adjustment reform, the data on the first page of medical records in the hospital medical record management system are divided into two groups, including before the implementation of the policy (2016) and after the implementation of the policy (2017-2018). Interrupted time series (ITS) was used to analyze the changes of hospitalization expenses before and after the adjustment of the policy. Results Before the implementation of the policy, the average hospitalization expenses in 2016 was (17 863.35±334.73) yuan; After the implementation of the policy, the average hospitalization expenses in 2017 was (18 066.16±398.42) yuan, and the average hospitalization expenses in 2018 was (18 238.95±258.28) yuan. ITS analysis showed that before the implementation of the policy, the average hospitalization expenses of patients increased by 26.616 yuan per month, but there was no statistical significance (P=0.323). In the month when the policy was implemented (December 2016), the average hospitalization expenses of patients decreased by 141.212 yuan, but there was no statistical significance (P=0.547). After the implementation of the policy, the slope of average hospitalization expenses of patients 22.363, and the inpatient expenses showed an upward trend, but there was no statistical significance (P=0.881). In the past three years, the drug expenses has decreased by 13.64%, the material expenses has decreased by 3.69%, and the labor expenses has increased by 12.25%. Conclusions After the removing medicine makeups and two rounds of medical service price adjustment reform, the drug expenses and material expenses decreased during hospitalization, and the labor expenses increased, but no change in hospitalization expenses.
ObjectiveTo describe the status of epilepsy inpatients healthcare service in tertiary public hospitals in China by the data collected from the Hospital Quality Monitoring System.MethodsA population-based study was conducted with data of hospitalized patients collected from the Hospital Quality Monitoring System between 2015 and 2017. Diagnoses were identified by International Statistical Classification of Diseases and Related Health Problems 10th Revision codes for epilepsy (G40). The information of demographic characteristics, costs, payment methods, and discharge status were extracted and analyzed annually to make cross-sectional studies.ResultsA total of 329 241 hospitalized epilepsy patients from 585 tertiary public hospitals were identified. The average age of the patients was 31.74 and male patients accounted for 60.00% of the total. The proportion of patients covered by the national basic medical insurance in the three years was 50.15%, and that in the year 2015, 2016, and 2017 was 49.03%, 49.79%, and 51.80%, respectively; the proportion of patients with full self-payment was 30.40%. The average length of hospital stay was 6.65 d, the average cost for each stay was 7 985.53 yuan, the average self-payed cost for each stay was 3 979.62 yuan. In terms of the discharge way of the patients, 88.02% discharged following doctors’ advice, 0.40% were transferred to another hospital with doctors’ advice, and 6.59% discharged against doctors’ advice. The in-hospital mortality in the three years was 0.16%, and that in the year 2015, 2016, and 2017 was 0.19%, 0.16%, and 0.12%, respectively.ConclusionThe study shows that the in-hospital mortality rate of epilepsy inpatients in the tertiary public hospitals in China decreased gradually from 2015 to 2017, the coverage rate of national basic medical insurance increased year by year, and there is still room for further improvement.
Objective To understand the residents’ demands and utilization of the community health services and provide a basis for the construction of reasonable medical service system. Methods From July to September 2015, a purposive sampling questionnaire survey on general team mode service to bring benefits to the community residents was conducted in 20 provincial-level administrative regions of the country. SPSS 13.0 software was used for data analysis. Results A total of 1 300 questionnaires were distributed, and 1 273 valid questionnaires were recovered. In the 221 residents who were aware of the composition of general team, the awareness rate of general team composed of traditional Chinese medical doctors and gynaecologists/pediatricians was low (70.14%, 75.11%, respectively). The awareness rate of medical services including disease diagnosis and treatment, health consultation, health education and prescription in the 1 273 residents was 70.46%, 61.19%, 59.62% and 67.56%, respectively; the residents’ top five willing to accept medical services was prescribing medicine (77.77%), infusion (74.08%), health consultation (73.21%), health education (70.54%), and planned immunization (64.49%). The biggest change of the 433 patients with chronic diseases before and after treatment in the community was the increase in self-health management (70.67%) and the healthy lifestyle improvement (56.35%). Conclusion Community general team should be oriented by the objective needs and real demands of the residents; based on the ability of medical services supply, the adjustment of the key points of medical services should be made and the rational use of medical services should be guided for the residents.
ObjectiveTo analyze the application status of Kanban management in medical service management at home and abroad and to provide a reference for lean medical management practice in China.MethodsUsing the bibliometric method, in China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, Springer Link, Embase and PubMed, we used “Kanban” and “Kanban management” as Chinese search terms, “Kanban system” and “two-bin system” as English search terms to search for literature published from 2009 to 2019. The number of articles published, institutions, authors, citation frequencies, key words, Kanban usage, and improved areas where Kanban was applied in were statistically described and analyzed.ResultsA total of 219 articles were retrieved. Of the 14 articles included in the study, 12 articles were published from 2015 to 2019, 8 articles were published by hospitals, and 9 articles were cited more than or equal to 3 times. The key words were basically the combinations of Kanban and related topics in the field of medical service management, such as quality control and improvement, ward service, high-quality care and process evaluation; 11 articles used Kanban alone. Kanban was used in medicine supply chain management, ward bed management, and material inventory management abroad; and was used in medicine management, emergency room patient management, medical staff performance management, operating room equipment management, and high-quality medical service management in China.ConclusionsKanban as a lean management method was introduced into the domestic medical field late, and the current research development is not balanced. Asa visual management tool, Kanban needs to be extended in the medical field. As a lean improvement tool, Kanban has positive significance in improving medical quality and patient satisfaction. It is suggested that researchers should not be limited to the existing applied research, and can study the application of Kanban in different medical service fields in combination with different lean management tools according to the actual situation of the hospital.