基于病案首页信息的人工晶体使用风险分析及对策

Risk Analysis and Countermeasure of Intraocular Lens Based on Home Page Information of Medical Records

目的利用住院病案首页信息分析某院人工晶体使用情况,从廉政风险角度探索监管措施并提出有效建议。方法调取某院2018年1月1日-12月31日期间住院病案,以主要手术或其他手术名称为人工晶体置入术,ICD-9-CM-3编码为13.7的住院病案进行检索。使用Excel2007和SPSS 21.0软件,对患者分布情况、手术医师与手术量分布情况、品牌规格及用量等指标进行描述性统计分析,不同手术医师收治患者的住院总费用、一次性耗材费用、医用材料占比以(±s)表示,并对医用材料占比进行单因素方差分析。结果2018年使用人工晶体的住院患者27 134例,白内障中心住院患者21 580例(79.53%),其他科室住院患者5554例(20.47%);主要手术医师89人,白内障中心医师16人(17.98%),其他科室医师73人(82.02%);晶体规格23个,总量35 406个,使用量前十位的晶体规格累计构成比95.944%;白内障中心某术式医用耗占比全科均值79.88%,4名医师耗占比高于全科均值。结论发现非白内障中心具有白内障手术权限的医师人数较多、晶体规格多、耗占比高等风险点,提出在医师手术权限、晶体采购准入及合理使用等方面加强管理。

Objective To analyze the use of intraocular lens(IOL)in a hospital by using the information on the front page of hospitalized medical records,and to explore the regulatory measures and put forward effective suggestions from the perspective of honest and clean government risk.Methods The medical records of a hospital from January 1 to December 31,2018 were collected and retrieved by intraocular lens implantation under the name of major surgery or other operations.The medical records coded ICD-9-CM-3 as 13.7 were retrieved.Using Excel 2007 and SPSS 21.0 software,descriptive statistical analysis was made on the distribution of patients,the distribution of surgeons and surgical volume,brand specifications and dosage.The total hospitalization cost,disposable consumables cost and the proportion of medical materials in patients received by different surgeons were expressed as(±s),and the proportion of medical materials was analyzed by one-way ANOVA.Results In 2018,there were 27134 in-patients who used intraocular lenses,21580 in cataract center(79.53%)and 5554 in other departments(20.47%);89 major surgeons,16 in cataract center(17.98%)and 73 in other departments(82.02%);23 lens specifications,totaling 35406,and the accumulative ratio of crystallographic specifications in the top ten was 95.944%.The medical expenditure of one operation in cataract center accounted for 79.88%of the average of general practice,and the expenditure of four doctors was higher than the average of general practice.Conclusion It is found that the number of doctors with cataract surgery authority in non-cataract center is large,the lens specifications are large,and the consumption ratio is high.It is proposed to strengthen the management of doctors’operation authority,lens procurement access and rational use.