Hospital-based health technology assessment:The next frontier for traditional Chinese medicine hospitals

Hospital-based health technology assessment(HB-HTA)is highly valuable in the application of hospital medical technology,cost control,improvement of medical quality,and protection of medical safety,and its use is increasing daily globally.However,in China,HB-HTA is still in its infancy,and it is yet to be adopted in traditional Chinese medicine(TCM).Therefore,this article introduces the application and development of HB-HTA,as well as discusses the current situation of TCM and related future development strategies to provide ideas and references for the development of HB-HTA in TCM.We conclude and recommend that all major stakeholders,including the state,health departments,and hospital leaders,support and promote the exploration and development of HB-HTA in TCM hospitals and integrative medicine hospitals.We also suggest the utilization of existing talents and introduction of other necessary talents to promote better and faster organizational development,as well as suggest the formation of a national and internationally recognized HB-HTA guidance manual and toolkit for TCM hospitals based on both the national HTA guidelines and the evaluation of TCM hospitals pilot projects.Moreover,we recommend that HB-HTA pilot study should be executed with Chinese patent medicine as the starting point to form the implementation process and framework in the TCM arena.

Assessing the Effectiveness of a Cervical Cancer Screening Program in a Hospital-based Study

This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.

三级医疗机构医院卫生技术评估实施现况

目的分析三级医疗机构医院卫生技术(hospital-based health technology assessment,HB-HTA)评估开展现状,为完善医疗机构HB-HTA的应用提供参考和依据。方法运用便利抽样方法,对国家卫生健康委员会医疗管理服务指导中心HB-HTA工作试点医院和已开展HB-HTA的其他医院进行问卷调查和关键知情人访谈。结果共调查19家三级医疗机构,开展HB-HTA有利于促进医疗机构科学管理决策、保障医疗质量和安全、节约医院预算、提高HB-HTA认知水平。但目前HB-HTA还存在缺乏长期持续开展的激励机制、缺乏HB-HTA相关专业人才和部门、HB-HTA流程过于繁杂、卫生技术评估时效性较差、决策支持效率较低、研究结果推广率低等问题。结论建议加强政策、资金支持,注重加强医院内部卫生技术评估人才的引进和能力培训,积极鼓励和引导医院内部建立具体HB-HTA小组或者部门,探索开发HB-HTA支持决策流程的智能化工具或软件,通过多种方式促进评估成果和评估报告的传播共享,不断完善HB-HTA的开展。

基于医院卫生技术评估体系的4种口服铁剂的综合评价

目的:基于医院卫生技术评估(HB-HTA)体系,对硫酸亚铁片、乳酸亚铁胶囊、多糖铁复合物胶囊和琥珀酸亚铁片等4种口服铁剂的临床价值进行多维度综合评价,为医院药品目录动态调整、临床合理使用口服铁剂类药物等提供循证依据。方法:根据《中国医疗机构药品评价与遴选快速指南》并结合眉山市人民医院实际情况,制订百分制评分体系,从药品药学特性、有效性、安全性、经济性及其他属性共5个方面分别对硫酸亚铁片、乳酸亚铁胶囊、多糖铁复合物胶囊和琥珀酸亚铁片开展评价。结果:4种口服铁剂的评分在40~70分,其中硫酸亚铁片为57.5分,乳酸亚铁胶囊为43.5分,琥珀酸亚铁片为64.5分,多糖铁复合物胶囊为69.0分。结论:基于HB-HTA对4种口服铁剂进行多维度综合评价发现,与其他3种口服铁剂比较,乳酸亚铁胶囊在经济性、医保属性方面差距较大,可为医院遴选与合理使用口服铁剂提供参考。

X射线计算机体层摄影技术的临床应用现状与评估

目的建立CT技术的临床应用评估指标体系并进行卫生技术评估。方法应用流行病学、统计学方法及卫生技术评估方法对某省36家基层装备CT医疗机构从医院性质、CT机性能、临床图像质量、人员资质、安全性、CT利用效率、CT投资效益等方面进行应用评估。结果1.二手CT11台,占30.56%。2.CT机性能检测不合格占14.71%。3.CT临床影像图片质量受多种因素影响。4.人员资质只有17家满足要求,存在无证上岗的情况。5.病人安全性措施参差不齐。6.CT日均检查平均6人次,阳性率平均65%。7.21家CT平均投资回收期是7.7年。讨论36家基层装备CT临床应用评估结果不容乐观,存在应用质量问题及资源浪费现象。建议建立技术使用标准及加强技术准入管理,保障技术应用质量。

System for the Management of the Continuity of Use of Medical Devices in Hospitals

The Technical Services and the Medical Administration of the Hospitals of Trieste have been working for years to ensure the optimal functioning of the Surgery, Intensive Care, Diagnostics and Research Services offered to the Patients and to the University in an 800-bed hospital complex, transforming and innovating the buildings and support installations. We have dedicated special attention to the technologies necessary to guarantee the continuity of the power supply to the electromedical devices, increasingly numerous in highly specialized hospitals. We report the power of the generator sets and the UPS and our opinion that their power must be related to the overall consumption of the hospital, with a reserve margin.