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《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R]

卷:

第27卷

期数:

2020年01期

页码:

014-18

栏目:

特别关注

出版日期:

2020-01-28

文章信息/Info

作者:

曾慧慧 张雨 蒋荣猛 马旭东

首都医科大学附属北京妇产医院

关键词:

感染性疾病; 医疗质量; 持续改进

Keywords:

Infectious Diseases; Medical Quality; Continuous Improvement

DOI:

10.13912/j.cnki.chqm.2020.27.1.04

摘要:

目的基于国家卫生健康委医政医管局医疗质量与评价处年度医疗质量调查数据，对我国感染性疾病专业医疗质量进行回顾性分析。方法调查全国30个省级行政区域（除西藏自治区）医疗机构在2016年至2018年上报年度医院感染性疾病科医疗质量相关数据，对专科建设指标、环节指标及终末指标进行横断面研究及纵向比较。结果68.53%三级公立医院和31.68%二级公立医院设置了感染性疾病科；有负压病房项目建设的三级及二级公立医院分别为49.47%和16.43%，传染病专科医院为96.3%。感染性疾病科医护比平均为0.61：1，住院患者平均住院天数三级、二级以及传染病专科医院分别为11.49天、9.65天及18.27天，2018年与2017年、2016年同期上报数据相比有所降低。 三级及二级医院住院患者抗菌药物率抗菌药物使用率分别为 58.55%、71.72%及传染病专科医院39.97%。感染性疾病科医生参与医院抗菌药管理委员会比例分别为91.72%、79.30%及传染病专科87.50%，2018年较2017年有所增长。感染性疾病科住院收治前5位的病种为：肝病、结核病、手足口病、呼吸道感染和其他感染疾病。单病种不明原因发热病因各省医院平均确诊率55.15%；门诊流感样病例平均病原学诊断率13.20%；门诊流感样病例抗流感病毒药物使用率分别为33.60%、30.03%及传染病专科医院48.28%。经组织学和/或细菌学证实的各省肺结核医院平均确诊率为19.76%，艾滋病并发PCP实验室确诊率医院实验室确诊率较低:三级公立医院23.88%、二级公立医院25.28%、传染病专科医院18.01%。结论我国国家感染性疾病专业医疗质量建设具备良好基础，但仍存在感染性疾病科建设不充分，感染性疾病病原学诊断能力不足等问题，需加强感染性疾病科医疗质量管理及持续改进。

Abstract:

ObjectiveA retrospective study was used on the medical quality of infectious diseases in China,based on the data of the annual medical quality survey conducted by the Medical Quality Department of the Medical Administration and Hospital Administration of the National Health Commission from 2016 to 2018.MethodsThe annual medical quality data of hospital infectious disease departments, reported by 30 provincial administrative regional medical institutions（except Tibet autonomous region） in China from 2016 to 2018, were analyzed and compared vertically.ResultsA total of 68.53% of tertiary public hospitals and 31.68% of secondary public hospitals had set up the department of infectious diseases.The construction proportions of negative pressure wards were 49.47% and 16.43% intertiary and secondary public hospitals, and 96.3% of the infectious disease hospitals set up negative pressure wards. The ratio of doctors to nurses in infection department was 0.61 to 1. The average hospitalization days were 11.49 days in tertiary public hospitals and 9.65 days in secondary public hospitals and 18.27 days in infectious disease hospitals in 2018, and these were lower than thedata reported for the same period in 2017 and 2016.The utilization rates of antimicrobial agents in inpatients were 58.55%, 71.72% and 39.97% respectively; and the proportions of doctors of infectious diseases participating in the committee of antimicrobial administration of the hospital were 91.72%, 79.30% and 87.50% respectively,in tertiary or secondary public hospitals and in infectious disease specialist hospitals in 2018, which increased compared to those of in 2017. The top five diseases in the Department of Infectious Diseases were liver disease, tuberculosis and hand, foot and mouth disease, respiratory tract infection and other infectious diseases.The average diagnostic rate of unidentified fever in hospitals of each province was 55.15%. The average etiological diagnosis rate of influenza in outpatient was 13.20%. The utilization rates of anti-influenza virus drugs in tertiary or secondary public hospitals and in infectious disease specialist hospitals were 33.60%, 30.03% and 48.28%, respectively.The average utilization rate of anti-influenza viral drugs in infectious diseases department within 48 hours was 75.35%. The average diagnostic rate of tuberculosis confirmed by histology and/or bacteriology in provincial hospitals was 19.76%. The laboratory diagnosis rate of AIDS complicated with PCP was 23.88% in tertiary public hospitals, 25.28% in secondary public hospitals, and 18.01% in infectious disease specialist hospitals.Conclusion The construction of medical quality of national infectious diseases had a good foundation, but there are still problems, such as inadequate construction of infectious diseases department, the insufficient ability of etiological diagnosis of infectious diseases. It is necessary to strengthen the medical quality management and continuous improvement of infectious diseases department.

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更新日期/Last Update: 2020-01-28