Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
According to the characteristics of the diversified employment system of general hospitals, we have independently developed a set of personnel information platforms suitable for our hospital's operating model and work-flow which achieved establishing a novel big data management model for big personnel. After a year of trial operation, the big data management of personnel has completely covered the target management and requirements of the hospital, covering basic quality, public services, teaching work, medical work, scientific research, and other dimensions of information, which helped the hospital constructed a systematically networked and full-coveraged, personnel information system with strong early warning functions and incentives, enabling the reasonable utilization rate of human capital and continuous improvement of the quality of talent training.
ObjectiveTo measure the total factor productivity and its component changes of public secondary general hospitals in China from 2012 to 2018.MethodsFrom February to September in 2019, stratified systematic sampling method was used to collect the panel data of input and output indicators from 2012 to 2018 of 511 public secondary general hospitals in 5 provinces of China (Shandong, Hubei, Hainan, Anhui, and Shanxi), and Bootstrap-Malmquist-data envelopment analysis was used to calculate the total factor productivity and its component changes of the hospitals.ResultsFrom 2012 to 2018, the total factor productivity of the 511 public secondary general hospitals decreased by 0.22%, technical efficiency decreased by 5.24%, technical changes increased by 5.29%, pure technical efficiency decreased by 1.40%, and scale efficiency decreased by 3.89%, respectively.ConclusionsIn the past 7 years, the total factor productivity of public secondary general hospitals in China has declined slightly, mainly due to the decline of scale efficiency and pure technical efficiency, and the technological progress is the main reason for its improvement. The implications for the public secondary general hospitals are three folds: avoiding blind expansion and exploring optimum scale of beds, strengthening the internal fine management to improve the management practice and technical efficiency, and promoting technological progress by healthcare cooperating organizations.
Objective To investigate the effectiveness of teaching morning handover in clinical teaching of traditional Chinese medicine (TCM) in general hospitals. Methods A retrospective study was conducted at the Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University from April 2023 to March 2024, involving a total of 220 participants including interns, postgraduates/standardized training students, and residents/refresher students. The control group consisted of trainees who studied from April to September 2023, while the observation group included those who studied from October 2023 to March 2024. Teaching morning handover was added to the clinical morning report for the observation group, while the control group only conducted the conventional clinical morning report. Due to the differences in basic knowledge and clinical positioning, trainees except interns were classified as clinical residents. A questionnaire survey including satisfaction of teaching content, teaching methods, teaching ability and teaching management and graduation assessment including total score, theoretical assessment score, clinical process score and participation in teaching activities were compared between the two groups. Results Compared with those of the interns (n=57) and clinical residents (n=49) in the control group respectively, there was no statistically significant difference in satisfaction of teaching content, teaching methods or teaching ability of the interns (n=78) and clinical residents (n=36) in the observation group (P>0.05); however, teaching management satisfaction was significantly improved (interns P=0.002, clinical residents P=0.022). Both the interns and clinical residents in the observation group had a significantly higher total score as well as theoretical assessment score and increased participation in teaching activities (P values for interns were <0.001, 0.001, and <0.001, respectively, and for clinical residents were <0.001, 0.013, and <0.001, respectively). However, there was no significant difference observed between groups regarding clinical process score (P>0.05). Conclusion Teaching morning handover is helpful in improving the quality of TCM teaching in general hospitals and is an effective model for clinical teaching of TCM.
Objective To analyze the clinical epidemiological characteristics and trends of newly reported human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in Panzhihua Central Hospital, and provide a scientific basis for general hospitals to formulate precise prevention and control measures. Methods The information such as gender, age, ethnicity, and transmission route of the newly reported HIV/AIDS patients in Panzhihua Central Hospital from 2010 to 2019 was retrospectively analyzed. Results A total of 551545 patients were screened for HIV in Panzhihua Central Hospital between 2010 and 2019, among them, 1091 patients were confirmed as HIV infection finally, with a confirmed positive rate of 0.20%. The number of confirmed cases and the positive rate continued to increase from 2010 to 2017, and obviously declined after 2018. The male to female ratio of newly diagnosed HIV/AIDS patients was 2.86∶1, and the 31-45 years old middle-aged and young adults were the majority (31.16%). The majority of HIV/AIDS patients were identified as married (58.02%), primary school education (40.70%), farmers (46.38%), and Han nationality (79.84%). Yi nationality also had a high proportion (18.52%) with an increasing trend year by year (χ2trend=8.131, P=0.004). Yi nationality patients were mainly from Liangshan Yi Autonomous Prefecture (58.42%). A high proportion of 50.32% of patients came from other cities, among them, the proportion of patients from Liangshan Yi Autonomous Prefecture increased over time (χ2trend=13.608, P<0.001). The transmission routes were mainly through heterosexual sex (90.93%), with an upward tendency of proportion (χ2trend=22.137, P<0.001), and transmission through drug abuse was following (4.49%), with an downward tendency of the proportion (χ2trend=11.758, P=0.001). Significant differences in transmission routes were observed between males and females (P=0.020), and between Han nationality and Yi nationality (P<0.001). Conclusion The newly repored HIV/AIDS patients in Panzhihua Central Hospital have a high proportion of minority nationality, and heterosexual transmission is the main transmission route.
Objective To investigate the changes of multidrug-resistant organisms (MDROs) in the First People’s Hospital of Longquanyi District of Chengdu around its overall relocation. Methods The First People’s Hospital of Longquanyi District of Chengdu was overall relocated on December 31st, 2016. The detection rates of MDROs and the changes in nosocomial infections before the relocation (from 2015 to 2016) and after the relocation (from 2017 to 2020) were retrospectively analyzed. Results A total of 83634 qualified specimens were submitted for inspection, 8945 strains of pathogenic bacteria were detected, and the detection rate of pathogenic bacteria was 10.70%, showing an increasing trend in yearly detection rates of pathogenic bacteria (χ2trend=8.722, P=0.003); among them, 1551 MDRO strains were detected, and the detection rate of MDROs was 17.34%, showing an increasing trend in yearly detection rates of MDROs (χ2trend=11.140, P=0.001). The detection rate of pathogenic bacteria before relocation was lower than that after relocation, and the difference was statistically significant (9.64% vs. 11.08%; χ2=35.408, P<0.001); there was no significant difference in the detection rate of MDROs before and after relocation (16.32% vs. 17.66%; χ2=2.050, P=0.152). From 2015 to 2020, the detection rates of pathogenic bacteria from sputum+throat swab specimens (χ2trend=81.764, P<0.001) and secretion+pus specimens (χ2trend=56.311, P<0.001) showed increasing trends, while the detection rates of pathogenic bacteria from blood specimens (χ2trend=110.400, P<0.001), urine specimens (χ2trend=11.919, P=0.001), and sterile body fluid specimens (χ2trend=20.158, P<0.001) showed decreasing trends. The MDRO detection rates of Escherichia coli (χ2trend=21.742, P<0.001), Staphylococcus aureus (χ2trend=47.049, P<0.001), and Pseudomonas aeruginosa (χ2trend=66.625, P<0.001) showed increasing trends, while the MDRO detection rates of Klebsiella pneumoniae (χ2trend=2.929, P=0.087) and Acinetobacter baumannii (χ2trend=0.498, P=0.481) showed no statistically linear trend, but the MDRO detection rate of Acinetobacter baumannii dropped significantly in 2017. In the targeted monitored MDROs, the proportions of nosocomial infections in methicillin-resistant Staphylococcus aureus (χ2trend=4.581, P=0.032), carbapenem-resistant Enterobacteriaceae (χ2trend=8.031, P=0.005), and carbapenem-resistant Pseudomonas aeruginosa (χ2trend=6.692, P=0.010) showed decreasing trends; there was no statistically linear trend in the proportion of nosocomial infections in carbapenem-resistant Acinetobacter baumannii (χ2trend=0.597, P=0.440); only one strain of vancomycin-resistant Enterococcus was detected in 2017, and no nosocomial infection occurred. Conclusions The overall detection rate of pathogenic bacteria and MDROs in this tertiary general hospital around relocation showed increasing trends year by year. The detection rate of pathogenic bacteria after relocation was higher than that before relocation, but the detection rate of MDROs after relocation did not differ from that before relocation. The proportion of nosocomial infections among the targeted monitored MDROs decreased.
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.
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.
Objective To scientifically evaluate the nosocomial infection prevention and control ability of respiratory infectious diseases in general hospitals, and to construct a set of quantitative assessment system for the prevention and control ability of respiratory infectious diseases in general hospitals. Methods Papers, standards and guidelines online related to respiratory hospital infections published between January 1, 2010 and December 31, 2023 were selected, and infection control experience was summarized to build a pool of evaluation pionts. Then, this study used experts consultation to select the evaluation pionts, to calculate the weight coefficient and reached a consensus on the quantitative evaluation methods of each evaluation point. Results A total of 27 articles were included. The evaluation system included 17 evaluation points in 4 categories: “Basic management capacity” “Basic conditions of facilities and equipments” “The prevention and control capacity of nosocomial infection” and “The emergency response capacity”. Each evaluation point contained 3 quantitative evaluation indicators. The Cronbach’s α coefficients of the expert questionnaire consultation were 0.914 and 0.883, respectively. The scale-level content validity index was 0.932, and the item-level content validity index ranged from 0.823 to 1. Conclusions The evaluation system constructed in this study can be used for quantitative evaluation and quality self-examination of the prevention and control ability of respiratory infectious diseases in general hospitals. It also contributes to the continuous improvement of the quality of nosocomial infection prevention and control.
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.