本文選題：三級綜合醫(yī)院評審標準 + 評審辦法�。� 參考：《新疆醫(yī)科大學》2016年碩士論文

【摘要】：目的:本文主要通過比較JCI國際醫(yī)療機構(gòu)評審條例、ISO9001醫(yī)療質(zhì)量管理辦法與我國《三級甲等醫(yī)院評審辦法(2011版)》的指標標準和特點,來分析評審辦法的不同對所選樣本醫(yī)院的綜合服務效率、管理水平的影響,又通過對評審辦法的內(nèi)容對比分析,找出我國等級醫(yī)院評審標準中存在的缺陷或問題,提出進一步完善評審辦法,促進評審政策的完善,對我區(qū)醫(yī)療機構(gòu)的等級醫(yī)院評審政策進行探討并提出規(guī)范化的建議。方法:本文研究主要采用文獻查閱、比較研究、綜合指數(shù)法等對新疆烏魯木齊某五所綜合三級甲等醫(yī)院運行情況和綜合服務能力進行統(tǒng)計分析;其次,通過相關(guān)渠道獲得樣本醫(yī)院反應醫(yī)療機構(gòu)衛(wèi)生服務能力等情況的數(shù)據(jù),利用Epidata3.1軟件建立數(shù)據(jù)庫,Excel2007軟件進行數(shù)據(jù)整理,SPSS17.0統(tǒng)計軟件對得到的數(shù)據(jù)進行整理和分析,設立6個維度19個指標,并且判定指標的好于壞,最終使用綜合指數(shù)法對五所醫(yī)院指標指數(shù)化并得出結(jié)果與維度指標的對比得到結(jié)論。第三、對得到的標準數(shù)據(jù)使用T檢驗和卡方檢驗試驗出所參考指標有無統(tǒng)計學意義,并進行效益分析比較研究,最終比較出三種績效評審辦法視角下對所選樣本醫(yī)院有何影響,在哪一維度指標中影響較為明顯,我國等級醫(yī)院評審指標標準哪部分需要加強和完善。結(jié)果:1)通過對五所醫(yī)療機構(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、注冊護士占衛(wèi)生人員比例來看,作為使用JCI國際醫(yī)療機構(gòu)評審條例A醫(yī)院在碩士、博士比較其他醫(yī)院高為3.86%和24.1%,達到了JCI國際醫(yī)療機構(gòu)評審條例中衛(wèi)生人員的管理部分的指標標準;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,對衛(wèi)生人員起始質(zhì)量-中間質(zhì)量-終末質(zhì)量進行考核,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)院均使用我國頒布的等級醫(yī)院評審辦法,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)造價值均偏低;2)五所三級甲等醫(yī)院經(jīng)濟支出情況中,對人員支出、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%,病床服務情況比較中顯示衛(wèi)生人員的閑置現(xiàn)象嚴重;4)對五所三級綜合醫(yī)院提供的整體服務能力效率情況來看,使用綜合指數(shù)法對19項指標標準的對比分析顯示A、B、C、E四所綜合醫(yī)院提供服務能力效率均達標,而D綜合醫(yī)院未達標。從綜合指數(shù)排序來看,I_AI_BI_CI_EI_D,說明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甲等醫(yī)院使用的評審辦法對醫(yī)院綜合效益的影響可以看出現(xiàn)行的評價體系指標的特點和優(yōu)缺點。JCI國際標準指標最全面,對醫(yī)院質(zhì)量管理評審體系的促進最強,更是適用于醫(yī)生對病人的診治等無法標準化的工作,但是此標準職責過分繁多,評審指標細致和繁瑣,操作性較差,一般以咨詢、管理和教育集于一身,造成了成本的過分升高;ISO9001醫(yī)療質(zhì)量管理辦法則突出強調(diào)了領導的管理作用,關(guān)注醫(yī)護人員在工作中對各項技術(shù)程序的認真程度,相比JCI國際標準,它更關(guān)注于過程的管理,避免醫(yī)療差錯,提高醫(yī)療質(zhì)量,但是由于此標準最初是為企業(yè)而誕生,對醫(yī)療機構(gòu)針對性較差,缺少醫(yī)療活動的標準;三級甲等醫(yī)院評審體系分析來看,我國的評審一直由政府主導,但是任然存在醫(yī)療機構(gòu)被動參與、評審與評級合為一體帶來的弄虛作假,評審的目標過于全面、指標標準過于細致、不適宜操作等問題對醫(yī)療機構(gòu)帶來許多不利影響。從醫(yī)院總體的效益的比較來分析,使用JCI國際標準和ISO9001評審辦法的醫(yī)院總體效益較好,與通過等級醫(yī)院評審體系的醫(yī)療機構(gòu)相比較有明顯差異,從而可以在適合我區(qū)區(qū)情,借鑒國際上先進的評審體系標準,完善我國等級醫(yī)院評審體系。
[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.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R197.3

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