上海市直肠癌手术质量控制与评估体系建立与应用分析

Establishment and application of surgery quality control and evaluation system for rectal cancer in Shanghai

目的探讨构建直肠癌手术质量控制(质控)评估体系及应用效果。方法根据《上海市直肠癌外科手术管理规范(2017版)》,建立分值分配量化体系,进行上海市二级甲等及以上医疗机构直肠癌手术质控评估及改进。结果2019年,上海市三级甲等医院的直肠癌手术质量要优于二级医院(91.8分vs.87.4分),二级甲等医院和三级甲等医院在质控六项中所表现的问题特点有所差异。通过2年的针对性的质控工作,药品所占比例从23.6%降至18.9%(-4.7%),总住院天数从14.5 d降至13.3 d(-1.2 d),术前天数从4.2 d降至4.0 d(-0.2 d)。但耗材所占比例略有上升,从33.3%升至35.85%(+2.55%)。结论上海市直肠癌手术数量逐年提升,同时手术质量稳步提高,但二级及三级医院仍然存在不同程度的质量问题。通过质控督查并持续推进直肠癌手术管理规范,是提高直肠癌手术质量的有效途径。

Objective To explore the effect of establishment and application of surgery quality control and evaluation system for rectal cancer in Shanghai.MethodsAccording to the Rules of Rectal Cancer Surgery in Shanghai(2017),a quantitative system of score was established to evaluate and improve the quality control of rectal cancer surgery in order to evaluate and promote quality of rectal cancer surgery in the second and third level hospitals.ResultsThe quality of the third level hospital was better than that of the second level hospital(91.8 points vs.87.4 points).There were some differences in the characteristics of quality problems between the second level hospital and the third level hospital.Through 2 years of continuous improvement,the proportion of drugs decreased from 23.6%to 18.9%(-4.7%),the total hospitalization days decreased from 14.5 days to 13.3 days(-1.2 days),and the preoperative days decreased from 4.2 days to 4.0 days(-0.2 days).However,the proportion of consumption increased slightly from 33.3%to 35.85%(+2.55%).ConclusionThe number of rectal cancer operations in Shanghai is increasing year by year,and the quality of surgery is steadily improving.However,there are still quality problems in the second and third level hospitals.It is an effective way to improve the surgery quality of rectal cancer by quality control supervision and continuous promotion of the surgery management standard.