我国三级医院改善医疗服务第三轮评估结果分析

Outcomes analysis of the 3rd round evaluation for China′s tertiary hospitals in Healthcare Improvement Initiative

目的评估全国136家三级公立医院2017年落实《进一步改善医疗服务行动计划》(以下简称"行动计划")情况,为完善有关政策提供参考。方法设计《医院调查表一》《医院调查表二》,于2017年12月至2018年1月,通过医院自报、专家打分等方法收集数据,采用描述性统计、Mann-Whitney U检验、Kruskal-Wallis H(K)和Spearman秩相关等进行统计分析。结果136家样本医院医疗服务评估指标的前11个维度总得分率的中位数为91.89%, 30家妇幼保健院12个维度总得分率的中位数为90.54%。东部地区医院前11个维度的总得分率高于中部、西部地区医院(P<0.001);东部地区妇幼保健院12个维度的总得分率高于中部、西部地区(P=0.032);委属委管医院前11个维度的总得分率高于地方医院(P=0.004);综合医院前11个维度的总得分率高于中医医院和专科医院(P=0.018)。总诊疗人次数与前11个维度总得分率、12个维度总得分率的相关系数分别为0.578、0.413。结论"行动计划"落实情况总体较好,中、西部地区医院和地方医院在落实"行动计划"方面还有进步的空间;中医医院、专科医院在落实"行动计划"方面较综合医院仍有一定的差距;机构规模越大的医院,"行动计划"落实工作越到位。

Objective To assess the implementation of Healthcare Improvement Initiative(the Initiative)by 136 tertiary hospitals nationwide in 2017, and provide reference for improving relevant policies. Methods Hospital questionnaires 1 and 2 were designed, and data were collected by self-report and expert scoring.Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H(K), and Spearman rank correlation were used for statistical analysis. Results The median score of the first 11 dimensions of these hospitals was 91.89%, and that of the first 12 dimensions of 30 women and children hospitals was 90.54%.The total score rate of the top 11 hospitals in the eastern region was higher than that of both the central region and western region(P<0.001). The total score rate of the first 12 dimensions of women and children′s hospitals in the eastern region was higher than that in the central and western regions(P=0.032). The total score rate of the first 11 dimensions of the national level hospitals was higher than that of the local hospitals(P=0.004). The correlation coefficient between the total number of patients and the total score of the first 11 dimensions and the first 12 dimensions was 0.578 and 0.413, respectively. Conclusions Implementation of the Initiative is satisfactory in general.There are however still rooms of improvement for hospitals in the central and western regions, and local level hospitals as well.General hospitals are better than TCm and specialist hospitals.The larger the scale, the better the performance in service improvement.