Present situation and the countermeasures of health human resources in Guangxi general hospitals at the county - level

[目的] 了解广西县级综合医院卫生人力资源状况,为进一步推进县级医院改革提供建设性意见. [方法]通过问卷调查法、数理统计法等综合分析广西县级综合医院卫生人力资源现状.[结果]广西县级综合 医院在岗人员在编率为41.56%,医护比为1： 1.68, 67.12%的卫生技术人员职称为初级及以下,超七成拥有 大专及以上学历.[结论]广西县级综合医院卫生技术人员在编率较低,医护比、职称及学历结构不合理,整 体年龄偏低,需通过综合措施加以改善.

Update of Cultivated Land Quality Grade Based on GIS—A Case Study of a County in Guangxi

The quality of cultivated land has an important influence on agricultural output, food security, sustainable development and the ability of using cultivated land resources. As the trend of cultivated land quality is getting more and more attention, in order to strengthen the management of cultivated land quality, improve the precision of cultivated land quality and other achievements, and maintain the current situation of cultivated land quality and other achievements. For this paper, taking A county of Guangxi Zhuang Autonomous Region as an example, with the support of GIS, the paper studies the grade and grade renewal of cultivated land by using the superposition method, studies the grade and grade change of regional cultivated land and its spatial distribution, grasps the status quo change of cultivated land and the grade and grade change of cultivated land caused by the quality construction of cultivated land in the year, and then provides scientific data for land use plan, land consolidation and cultivates land protection.

SUSTAINABLE USE OF LAND RESOURCE AND ITS EVALUATION IN COUNTY AREA—A Case of Guangxi Zhuang Autonomous Region, China

Sustainable use of natural resources is different from sustainable development. As the most important natural resource, sustainable use of land resource is the essential guarantee of sustainable development. The nature of sustainable use of land resource is to retain the quantity and productivity of land resource from generation to generation.The evaluation of sustainable use of land resource is an important method to ensure land use to get onto the sustainable track. Furthermore, building index system is the key of the evaluation. In view of tendency of the evaluation indexes chosen so widely, the evaluation indexes should include only three kinds in the researches on the evaluation of sustainable use of land resource. The first is the stock and structure index of land resource, viz. Areas quantity structure of land resources. In China, it is especially paid attention to the per person index of land quantity and rate between cultivated land and farmland. The second is the productive index of land, which includes the productivity, potentiality, stability and renewal situation of land. The third is the sustained index of land environment. On the evaluation research of area level, we should lay particular emphasis on statistic indexes. With a case of Guangxi Zhuang Autonomous Region in China, the evaluation index system of sustainable land use in county area has been built in this thesis. Using the weighted average method to calculate the means of sustainable land use in each county, according to the land using situation, all counties in the autonomous region have been divided into three types. (1) Sustainable Pattern contains 18 counties, which have higher land resource productivity, stronger sustained abilities of land environment .The economic benefits of land using in these counties are obviously higher. These counties have gotten highly intensive farming, and they are all in the good circumstance. (2) Basically Sustained Pattern contains 48 counties, which productivity of land resource is of middle level. In part of counties and cities, the stock of land resource inclines to lower level, but their land using potentialities are still greater. Through changing land using pattern, these counties can rapidly enter in a good circumstance. (3) Critically Sustained Pattern contains 14 counties, which are mostly in the karst mountain areas. They have less stock of land resource, lower productivity and more extensive cultivation. The productivity of land renewing has been hindered, so it urgently need to be renovated. At last, the writers have explored the basic ways of sustainable use of land resource in Guangxi, China — (1) Retain the stock of land resource and strictly manage farmland uses. (2) Strengthen the value accounting of land resource, and control the farmland occupation of non agricultural construction. (3) Depend on technology advanced, optimize the land using structure, and promote the productive level. (4) Carry out land management all round, and improve the ecological environment of land resource. (5) Enhance evaluation researche and land monitoring, and promote the sustainable utilization level of land resource.

A Basal Titanosauriform from the Early Cretaceous of Guangxi, China

Based on a partial postcranial skeleton collected from the Lower Cretaceous Napai Formation of Guangxi, China, we erect a new sauropod taxon, Fusuisaurus zhaoi gen. et sp. nov. The holotype specimen consists of the left ilium, left pubis, anterior caudals, most of the dorsal ribs and distal end of the left femur. Fusuisaurus zhaoi is diagnosed by a unique combination of character states among the known sauropods. It displays several synapomorphies of Titanosauriformes but lacks many derived features seen in other titanosauriforms, suggesting that the new taxon represents the basalmost known titanosauriform and providing new evidence that Titanosauriformes originated from Asia. A size comparison suggests that Fusuisaurus zhaoi is among the largest Early Cretaceous sauropods, providing an important addition to the Early Cretaceous Chinese sauropod diversity.

A Cross-sectional Study Assessing Predictors of Essential Medicines Prescribing Behavior Based on Information-motivation-behavioral Skills Model among County Hospitals in Anhui, China

Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills （IM B） model to identify the predictors of essential medicines prescribing behavior （EMPB） among doctors and to examine the association between demographic variables, IMB, and EMPB. Methods： A cross-sectional study was carried out to assess predictive relationships among demographic variables and IM B model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the I MB model to test the instruments using analysis of moment structures 17.0. Results： A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old （range： 22-67 years old）. The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 a： 7.34 （hundred mark system： 75.77） and 19.92 ± 3.44 （hundred mark system： 79.68）, respectively. Approximately half（50.8%） of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data （x^2/df= 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066）. More work experience （β = 0.153, P 〈 0.001 ） and behavioral skills （β = 0.449, P 〈 0.001 ） predicted more EMPB. Higher income predicted less information （β = -0.197, P 〈 0.001） and motivation （β =0.204, P 〈 0.001 ）. Behavioral skills were positively predicted by information （β = 0.135, P 〈 0.001 ） and motivation （β = 0.742, P 〈 0.001 ）. Conclusion： The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.

Impact of the zero-markup drug policy on volume of medical service:based on 57 county hospitals of China

In the present study,we aimed to assess the long-term impact of zero-markup drug policy on volume of medical service in county hospitals of China.This study used 57 county hospitals’records of medical service from 2011 to 2015,and a fixed effect model was applied to examine the impact of the zero-markup drug policy on volume of medical service.The outcome indicators included the number of patient visits,the number of prescriptions,the number of discharged patients,the length of stay,the number of patients who had surgeries and the number of patients who had CT or MRI,monthly.The number of hospitals which implemented the zero-markup drug policy was increased continuously.By the end of 2015,41 hospitals(71.9%)implemented this policy.The panel regression showed that most indicators were insignificantly decreased,including the number of patient visits(P<0.01),the length of stay(P<0.05),the number of patients who had surgeries(P<0.01)and the number of patients who had CT or MRI(P<0.01).However,the number of prescriptions and the number of discharged patients were not significantly changed.The implementation of the zero-markup drug policy might affect the reduction of the volume of medical service in county-level hospitals and the reason needs to be clarified in future studies.

Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

基于DRG质量绩效视角的县域医院协作成效评价体系构建及应用

目的:基于DRG质量绩效视角搭建县域医院协作成效评价指标体系,为评估协作成效提供科学依据。方法:应用文献研究、半结构访谈梳理形成初步指标池,再通过“德尔菲专家咨询-层次分析”方法确定评价指标体系和权重,采用加权TOPSIS进行实证案例分析。结果:两轮德尔菲专家咨询问卷有效回收率分别是94.74%和100%,权威系数为0.878,Kendall协调系数均在0~1,CR<0.1,指标通过一致性检验,最终构建了由3个维度18个指标的协作成效评价体系,维度层面“工作量”权重最大(50.682%),指标层面“出院人次”权重最大(12.903%),加权TOSIS结果显示近5年2023年医院质量绩效最好,协作成效开始显现。结论:基于质量绩效视角构建的协作成效评价体系具有科学性和可操作性,两院合作有成效。

区县级医院学科发展竞争力指标体系研究

目的:构建一套科学实用的区县级医院学科发展竞争力评价指标。方法:基于PEST+SWOT分析法探索区县级医院学科发展关键要素及其运行机制,初筛学科发展竞争力指标体系;运用德尔菲法开展两轮专家咨询确定指标体系及权重。结果:该指标体系包括一级指标4个维度(医院管理及综合实力、人才队伍建设、科研创新、教育培训)、二级指标16个、三级指标38个。两轮专家咨询积极系数均为100%,各指标评分变异系数CV值均<0.2,专家协调程度较高,专家权威系数分别为0.94和0.91;各指标第二轮专家评分均值>3.8,大多数指标得分4以上。结论:经专家反馈和统计检验,该指标体系具备科学性和实用性。

基于全流程仿真创伤救治模拟演练下的县域医院创伤救治现状分析

目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟演练。本研究对演练中创伤院前急救、院前院内信息联动、院内早期评估与处置、院内救治模式和流程、影响救治结局因素等进行归纳统计分析。结果40家县域医院,其中二级医院29家,三级医院11家;院前急救模式:依托型32家,指挥型6家,独立型2家;院前急救能力方面:院前规范处置31家,不规范处置7家,不处置2家;院前院内信息联动方面:电话/微信24家,院前急救系统8家,中国创伤联盟紫云系统6家,无信息交互2家;院内交接和早期评估:能够按照创伤救治规范化培训要求进行评估和处置23家,不规范17家;创伤救治模式方面:以急诊科为主导的多学科会诊模式34家,创伤科主导的创伤救治模式4家,专科主导多学科会诊模式2家;实体创伤病房6家,急诊病房23家,无病房11家;40名模拟创伤患者16人死亡,其余存活,死亡原因为早期评估和处置不规范,输血流程不合理、创伤相关核心技术缺乏,有效运行的创伤多学科团队缺乏。结论县域创伤救治过程中存在创伤早期评估和核心技术不足、缺乏院内高效的多学科救治团队、创伤集中收治模式尚未普及等问题,亟须重视解决。

广东省县区级医院感染管理质量控制中心的现状调查

目的调研广东省县区级医院感染管理质量控制中心现实情况,为本省院感质控中心对县区级院感质量控制中心质控管理方案的制定提供参考依据,并探讨相应的管理对策。方法通过问卷星问卷调查平台对广东省2023年12月31日前成立的县区级质控中心进行调研,内容包括医院感染管理专业质控中心的成立时间、人员架构、信息化水平、管理、质控及培训工作情况等。结果广东省有68家县区级院感质控中心,覆盖率达50.37%,近五年成立的占95.59%。专家以临床和护理为主(分别占23.75%、62.97%),学历以本科为主(占71.06%)。仅13%有运行经费。39家已建医院感染信息化监测,23家未配备,6家在建。20家进行质控督导出具质控报告,占29.41%;41家举办培训,占60.29%。结论广东省医院感染管理质量控制组织体系县区级覆盖率正在稳步提升,但是未完全覆盖所有县区,缺乏政策、经费支持,人员配备、人员专业覆盖面不足。卫生健康行政部门及县区级院感质控中心需统一监测标准、质控规范及考核评价方案,提升院感质控能力,完善“四级”管理与培训体系,以有效推动提升基层医疗机构的质量安全管理水平。

广西公立医院负债情况分析

目的:分析广西公立医院负债情况及成因,为促进医院高质量发展提供参考。方法:基于2019—2022年384家公立医院财务年报数据,采用Excel软件进行统计分析。结果:2019—2022年广西公立医院资产和负债规模持续上升,负债增长速度快于资产,资产构成以非流动资产为主,负债以流动负债为主;资产负债率持续上升并接近50%的警界线,流动比率偏低;规模扩张过快、医疗服务价格调整滞后和财政投入不足是导致公立医院债务负担加重的主要原因。结论:广西公立医院资产与负债结构失调,医疗亏损持续扩大,存在债务风险,应严禁医院举债建设,优化医疗资源规划布局,完善财政补助政策,建立医疗服务价格动态调整机制,提高医院运营管理水平。

广西边境地区县域卫生资源配置状况研究

目的分析广西边境地区县域卫生资源配置现状及其公平性,为优化县域卫生资源配置提供参考。方法收集广西边境地区8个县域2015—2021年的卫生资源数据,从人口、地理两个维度评价县域卫生资源配置的公平性。结果2015—2021年,广西边境地区8个县域的卫生资源总体呈逐年增加的趋势,但大部分县域千人口床位数、执业(助理)医师数、注册护士数低于广西平均水平;按人口配置的各类卫生资源公平性的基尼系数优于按地理配置的。结论应强化政府在卫生资源配置中的宏观调控功能,进一步提高广西边境地区卫生资源配置水平;加大边境地区县域卫生人力资源投入力度,持续提升卫生人力资源供给能力;多措并举,稳定边境地区村卫生室人员队伍;优化边境地区县域卫生资源空间布局,保障卫生资源配置的公平性。

医联体县级医院静脉输液治疗专科护理帮扶体系的构建

目的:构建医联体县级医院静脉输液治疗专科护理帮扶体系,为医联体县级医院静脉输液治疗专科护理帮扶提供依据。方法:以“结构-过程-结果”三维质量结构理论为理论基础,运用文献回顾、问卷调查、半结构式访谈初步拟定县级医院静脉输液治疗专科护理帮扶体系初稿,采用德尔菲专家咨询法构建医联体县级医院静脉输液治疗专科护理帮扶体系终稿。结果:3轮专家咨询问卷有效回收率分别为91.3%、100.0%、100.0%,专家权威系数均为0.931,肯德尔协调系数分别为0.239、0.244、0.312,经χ2检验,差异均有统计学意义(P<0.001)。最终形成的医联体县级医院静脉输液治疗专科护理帮扶体系包括结构、过程、结果3项一级指标、11项二级指标和54项三级指标。结论:医联体县级医院静脉输液治疗专科护理帮扶体系具有科学性、可靠性和临床适用性,符合静脉输液治疗专科护理临床实践与护理管理特点,能促进静脉输液治疗专科护理优质资源有效、有序地下沉到县级医院。

新疆维吾尔自治区三级医院对口帮扶贫困县县级医院的成效分析

目的:分析新疆维吾尔自治区三级医院对口帮扶贫困县县级医院的成效。方法:2019年1月—2021年12月,新疆医科大学第一附属医院对贫困县4家县级医院进行对口帮扶,采用定量调查和定性访谈相结合的方式评估4家医院的人才队伍发展情况、医疗服务发展情况、经济发展情况。结果:2018—2021年,墨玉县人民医院职工总数、执业医师占比、注册护士数占比逐年上升,年门急诊人次整体呈上升趋势,年出院人次整体呈下降趋势,年手术人次变化较小,总收入处于持平状态,医疗服务收入占总收入比重逐年下降;阿合奇县人民医院职工总数、注册护士数占比变化较小,执业医师占比逐年下降,年门急诊人次变化较小,年手术人次整体呈下降趋势,总收入逐年增长,医疗服务收入占总收入比重逐年下降;莎车县人民医院职工总数、执业医师占比、注册护士数占比逐年上升,年门急诊人次整体呈上升趋势,年出院人次整体呈下降趋势,年手术人次呈逐年上升趋势,医院总收入逐年增长,医疗服务收入占总收入比重总体呈下降趋势;叶城县人民医院职工总数、注册护士数占比逐年上升,执业医师占比变化较小,年门急诊人次、年出院人次整体呈上升趋势,年手术人次呈逐年上升趋势,总收入、医疗服务收入占总收入比重总体呈增长趋势。结论:通过新疆维吾尔自治区三级医院对口帮扶,4家贫困县县级医院人才队伍发展情况、医疗服务发展情况、经济发展情况得以改善,建议政府部门加大支持力度和财力投入,明确对口帮扶任务指标,制定切实可行的长远帮扶规划,提高县医院综合竞争力。

基于应急管理全过程均衡理论的县级公立医院应对突发公共卫生事件应急管理研究——以资阳市安岳县为例

在面对突发公共卫生事件时,县级公立医院主导的救治体系是应对突发公共卫生事件、保障人民生命安全和身体健康的重要基础,是应对突发公共卫生事件实施医疗救援的主阵地。本文基于应急管理全过程均衡理论的“6+1”框架模型,以四川省安岳县县级公立医院为研究对象,对该县县级公立医院应对突发公共卫生事件应急管理流程进行分析,梳理县级公立医院应对突发公共卫生事件的特点,针对不足和短板提出优化安岳县县级公立医院应对突发公共卫生事件应急管理的路径,以期提升县级公立医院应对突发公共卫生事件应急管理的能力与水平。

县级公立医院综合能力评价体系研究

目的:构建适用于县级医院的综合能力评价指标体系,为县级医院高质量发展相关政策实施的跟踪评估提供参考依据。方法:采用文献分析法检索政策文件及文献资料,参考“千县工程”的重点任务,基于结构-过程-结果模型筛选初始指标池;采用德尔菲法和层次分析法构建指标体系并计算指标权重。结果:经两轮专家咨询,专家意见基本达成一致。该指标体系包含4个一级指标(服务能力、辐射引领、运营管理、医疗质量)、12个二级指标和34个三级指标。结构指标占总权重36.9%,过程指标占33.6%,结果指标占29.5%。县级医院结构指标中,医防融合、病例组合指数和信息化建设权重最高;县域医共体结构指标中,慢病管理中心、医保管理中心和信息数据中心权重最高,共同构成了整合型医疗服务体系的基础。样本医院采用本指标体系预评,验证了实用性。结论:指标体系适用于评价县级医院综合能力,可为县级医院高质量发展提供基线调查和后期效果评估的量化工具。

县级医院预算管理中HERP运用案例分析--以A医院为例

近年来,以信息技术为依托的HERP系统受到社会各界的广泛关注.文章以县级医院的预算管理为研究对象,通过对A医院实施HERP系统案例的分析,揭示其在数据集成与共享、实时数据监控、自动化流程、数据分析与决策支持、预算控制与合规性等方面的应用效果,并对县级医院信息化建设未来的发展趋势进行了梳理.

基于三维质量评价模型的县级公立医院高质量发展评价指标体系构建研究

目的基于Donabedian三维质量评价模型构建县级公立医院高质量发展评价指标体系,为科学且系统地衡量县级公立医院高质量发展水平提供参考。方法通过梳理县级公立医院高质量发展相关文献政策,明确高质量发展的内涵,拟定评价指标体系初稿,开展两轮德尔菲专家咨询,确定评价指标体系。结果2轮专家积极系数均为100%,专家权威系数为0.789、0.816,Kendall’s W系数逐轮上升,最终确立涵盖3个一级指标、9个二级指标、37个三级指标的评价指标体系。结论所构建的县级公立医院高质量发展评价指标体系具有一定的可靠性与科学性,为评价县级公立医院高质量发展水平提供依据。

县级医院护士参与“互联网+护理服务”的体验研究

目的深入了解县级医院护士参与“互联网+护理服务”的体验。方法2022年6月—7月,采用目的抽样法,对2组共18名县级医院护士进行焦点小组访谈,运用Colaizzi 7步分析法对资料进行分析,归纳访谈主题。结果共提炼出参与带来的积极体验(收入获得感、自我价值感、职业认同感)、承受诸多负担(工作负担加重、出行不便、服务平台使用困难)、失落感(服务对象范围较窄带来的失落感、出行保障配备不足带来的失落感、服务收费标准与保障机制不完善带来的失落感)3个主题、9个子主题。结论县级医院护士对“互联网+护理服务”的参与体验较为复杂。建议通过优化薪酬激励机制、护理人力资源配置、服务平台、服务收费标准与保障机制等,推动“互联网+护理服务”的顺利运行。