上海市临床医学中心绩效评估研究
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摘要
为了保持和发展上海医学领先地位及整体优势特色,上海卫生系统在“十五”期间推出了“上海市临床医学中心建设”计划,在市级医疗机构投入机制改革的基础上,自2001年起有计划的在市三级医院建设若干个临床医疗水平达国内领先及国际先进的临床医学中心。预期经过5年左右的建设,形成管理现代、服务精良、技术先进、设备完善、以诊治疑难杂症为宗旨,并具有相当规模的标志性医疗中心,使其总体临床水平达到国内一流、亚洲领先及国际先进水平,成为全国乃至亚洲的临床医学中心之一。迄今经过三次选拔,共有在建临床医学中心33个,入选临床医学中心建设的学科均是市三级医院中的优势和重点学科,学科总体水平居国内领先地位。目前,建设3年,需要对临床医学中心进行中期评估,因此,必须建立一套客观、科学、量化的评估指标体系和评估方案,既要体现客观规律、共性目标,又要反映分类指导、个性目标。
方法:①指标体系的构建和制定具体调查表②数据的收集、分析阶段③数据质量的质控:采用统一的调查表,明确调查指标的界定,各定性指标要求附相关证明,同时上报的各部分数据由相关责任人和中心主任签字;数据录入EXCEL数据库,结果的计算用SAS9.0统计软件完成。④评估的统计方法:对各基础数据进行标准化处理:采用计算比值和均值的方法,消除各评估单位基数不同的影响;定性指标有程度不同的(如获得课题和获奖等级等),采用给予不同分值加权值并计算指数的得分;资助后的绩效采用2004年各指标比基年纵向增加%表示。⑤综合评估方法:对处理后的各二级指标采用秩和比方法对指标进行计算得各一
In order to maintain and develop the overall advantages and distinguishing features of medicine in Shanghai, during the Tenth Five-Year Plan of China, the city's health system implemented the program of constructing centers for clinical medicine, on the base of innovate of devotion mechanism of health bureau on city-level, several centers for clinical medicine whose clinical medicine level are advance both domestic and abroad were set up in hospitals which was qualified as Grade 3 in Shanghai since 2001.We expect that, after 5 years' construction, there will be several centers for clinical medicine as a symbol, which have certain scale, and are under modern management, and can offer excellent service, and have advanced technology and well appointed, with making a diagnosis and giving
treatment to difficult and complicated cases for aim, and make it's total clinical level on top not only in domestic but also in Asia and abroad, and make it one of the centers for clinical medical in our country and even in Asia.After three selections , there are totally 33 centers for clinical medicine which have been set up by now, and the disciplines be selected are all superior and major in hospitals which was qualified as Grade 3 in Shanghai, and their total level take a leading position in domestic.By now, after 3 years' construction, we need to make a medium - term evaluation to the centers, therefore, we must establish a set of evaluation index system and evaluation program which is objective, scientific, and quantitative, which not only express objective law, and universality purpose, but also reflect the classification guidance, and individuality purpose. Method: ?establishment of index system and constituting of concretely questionnaires(2)stage of collection and analysis of data(3)quality control of data' s quality: we should adopt uniform questionnaires, and make definite the boundary of the investigate index, and a correlative certificate is requested to attach every qualitative index, meanwhile, each parts of reported data must be signed by the one in charge and the director of the center. The data records into the EXCEL database;The calculation is completed by SAS9.0 statistic software complete.(4)statistical method for evaluationResult: According to the principle of scientific, evaluable, systemic, representative, universal, and dynamic, and by using the methods such as literature review, Delphi method, and so est. the study established the performance evaluation index system of center for clinical medicine in Shanghai. The study has established 6 first-class indexes and 30 second-class
indexes in all. The features of the index system are: ?rationality of the index system: the evaluation system study the material by adopting the methods of literature review, and use foreign idea of evaluation for reference, and consult the evaluation index system of the past, and combine the management practicality of centers for clinical medicine which are existing, and widely ask correlative specialists for advice, then disassemble our targets' element and through Delphi method, establish a primary index system, and then confirm connotation and strong of index of all levels, ?practicability of the index system.This is designed aiming at that centers for clinical medical in Shanghai is still lack a index system which can evaluate its performance objectively, so the this set index system is of great value and practicability.2> By applying the theories and method of case classification, we solved transverse comparability of medical treatment quality among centers for clinical medicine of different disciplines.3 ^ We use CD rate to adjust the comprehensive evaluation index of the medical treatment quality. In practical analysis, the result adjusted by CD rate is correspond with the center's practical situation, and we obtain satisfied results, which is of reference value to evaluate and orientate the medical treatment quality of the center.Conclusion: To establish a set of scientific, reasonable, feasible performance evaluation index system is the footstone of this study. This set of index system has carried out pilot study in the center for clinical medicine of the affiliated hospital of our school, and then gone through 2 turns' Delphi method, further improved the evaluation index system, and then make cohort study and comparison study to the 29 centers which were selected in the first and second batch. The research shows that: this index system has better
reliability and distinction degree, stronger applicability, directional and operative.Within the parameter of time and funds, this evaluation didn't use a CD rate and didn't carry on valuation completely, meanwhile, because some centers were established not long before and have a relatively weak base, much of the performance can't be sufficient displayed in a short time, so we suggest to evaluate after all centers have been classified by CD rate 2-3 years later, and during this period further improve the evaluation index system to approximate perfection, and make it effective tool which evaluates hospital performance, provide scientific basis to hospital for management and decision.
方法:①指标体系的构建和制定具体调查表②数据的收集、分析阶段③数据质量的质控:采用统一的调查表,明确调查指标的界定,各定性指标要求附相关证明,同时上报的各部分数据由相关责任人和中心主任签字;数据录入EXCEL数据库,结果的计算用SAS9.0统计软件完成。④评估的统计方法:对各基础数据进行标准化处理:采用计算比值和均值的方法,消除各评估单位基数不同的影响;定性指标有程度不同的(如获得课题和获奖等级等),采用给予不同分值加权值并计算指数的得分;资助后的绩效采用2004年各指标比基年纵向增加%表示。⑤综合评估方法:对处理后的各二级指标采用秩和比方法对指标进行计算得各一
In order to maintain and develop the overall advantages and distinguishing features of medicine in Shanghai, during the Tenth Five-Year Plan of China, the city's health system implemented the program of constructing centers for clinical medicine, on the base of innovate of devotion mechanism of health bureau on city-level, several centers for clinical medicine whose clinical medicine level are advance both domestic and abroad were set up in hospitals which was qualified as Grade 3 in Shanghai since 2001.We expect that, after 5 years' construction, there will be several centers for clinical medicine as a symbol, which have certain scale, and are under modern management, and can offer excellent service, and have advanced technology and well appointed, with making a diagnosis and giving
treatment to difficult and complicated cases for aim, and make it's total clinical level on top not only in domestic but also in Asia and abroad, and make it one of the centers for clinical medical in our country and even in Asia.After three selections , there are totally 33 centers for clinical medicine which have been set up by now, and the disciplines be selected are all superior and major in hospitals which was qualified as Grade 3 in Shanghai, and their total level take a leading position in domestic.By now, after 3 years' construction, we need to make a medium - term evaluation to the centers, therefore, we must establish a set of evaluation index system and evaluation program which is objective, scientific, and quantitative, which not only express objective law, and universality purpose, but also reflect the classification guidance, and individuality purpose. Method: ?establishment of index system and constituting of concretely questionnaires(2)stage of collection and analysis of data(3)quality control of data' s quality: we should adopt uniform questionnaires, and make definite the boundary of the investigate index, and a correlative certificate is requested to attach every qualitative index, meanwhile, each parts of reported data must be signed by the one in charge and the director of the center. The data records into the EXCEL database;The calculation is completed by SAS9.0 statistic software complete.(4)statistical method for evaluationResult: According to the principle of scientific, evaluable, systemic, representative, universal, and dynamic, and by using the methods such as literature review, Delphi method, and so est. the study established the performance evaluation index system of center for clinical medicine in Shanghai. The study has established 6 first-class indexes and 30 second-class
indexes in all. The features of the index system are: ?rationality of the index system: the evaluation system study the material by adopting the methods of literature review, and use foreign idea of evaluation for reference, and consult the evaluation index system of the past, and combine the management practicality of centers for clinical medicine which are existing, and widely ask correlative specialists for advice, then disassemble our targets' element and through Delphi method, establish a primary index system, and then confirm connotation and strong of index of all levels, ?practicability of the index system.This is designed aiming at that centers for clinical medical in Shanghai is still lack a index system which can evaluate its performance objectively, so the this set index system is of great value and practicability.2> By applying the theories and method of case classification, we solved transverse comparability of medical treatment quality among centers for clinical medicine of different disciplines.3 ^ We use CD rate to adjust the comprehensive evaluation index of the medical treatment quality. In practical analysis, the result adjusted by CD rate is correspond with the center's practical situation, and we obtain satisfied results, which is of reference value to evaluate and orientate the medical treatment quality of the center.Conclusion: To establish a set of scientific, reasonable, feasible performance evaluation index system is the footstone of this study. This set of index system has carried out pilot study in the center for clinical medicine of the affiliated hospital of our school, and then gone through 2 turns' Delphi method, further improved the evaluation index system, and then make cohort study and comparison study to the 29 centers which were selected in the first and second batch. The research shows that: this index system has better
reliability and distinction degree, stronger applicability, directional and operative.Within the parameter of time and funds, this evaluation didn't use a CD rate and didn't carry on valuation completely, meanwhile, because some centers were established not long before and have a relatively weak base, much of the performance can't be sufficient displayed in a short time, so we suggest to evaluate after all centers have been classified by CD rate 2-3 years later, and during this period further improve the evaluation index system to approximate perfection, and make it effective tool which evaluates hospital performance, provide scientific basis to hospital for management and decision.
引文
1 上海市医学重点学科建设实施办法.沪卫科教[2004]29号
2 张勘,刘俊.上海市临床医学中心建设计划基本思路及实施情况.中国卫生资源,2002,5:238-239
3 张勘,许铁峰,夏擎世.上海市临床医学中心建设的探索与实践.医学信息,2004,8:1-3
4 许铁峰,张勘,张士柯,等.上海市l临床医学中心绩效分析.解放据医院管理杂志,2004,11(6):570-571.
5 黄山,张勘,金其林.上海市医学领先学科建设与绩效评估.中华医学科研管理杂志,2003,16(4):239-242.
6 张斟,杨志平,许铁锋,等.美国医院评价体系及其借鉴作用.中国卫生资源,2005,8(2):91-93.
7 朱役,夏合全,吴雁鸣,等.学科带头人培养对象考评方法的探讨[J].中华医院管理杂志,2002,18:622—623
8 胡琳,于爽.医院综台效益评价指标体系的问题.中华医院管理杂志,1993,9(6):321
9 张罗漫,贺佳.医院综台效益的评价方法.中华医院管理杂志,1993,9(6):326
10 张力,钱亢,马健,等.我院建立计算机病例分型的方法初探[J].解放军医院管理杂志,1999,6(1):27-29
2 张勘,刘俊.上海市临床医学中心建设计划基本思路及实施情况.中国卫生资源,2002,5:238-239
3 张勘,许铁峰,夏擎世.上海市临床医学中心建设的探索与实践.医学信息,2004,8:1-3
4 许铁峰,张勘,张士柯,等.上海市l临床医学中心绩效分析.解放据医院管理杂志,2004,11(6):570-571.
5 黄山,张勘,金其林.上海市医学领先学科建设与绩效评估.中华医学科研管理杂志,2003,16(4):239-242.
6 张斟,杨志平,许铁锋,等.美国医院评价体系及其借鉴作用.中国卫生资源,2005,8(2):91-93.
7 朱役,夏合全,吴雁鸣,等.学科带头人培养对象考评方法的探讨[J].中华医院管理杂志,2002,18:622—623
8 胡琳,于爽.医院综台效益评价指标体系的问题.中华医院管理杂志,1993,9(6):321
9 张罗漫,贺佳.医院综台效益的评价方法.中华医院管理杂志,1993,9(6):326
10 张力,钱亢,马健,等.我院建立计算机病例分型的方法初探[J].解放军医院管理杂志,1999,6(1):27-29
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