2012-2016年西安市10家三级综合医院抗菌药物管理效果TOPSIS法综合评价

Synthesis Evaluation of the Effect of Antibacterials Management in 10 Third Grade General Hospitals of Xi'an by TOPSIS Method from 2012 to 2016

目的:为进一步提高医院抗菌药物管理水平及形成相关管理决策和长效机制提供科学依据。方法:采用逼近理想解排序法(TOPSIS),选取住院患者抗菌药物使用率等8项抗菌药物管理指标对2012-2016年西安市10家三级综合医院的抗菌药物管理效果进行综合评价。结果:通过采用TOPSIS法综合评价可知,抗菌药物管理效果2012年最差[评价对象与最优值的相对接近程度系数(Ci)=0],2013-2015年逐步提升,到2015年达到最优(Ci=0.918 3),而到2016年有倒退迹象(Ci=0.838 5)。5年间,8项指标中仅接受特殊使用级抗菌药物治疗的住院患者微生物送检率1项指标得到显著改善(P<0.01),其余7项指标数据前后比较差异均无统计学意义(P>0.01)。结论:西安市10家三级综合医院抗菌药物管理效果在2012-2015年逐步优化,但到2016年略有倒退,可能出现一定的松懈。故当地三级综合医院应建立抗菌药物管理长效机制,巩固"抗菌药物临床应用专项整治活动"获得的成果,进一步推进各项抗菌药物管理措施常态化和动态化运行。采用TOPSIS法对医院抗菌药物管理效果进行综合评价,有助于得出客观、全面的评价结果,对保障医院抗菌药物的监管与使用水平具有重要意义。

OBJECTIVE:To provide scientific evidence for the further improvement of hospital antibacterial management,the formulation of related management decisions and long-acting mechanism. METHODS:Technique for order preference by similarity to ideal solution(TOPSIS)was used to select 8 evaluation indexes as utilization rate of antibiotics in the inpatients to synthetically evaluate the effect of antibacterial management in 10 third grade general hospitals of Xi'an from 2012 to 2016. RESULTS:Results of synthesis evaluation by TOPSIS method showed that the least effect was in 2012 [coefficient of proximity from the object of evaluation to the optimal value(Ci)=0];the effect of antibacterials management was improved gradually during 2013-2015,and there was the best effect in 2015(Ci=0.918 3);but declined in 2016(Ci=0.838 5). Only one evaluation index(the rate of microbial examination in the inpatient receiving special use of antibacterials)was improved significantly in the 5 years(P<0.01),but there was no statistical significance in the data of other 7 indexes(P>0.01). CONCLUSIONS:The effect of antibacterials management in 10 third grade general hospitals of Xi'an was on the rise from 2012 to 2015,but was declined in 2016. It might be slack. A long-acting management mechanism of antibacterial management is needed to be established, in order to consolidate the achievements from"special rectification for clinical antibacterial use"and further improve the normal and dynamic operation of antibacterial management measure. TOPSIS method is objective and comprehensive method for synthesis evaluation of the effect of antibacterial management,and is of significance to antibacterial supervision and use.