出院患者手术占比管控路径探索
发布人：yaot 发布时间：2023/11/23 17:36:24 浏览次数：541次
【字体:
】
】——高晴 顾乡 李伟荣 王慧英
【摘要】出院患者手术占比是公立医院绩效考核的重要指标。通过修订医院手术目录，规范手术占比指标统计口径，明确全院出院患者手术占比目标值，将全院目标和科室目标有效结合，科学、合理、个性化设置科室出院患者手术占比目标值，建立了科室出院患者手术占比评估体系。该体系可充分挖掘科室出院患者手术占比管控潜力，帮助科室更好地校准发力点，引导科室提质增效，着力推进学科发展。
【关键词】出院患者；手术占比；科室；管控路径
中图分类号：R197.323 文献标识码：B
Control Approach of Operation Proportion of Discharged Patients/GAO Qing,GU Xiang,LI Weirong,et al.//Chinese Health Quality Management，2023,30(10):28-31
AbstractThe operation proportion of discharged patients is an important indicator of performance appraisal of public hospitals. By revising the operation catalogue of the hospital, standardizing the statistical caliber of the operation proportion index, and determining the target value of the operation proportion of discharged patients in the whole hospital, the target value of the surgical proportion of discharged patients in the department was effectively combined with the goal of the whole hospital and the department goal, and the target value of the operation proportion of discharged patients in the department was scientifically, reasonably and personalized, and the evaluation system of the operation proportion of discharged patients in the department was established. This system can fully tap the potential of surgical control of discharged patients in the department, help the department better calibrate the force point, guide the department to improve quality and efficiency, and strive to promote the development of the discipline.
Key words Discharged Patients；Operation Proportion；Clinical Department；Control Path
Firstauthor's address Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
2019年1月，国务院办公厅印发《关于加强三级公立医院绩效考核工作的意见》（国办发〔2019〕4号）［1］，要求公立医院逐步提高出院患者手术占比。综合考核出院患者手术占比对于提高三级公立医院医疗技术和管理水平以及疑难危重症诊疗能力具有积极意义［2］。出院患者手术占比计算方法为：出院患者手术台次数/同期出院患者总人次数×100%，其中，出院患者手术台次数以人数计算，总数为手术和介入治疗人数累加。手术和介入治疗数量尤其是疑难复杂手术和介入治疗数量与医院综合诊疗能力及临床管理流程呈正相关。当前，各级公立医院虽已意识到提升出院患者手术占比的意义，但对此项指标的管控仍处于探索阶段，尚未形成科学统一的出院患者手术占比目标值评估体系。针对出院患者手术占比管控，常用方法是各科室按照统一比例普升，该方法未充分考虑科室实际，缺乏个性化；部分医院将学科排名靠前的完成值直接作为科室出院患者手术占比目标值，该方法未充分考虑各医疗机构诊疗能力与患者构成，导致科室短期内难以找到精准发力方向，无法真正实现提质增效。本研究基于北京市某大型三甲综合医院2022年1月-2023年3月运营数据，以实现全院“45%”出院患者手术占比为目标，探讨分解医院出院患者手术占比目标值，尝试构建科室出院患者手术占比标准值评估体系。?/div>
1 出院患者手术占比管控实践
1.1统一测算方法
将全院出院患者手术占比目标值与各科室出院患者手术占比目标值有效结合是本研究的主要目标。为了使目标值分解与宏观政策要求一致，该院根据《手术操作分类代码国家临床版3.0（2021版）》目录以及医院原有手术目录，更新修订《医院手术目录（2021版）》。该目录共包含手术及介入治疗4 855条，规范了手术占比指标统计口径，统一了测算方法。
……
