某三甲医院单病种质量管理的实践与思考

Reflections on quality control of monopathy in a tertiary hospital

目的通过某三甲医院单病种管理工作的开展情况,分析单病种质量管理过程中存在的问题和不足,提出相关建议和措施。方法采用回顾性调查研究方法,收集2019年1月1日—2021年12月31日某三甲医院单病种住院患者的病历资料,对单病种患者的住院时间、住院费用及构成等进行回顾性分析。结果2019—2021年间,某三甲医院单病种患者收治例数从1225例增加至1410例,平均住院日由13.25 d下降至12.74 d,平均住院费用从35999.44元减少到31670.48元,其中,药品费(35.93%)、治疗费(33.46%)、检查费(22.51%)是各单病种的主要构成费用。虽取得一定进展,但仍存在单病种费用构成不合理、临床路径管理机制不完善、医务人员积极性不高等问题。结论医院需进一步加强单病种质量管理,通过调节费用结构、优化临床路径、完善激励机制、建立监管体系,以促进医疗质量的持续改进,切实提升医疗服务水平。

Objective To find out the general existing problems and deficiencies of the quality control of monopathy according to the data collected from a tertiary hospital and put forward suggestions and measures.Methods The medical records of patients with monopathy hospitalized in the tertiary hospital from January 1,2019 to December 31,2021 were collected by means of a retrospective investigation,in which their length of hospital stay,hospitalization expenses and compositions of the expenses were analyzed.Results During 2019 and 2021,the number of admitted patients with monopathy increased from 1225 to 1410.The average hospital stay was decreased from 13.25 d to 12.74 d,and the average hospitalization expenses reduced from 35999.44 yuan to 31670.48 yuan in the tertiary hospital.The hospitalization expenses were mainly composed of drug(35.93%),treatment(33.46%)and examination(22.51%)for each patient.Although some progresses had been made,there were still some problems,such as unreasonable expense of monopathy,imperfect mechanism of clinical pathway management,and medical personnel’s lack of enthusiasm.Conclusion Hospitals need to further strengthen the management of monopathy through adjusting hospitalization expenses,optimizing clinical pathway,improving incentive system and establishing supervision system,so as to promote the continuous improvement of quality of medical care and effectively enhance the level of medical service.