我国三级公立医院改善医疗服务评估的机构调查结果:2018—2020年

Evaluation of the China Healthcare Improvement Initiative(2018-2020)in tertiary public hospitals in China:results of institutional survey

目的评估全国143家三级公立医院"进一步改善医疗服务行动计划(2018—2020年)"(以下简称"行动计划")的机构落实情况。方法于2019年3月和2021年1—3月,采用统一的《医疗机构调查表一》和《医疗机构调查表二》对全国31个省份的143家三级公立医院同步开展调查,通过医院自报和专家现场评分方式收集数据。采用描述性和推断性统计分析数据,并进行两次横断面调查数据的对比分析。结果2020年全国143家三级公立医院落实"行动计划"得分率均值为88.9%,较2018年(84.4%)有所提升,预约诊疗制度、临床路径管理制度、日间服务、智慧医院和人文服务提升显著。2020年评估中,后勤服务、优质护理服务和临床路径管理制度得分率均值超过95%,日间服务、远程医疗制度和医务社工制度得分率均值低于85%。综合医院总得分率均值显著高于各专科医院(P<0.001)。2020年评估中,29个(74.4%)二级指标的满分医院占比超过80%,达到达标水平。结论我国三级公立医院"行动计划"落实水平持续改善,取得明显进步,但部分维度和指标需进一步完善。

Objective To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods In March 2019 and from January to March in 2021,143 tertiary public hospitals in 31 provinces of China were investigated using the unified"medical institution questionnaireⅠ"and"medical institution QuestionnaireⅡ".The data were collected by means of hospital self-report and expert on-site scoring.Descriptive and inferential statistical analysis were used to analyze the data,and the data of two cross-sectional surveys were compared and analyzed.Results The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%,which was higher than that in 2018(84.4%).The appointment diagnosis and treatment system,clinical pathway management system,day service,smart hospital and humanistic service were significantly improved.In 2020,the average score rate of logistics service,high quality nursing service and clinical pathway management system was higher than 95%,while the average score rate of day service,telemedicine system and medical social work system was lower than 85%.The total score rate of general hospitals was significantly higher than that of specialized hospitals(P<0.001).In 2020,the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%,reaching the standard level.Conclusions The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress,but some dimensions and indicators need to be further improved.