利用戴明循环法开展北京市超声医学质量控制的干预成效

Effectiveness of Deming cycle intervention in quality control of ultrasound medicine in Beijing

目的探究开展戴明循环法干预后北京市超声医学专业的质量控制变化。方法从超声结构、过程、结果三个层面,制定质量控制管理指标,并通过开展质量控制培训、单病种质量控制、现场质量控制指导进行戴明循环管理,比较戴明循环管理前后的2017年和2019年北京市71家哨点医院超声专业质量控制指标的数据,其中超声结构及过程质量分析指标采用秩和检验,超声结果质量分析指标采用成对样本t检验。结果基于戴明循环法管理,2019年北京市超声医师医患比为1.18(0.92,1.58)人/万人次,与2017年相比较[1.34(1.01,2.31)人/万人次]减少11.94%。2019年北京市超声医师人均每日工作量为33.85(25.59,43.36)人次,与2017年相比较[29.86(17.86,39.65)人次]增加13.36%。2019年北京超声报告阳性率为(0.72±0.19),与2017年相比较(0.56±0.23)明显提高,差异具有统计学意义(t=-4.021,P<0.001)。2019年北京市医疗机构超声诊断符合率为(0.84±0.09),与2017年相比较(0.81±0.14)增加3.70%。结论实施戴明循环法的质量控制管理,在超声工作量增多的情况下,仍提高了北京市超声医学的超声诊断符合率等核心质量控制结果指标。

Objective To explore the quality control effect of the Deming cycle method by comparing the core ultrasound quality control indicators of Beijing sentinel hospitals in 2017 and 2019.Methods We developed quality control indicators at the structure,process,and result levels,and conducted Deming cycle management through quality control training,single disease quality control,and on-site quality control guidance.Structure and process quality control indicators in 71 hospitals in Beijing were compared between 2017 and 2019 by the rank sum test.Result quality control indicators were compared by paired sample t test.Results Based on the Deming cycle management,Beijing had an average of 1.18(0.92,1.58)sonographers per 10,000 patients in 2019,which had a 11.94%decrease compared with that in 2017[1.34(1.01,2.31)persons/10,000 person-times].In 2019,the average daily workload of sonographers in Beijing was 33.85(25.59,43.36)person-times,which exhibited an increase of 13.36%compared with that in 2017[29.86(17.86,39.65)person-times].The average positive rate of ultrasound in 2019 was(0.72±0.19),which was significantly higher than that in 2017(0.56±0.23,t=-4.021,P<0.001).In 2019,the average coincidence rate of ultrasound diagnosis was(0.84±0.09),which had an increase of 3.70%compared with that in 2017(0.81±0.14).Conclusion The implementation of the Deming cycle improves the core quality control indicators,such as the coincidence rate of ultrasound diagnosis,though ultrasound workload increases.