Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Effect and satisfaction of outpatient services by precision valuation reservation registration

BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatient clinics in these hospitals.AIM To establish precision valuation reservation registration aimed at shortening waiting time,improving patient experience and promoting the satisfaction of outpatients and medical staff.METHODS On the basis of the implementation of a conventional appointment system,more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients,and appointment times were made more accurate through intervention.The change in consultation waiting time of patients was then compared.Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed.RESULTS After precision valuation reservation registration,the average consultation waiting time of patients reduced from 18.47 min to 10.11 min(t=8.90,P<0.001).The satisfaction score of patients increased from 91.33 to 96.27(t=-8.62,P<0.001),and the satisfaction score of medical staff increased from 90.51 to 96.04(t=-10.50,P<0.001).The consultation waiting time of patients was negatively correlated with their satisfaction scores(γ=-0.89,P<0.001).The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores(γ=-0.96,P<0.001).CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff.This approach played an important role in improving outpatient services,provided a model that is supported by relevant evidence and could continuously improve the quality of management.Precision valuation reservation registration is worth promoting and applying in the clinic.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Antibiotics prescribed to febrile under-five children outpatients in urban public health services in Burkina Faso

Appropriate use of antibiotics remains critical for success in achieving MDG4. The aim of this study was to investigate antibiotics prescribing practices to febrile under-five children outpatients in urban public health services in a low income country. Methods: From March to April 2013, a cross-sectional epidemiological study of care facilities visit by under-five age, for febrile illness, was carried out in urban health services in Bobo-Dioulasso, Burkina Faso. Patient demographics, diagnoses and medications were recorded. We calculated for each diagnoses several indicators for antibiotics use. Results: Our study showed an over-prescription of antibiotics at the university teaching hospital (78.08%) and at the first level facilities (57.71%) for under-five outpatients for febrile illness. There was evidence of high antibiotic prescription in children with diarrhea (more than 9 on 10 at university teaching hospital of diarrhea cases and 60% at the first level facilities), in children with Upper respiratory tract infections (respectively 60% and 85.2% of cases at university teaching hospital and at the first level facilities) and in children with malaria (respectively 47.5% and 17.6% of cases at university teaching hospital and at the first level facilities). Overuse, misuse and inappropriately prescribed antibiotic coexisted in our results: at university teaching hospital 90.9% of diarrhea cases, 60% of URTI cases,?47.5% of malaria cases received antibiotic prescription;at first level heath care facilities 85.2% of URTI, 17.6% of malaria cases received an prescribed antibiotic and 11.8% of LRTI did not received a prescribed antibiotic. Developing countries have poor access to newer antibiotics and irrational antibiotics use remains a global problem. Overuse and misuse of antibiotics combat, rigorous infectious diseases diagnosis, antimicrobial resistance consequences education of users and health professional’s prescribers, and improved surveillance of antimicrobial resistance, must be strengthened.

Impact of slope farmland use change on ecosystem services value in China,2000-2020

Slope farmland is an important component of farmland resources in China.The utilization and change of slope farmland have significant effects on ecosystems,and understanding the impact of slope farmland change on ecosystem services(ESs)is critical for effective land utilization and ecosystem protection.This study aims to analyze slope farmland changes in China between 2000 and 2020 and quantify the impact of these changes on ESs by the use of a land use dynamic attitude study,and an ecosystem services value(ESV)equivalent.Results show that the area of slope farmland in China was mainly concentrated on slopes of 2°-6°,and exhibited a downward trend between 2000 and 2020.There were significant differences in the spatial distribution of the farmland,which was mainly located in the Taihang,Qinling,Wushan,and Xuefeng mountains.ESV increased by$179.235 million due to the conversion between slope farmland and forest,grassland,and construction land from 2000-2010.Conversely,from 2010 to 2020,ESV decreased by$2613.919 million due to the conversion of forest and grassland to slope farmland as well as the conversion of slope farmland to construction land.

Development and Utilization of Solar Energy Resources and Meteorological Services in Hami City

Hami City is rich in light resources and is a key area for the development of photovoltaic power generation industry in Xinjiang.In the past 11 years,annual sunshine duration in Hami tended to increase,but annual solar radiation decreased.Sunshine duration and solar radiation were more in summer and less in winter.They were the most in May and the least in December.Meteorological departments should strengthen the observation of illumination and other elements,do a good job in the assessment of solar energy resources and other professional services,and provide technical support for the development and utilization of light energy resources.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Utilization and Satisfaction with HIV Services at 7 Provinces in Vietnam: A Cross-Sectional Study

The study was carried out to determine utilization and satisfaction with essential HIV services from HIV individuals and high-risk populations in 7 socioeconomic provinces nationwide. A cross-sectional approach was applied in the study. Data were collected through face-to-face interviews using self-report questionnaires. Findings from 2380 respondents indicated a high percentage of utilization as well as a high level of satisfaction, in particular among men who have sex with men (MSM) and female sex worker (FSW) sub-group. Needle, syringe, and condom programs had lower usage and satisfaction mean scores in comparison with other services. The proportion of people who used drugs (PWID) and participated in the needle and syringe program was 53.6%. HIV counseling and testing uptake proportion of overall respondents in the last 12 months was 82.2% while the rate of antiretroviral treatment among infected PWID was 74.9%. The level of satisfaction with treatment services was found to be higher than preventive interventions (p < 0.05). Analysis using univariable logistic regression suggested an association between some socioeconomic factors such as income, employment, educational attainment, and marital status with subjects’ satisfaction with several HIV services. Preventive services, especially needle, syringe and condom programs should be prioritized to scale up the coverage and effectiveness. Innovative approaches targeting at PWID should be promoted to increase their access to prevention programs as well as HIV care when needed.

Utilization of HIV and Sexually Transmitted Infections Prevention Services, and Associated Factors among the Long-Distance Truck Drivers along the Northern Corridor Highway, Kenya

Background: Often, long-distance truck drivers’ (LDTDs’) work predisposes them to sexually transmitted infections (STIs) whose outcomes are influenced by access and behavior of seeking sexual health care. Methodology: In this study, we assessed the utilization of HIV/STI preventive services and associated factors among 296 LDTDs operating along the northern corridor highway using an interviewer-administered questionnaire for data collection at Mlolongo stopover in Machakos, Kenya. Responses for the investigated variables, including condom use, history of HIV testing, frequency of HIV testing, antiretroviral therapy (ART) use and follow-up for the HIV positive and STI treatment, were assigned a score of either 1 or 0 depending on the question’s dimension. Following summing up for each participant, we computed a weighted score ranging between 0 and 1 by dividing the summed responses by the number of eligible variables. We arbitrarily multiplied these scores by 8 to generate endpoint scores ranging from one to eight for each participant to help create a dichotomized outcome variable for utilization levels: limited utilization (1 to 4) and good utilization (5 to 8). Association between certain independent variables and the outcome variable (level of utilization of H.I.V./STIs preventive services) was analyzed using binomial logistic regression analysis in R statistical software. Results: The mean age of the LDTDs was 38.4 years, ranging from 24 - 57 years. The majority (n = 287, 97%) of the LDTDs had been tested on HIV at least once since the beginning of their career. Only 4.9% of the LDTDs had been tested on HIV within the previous three months. Of the 175 LDTDs who reported a history of STI, most (n = 173, 98.9%) of them had sought treatment. Condom use rates were higher (97.1%) among the LDTDs who had sexual interactions with casual sexual partners compared to 47.2% among regular sexual partners. Analyses classed most of the respondents (n = 231, 78.0%) as having good utilization, while the rest (22%) had limited utilization. History of STI was independently associated with utilizing HIV/STI preventive services (OR 8.4;95% CI;4.5, 16.7;P < 0.001). Conclusion: Although most of the LDTDs were classed to have good utilization of HIV/STI preventive services, the uptake of subsequent HIV testing services among them was low at only 4.9%. The association of STI history with utilization levels that we determined supports policies of integrating HIV and STI services in the delivery of sexual healthcare provision among LDTDs.

Utilization and Felt Need of Oral Health Care Services among Women in Chennai-Descriptive Cross-Sectional Study

Introduction： Oral health is window to overall health. There is a greatest burden of oral diseases on the underprivileged group. In developing countries like India the affordability to oral health care services is very limited thereby leading to poor oral wellness ＆ millions suffer intractable toothache and poor quality of living and end up with few dentition. Objective： To assess the utilization level of oral health services among women in Chennai. Material and methods： A cross-sectional questionnaire survey was conducted among 200 women in Teynampet Zone in Chennai District, Tamil Nadu. The women were chosen by simple random sampling and were interviewed using the semi-stzuctured questionnaire to assess their utilization level during the period of June to July 2016. The data were analyzed by SPSS Version 22. Result： Descriptive statistics and multivariate analysis--MANOVA were used to analyze the utilization level. Majority of the respondents were in the age group of 30-35years, most of the respondents had oral problem and almost everyone had visited dentist at least once within 3 years. Multivariate analysis--MANOVA also showed that the utilization levels were directly influenced by accessibility, availability and affordability and showed statistical significance （p value 〈 0.05） and also from MANOVA analysis it showed that the respondents who had poor oral hygiene did not utilize oral health care services as the affordability was a problem although accessibility and availability was adequate. Conclusion： Our fmdings suggest that people who had oral problem had visited dentist in previous 3 years and most of the people who visited dentist had a good oral hygiene. Cost of the treatment affected the dental visits. They believed that visiting the dentist is necessary only for pain relief.

Analysis of the Dilemma and Strategies of Elderly Patients Access to Outpatient Services-Based on the Examples from three Grade A Tertiary Hospitals in Jiangxi Province

Objective:To identify the dilemma of elderly patients’access to outpatient services,develop strategies to improve the environment and functions of the outpatient department,and encourage the elderly to access medical services independently.Methods:By observing and interviewing,this paper studies the environment,behavior,and experiences of elderly patients when accessing medical services,identifies and classifies the key issues,and provides corresponding suggestions.Results:Existing signs and voice prompt systems fail to guide elderly patients to access to medical services;Elderly patients have difficulty in finding places to transit and rest when accessing to outpatient services;Elderly patients have problems in using AI(artificial intelligence)technologies when they access to outpatient services;There are communication barriers between elderly patients and medical staffs.Conclusion:Optimizing the guiding signs and voice prompt systems according to the characteristics of elderly patients;Designing the areas of transition and rest reasonably;Enhancing the ability of elderly patients to use self-service equipment;Promoting the medical treatment process to the elderly in a humanized way.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Utilization of Resources and Optimization of Services in Libraries

“Resource utilization”is the foundation of library services.This article analyzes the reasons of low utilization of library resources.Besides that,the existing resources are classified according to different genres.The methods of utilizing the existing resources in the library are also discussed.Based on the analysis,by optimizing the service patterns,the service reaches more targeted readers as well as improve the utilization rate of existing resources.

居家社区医养结合服务利用及满意度现状研究

目的 了解居家社区医养结合服务的利用情况和满意度现状,提出促进医养结合发展的对策和建议。方法 通过目的抽样法于2023年5-7月在我国东、中、西部分别选取无锡市、长沙市、成都市对2 125名60岁及以上正在接受或曾接受过服务的老年人进行问卷调查。采用描述性分析、卡方检验、单因素方差分析、多元线性回归等统计学方法对有效问卷数据进行分析。结果 不同地区的就医习惯、服务方式、常用药的获取情况差异具有统计学意义(P<0.05)。服务总体满意度均值为(4.32±0.625)分,处于“满意”与“非常满意”之间。线性回归结果显示,失能程度、慢性病患病情况、地区差异、就医习惯、服务方式、常用药获取情况、地理可及性情况是服务满意度的影响因素(P<0.05)。结论 老年人所接受的居家社区医养结合服务对于基层医疗卫生机构利用情况较好,服务总体满意度较高,但存在地区之间发展不平衡的问题。应进一步以基层医疗卫生机构为重点发展居家社区医养结合服务,完善医保支付机制,加快建立健全长护险制度,不断提高居家社区老年人的满意度和居家社区医养结合服务质量。

运用一站式智能导医平台改善患者就医体验

智能导医是医院智慧服务的重要组成部分。上海市胸科医院借助事件驱动和人工智能技术,以微信公众号为载体,构建了一站式智能导医平台,根据不同患者门诊就医需求,制订个体化就医规划,以任务流形式串联各就诊环节,缩短了患者候诊时间,缓解了导医工作压力,改善了患者就医体验。

基于门诊全流程服务管理的提升患者体验实践探索

提升患者门诊全流程就诊体验是改善患者就医感受的重要举措。首都医科大学附属北京同仁医院在持续改善医疗服务的基础上探索建立门诊全流程服务管理体系,通过理念向前服务前置,聚焦患者诊前体验;流程简化智慧引领,优化患者诊中体验;延续诊疗模式创新,提升患者诊后体验。打造现代门诊医疗服务模式,不断满足人民群众日益增长的医疗服务需要。

基于改善患者就医体验的门诊服务模式构建与效果分析

门诊服务质量直接影响患者就医体验。绵阳市中心医院以患者为中心,聚焦就医流程、服务要素、特殊群体就医需求、组织保障等,简化服务流程,优化服务要素配置,满足特殊群体就医需求,实现了门诊服务的精细化管理,改善了患者就医体验。

基于结构变动分析的我国医院医疗资源配置及服务利用现况研究

目的以我国医院分类为基础,分析我国医院医疗资源配置及服务利用变动情况,为了解我国医疗服务体系建设现状和探索合理配置资源提供数据支持和依据。方法通过采集我国2013—2022年公开发布的卫生事业发展相关数据,选取机构数量、卫生技术人员、执业(助理)医师、注册护士、管理人员、门诊服务诊疗人次和入院人次作为评价指标,采用结构变动分析法对我国医院医疗资源配置及服务利用结构变动情况进行现况描述与分析。结果我国医院医疗卫生服务资源绝对数量呈现逐年增长趋势,其中综合医院和专科医院构成比和结构变动贡献率位列前两位。综合医院机构数量、卫生技术人员、执业(助理)医师、注册护士、门诊服务诊疗人次和入院人次的结构变动值在研究期内均为负数,呈负向变动,专科医院则相反。综合医院管理人员在2020—2021年由负向变动转为正向变动,而专科医院相反。中医医院、中西医结合医院、民族医院以及护理院医院各评价指标结构变动幅度和贡献率均相对较小。结论综合医院医疗资源及服务利用整体呈负向变动,专科医院整体呈正向变动,说明我国在有力推动优质资源总量增加的基础上,建设优质高效的整合型医疗卫生服务模式取得成效。医院在对从事管理人员的选拔、培训及发展制度体系建设中仍不完善,中医、中西医结合、民族医院和护理院迫切需要加强统筹与规划。