In order to establish objective, scientific, effective performance assessment system and strengthen government’s supervision on health service in our country, this research retrieved literature on relevant official UK websites and databases to get the whole picture of NHS (National Health Service) performance assessment policy, documents and reports. Based on the introduction of NHS Performance Assessment Framework (1999), NHS Performance Assessment Framework: Implementation Guidance (2009) and NHS Performance Rating, it summarized and analyzed the experience and measures of NHS Performance Assessment, which enlightened us in the following aspects: a) We should pay more attention to the performance assessment of national healthcare system and spread out the relevant work in China; b) Performance assessment is closely linked with national health policy and its strategic focus; c) Performance assessment centers on quality; d) We should take performance assessment as a strategic tool to improve the healthcare system performance.
ObjectiveTo comprehensively evaluate the essential public health service in Xinjin county of Chengdu from 2009 to April 2011, so as to provide evidence for improving primary healthcare system reform in Chengdu city. MethodsThe data was collected from the Xinjin county-wide health information system. The electronic health records, chronic disease management, childbirth management and mental health were quantitatively described and compared. Resultsa) In 2010, 88 772 residents had the physical examination and health assessment, among which, 14 497 (16%) were detected with some health problems. The average cost per positive detection was RMB 122.5 yuan. b) Up to April 2011, 98.2% of people in Xinjin county have their health records but the proportions were ranged from 68.08% to 109.02% in different primary healthcare providers. The details of the most health records were incomplete. c) 7 318 patients with hypertension and 2 187 diabetes mellitus were detected, and among them, 90.1% of patients with hypertension and 95.1% of patients with diabetes had their health records for chronic diseases management. d) The rate of stillbirth or neonatal mortality was lower than 4‰. There was no maternal death in the 8 years. But the cesarean section rate was about 61%. e) 97.3% of the patients with mental disorders were supervised in 2010, which was reduced by 2.7% compared to 2009. Conclusionsa) There is low proportion of all the residents in Xinjin having physical examination and health assessment and the rate of diseases detection is low as well. b) There is very wide coverage of health records for residents in Xinjin county, nearly universal coverage. c) The health records for the chronic disease patients were well-established, but the early detection rate of the chronic diseases is low. d) High proportion of the patients with mental disorders is supervised. e) The strategy that only county-level hospitals could provide obstetrical service instead of township hospitals is successful to reduce the neonatal mortality and maternal mortality. However, the cesarean section rate is high. f) It acts, to some extent, as a model to successfully improve the essential public health service and management based on the conuty-wide healthcare information system. However, the data quality, data mining and data utilization should be further improved
Objective To assess the public health impacts and needs, to evaluate performance of anti-epidemic efforts after Lushan earthquake, so as to provide references for the following anti-epidemic work. Methods The day of earthquake occurrence was defined as the first day after earthquake. We collected information and data from the Sichuan Provincial Government, the National Health and Family Planning Commission of the People’s Republic of China, the Health Department of Sichuan Province, Sichuan Center for Disease Control and Prevention, and then we compared the situations of disaster, public health situation in stricken area, emergency response, resource deployment, etc. with those after Wenchuan earthquake in 2008, in order to evaluate the performance of anti-epidemic response during 2 weeks, clarify current situations and demands, and offer a proposal for the following work. Results Emergency response was conducted immediately after the Lushan earthquake. The counterpart assistance was considered at the beginning of team arrangement. The number and professional structure of rescue participants were planned according to needs. Three days after earthquake, anti-epidemic staff arrived at every involved county, town, and even village, which achieved full rescue coverage of locations and interventions. The staff helped reconstruct disease surveillance system, protect source of drinking water and environmental hygiene, etc., which resulted in progressive achievement. Two weeks after the earthquake there were no outbreak and public health emergency event occurred in stricken area. Conclusion The anti-epidemic efforts after Lushan earthquake inherit and develop the lessons from Wenchuan earthquake in 2008. Emergency response is timely, orderly, scientific, and moderate. The deployment of policies, technologies and resources has already been completed during two weeks. Anti-epidemic efforts achieve preliminary results. We suggest that key issues of further work should be the implementation of policies, strategies and measures, such as health management at relocation sites, water and food hygiene, disease monitoring, prevention and control, mass vaccination, scientific disinfection, and health education, in order to improve long-efficacy mechanism and stabilize work performance.
ObjectiveTo evaluate the complete blood count performance quality of Sysmex-XN automatic hematology analyzer. MethodsWe investigated the precision rate, residual contamination rate, analytic linearity range, and background counting of Sysmex-XN-B3 analyzer. ResultsThe inner and inter-group precision test showed that the inaccuracy of the analyzer was lower than the allowable standard of 1/4 (CLIA'88). The highest level of residual contamination rate was 0.12%, lower than the standard of manufacturer (≤1%). Linearity evaluation showed that the white blood cell count analytic linear range was from 0.51×109/L to 393.40×109/L, the red blood cell count analytic linear range was from 0.51×1012/L to 8.15×1012/L, the hemoglobin analytic linear range from 15.0 g/L to 244.5 g/L, and the platelet count analytic linear range was from 3.0×109/L to 2 072.5×109/L. Background counting was also lower than the standard of manufacturer. Comparison between the two different series of analyzers showed that the inaccuracy rate of Sysmex-XN-B3 was not only lower than the standard of National Center for Clinical Laboratories, but also lower than the standard of 1/2 (CLIA'88). ConclusionSysmex-XN automatic hematology analyzer has a high performance in capability evaluation. It is an excellent tool for routine hematologic blood examination.
Regarding the working hours generated by clinical trial project services under the guidance of good clinical practice (GCP), taking the standard process of a cancer project screening period as an example, and relying on a standardized management model, this paper uses standard time measurement methods to calculate the standard time of the 12 regular tasks in the GCP project. On this basis, it analyzes the GCP project process in detail to find out the reasons for wasted performance hours, and proposes a series of improvement methods and suggestions, such as formulating and implementing a target assessment mechanism, developing standard format cards, using double-line operations research to carry out parallel operations, using quadrant method to divide tasks, using site management organization and resources of hospital departments to reduce coordination loss, and introducing big data management systems, so as to make the work process of clinical research coordinators more refined and professional.
ObjectiveTo explore the new hospital management method about diagnosis-related groups (DRGs), and put forward some strategic suggestions.MethodsIn March 2019, using literature research method, relevant documents were consulted to understand the research policy and background. In April 2019, the DRGs data and first pages of medical records of a tertiary grade A hospital in 2018 were obtained through field survey. The DRG with the largest quantity of patients was selected, and then the top two treatment centers ranked by the quantity of patients were selected for analysis.ResultsA total of 11 936 patients’ face sheets for medical records were investigated, covering 18 major disease categories (MDCs) and 93 DRGs. Treatment center A and B were the top two treatment centers ranked by the quantity of patients, covering 8 MDCs and 34 DRGs. There were 1 116 patients in treatment center A and 470 patients in treatment center B, with the same case-mix index (0.820). There was no statistically significant difference in the average length of hospital stay between the two treatment centers (t=?1.926, P=0.054). The average hospitalization expenses [(45 902.64±30 028.22) vs. (40 763.34±25 141.12) yuan, t=?3.260, P=0.001], drug expenses [21 481.43 (10 663.16, 34 251.64) vs. 11 740.36 (5 818.37, 21 572.09) yuan, Z=?9.812, P<0.001], and other expenses [138.00 (84.00, 178.00) vs. 120.00 (72.00,155.28) yuan, Z=?3.573, P<0.001] in treatment center B were higher than those in treatment center A. But the medical technology expenses [(7 319.11±3 781.52) vs. (10 995.61±4 784.55) yuan, t=12.324, P<0.001] and nursing expenses [(578.42±226.82) vs. (882.99±781.63) yuan, t=8.187, P<0.001] in treatment center B were lower than those in treatment center A.ConclusionsThe disease diagnosis and treatment specifications need to be strengthened and the process needs to be optimized. In the next hospital management, we should pay attention to key indicators to improve performance appraisal, standardize the diagnosis and treatment process to promote clinical path, and mine deep data to make performance management detailed.
Objective To explore the performance management intervention effect and optimization mode analysis of prefecture-level city hospitals under the reform of diagnosis-intervention packet (DIP) payment system. Methods Taking Deyang peopel’s hospital as the research object and 2021 as the time node of the DIP payment system reform, the data related to the hospital’s operational performance before the implementation of DIP payment (2019-2020) and the hospital’s operational performance after the implementation of DIP (2021-2022) were collected. The performance management evaluation system of Deyang peopel’s hospital was constructed based on game combination weights. The performance management level of Deyang People’s Hospital was measured, and the changes in hospital performance before and after the implementation of DIP payment system reform were analyzed through the construction of the interrupted time series model. Results After the implementation of DIP payment system reform in Deyang People’s Hospital, it had a significant impact on drug revenue, consumables revenue, and medical service revenue (P<0.05). Among them, drug revenue, examination revenue, acceptance revenue before the DIP payment system reform all showed a downward trend, medical service revenue showed an overall upward trend. However, there was no significant impact on the average hospitalization days of the patients, inpatient per capita medical costs, outpatient per capita medical costs, and the proportion of hospitalization income from the health insurance fund for patients (P>0.05). Conclusion The implementation of the DIP payment system can effectively improve the comprehensive level of performance of Deyang peopel’s hospital.
ObjectiveTo evaluate the current status of primary healthcare system reform in Xinjin county, in order to provide baseline data for improving the healthcare service system and population health in Chengdu. MethodsPrimary health care services and population health in Xinjin county were quantitatively described and compared. Resultsa) Eleven township hospitals (100%) and 89 village clinics (66.42%) were upgraded according to the national standards. The management of 60 village clinics were integrated with township hospitals. And 417 and 76 essential healthcare services were provided by township hospitals and village clinics, respectively. b) In 2010, the number of outpatients and inpatients in Xinjin county were increased by 24.2% and 46.3% respectively compared to those of 2009, while the costs per outpatient visit and inpatient discharge were reduced by 21.5% and 18.6% respectively. c) In 2010, health records of 98.2% of population in Xinjin county have been established; 96.3% of pregnant women were managed systematically; 98.8% of children immunization programs were implemented; 100% patients with severe mental disorders and about 78% with hypertension and diabetes were in follow-up and treatment; and 28.8% of total population got the free physical exams in 2010. d) The essential medicine accounted for 96.7% of total types of medicines and 97.8% of total expenditure of medicines in primarily healthcare institutions in Xinjin. The cost of medicine management was reduced from 8.5% to 4.2% while the medicine turnover rate was increased by 50%. e) Average life expectancy in Xinjin county was 77.97 years, infant mortality rate was 6.82‰ in 2010; and there was no maternal death in recent 8 years. f) The regional healthcare information system was established covering three-tier rural health care network spanning the county, township and village. Conclusiona) The primary healthcare system reform in Xinjin county improves the infrastructure of primary care system, the utilization of essential medical care, essential public health service, and essential medicines. b) Life expectancy, infant mortality rate and maternal mortality of Xinjin county are better than the average levels in Sichuan province and China. Xinjin county is a representative pilot county for healthcare service system reform in Chengdu city and a nice model to successfully promote healthcare system reform based on regional healthcare information system.
As an advanced mode of diagnosis and treatment, day surgery is widely carried out in foreign countries. Although it started late in China, it has been gradually valued and vigorously promoted in medical and health field in recent years. The effective implementation of day surgery in hospital cannot be separated from the strong support of performance management system. Through introducing the performance management experiences in promoting day surgery mode in West China Hospital of Sichuan University, this article discusses how to construct an effective whole-course performance management system for day surgery combined with operation management through three mechanisms: the management committee mechanism, the operation management mechanism and the performance assessment mechanism, which are based on the structure-process-outcome dimensions of quality management system, at the three levels of hospital, department and position, so as to provide a reference for developing day surgery in China.
ObjectiveTo investigate the essential healthcare system performance in Xinjin county of Chengdu city from 2009 to 2010, so as to provide baseline data for further study. MethodsThe general information of the essential healthcare, such as the numbers of out and in-patients, service and profits were collected and then analyzed using the software of Microsoft Excel 2003 and SPSS 13.0. Resultsa) The results showed that the numbers of out and in-patients were in the rank of the county, township and community hospital. The numbers of out and emergency patients has been decreased 31.0% and 25.3% in the community hospital from 2009 to 2010, while patients in the county and township hospital has been increased. The numbers of in-patients has been increased by year; b) hospital bed occupancy has been increased by year, and the hospital bed occupancy of county hospitals was 8% lower than national level in 2009, 33.5% higher in 2010, the hospital bed occupancy of township hospitals from 2009 to 2010 was higher than national level, the ones of community hospital was lower than national level; c) there is an annual decreasing tendency for average days for hospitalization in county and community hospital, which were higher than national level; d) it was lower than national average rate; e) the inpatient fee per time was lower than national average rate; f) in the components of the in-patients expense, drug expense, operation expense and diagnose expense were constituted more than 86% in all eight costs; and g) the receipts and expenditure of Xinjin hospital throughout the year increased by years, the income and expenses showed 39.3% and 37.7%. ConclusionThe hospital bed occupancy, average hospitalization days and the inpatient fee per time in Xinjin county of Chengdu city during 2009-2010, were higher than national level. The overall health performance of hospitals in Xinjin county was satisfied. However, there was significant difference between the best and the worst. In order to distribute health resources, both benefit and efficient should be emphasized.