医疗质量监测与分析课件

CHINESE HOSPITAL ASSOCIATION CHINESE HOSPITAL ASSO,CHINESE HOSPITAL ASSOCIATION CHINESE HOSPITA,CHINESE HOSPITAL ASSOCIATION CHINESE HOSPITAL ASS,CHINESE HOSPITAL ASSOCIATION CHINESE HO,CHINESE HOSPITAL ASSOCIATION CHINE,CHINESE HOSPITAL ASSOCIATION CHINESE HOSPITAL ASSOCIA,CHINESE HOSPITAL ASSOCIATION,CHINESE HOSPITAL ASSOCI,CHINESE HOSPITAL ASSOCIATION CHINESE HO,CHINESE HOSPITAL ASSOCIATION CHINE,CHINESE HOSPITAL ASSOCIATION,CHINESE HOSPITAL ASSOCIA,CHINESE HOSPITAL ASSOCIATION CHINESE HOSPITA,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,医疗质量监测与分析,医疗质量监测与分析,“,医疗质量,医院立院之本,”,医疗质量是医院管理永恒的主题,“医疗质量,提 要,医疗质量监测的目的和意义,医疗质量的监测方法,我省医疗质量监测的现状,我省医疗质量监测中存在的问题,提 要医疗质量监测的目的和意义,一、,医疗质量监测的目的和意义,1,、了解和掌握医疗质量的现状,2,、分析医疗质量存在的问题,3,、制定医政管理政策的依据,4,、指导医院确定努力的方向,二、,医疗质量监测方法,监测工具,“河北省医疗质量监控软件系统”,二、医疗质量监,软件功能,通过对医院的出院患者病案首页信息来监测以下五大类指标,出院患者情况,住院死亡类指标,重返类指标,患者安全类指标,住院日和住院费用指标,软件功能通过对医院的出院患者病案首,软件功能,出院患者情况：,对各年份医院出院患者人次及手术患者出院人次进行分析,住院死亡类指标：,包括住院总死亡率、新生儿患者住院死亡率、手术患者住院死亡率、手术患者围手术期住院死亡率、重点疾病患者住院死亡率、重点手术患者住院死亡率及恶性肿瘤择期手术住院死亡率；,重返类指标：,包括患者出院,31,天内再住院率及手术患者重返手术室发生率,患者安全类指标：,包括住院患者压疮发生率、择期手术患者肺部感染发生率、择期手术患者肺栓塞发生率及择期手术患者手术并发症发生率,住院日及住院费用指标：,包括出院患者住院日（中位数）,/,住院费用（中位数）、重点疾病住院日,/,住院费用，及重点手术住院日,/,住院费用分析,数据的应用,基准值,是根据国内,200,家医院,5,年数据计算得到的指标结果，取,25,分位，并进行专家咨询后确定的值。,用于比较、参考,并出具,监测分析报告,.,.,出院患者情况,出,住院患者死亡情况,住院患者死亡情况,住院手术患者死亡情况,住院手术患者死亡情况,新生儿死亡情况,新生儿死亡情况,手术患者围手术期住院死亡情况,手术患者围手术期住院死亡情况,重点疾病患者住院死亡情况,重点疾病患者住院死亡情况,重点手术患者住院死亡情况,重点手术患者住院死亡情况,重返类指标,重返类指标,重返类指标,重返类指标,负性事件类指标,负性事件类指标,负性事件类指标,负性,出院患者住院日平均数及住院费用平均数,年度,住院人数,平均住院日,人均费用,2010,19476,15,11618,2011,21293,13,11454,2012,26065,12,10898,出院患者住院日平均数及住院费用平均数年度住院人数平均住院日,三、我省医疗质量监测工作,医院评审,日常监测（医疗管理的重要抓手）,三、我省医疗质量监测工作,1,、成功用于,3,家医院带教评审,完成对河北人民医院、联合大学附属医院和邯郸市第一医院等,3,家医院的三年医疗质量监测分析 用于指导带教评审,用于医院周期性评审的医疗信息统计评价,用于医院现场评审设计路径、找出现场检查的切入点、关键点,用于现场评审各组确定抽取病历参考,帮助医院分析医疗质量上存在的问题,1、成功用于3家医院带教评审完成对河北人民医院、联合大,医院带教评审（统计学评价）,医院带教评审（统计学评价）,根据监测报告设计路径、确定抽病历,根据监测报告设计路径、确定抽病历,讲解医疗质量分析结果,分析医院存在问题,讲解医疗质量分析结果,2,、全省三级医院,2013,年度,医疗质量评价,全省三级医院,50,家,按照各项指标排出顺序,找出各医院差距与不足,2、全省三级医院 2013年度,医院名称,出院人次,手术人次,平均住院日,住院均次费用,出院死亡率,手术死亡率,新生儿死亡率,压疮发生率,术后并发症发生率,术后肺部感染发生率,术后肺栓塞发生率,河北省人民医院,42144,9899,12.79,19427.95,1.17%,0.46%,1.28%,0.00%,0.65%,0.70%,0.17%,河北医科大学第一医院,22070,1363,14.53,14537.1,0.81%,1.25%,0.00%,0.00%,0.46%,0.09%,0.18%,河北医科大学第二医院,95014,21646,12.58,19475.32,0.32%,0.06%,0.00%,0.01%,0.13%,0.00%,0.08%,河北医科大学第三医院,44255,24107,14.08,19325.38,0.36%,0.19%,0.00%,0.00%,0.11%,0.00%,0.01%,河北医科大学第四医院,84428,20758,12.74,16580.79,0.54%,0.40%,0.28%,0.01%,0.40%,0.37%,0.07%,石家庄市第一医院,44863,16403,10.97,17802.63,0.89%,1.05%,0.00%,0.00%,0.25%,0.33%,0.03%,河北大学附属医院,48661,12291,11.36,14235.91,0.59%,0.23%,0.50%,0.00%,0.11%,0.00%,0.05%,保定市第一中心医院,53042,14250,10.39,11990.09,0.71%,0.39%,0.11%,0.03%,0.31%,0.11%,0.00%,保定市第一医院,20937,4904,10.67,11647.76,0.61%,0.29%,0.37%,0.00%,0.16%,0.00%,0.13%,保定市第二医院,20566,6058,14.3,15840.9,1.39%,0.59%,1.22%,0.00%,0.43%,0.00%,0.00%,涿州市医院,34720,9698,8.83,8737.22,0.47%,0.12%,0.23%,0.00%,0.07%,0.09%,0.00%,河北北方学院附属第一医院,46198,15690,12.95,11300.56,0.65%,0.18%,1.12%,0.00%,0.00%,0.03%,0.00%,张家口市第一医院,20493,3478,16.2,14599.89,2.03%,0.81%,0.31%,0.16%,0.00%,0.00%,0.00%,医院名称出院人次手术人次平均住院日住院均次费,承德医学院附属医院,25281,8514,12.73,11781.94,0.75%,0.94%,0.82%,0.00%,0.04%,0.00%,0.01%,承德市中心医院,16382,4019,13.22,12779.08,1.02%,0.55%,0.00%,0.00%,-,-,-,唐山市工人医院,54246,10063,10.98,15503.25,0.07%,0.03%,0.00%,0.00%,0.27%,0.13%,0.07%,河北联合大学附属医院,26495,6344,11.15,12138.89,0.37%,0.20%,0.00%,0.15%,0.50%,0.28%,0.18%,开滦总医院,31383,6006,11.47,12423.9,1.32%,0.47%,0.00%,0.21%,0.46%,0.11%,0.11%,唐山市人民医院,33879,7829,16.67,14069.11,0.77%,0.34%,0.00%,0.06%,0.52%,0.00%,0.00%,廊坊市人民医院,28176,7472,12.74,11475.31,0.82%,0.41%,0.00%,0.00%,0.20%,0.00%,0.08%,中国石油天然气集团公司中心医院,16285,3610,12.52,12783.18,1.50%,0.66%,0.10%,0.00%,0.05%,0.00%,0.00%,沧州市中心医院,116809,27306,10.2,11468.19,0.42%,0.24%,0.19%,0.00%,0.21%,0.17%,0.01%,沧州市人民医院,72362,18481,9.6,9086.34,0.34%,0.18%,0.00%,0.00%,0.22%,0.00%,0.03%,华北石油管理局总院,16285,4004,12.52,12783.18,1.50%,1.05%,0.10%,0.00%,1.01%,0.58%,0.24%,衡水哈励逊和平医院,33505,8924,10.5,13660.98,0.51%,0.22%,0.27%,0.00%,0.13%,0.04%,0.06%,邢台市第三医院,27910,5988,10.14,11915.42,0.01%,0.02%,0.00%,0.00%,0.43%,0.07%,0.07%,邢台医学高等专科学校第二附属医院,12383,4071,11.21,8444.24,0.59%,0.27%,0.00%,0.00%,0.28%,0.00%,0.00%,承德医学院附属医院25281851412.7311781.9,四、监测中存在的问题,医院信息化水平和电子病历不能满足 统计分析需要，需进一步加强,邢台市人民医院、燕达医院、衡水市第四医院不能提供相关病案首页资料,河北省胸科医院、石家庄市第三医院、石家庄市第五医院、保定市第二中心医院所报病案首页信息不规范，不能正常提取数据进行监测分析,四、监测中存在的问题 医院信息化水平和电,监测中存在的问题,病案编码正确率低，影响医疗质量监测分析的准确性,很多大医院编码也存在问题,加强病案编码员的培训迫在眉睫,监测中存在的问题,监测中存在的问题,一、部分手术编码一致而名称不同，按照编码无法进行分析，包括,03.09,椎扳切除术,03.09,椎板减压术,32.5,肺切除术伴纵隔淋巴结清扫术,32.5,全肺切除术,36.06,经皮冠状动脉内支架植入术,36.06,经皮冠状动脉支架术,(,药物涂层,),41.31,骨髓穿刺活组织检查,41.31,骨髓活组织检查,监测中存在的问题一、部分手术编码一致而名称,监测中存在的问题,51.98,胆道扩张术,51.98,经皮肝穿胆道引流术,57.17,膀胱造口术闭合性（耻骨上）（经皮）,57.17,经皮膀胱造口术,68.4,经腹全子宫切除术,68.4,子宫全切除术,68.41,腹腔镜下经腹全子宫切除术,68.41,经腹腔镜子宫切除术,77.6,骨肿瘤病灶刮除术,77.6,骨肿瘤骨切除术,79.1,骨折鹅头钉内固定术,79.1,骨折克氏针内固定术,79.1,骨折螺丝钉内固定术,监测中存在的问题51.98胆道扩张术,监测中存在问题,1,、很多病案没有主要诊断。,2,、有的病案只有主要诊断没有诊断编码，按照编码无法进行分析。,3,