3074 hospitals participated!

I still remember that at the end of 2019, the notice of performance appraisal of secondary public hospitals was issued, which caused a lot of ripples in the medical circle
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Before I knew it, two years later, the transcripts of the second-level public hospital and the national examination were released for the first time
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On January 6, 2022, the National Health and Health Commission announced the "Circular on the National Monitoring and Analysis of the National Second-level Public Hospital Performance Evaluation in 2019" (hereinafter referred to as the "Circular")
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The "Circular" pointed out that, upon review and confirmation by provincial health administrative departments, a total of 3,074 second-level public hospitals (including 908 second-level public hospitals of traditional Chinese medicine) participated in the first year (2019) performance assessment, accounting for about 3,000 of the national total.
53% of the total number of secondary public hospitals
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3,074 hospitals participated, which is undoubtedly the largest number of contestants in public hospitals since the Unified Examination
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The long process indicates that the process is difficult
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A person close to the National Health and Medical Commission's Medical Administration and Hospital Administration revealed that the statistical work of the performance appraisal work of secondary public hospitals is relatively difficult
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Due to the poor informatization foundation of the second-level hospital, there were many problems with the data submitted initially, and it went through multiple rounds of rework
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Li Jidong, director of Jingxing County Hospital in Hebei Province, confirmed this statement
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He told the health community that among the secondary hospitals, it is a hospital with a high level of informatization, but the data was filled in three times before it passed the border
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The reason is that when I first started filling out the report, I went through the process of misunderstanding and inaccurate understanding
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? This is the first time that the portrait of a second-level public hospital and the issues that need to be paid attention to are comprehensively announced, which is of great significance
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? The above-mentioned people said to the health community
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The level of electronic medical records needs to be improved, half of which are below level 2? National examination? A large amount of data comes from the homepage of medical records
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Therefore, the completeness and accuracy of data reporting is the basis for the smooth development of the National Examination
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This is closely related to the level of electronic medical records in the hospital
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The "Notice" shows that as of the end of 2019, among the second-level public hospitals that participated in the assessment, a total of 1,843 hospitals participated in the grading evaluation of the application function level of electronic medical records, with a participation rate of 85.
09% and an average grade of 2
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Among them, 33.
75% of the hospitals have reached the level 3 and above, which can meet the requirements of inter-departmental data exchange; 51.
34% of the hospitals are at the level of 2 and below, and the data exchange between departments within the hospital has not yet been achieved
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In contrast, in 2019, 1,874 tertiary public hospitals participated in the grading evaluation of electronic medical records application level, with a participation rate of 99.
36% and an average level of more than 3
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Among them, 78.
13% of the hospitals have an average level of 3 or above, and 4 hospitals have been rated as level 7
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From this, it can be seen that the level of electronic medical records of secondary public hospitals is obviously not as good as that of tertiary hospitals, which will inevitably affect the smoothness of the national examination process
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?During this process, the hospital experienced difficulties in data capture and a lot of manual statistical data, resulting in inaccuracy and errors of data
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?Ningxia Yanchi County People's Hospital Party Branch Secretary and President Rao Rui told the health community that later, the hospital solved the problem of data export by adding the medical record management system, the medical record homepage quality control system, the electronic medical record system and the hospital HIS and other related systems.

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It is worth affirming that among the second-level hospitals participating in the assessment, there is also no shortage of informatization construction? Top students? - 5.
7% of the hospitals have reached the level of 4, which can realize the sharing of information in the whole hospital and meet the decision support of primary medical care; 11 out of 1843 hospitals If the family reaches the level 5, it can realize unified data management and meet the middle-level medical decision support
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In addition, most of the secondary hospitals participating in the assessment performed the function of helping the grassroots through the information platform
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60.
16% of secondary public hospitals have established telemedicine centers, which can provide services such as remote consultation, remote imaging diagnosis, and remote ECG diagnosis to primary medical institutions
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Among them, the proportion of secondary public hospitals that can provide remote consultation services (54.
34%) or remote imaging services (48.
57%) is relatively high
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High patient satisfaction, salary and benefits to be improved This report card shows that the overall patient satisfaction in the country is at a high level, but the satisfaction of medical staff needs to be further improved
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in satisfaction evaluation
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In 2019, the satisfaction of outpatients in secondary public hospitals participating in the assessment was 84.
43 points, that of inpatients was 89.
32 points, and that of medical staff was 76.
48 points
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Compared with the satisfaction level of tertiary public hospitals in the same year, the satisfaction levels of outpatients, inpatients and medical staff in secondary public hospitals were 0.
98 points, 1.
69 points and 2.
36 points lower, respectively
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? This shows that there is still a gap between the service quality of secondary hospitals and tertiary hospitals, and there is still a lot of room for improvement
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?Wang Dan, executive director of the Hospital Management Research Center of Renmin University of China, analyzed the health community
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From the perspective of specific dimensions, outpatients are generally more satisfied with the communication between nurses, communication with doctors, and the response of medical staff than in tertiary hospitals
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? Medical staff in secondary hospitals are more patient and careful, and have been recognized by patients
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? Wang Dan also mentioned that this may also be because patients' expectations for secondary hospitals are not as high as those of tertiary hospitals
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Environment and signs are the dimensions that outpatients and inpatients in secondary hospitals are not satisfied with
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This suggests that secondary hospitals need to continue to work hard in the construction of the medical environment
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Consistent with the satisfaction results of medical staff in tertiary hospitals, medical staff in secondary hospitals were also the least satisfied with their salary and benefits, job content and environment
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? Salary and benefits are an important factor affecting the satisfaction of medical staff.
The mismatch of compensation and benefits, combined with greater work pressure and poor working environment, cause the satisfaction of these two dimensions to affect each other and become the two most dissatisfied medical staff.
dimension
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?Wang Dan believes that this requires relevant government departments and medical institutions to further establish and improve the salary and welfare system that conforms to the characteristics of the medical industry, while improving the working atmosphere and environment of medical staff, improving the experience of practice, and ultimately improving the satisfaction of medical staff
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Tertiary surgeries accounted for 33.
46%.
The use of antibiotics was not up to standard.
The level of rational drug use was low, which was a prominent problem in the medical quality of secondary public hospitals
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In 2019, the intensity of antimicrobial use in secondary public hospitals was 40.
96 DDDs, which has not yet met the requirement that the intensity of antimicrobial use in general hospitals should not exceed 40 DDDs, and there are still 44.
64% of secondary general hospitals where the intensity of antimicrobial use exceeds 40 DDDs
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In contrast, the intensity of antimicrobial use in tertiary public hospitals in 2019 remained basically stable, and was better than the national requirement of 40 DDDs
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? Antibacterial drugs still have certain blindness in clinical application
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?Teng Hailong, director of the Pharmacy Department of Heilongjiang Mudanjiang Cardiovascular Hospital, analyzed to the health community for three reasons: On the one hand, it comes from factors such as clinicians' inaccurate grasp of indications, excessive dosage, and excessive combination drugs; on the other hand, from clinical pharmacists Insufficient function of the hospital and insufficient implementation of the "Guiding Principles for the Clinical Application of Antibacterial Drugs"; on the one hand, the leaders of medical institutions did not pay enough attention to the national normative requirements to the height of the hospital's core management
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The development of minimally invasive surgery and tertiary surgery is an important manifestation of the level of medical technology
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According to the "Notice", surgery accounted for 18.
14% of discharged patients from secondary public hospitals; among surgical patients, minimally invasive surgery accounted for 12.
07%, and tertiary surgery accounted for 33.
46%
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Among them, minimally invasive surgeries such as laparoscopic cholecystectomy (84.
90%) and laparoscopic appendectomy (81.
95%) are relatively common in secondary public hospitals, and more than 80% of the hospitals participating in the assessment can carry out
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On the basis of the previously available tertiary surgery, in 2019, some secondary public hospitals have newly carried out common carotid artery repair, endoscopic sphenopalatine artery ligation, partial popliteal artery resection with artificial blood vessel replacement, combined Among them, about 50% of the newly carried out tertiary operations are completed under the support and guidance of the counterpart supporting hospital
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"National Examination" is also guiding the improvement of the level of specialty construction in secondary public hospitals
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Li Jidong, president of Jingxing County Hospital in Hebei Province, said that in the process of preparing for and participating in the National Examination in the past two years, the hospital has gradually clarified the development path under the role of the baton: specialist, more detailed development
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For example, subspecialties have been further developed, and gastroenterology, respiratory, and thoracic surgery have been established
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The general practitioners have also sunk to the village level accordingly
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There is still more room for vacating the cage and changing the bird.
The task of operation and management of secondary public hospitals is still arduous
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In 2019, the average outpatient and inpatient medical expenses of secondary public hospitals increased by 6.
75% and 6.
08% respectively, and the average outpatient and inpatient drug expenses increased by 8.
36% and 3.
31% respectively
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The increase in the average cost of inpatient drugs per time was lower than the average cost of inpatient drugs, which is a positive signal, indicating that the hospital's income structure has changed and the effect of drug management has been strengthened
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However, on the other hand, the proportion of personnel expenses in secondary public hospitals is 38.
45%, and the proportion of medical service income (excluding drugs, consumables, inspection and inspection income) in medical income is 29.
56%, which is not a high proportion.
This shows that medical services There is still a lot of room for project price adjustment
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According to the announcement of the National Health Commission, the medical surplus rate of the 3,074 secondary public hospitals participating in the assessment was 2.
07%, but 16.
88% of the hospitals had a negative medical surplus rate and a loss rate of 24.
59%.
The average profit ratio is 3.
00%, and the loss ratio is 17.
61%
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At present, the asset-liability ratio of secondary hospitals is 49.
39%, but among the loss-making hospitals, 3.
22% of secondary public hospitals have an asset-liability ratio of more than 100%, and 40.
60% of secondary public hospitals have an asset-liability ratio of more than 50%
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?A public hospital's asset-liability ratio greater than 50% does not fully indicate that the hospital's economic operation is not good, but to some extent reflects the asset-light operation model of public hospitals
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?Liu Hongwei, chief accountant of the People's Hospital of Inner Mongolia Autonomous Region, once mentioned to the health community that from an academic perspective, it is generally reasonable to maintain the asset-liability ratio of various industries and institutions at around 60%
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It is worth mentioning that the operating cost of secondary hospitals is relatively higher than that of tertiary hospitals, and the energy expenditure per ten thousand yuan of income is 125.
31 yuan, while that of tertiary hospitals is 95.
71 yuan
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The ratio of medical and nursing staff is 1:1.
55.
Talent team building is still difficult.
Talent team building has always been a relatively common problem and challenge faced by secondary hospitals
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According to the "Notice", secondary public hospitals accounted for 0.
38% of the investment in talent training
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Li Jidong, president of Jingxing County Hospital in Hebei Province, said that in the past two years, the hospital has made the talent team more stable than before by building a platform and improving treatment
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However, it still takes a process to recruit higher-quality and more capable talents
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According to the "Notice", the structure of secondary hospitals in the construction of talent teams has continued to be reasonable
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In 2019, the medical-to-nursing ratio of second-level public hospitals nationwide was 1:1.
55, exceeding the target requirement of 1:1.
25 in 2020 set forth in the National Medical and Health Service System Planning Outline
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In addition, in most secondary public hospitals, anesthesiologists account for about 3% to 5%, pediatricians account for about 3% to 8%, intensivists account for about 0.
2% to 1%, and pathologists account for about The proportion of TCM physicians is about 5% to 15%
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The National Examination also pointed out the direction for the construction of talent teams in secondary public hospitals
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After passing the national examination, Rao Rui, secretary of the Party branch and president of the People's Hospital of Yanchi County, Ningxia, found that his own hospital accounted for a relatively low proportion of pathology and intensivists, and it was necessary to further strengthen the introduction and training of talents
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He said that the next step of the hospital's work is to promote the connotation construction, and work hard on the introduction of high-level talents, the supply of high-tech medical services, and advanced scientific management concepts
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The National Examination is a comprehensive physical examination and accurate pulse-taking of the hospital's work
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Rao Rui said that with the announcement of the results of the first secondary public hospital's national examination, the hospital will recognize its own problems in management and operation, so as to continuously improve and improve its management level
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According to the requirements, the national second-level public hospitals should be gradually included in the performance appraisal scope within 3 years (2020-2022)
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