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.

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

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The role played by traditional Chinese medicine in preventing and treating COVID-19 in China

Traditional Chinese medicine(TCM),an ancient system of alternative medicine,played an active role in the prevention and control of COVID-19 in China.It improved the clinical symptoms of patients,reduced the mortality rate,improved the recovery rate,and effectively relieved the operating pressure on the national medical system during critical conditions.In light of the current global pandemic,TCM-related measures might open up a new channel in the control of COVID-19 in other countries and regions.Here,we summarize the TCM-related measures that were widely used in China,including TCM guidelines,the Wuchang pattern,mobile cabin hospitals,integrated treatment of TCM and modern medicine for critical patients,and non-medicine therapy for convalescent patients,and describe how TCM effectively treated patients afflicted with the COVID-19.Effective TCM therapies could,therefore,be recommended and practiced based on the existing medical evidence from increased scientific studies.

Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data

Objective:To assess the trends in characteristics,treatments,and outcomes of acute myocardial infarction(AMI)patients in tertiary Chinese medicine(CM)hospitals in China between 2006 and 2013.Methods:This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years(2006 and 2013).Patients admitted to the hospital for AMI were enrolled.Hospital records were used as the data source.Case data were derived regarding baseline characteristics,treatments,and outcomes of patients to assess changes from 2006 to 2013.Logistic regression was used to analyze the relationship between prognosis,general influencing factors of disease,and various treatment measures.Results:Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013(18 were repetitive)were surveyed.A total of 2,311 patients with AMI were enrolled(1,094 cases in 2006 and 1,217 cases in 2013).From 2006 to 2013,the mean age did not significantly change,but the proportion of patients younger than 65 years increased.The prevalence of risk factors such as hypertension,diabetes,and hyperlipidemia also increased.Significant increases were observed in primary percutaneous coronary intervention[20.48%(2006)vs.24.90%(2013)]and revascularization[36.11%(2006)vs.52.42%(2013)].In-hospital mortality decreased from 11.15%in 2006 to 10.60%in 2013.A mortality logistic regression analysis identified reperfusion therapy[odds ratio(OR),0.222;95%confidence interval(CI),0.106–0.464],Chinese patent medicines(OR,0.394;95%CI,0.213–0.727),and CM decoctions(OR,0.196;95%CI,0.109–0.353)as protective factors.Conclusion:Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly,but in-hospital mortality has not significantly decreased.Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.

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。

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。

2018年至2022年某中医院第二类精神药品使用情况分析

目的促进中医院第二类精神药品的合理使用。方法利用医院信息系统收集安徽省芜湖市中医医院2018年至2022年第二类精神药品的销售数据,分析用药频度(DDDs)、限定日费用(DDC)、排序比(B/A);按第二类精神药品门急诊处方150张/年和病历医嘱50份/年,根据药品说明书、相关指南及专家共识进行处方点评。结果2020年,第二类精神药品销售金额最大,占全院药品销售总金额的1.86%;地佐辛注射液、盐酸曲马多缓释片、咪达唑仑注射液销售金额排名前3;阿普唑仑片、艾司唑仑片、地佐辛注射液的DDDs排名前3;阿普唑仑片的DDC最低;地佐辛注射液的B/A在0.33~1.00之间。共收集1000张处方/医嘱,其中合理处方709张,合理医嘱228条,合理率为93.70%;不合理类型包括用药不规范、不适宜。结论该院2018年至2022年第二类精神药品的使用存在不合理现象,应继续加强对其的管理和监控,确保临床用药安全、合理。

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。

深圳市公立中医医院医疗服务价格改革历程与思考

通过梳理深圳市公立中医医院医疗服务价格改革历程,分析优势与难点,提出动态调整中医药服务价格,定价应体现中医劳务价值和技术价值,完善医疗服务价格目录,建立中医医疗技术评定指标体系等建议,以助推中医药综合改革,优化深圳中医医疗服务价格改革模式。

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。

2019~2023年某中医院6种多重耐药菌临床分布与耐药性分析

目的了解本院6种多重耐药菌的分布及耐药情况。方法对北京中医药大学东方医院2019年1月至2023年12月分离的菌株进行分析,统计6种临床常见耐药菌的检出情况。结果耐碳青霉烯类大肠埃希菌(CRECO)、耐甲氧西林金黄色葡萄球菌(MRSA)检出率呈逐步上升趋势;耐碳青霉烯类肺炎克雷伯菌(CRKPN)、耐碳青霉烯类铜绿假单胞菌(CRPA)呈波浪形下降趋势;耐碳青霉烯类鲍曼不动杆菌(CRAB)起伏波动较大;万古霉素耐药肠球菌(VRE)总体检出率较低,变化趋势不大。6种多重耐药菌主要分布于脑病内科、脑病外科、呼吸热病科、急诊科、重症监护、肿瘤科等科室。标本来源中CRKPN、CRPA、CRAB、MRSA均以痰标本为首,CRECO、VRE均以尿标本为首。性别方面,CRKPN、CRPA、CRAB、MRSA男性多于女性,CRECO和VRE则反之;6种耐药菌年龄分布均以60岁以上老年患者为主;季节分布上,CRKPN、CRPA、VRE以冬季占比最高,CRAB以夏季占比最高,CRECO、MRSA则是以秋季占比最高。CRECO、CRKPN、CRAB对多种抗菌药物耐药率均较高。结论应加强对多重耐药菌的监控,延缓细菌耐药发生。

“六一”绩效管理模式赋能中医医院高质量发展实践探索

目的探索构建公立中医医院内部绩效考核管理体系,实现以绩效“国考”推动公立医院高质量发展的目标。方法在分析绩效考核过程中存在的问题与面临的困境的基础上,以三级公立中医医院绩效考核指标为导向,创新“六一”绩效管理策略和手段,即坚持“一盘棋”整体规划、“一条链”融会贯通、“一张网”全面覆盖、“一条龙”全程服务、“一本账”精细管理、“一个螺旋”持续改进,建立医院内部绩效考核管理体系。结果医院内涵建设取得一定成效,中医特色优势持续彰显,质量安全内涵日趋深化,运营管理效率稳步提升,学科建设成果实现突破,人才培养成效显著,医患双方满意度提升明显。结论构建科学、规范、标准的医院内部绩效考核管理体系,确保国家三级公立中医医院绩效考核工作落实到位,促进公立医院高质量发展。

国家医院绩效考核引领下的中医院发展策略探讨

随着国家对医疗卫生事业的重视和投入不断加大,公立医院的绩效考核成为衡量医院综合能力的重要标准。在本轮国家公立三级中医院绩效考核中,宁波市中医院以绩效改革为引擎,推动精细化管理,注重医疗质量和行为规范考核,建立科学的绩效分配考核体系,按劳分配,优劳优酬。此外,医院还注重学科建设,发展中医特色专科,加强优势品牌专科和保障性专科的建设,提升医疗质量和声誉,推动中医药事业健康发展。

传统膏方在中医院临床应用规律及经济发展前景

目的 通过分析中医院近十年膏方使用情况,研究其临床应用变化并了解在药物经济学下的影响。方法调取2014—2023年浙江中医药大学附属第一医院门诊膏方信息资料,采用Excel表对处方信息分类汇总及分析。结果 服用膏方人群以女性为主,平均年龄45岁;大众对膏方认可度较好,具有良好的依从性,且个性化服务需求明显;膏方具有良好的经济性价比。结论 膏方发展前景广阔,应从多方面提高膏方消费者满意度。

强内涵 促发展——现代中医医院建筑形态布局研究

结合中医医院建筑的发展历程和时代需求,对我国当今中医医院建筑形态布局的类型进行归纳,分析总结各类形态布局特点,探讨中医医院建筑形态布局的设计方法,提出与自然环境有机结合、传承创新建筑文化、功能布局高效便捷、弹性设计等设计策略,为现代中医医院建筑形态布局设计提供参考。