ObjectiveTo measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.MethodsFrom February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.ResultsThe medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.ConclusionsThe overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.
【摘要】 目的 研究综合医院心理咨询初诊患者的特征。 方法 对2007年1月1日-2009年12月31日初诊患者的性别、年龄、居住地、学历、职业、咨询目的与疾病分布等特征进行统计分析。 结果 共纳入1 933例初诊患者，女性略多于男性（男女比1∶1.1）；年龄3~75岁，以青少年（10~19岁，34.5%）和青年（20~29岁，29.7%）为主；当地居民居多（66.0%），外地居民亦占较大比例（34.0%）；学历主要分布在中学（初中:21.5%；高中:35.6%）和大学（33.6%）；职业分布以学生比例最大（40.0%），其次为无固定职业者（14.9%），专业技术人员（12.5%），商业、服务人员（9.4%），办事人员和有关人员（7.7%）。患者中有心理问题的健康人占27.5%，以亲子教育咨询（53.4%）和婚恋咨询（41.5%）为主；患精神障碍的患者占72.5%，以心境障碍（30.6%）、神经症（23.1%）和精神分裂症（10.1%）为主，新确立的精神障碍网络成瘾占1.1%。 结论 综合医院心理咨询初诊患者来源广泛，需要更加关注青少年、学生和无固定职业者的心理问题。【Abstract】 Objective To investigate the characteristics of the new clients from the psychological counseling clinic in general hospital. Methods The clients’ data were prospectively analyzed from the successively registered database of the counseling clinic from January 1, 2007 to December 31, 2009. The data included sex, age, habitation, educational background, career, problems, and diagnosis of the new clients. Results A total of 1 933 clients were included in the study, and the sex ratio was 1∶1.1(male∶female). The age ranged from three to 75 years old. The clients aging from 10 to 29 yeas old accounted for 64.2%. Sixty-six percent of the clients were local residents. The education backgrounds of them were middle school (21.5%), high school (35.6%), and graduate (33.6%). Forty percent of the clients were students and 14.9% had no regular works. Special technician, business and service workers, and office workers accounted for 12.5%, 9.4%, and 7.7%, respectively. The percentage of healthy clients was 27.5%, whose main problems were child education (53.4%), and marriage relationship (41.5%). And 72.5% of the clients suffered from mental disorders, with mood disorder (30.6%), neurosis (23.1%), and schizophrenia (10.1%). Internet addiction, as a new established mental disorder in China, accounted for 1.1%. Conclusion At present, the clients of counseling clinic in general hospital are more widespread, and more attention should be paid to the young, the students, and the people without regular work.
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
Objective To analyze the drug resistance of Mycobacterium tuberculosis complex (MTBC) in West China Hospital of Sichuan University in recent years to provide reference for drug resistance monitoring and prevention strategies of tuberculosis in general hospitals. Methods The clinical strains of MTBC that performed drug susceptibility tests in West China Hospital of Sichuan University between January 2019 and December 2022 were collected. The drug susceptibility information of 13 anti-tuberculosis drugs, namely rifampicin, isoniazid, ethambutol, streptomycin, rifabutin, amikacin, kanamycin, ofloxacin, levofloxacin, moxifloxacin, para-aminosalicylic acid, ethionamide, and capreomycin, was collected and retrospectively analyzed. Results A total of 502 clinical strains of MTBC were included, and 366 of them were isolated from newly-treated patients while 136 form re-treated patients. The resistance rates of MTBC strains to the first-line anti-tuberculosis drugs in descending order were 28.69% (isoniazid), 19.72% (ethambutol), and 14.94% (rifampicin). Among the second-line drugs, the resistance rates to ofloxacin, levofloxacin, and moxifloxacin were 13.55%, 12.15%, and 11.95%, respectively. The resistance rates to amikacin, kanamycin, para-aminosalicylic acid, and ethionamide were all less than 10%. The resistance rates to streptomycin, capreomycin, and rifabutin were 17.53%, 13.55%, and 12.15%, respectively. The resistance rates to the remaining 12 anti-tuberculosis drugs except capreomycin of MTBC strains isolated from re-treated patients were higher than those of MTBC strains isolated from newly-treated patients, and the differences were statistically significant (P<0.05). The isolation rates of monodrug-resistant, polydrug-resistant, multidrug-resistant (MDR) and pre-extensively drug-resistant (pre-XDR) strains were 9.36%, 7.37%, 7.17%, and 7.77%, respectively. The isolation rates of strains with the four drug-resistant phenotypes generally showed a downward trend during the four years, and the changing trends were statistically significant (P<0.05). The isolation rates of MDR and pre-XDR strains from re-treated patients were higher than those from newly-treated patients, and the differences were statistically significant (P<0.001). Conclusion Tuberculosis drug resistance in West China Hospital of Sichuan University, which is a comprehensive tuberculosis-designated hospital, remained severe during the four years from 2019 to 2022, and the prevention of tuberculosis and the monitoring of drug resistance should be further strengthened.
ObjectiveTo understand the current situation of outpatient service, strengthen outpatient physicians management, maintain outpatient clinical order, and improve the credibility and service quality of public hospitals.MethodsThe measures such as deepening the supply-side reform of outpatient service, strengthening the awareness of integrity service, regulating suspending or substituting diagnosis service management, and optimizing doctors’ scheduling were performed to improve the outpatient service plan management since 2012. The data of outpatient diagnosis and treatment and doctor appraisals from 2013 to 2016 were retrospectively collected from hospital information system, combined with the third party satisfaction data; and the rates of suspending and substituting of outpatient service, clinical service time distribution for doctors at all levels, proportion of appointment register, and the average satisfaction index were analyzed.ResultsThe rates of suspending and substituting of clinical service reduced from 5.8% and 6.4% in 2013 to 2.5% and 4.1% in 2016, respectively, and the differences were statistically significant (P<0.05); the proportion of outpatient physicians with vice-senior title or above from 2014 to 2016 was lower than that in 2013, with the decrease from 81.0% in the morning and 73.0% in the afternoon to 75.9% and 69.1%, respectively; the proportion of appointment register increased from 54.7% in 2013 to 68.2% in 2016; the patients’ satisfaction was higher in 2016 than that in 2015.ConclusionThe outpatient service management of large general hospitals should be patients’ needs-oriented; with the awareness of integrity service, regulating the approval system of suspending or substituting of outpatient service, improving the pre-arranged planning for suspending service, optimizing the qualification admittance system, and improving the regular appraisal system, may effectively solve the problems of unbalanced outpatient physicians resources and service, maintain the good order of medical service, improve medical care quality, and raise patients satisfaction.
West China Hospital of Sichuan University has explored and established an intelligent assistant evaluation mechanism for professional titles based on the personnel information system, which makes the evaluation more convenient, more efficient, and the whole process more open and transparent. This paper aimed to introduce it and to provide references for evidence-based decision-making of medical institutions.
ObjectivesTo survey the features of reservation bed and investigate the factors of hospital operation which may affect the patient loyalty of reservation bed in large general hospital. MethodsAll patients who reserved bed before July 2013 in hospital service center of a large general hospital were investigated by questionnaire in telephone and collected the basic data. Measurement index was designed to conclude the characteristics of patient loyalty of reservation bed in different departments. Multivariate statistical analysis was used to analyze the influence factors of patient loyalty. ResultsIn the large general hospital, significant difference was found in patient loyalty of reservation bed in different departments. The diversity was mainly impacted by average waiting time of admission, cancelling waiting length, loyalty of patient inside the province, average length of stay, readmission rate on the day of discharge. ConclusionLarge general hospital should pay more attention to dynamic monitoring and disclosure of supply and demand information of bed resources, to improve the management of beds resources and optimize reservation system, to elevate patient's loyalty of reservation bed in hospital.
ObjectiveTo investigate the current situation of orthopedic quality control and management in county-level regional general hospitals in Guangdong, and to provide a scientific basis for further standardizing the procedures of orthopedic quality control and management in county-level regional general hospitals and continuously improving the work of provincial orthopedic quality control center.MethodsFrom June 2019 to July 2020, online and offline questionnaire survey and field survey were used to investigate the quality control and management of orthopedic departments in 22 county-level regional general hospitals in Guangdong.ResultsAmong the overall scores of the surveyed hospitals, the highest score was 96.5, the lowest score was 72.0. There were 6 hospitals with a total score of “excellent” (accounting for 27.3%). The “facilities and equipment” and “medical quality” of the surveyed hospitals were relatively valued. Taking Guangzhou, the capital of Guangdong as the center, the districts and counties were divided into the east, the south, the west and the north regions, and the difference in overall scores of orthopedics among the four regions was statistically significant (F=6.299, P=0.004). The unqualified rates of department setting, key technology development, average hospitalization days of representative diseases, equipment allocation, personnel allocation, department management and building layout were relatively high, which were 77.3%, 63.6%, 45.5%, 40.9%, 40.9%, 36.4% and 36.4%, respectively. Most hospitals had set up special debridement rooms in orthopedic department (95.5%), and the management and monitoring of the use of antibacterial drugs was mostly reasonable (90.9%). In terms of the level of orthopedic medical treatment, only 3 hospitals with sufficient key technologies reached the standard, accounting for 13.6%, and only 7 hospitals reached the standard of scientific research capacity, accounting for 31.8%. In terms of quality control, the numbers of hospitals with qualified medical record sampling (72.7%), perfect management and supervision mechanism (86.4%) and quality management team in departments (77.3%) were the least. In addition, among the investigated hospitals, beds were in short supply in orthopedic departments, with 12 hospitals accounting for 54.5% being deducted; 16 hospitals (72.7%) were deducted for unqualified doctor-patient ratio and 11 hospitals (50.0%) were deducted for unqualified nurse-patient ratio.ConclusionsThe overall level of orthopedics construction and management in the surveyed hospitals is uneven. The medical professional and technical level is insufficient. It is difficult to meet the practical needs, and there is an imbalance in the ratio of medical personnel. In the future, it is necessary to strengthen the quality control of orthopedic medical care, strengthen the medical technology training of county-level regional general hospitals and increase the medical and health resources and capital investment, so as to improve the quality control of county-level regional general hospitals.