基于公立医院高质量发展的一院多区学科布局设置研究
发布人：yaot 发布时间：2023/10/18 9:36:52 浏览次数：1114次
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】——石函宁 徐道亮 李小芳 赵曼 周静 宋慧
【摘要】目的 构建一院多区学科布局评价指标体系，探索适宜分院区发展的学科方向。方法 运用文献分析法和德尔菲法确立评价指标体系；采用AHP-CRITIC组合赋权法计算权重系数，结合各临床科室运行数据测算科室得分；采用K-means聚类分析对科室进行分类，推选出最优学科。结果 评价指标体系包含3个一级指标、10个二级指标、54个三级指标，两轮咨询专家权威系数均为0.88，协调系数分别为0.29和0.18，三级指标权重在0.005到0.065之间。得分较高的科室：妇产科（55.77分）、介入放射科（53.88分）、普外胃肠外科（53.86分）等，得分较低的科室：内分泌科（40.39分）、肾脏内科（40.35分）、临床心理科（40.28分）等。通过K-means聚类，43个临床科室分为I类科室5个（占比12%），II类科室11个（占比26%），III类科室18个（占比42%），IV类科室9个（占比21%）。结论 优先推荐到分院区开展的科室包括妇产科、介入放射科、普外胃肠外科等。分院区科室布局重点考虑指南标准、科室资源使用程度、区域医疗能力提升程度、突发公共卫生事件应急能力等因素。
【关键词】高质量发展；一院多区；科室布局；评价指标体系
中图分类号：R197.6；R331.1 文献标识码：B
Study on the Setting of Discipline Layout of One Hospital and Multiple Districts Based on the High-Quality Development of Public Hospitals/SHI Hanning,XU Daoliang,LI Xiaofang,et al.//Chinese Health Quality Management，2023,30(9):85-89
Abstract Objective To establish an evaluation index system of disciplinary layout of one hospital and multiple districts, and to explore the discipline direction suitable for the development of branch districts.Methods Literature analysis and Delphi method were used to establish the evaluation index system. The weight coefficient was calculated by AHP-CRITIC combined weighting method,and the department score was calculated by combining the operational data of each clinical department, and the departments were classified by K-means cluster analysis, and the optimal discipline was selected for the new hospital district. Results The evaluation index system contains 3 first-level indicators, 10 second-level indicators and 54 third-level indicators. The authority coefficient of the two rounds of consulting experts is 0.88, the coordination coefficient is 0.29 and 0.18, respectively, and the weights of the third-level indicators are between 0.005 and 0.065. The departments with high scores were Obstetrics and Gynecology (55.77 points), Interventional Radiology (53.88 points), General Gastrointestinal Surgery (53.86 points), etc. The departments with low scores are Endocrinology (40.39 points), Nephrology (40.35 points), Clinical Psychology (40.28 points), etc. Through K-means clustering, the 43 clinical departments were divided into 5 departments in category I(12%), 11 departments in category II (26%), 18 departments in category III (42%), and 9 departments in category IV (21%).Conclusion The priority departments recommended for the 7 branch hospitals included Obstetrics and Gynecology, Interventional Radiology, General Gastrointestinal Surgery, etc. The layout of branch departments should focus on the factors such as guideline standards, the degree of departmental resource use the degree of regional medical capacity enhancement and the emergency response capacity for public health emergencies.
Key words High Quality Development；One Hospital and Multiple Districts；Department Layout； Evaluation Index System
Firstauthor's address Subei People's Hospital, Yangzhou, Jiangsu, 225001, China
2021年6月，国务院办公厅印发《关于推动公立医院高质量发展的意见》（国办发〔2021〕18号），明确支持部分实力较强的公立医院在控制单体规模的基础上适度建设发展多院区。2022年，国家卫生健康委印发的《关于印发医疗机构设置规划指导原则（2021-2025年）的通知》（国卫医发〔2022〕3号）（以下简称《指导原则》）和《关于规范公立医院分院区管理的通知》（国卫医发〔2022〕7号），都特别强调了公立医院分院区概念、设置规范和管理要求。以“一院多区”的模式，加快优质资源扩容和区域均衡分布，充分发挥优质医疗资源的辐射带动作用，提高医疗卫生质量和服务水平，已经成为公立医院高质量发展新的形式。然而，一院多区在管理层面也面临差异化的挑战［1-3］，如何避免院区间内耗，补短板，错位发展以及打造学科高峰，形成特色鲜明的差异化竞争优势是亟待解决的重要问题。本研究旨在根据政策导向，结合区域资源配置及医院实际运营情况，构建一院多区学科布局设置评价指标体系，通过数据测算，科学规划分院区学科布局，为医院高质量发展提供决策依据。
1研究对象与方法
1.1研究对象
研究对象为省内某三甲医院，该院连续4年国考成绩A+，2022年度开放床位2 440张，年门诊量180万余人次，年出院患者14万余人次，平均住院日6.06天，床位使用率110.86%，床位需求函数R值1.43。医院地理位置处于市中心，人流量大，交通频繁拥堵，需要分院区分流患者。
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