Quality Of Care Evaluation In County-level Public Hospitals In Shandong Province

BackgroundThe level of medical service in county-level public hospitals is an important reflection of primary health service capacity.Scientific and reasonable evaluation of the quality of medical services in county-level public hospitals and the comprehensive improvement of their service capacity play a key role in meeting the multi-level health needs of county residents and realizing the integration of county and township medical and he 4th services.At present,domestic research on medical service quality evaluation mostly focuses on high-level general hospitals and focuses on the quality of medical service outcomes,with little attention paid to the quality of medical service structure and process.ObjectiveThis study aims to evaluate the quality of medical services in county-level public hospitals in Shandong Province from the three dimensions of structure,process and outcomes.So as to provide decision-making basis for promoting the continuous improvement of medical service quality of public hospitals in the county level and provide suggestions for improving the evaluation system of medical service quality in shandong province.MethodsThe research data comes from the "China County Public Hospital Reform Research" project supported by the China Medical Board.Six county-level public hospitals in three counties of Shandong Province were selected as research objects,and questionnaires,medical record review and telephone follow-up were used to collect research data.The main contents of the questionnaire include the number and efficiency of hospital medical services,safety and infection,the composition of health human resources,infrastructure configuration,management system use and climical pathway development.The main contents of the medical record review include the implementation of key indicators of the clinical pathway of pneumonia,heart failure and stroke.The maim contents of telephone follow-up include investigating the level of satisfaction of discharged patients with medical care communication,hospital environment,treatment management and discharge guidance.Descriptive analysis was used to analyze and compare the medical service structure,process and outcome quality of county-level public hospitals.Multiple linear regression model and multiple logistic regression model were used to explore the relationship between medical service processes and medical service outcomes.Data analysis is mainly done by Exce12010 and SPSSv21.0.Results(1)Quality of medical service structureThe average hospital management staff of the six hospitals accounted for 5%,farbelow the standard level(10%).The average number of pharmacy personnel in the three general hospitals was 5%,far below the standard level(8%).Inspection and radiation personnel accounted for an average of 6%,far below the standard level(9%).The average ratio of doctors to nurses in three traditional Chinese medicine hospitals was 1:1.24,which was lower than the provincial average(1:1.25).Medical staff in 6 hospitals were mainly of bachelor,junior college or below,accounting for 47%and 43%respectively;master’s degree and above accounted for only 10%.Hospital basic medical facilities have been equipped,some hospitals need to be improved.The number of medical equipment over ten thousand yuan in general hospitals was significantly higher than that in traditional Chinese medicine hospitals.The installation and use of the management information system of the county-level traditional Chinese medicine hospital is not in place,and the number of diseases in the clinical pathway is less than 20 kinds.(2)Quality of medical service processThe implementation rate of key indicators of clinical pathway of heart failure.pneumonia and stroke is not high,and there are differences in implementation in different regions.The overall implementation of county-level general hospitals is better than that of traditional Chinese medicine hospitals.Among them,the implementation of inspection indicators is relatively poor,the implementation of discharge indicators is general,and the implementation of drug guidance indicators is better than lifestyle guidance.Only 4%of patients with pneumonia underwent blood culture before the first antibiotic treatment;70%of patients with stroke were prescribed medication and medication guidance,but only 8.93%of patients were given written cessation guidance(3)Quality of medical service outcomeThe medical service capacity and efficiency of county-level general hospitals are significantly higher than those of traditional Chinese medicine hospitals.The average number of outpatient and emergency visits and hospital admissions in general hospitals is more than three times that of traditional Chinese medicine hospitals.The average length of hospital stay in the 3 county-level traditional Chinese medicine hospitals(10.7)was higher than the 2016 provincial average(8.9).and the average number of hospital bed turnovers(32.1)was lower than the provincial average(33.9).There is a lack of relevant policy evaluation criteria for in-hospital safety and infection.Hospitalization patients were less satisfied with treatment management and discharge guidance,55%and 60%,respectively.(4)A correlation between medical process and outcomePatients with pneumonia underwent oxygenation assessment after admission(β=-0.155,P=0.004).antibiotics were used within 6 hours of admission(β=-0.128,P=0.045),and sputum culture was performed before the first antibiotic treatment(β=-0.123,P=0.018)have a significant effect on reducing the number of hospital stay.About stroke,anticoagulant drugs were used immediately within 24 hours of stroke(P=0.003,OR=0.180),having explicit instructions for discharge of drugs(P=0.002,OR=0.048)have significant effects on improving the treatment outcomes.Conclusion and suggestionsThere are certain problems and shortcomings in the quality of medical service structure,process and outcome in county-level public hospitals,which need to be further improved.About structure,the main problems are inadequate staffing,imperfect infrastructure and management information systems,and inadequate implementation of clinical pathways.About process,the main problem is poor implementation of clinical pathways.About outcome,the main problem is that the service capacity of county-level traditional Chinese medicine hospitals is low,and the sense of service centered on "health" is not in place.About suggestions:1)Improve the evaluation standards and systems for medical service quality,so that comprehensive assessment has rules to follow;2)Increase policy inclination and financial input,improve the construction of the health talent team system;3)Strengthen the education and training of the clinical pathways of medical staff;4)Improve the performance appraisal system in the hospital,strengthen inspection and feedback,and implement standardized management.