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On September 30, the performance assessment results of the national tertiary public hospitals in 2021 were released, and the assessment index system was composed of 4 first-level indicators, 14 second-level indicators and 55+1 third-level indicators of medical quality, operational efficiency, sustainable development and satisfaction evaluation, which was known as the "national examination"
of public hospitals in the country.
"This is the third time to release the national examination results of tertiary public hospitals, and the national examination data shows the performance of hospitals in the national tertiary public hospital performance evaluation index system, which is a 'baton' of hospital management and points out the direction
for the strategic development of tertiary public hospitals.
" Qian Dongfu, deputy dean of the Jiangsu Institute of Health Research of Nanjing Medical University, said
in an interview with a reporter from Health Times.
He believes that the influence of the "national examination" on society is increasing, and more and more local governments have begun to pay attention to the results of the national examination of hospitals, and the results are gradually linked
to the financial subsidies of hospitals, the allocation of medical insurance funds, the evaluation of hospital leaders, and the total performance salary.
In the work of the health system, the results of the "national examination" will affect the hospital's
application for the construction project of national medical center and regional medical center.
Medical quality is an important first-level indicator of the national examination, followed by operational efficiency, sustainable development and satisfaction evaluation Qian Dongfu introduced that the index system of the "national examination" is composed of 4 first-level indicators, 14 second-level indicators and 55+1 third-level indicators of medical quality, operational efficiency, sustainable development and satisfaction evaluation, of which 26 indicators are national monitoring indicators
。 The national examination results are obtained according to the weighted assignment of scores to these 26 monitoring indicators, with a total score of 1,000 points, and are divided into three levels A, B and C according to the respective scores of the third-level public hospitals participating in the assessment, of which the third-level public general hospitals are third-level and ninth-class, and the highest grade is A++
.
The evaluation results of tertiary public specialized hospitals are A, B, and C, and the highest grade is A
.
The ratio of the four first-level indicators for tertiary public hospitals is roughly 4:3:2:1
.
Taking tertiary public general hospitals as an example, the scores and proportions of its four first-level indicators in the total score of 1000 are: 43% of medical quality 430 points, 27% of operational efficiency of 270 points, 180 points of sustainable development and 12%
of satisfaction evaluation.
It can be seen that medical quality is an important first-level indicator of the "national examination", followed by operational efficiency, continuous development and satisfaction evaluation
.
"The full score of the monitoring indicators in the 26 countries is also different, and the weight of the national examination can also be
judged from the size of the score.
" Qian Dongfu said that taking tertiary public general hospitals as an example, the proportion of discharged patients for surgery, the proportion of discharged patients for fourth-level surgeries and the funding of scientific research projects per 100 health technicians have the highest full score, with 100 points
.
The remaining monitoring indicators do not have a maximum score of more than 50 points, and 7 monitoring indicators have a maximum score of only 20 points
.
Therefore, the three monitoring indicators of the proportion of discharged patients undergoing surgery, the proportion of discharged patients undergoing fourth-level surgery and the funding of scientific research projects per 100 health technicians are the contents
that need to be focused on in tertiary public general hospitals.
The proportion of surgery of discharged patients and the proportion of fourth-level surgery of discharged patients belong to the category of functional positioning of medical quality, and the scientific research project funding for every 100 health technicians belongs to the scope
of hospital discipline construction.
The above three high-scoring indicators fully show that the national level requires tertiary public general hospitals to focus on their functional positioning and key discipline construction
.
Tertiary public general hospitals should focus on the top medical technology, excellent medical quality, efficient medical services, and refined hospital management as the development goals of hospitals, and their discipline construction should be aimed at
the peak of national clinical medicine, the leading base for talent training and the transformation of scientific research achievements.
A number of hospitals have announced the results of the national examination, and 1355 tertiary public hospitals have participated Up to now, Qilu Hospital of Shandong University, the First Affiliated Hospital of China Medical University, Sichuan Provincial People's Hospital, Chengdu Fifth People's Hospital, etc.
have announced their national examination results
.
The First Affiliated Hospital of China Medical University ranked 13th in the country among the 1355 tertiary public hospitals that participated in the evaluation, up 4 places from the previous year, entering the highest grade A++ sequence, ranking in the top 1%
of tertiary public hospitals (comprehensive Western medicine) in the country.
This is the first time that a hospital in Northeast China has entered the first echelon
of national tertiary public hospital performance evaluation.
Qilu Hospital of Shandong University tied for 13th place in the country and entered the A++ ranks, of which the case combination index (CMI) ranked 6th in the country
.
Chengdu Fifth People's Hospital ranked 124th among the 1,355 tertiary public general hospitals in the country, entering the top 10% of the country and advancing to the A+ level
.
The Case Mix Index (CMI, Case-Mix Index) is an internationally recognized representative of the technical difficulty of diagnosing and treating disease cases in hospitals and the ability to
admit difficult and severe diseases.
Qian Dongfu told the People's Daily health client reporter that CMI only represents the ability of tertiary public hospitals to diagnose and treat diseases and the ability to admit difficult and severe diseases, which is mainly reflected in the medical quality dimension
of hospitals.
Qian Dongfu analyzed that according to the just-released "national examination" results, Qilu Hospital's assessment ranking is 13th, in the top 1%, and it is rated as A++, which shows that the comprehensive strength of the hospital is quite strong
.
The hospital's CMI ranked 6th, ranking higher among the participating hospitals, indicating that the hospital's technical ability to diagnose and treat difficult and critical cases has reached the leading level
among the participating hospitals.
How to increase the proportion of four-level surgery, minimally invasive surgery, and the proportion of discharged patients, improve CMI value, improve relevant revenue and expenditure structure, cost control and other operational efficiency indicators are the key core to improve the results of the national examination "National examination" has a distinct baton role
.
Qian Dongfu said that the goals pursued by the "national examination" mainly involve four aspects
: "quality, efficiency, development and satisfaction".
As everyone becomes more and more aware of the rules and indicators of the national examination, the pressure of competition in the national examination will increase
.
At the beginning, some hospitals did not pay attention to informatization and data quality, and some mistakes in data transmission would greatly affect the ranking
.
With everyone's attention and the general improvement of data quality, the "national examination" should score high, how to increase the proportion of fourth-level surgery, minimally invasive surgery, the proportion of discharged patients, improve CMI value, and improve the relevant income and expenditure structure, cost control and other operational efficiency indicators, is the key core to
improve the national examination results.
In terms of hospital management, Qian Dongfu suggested that, first of all, it is necessary to carry out quality management of personnel, technology, equipment, materials and information infrastructure from the structure, strengthen access management from the source, strengthen infection control and adverse event reporting, etc.
, so as to improve the technical level to promote the development of disciplines and ensure medical safety
with behavioral norms 。 Secondly, quality control should be carried out in the whole process of disease diagnosis and treatment admission, diagnosis, treatment, discharge and follow-up, which requires hospital managers to strictly implement the core system and diagnosis and treatment specifications, and pay attention to the management of key departments, key links and key indicators; Strengthen clinical pathway and single-disease management, and promote the homogeneity and standardization
of quality management.
Third, to carry out the final effect evaluation based on data and results, hospitals can establish a monitoring database of performance evaluation medical indicators, evaluate and analyze the results of indicators every quarter, and continuously improve
with reference to the medical quality control indicators of tertiary hospitals.
For patients, Qian Dongfu believes that doctor-patient satisfaction is the ultimate foothold of the "national examination" and the hospital's high-quality development goals
.
There are two secondary indicators in the satisfaction evaluation index part: patient satisfaction and medical staff satisfaction
.
Patient satisfaction is closely related to medical quality, service efficiency and level, and is positively correlated with the internal management level of hospitals and the quality of medical staff
.
If patient satisfaction is low, the hospital's "national examination" score cannot be high
.
The results of the "national examination" have a certain reference for patients' choice of medical treatment, but it should also be noted that the results of the "national examination" are not completely comparable at the national level, such as a large amount of investment expenditure and a large number of new recruits in the short term of a hospital's new campus, which will have an impact on its operational efficiency and other related indicators, and the specific implementation of satisfaction surveys is not uniformly completed by a third party, and so on
。 From the perspective of public health system construction, the current "national examination" has no direct assessment indicators for public health services, and the performance of public health duties by public hospitals in the future can be included in the performance evaluation index system, which will play a positive role
in promoting the integration and cooperation of the public health system and the medical system.
"Only by integrating the goals of the four dimensions of the national examination into the daily work of tertiary public hospitals can we better make up for shortcomings, strengthen advantages, build peaks, and fully improve the modernization level
of hospital governance system and governance capacity.
" Qian Dongfu said
.
Ranking of some hospitals According to the "Health Circle", many hospitals have announced the results of the "national examination" of their own hospitals on the health account (in no particular order): The Second Affiliated Hospital of Inner Mongolia Medical University ranked 3rd in the country in other specialized surgical groups and 1st in Inner Mongolia Autonomous Region; The Fourth Hospital of Hebei Medical University ranked 47th, representing Hebei Province to enter the top
50 in the country for the first time.
What's more valuable is that the CMI value of the hospital ranked 4th in the country this time; The Affiliated Hospital of Guizhou Medical University ranked 67th among the western medicine general hospitals participating in the national evaluation, with a grade of A+, ranking first in Guizhou Province for consecutive years; The Affiliated Hospital of Nantong University ranked 54th in the country; Shandong First DoctorThe First Affiliated Hospital of Shandong University (Qianfoshan Hospital of Shandong Province) ranked 44th among more than 1,300 general hospitals in China Qilu Hospital of Shandong University and the First Affiliated Hospital of China Medical University ranked 13th, of which the Case Combination Index (CMI) of Qilu Hospital of Shandong University ranked 6th in the country.
The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) ranked 21st; Sichuan Provincial People's Hospital ranked 27th; The First Affiliated Hospital of Guangxi Medical University ranked 43rd, the number of fourth-level surgeries ranked 57th in the country, and the technical difficulty (CMI) ranked 14th in the country; The First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital) ranked 44th; Peking University Shenzhen Hospital ranked 53rd and Shenzhen 1st with a good score of 839.
7 points; The Affiliated Hospital of Nantong University ranked 54th in the country and 4th in Jiangsu; Jiaxing First Hospital (Affiliated Hospital of Jiaxing University) ranked 76th in the country; The Affiliated Hospital of Xuzhou Medical University ranked 100th in the country, of which the fourth-level surgery ranked 48th in the country; Changzhou First People's Hospital (the Third Affiliated Hospital of Soochow University) ranked 101st in the country Among the cancer specialized hospitals, the Cancer Hospital of the Chinese Academy of Medical Sciences ranked first Among the hospitals of integrated traditional Chinese and Western medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine won the first place
in the performance evaluation of tertiary public integrated traditional Chinese and western medicine hospitals in the country for the fourth time.
Yueyang Hospital is also the only hospital
in Shanghai that has won the first place in the national examination four times in a row.
Among the general hospitals of traditional Chinese medicine, Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine ranked first and has maintained the top three
for four consecutive years.
Among the specialized hospitals of maternity hospitals (including maternal and child health care hospitals), the Second Hospital of West China of Sichuan University ranked first
.
Shanghai Chest Hospital ranks second among similar hospitals in China; The Second Affiliated Hospital of Inner Mongolia Medical University ranked third in the country in other specialty surgical groups; The Second People's Hospital of Lishui ranked tenth among psychological hospitals; The Second Affiliated Hospital of Chengdu Medical College and the 416 Hospital of Nuclear Industry (416 Hospital of the Second Affiliated Hospital of Chengdu Medical College) ranked 18th among 183
hospitals without financial annual reports.
In the past four years since the performance evaluation of national tertiary public hospitals, Beijing Obstetrics and Gynecology Hospital has won the fifth place in the country for three consecutive years in the evaluation of more than 110 maternal and maternal and children's hospitals
.
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