Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Nursing emergency management practice of COVID-19 in a traditional Chinese medicine hospital

Nursing work is an integral part of hospital work.Under the challenge of the COVID-19 epidemic,it is particularly important to establish a timely and efficient nursing management system.The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills.The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions,rational allocation of human resources,and strengthening personnel training,so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

ChatGPT在中医医院智慧化建设中的应用、挑战及对策

以ChatGPT为代表的生成式人工智能给中医医院智慧化建设带来了机遇与挑战。文章探讨了ChatGPT在助力中医经验传承发展、辅助青年中医提高诊疗质量、提升中医医院运营管理效率、实现全生命周期健康管理几个方面的应用场景,指出其应用面临着医患双方的传统观念、中医医院信息化基础薄弱、生成式人工智能技术缺陷、管理制度与监管体系尚不健全等挑战。提出需要调整认知、树立对生成式人工智能的正确观念;加强中医医院信息基础设施建设;鼓励生成式人工智能技术研发;完善管理制度与监管体系,推进生成式人工智能技术在中医医院智慧化领域的合理应用等建议。

基于CiteSpace可视化下的国内医疗机构中药制剂研究热点与趋势分析

目的 探索20年来医疗机构中药制剂发展脉络趋势,以期为将来医疗机构中药制剂的发展提供路线参考。方法 通过CNKI检索2003~2023年医疗机构中药制剂相关文献,利用CiteSpace软件,将作者、发文机构、关键词等信息做可视化分析。结果 共检索文献666篇,随国家政策的变化,发文量在2010年后逐年增加,并于2021年迎来高峰,杨忠奇团队近年来发文量较多,且研究课题较为前沿,北京市药品审批中心为发文量最多的机构,且合作机构较多。结论 医疗机构中药制剂近年来发展迅速,研究热点从基本的工艺流程、临床研究、制剂分析向传统工艺中药制剂备案管理、新药孵化、质量控制、传承创新转换,未来长时间内新药孵化、备案管理、质量控制仍将作为本领域的研究热点及方向。

基于DEA-Malmquist指数模型的我国中医医院服务效率评价研究

目的评价2017—2023年全国30个省(区、市)中医医院的服务效率,为促进中医医院高质量发展提供参考。方法运用数据包络分析法中的BCC模型和Malmquist指数模型测算全国中医医院服务效率的静态和动态变化,利用时间序列预测法预测2022—2023年的指标变化并进行动态评价。结果2021年全国中医医院的综合效率均值为0.852,50%的省(区、市)处于DEA无效状态,2017—2021年全国中医医院的总体服务效率呈现下降态势,全要素生产率指数均值为0.958,平均下降4.2%,东、中、西部地区的指数均值分别为0.978、0.946和0.951,3大地区均出现不同程度的下降,经预测分析后的2017—2023年整体效率变化趋势不大。结论全国中医医院的总体服务效率处于较低水平,且区域发展差异明显,其中技术进步指数是一项重要影响因素。各省(区、市)应合理控制中医医院的发展规模,不断推动技术进步,提高资源利用率,逐步缩小地区差异,进而提升中医医院的服务效率。

基于三阶段DEA模型和Malmquist指数的我国中医医院运营效率研究

目的:分析2017—2021年我国30个省(区、市)中医医院运营效率变化情况,为促进中医医疗资源均衡布局提供依据。方法:运用三阶段DEA模型对2021年数据进行静态分析,采用Malmquist指数模型对2017—2021年数据进行动态分析。结果:剔除环境变量和随机干扰的影响后,2021年我国中医医院运营综合效率均值为0.886,环境变量对中医医院运营效率的影响显著,2017—2021年全要素生产率变化指数均值为0.958,各省(区、市)的技术变化指数均小于1。结论:我国中医医院运营效率存在区域差异;各地应积极适应人口老龄化趋势,科学规划中医资源以促进区域协调发展;中医医院应优化管理模式,提升中医技术水平,促进中医技术的传承与创新。

两组不同中医体质安氏Ⅱ^(1)错(牙合)患者运用PASS技术矫正前后牙颌相关指标及体质的变化

目的:比较平和质与阴虚质安氏Ⅱ1错(牙合)患者运用PASS矫正技术治疗后牙颌及体质相关指标的变化。方法:选择2019年2月-2023年2月来笔者医院口腔科就诊的安氏Ⅱ类1分类患者为研究对象,通过体质分型选择平和质(10例)与阴虚质(10例)错(牙合)患者运用PASS矫正技术进行治疗,比较两组患者矫正时托槽的脱落情况,矫正前后面型、牙颌及体质的改变。结果:平和质组患者托槽的脱落率明显小于阴虚质组(P<0.05);两种体质患者运用PASS矫正技术治疗前后的头影测量结果差异有统计学意义(P<0.05);矫正结束半年后,阴虚质较平和质患者的体质发生了明显改善(P<0.05)。结论:相较于阴虚体质错(牙合)患者,平和质体质错(牙合)患者在托槽脱落情况及矫正结束后体质的转归方面具有明显优势,因此不同体质对于错(牙合)畸形的矫正具有一定的指导意义。

DRG支付改革对A市中医院运行的影响

分析A市某三甲中医院在DRG支付改革下面临的问题,提出相应对策。采用间断时间序列模型分别对改革前(2019年1—12月)与改革后(2020年1月—2021年12月)共三年的3个医疗服务效率指标、4个费用控制指标、6个中医医疗服务水平指标共13个指标数据进行分析。结果显示,改革后平均住院日呈下降趋势,次均门诊费用增速放缓。材料费用占比呈上升趋势。中药饮片收入占药品收入比例、住院中医医疗服务项目收入占住院医疗收入比例、中医药治疗收入占住院医疗收入比例、出院患者使用中医非药物疗法的比例呈下降趋势,出院患者中药饮片使用率增速放缓。基于此,建议针对不同治疗特点的病种采取不同的医保支付方式,继续加大医保对中药的政策支持力度,加强费用控制,适时调整付费标准以体现中医“简便验廉”的优势。

基于PDCA的同质化质量管理模式对中医院门诊服务质量的影响

目的:探讨基于PDCA的同质化质量管理模式对中医院门诊服务质量的影响。方法:选取2022年10月—2023年4月于中山市中医院悦来门诊就诊的患者79例为实施前组,2023年5—10月同院门诊就诊的患者79例为实施后组。实施前组实施常规医疗质量管理,实施后组实施PDCA的同质化质量管理模式。比较两组医疗服务质量、服务满意度及不良事件发生情况。结果:实施后组流程秩序、服务态度、操作技术得分均高于实施前组(P<0.001);实施后组满意度高于实施前组(P=0.015);实施后组不良事件总发生率低于实施前组(P=0.028)。结论:基于PDCA的同质化质量管理模式能提高中医院门诊医疗服务质量及满意度,降低不良事件发生率。

基于Kano模型的中医医院微信公众号需求分析

采用Kano问卷调查方法,分析不同使用目的用户对中医医院微信公众号各功能点关注度的优先级排序,提出建议,包括明确自身定位、针对性功能开发等,从而构建特色微信公众号服务平台,促进中医医院品牌建设和微信公众号长期发展。

Brief Introduction to Xiyuan Hospital of China Academy of Traditional Chinese Medicine

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中药足浴联合光子治疗在Wagner 0级糖尿病足病人中的应用

目的:研究中药足浴联合光子治疗在Wagner 0级糖尿病足病人中的应用效果。方法:选取符合要求的Wagner 0级糖尿病足病人75例,随机分为对照组37例和治疗组38例,对照组予常规糖尿病治疗,治疗组在对照组的基础上加上中药足浴和光子治疗仪照射。4周后比较两组病人踝肱指数(ABI)、多伦多临床神经病变评分(TCSS)、中医证候及治疗有效率。结果:治疗4周后,两组病人的ABI均高于治疗前,且治疗组ABI优于对照组;治疗后,两组病人TCSS及中医证候积分较前降低,且治疗组TCSS及中医证候积分低于对照组(P<0.05);治疗后,治疗组有效率(89.5%)高于对照组(67.6%)(P=0.021)。结论:中药足浴联合光子治疗在Wagner 0级糖尿病足病人中应用,可以改善病人ABI,降低TCSS评分及中医证候积分,提高临床疗效。

中医医院新入职本科护士培训考核评价指标的构建

目的 构建中医医院新入职本科护士培训考核评价指标。方法 通过文献研究、小组讨论,建立中医医院新入职本科护士培训考核评价指标初稿,选取来自7个省份的中华护理学会中医中西医结合护理分会的15名专家进行2轮专家咨询,确定考核评价内容及其权重。结果 2轮专家函询问卷的有效回收率均为100%,专家权威系数分别是0.962、0.980,肯德尔协调系数分别是0.220、0.268(均P<0.05),最终形成的中医医院新入职本科护士培训考核评价指标包括5项一级指标、24项二级指标和77项三级指标。结论 构建的中医医院新入职本科护士培训考核评价指标具有较高的可靠性和科学性,可为中医医院管理者及培训者选拔人才提供参考。

湖北省中医医院信息化建设现状分析与思考

目的/意义了解湖北省中医医院信息化建设现状和问题,提出进一步推进中医医院信息化建设的建议。方法/过程基于2022年湖北省中医医院信息化建设现状调查数据,采用描述统计、χ^(2)检验、Fisher检验等方法,阐述湖北省公立中医医院信息化管理部门设置与人员结构、基础设施与资金投入、业务应用系统、信息标准及新一代信息技术应用等方面的现状,剖析存在的主要问题。结果/结论湖北省中医医院信息化建设取得初步成效,但仍应优化信息管理部门职能、充实信息化人才队伍、加强经费投入、强化标准应用、深化中医药特色优势、推进新技术应用等。

基于波士顿矩阵分析法的区域医院科技创新效率研究

目的通过客观评价了解区域医院科技创新效率,推动医院医学学科建设,为医院争创国家区域医疗中心的建设目标提供助力。方法基于医院科技量值指标体系,选取深圳市67家三级医院作为研究对象,分析医院科技创新发展情况,利用波士顿矩阵分析法反映医院科技创新效率。结果深圳市医院间科技创新效率有较大差距:6家医院以相对低的科技投入产生了较高的科技产出,科技创新效率最好;13家医院以较高的科技投入产生了较高的科技产出,具有较好的科技创新效率,科技产出仍可再提升;1家医院科技投入高而科技产出较低,具有较低的科技创新效率,在科技产出方面仍有较大提升空间;47家医院科技投入较低且科技产出也较低,在科技投入及科技产出两个维度仍需发力。结论应依据城市经济高质量发展水平,加强医院科技创新投入水平,引导产出高质量医学科技成果,提升医院科技创新效率。

疾病诊断相关分组支付方式对三甲中医院财务管理的影响及应对策略

探讨了疾病诊断相关分组(DRG)支付方式对三甲中医院财务管理的影响并提出应对策略。结合所在医院随机抽取的某月各科室相关数据,运用DRG支付方式下的相应指标并结合波士顿矩阵理论模型进行全面综合评价分析。2023年1月,所在医院5个科室CMI值高于全院平均水平,且盈余情况良好;8个科室CMI值低于全院平均水平,但有盈余;14个科室CMI值低于全院平均水平,且还有亏损;8个科室CMI值高于全院平均水平,却有亏损。DRG支付方式对三甲中医院来说,既是机遇也是挑战,对三甲中医院信息化数据系统、成本核算精细化提出高要求,对预算管理、拓展收入增长内涵提出新要求。三甲中医院应重视病案质量主体培训,强化成本内控,转为质量效益型运营管理模式,应用临床路径以“提质控费”,发挥中医药优势学科,结合中医治疗特点来制定适合中医发展的DRG支付方式。

在综合医院中医规培中加强中医经典教学的探索

中医住院医师规范化培训(以下简称“规培”)是中国住院知师培训的重要组成部分,同时也是医教协同深化中医学人才培养改革的关键环节,更是加强中医临床人才队伍建设的有效途径和加快构建具有中国特色医学人才培养体系的重要举措。中医经典理论是中医学术的灵魂,是数千年来中医实践的经验结晶,是培养中医临床思维,提升中医临床技能的重要途径。此文分析综合医院中医规培教学中经典教学的不足,提出相应对策,探讨加强中医规培经典教学、培养学员中医临床思维的方法。

基于双重差分法的DRG付费对中医医院的影响研究

目的:评估按疾病诊断相关分组(DRG)付费对中医医院住院患者例均总费用、费用结构、住院时长、出院人数及中医特色的影响。方法:以某中医类国家区域医疗中心为研究对象,使用双重差分回归模型(DID)分析付费改革政策实施前后医保患者(干预组)与非医保患者(对照组)的各项指标差异,通过平行趋势检验和安慰剂检验证实模型可靠性和稳定性。结果:例均住院总费用、病例数、住院天数、医疗服务收入占比、饮片收入占比等十一项指标的DID交互项系数显著(P<0.05),费用指标回归系数均小于0。饮片使用率、中医非药物疗法收入占比等四项指标DID交互项系数不显著(P>0.05)。结论:DRG付费政策显著降低付费病组例均总费用,其中耗材、医技费用下降显著,费用结构优化,中药饮片费用占比略微下降。应持续关注DRG付费对中医医院影响,进一步扩大样本范围,跟踪分析政策影响,全面评价DRG付费政策对我国中医医疗机构的影响。