Construction And Application Of Evaluation Index System For Homogenized Medical Services Under The Mode Of One Hospital And Multiple Districts In Public Hospitals

Objective: Public hospitals with one hospital and multiple districts have the advantages of expanding high-quality medical resources,improving resource utilization,and alleviating medical service pressure.Homogenization of medical services is one of the key issues in the development process of public hospitals with one hospital and multiple districts.This study attempted to construct a systematic,reasonable,and scientific evaluation index system and evaluation methods by reviewing the concept and research progress of homogenization of medical services in one hospital,multiple districts,and public hospitals in China.It explored the ways to evaluate the effectiveness of homogenization of medical services in one hospital,multiple districts,and conducted empirical analysis of the index system.The aim was to provide theoretical basis and practical guidance for the development practice of multiple districts in a public hospital,in order to promote the scientific and standardized management of branch districts.Methods: This research combed the relevant indicators of the existing public hospital multi district medical service homogenization evaluation,combined the Donabedian model to build the evaluation framework of the public hospital multi district medical service homogenization,and used the Delphi method to establish a set of public hospital multi district medical service homogenization evaluation indicator system.On this basis,the Analytic Hierarchy Process was used to determine the weights of indicators for homogenization of medical services in multiple districts of a public hospital,and consistency testing was conducted.Used 11 clinical departments from two comprehensive wards of a public hospital in Anhui Province as the research subjects,the TOPSIS+RSR method was used to comprehensively evaluate the homogenization level of medical services in multiple wards of a public hospital.Based on the evaluation results and synergy theory,explore optimization strategies for homogenizing medical services in multiple districts of a public hospital.Results:(1)In the first round of correspondence questionnaires,15 questionnaires were distributed and 13 questionnaires were returned,and the positive coefficient of experts was 86.67%,and in the second round of correspondence questionnaires,13 questionnaires were distributed and 13 questionnaires were returned,and the positive coefficient of experts was 100%,and the authority coefficient of experts was 0.877.In the results of the two rounds of expert consultation,the expert coordination coefficients W for importance and accessibility were above 0.2,and the W in the second round were better than those in the first round,and the coordination coefficients of P values of significance tests were all less than 0.001,and the differences were statistically significant.(2)Finally,three primary indicators(resource input,operational efficiency,medical quality),nine secondary indicators(infrastructure,talent support,revenue and expenditure structure,cost control,medical services,service volume,technical security,patient safety,rational use of drugs)and 41 tertiary indicators were identified.(3)In the process of assigning weights by hierarchical analysis,the consistency ratio of judgment matrix is less than0.100.In the middle tier,"patient safety"(0.338)has the highest weight,followed by "rational use of medication"(0.186),"medical services"(0.627),and "health care services"(0.627),"medical services"(0.110),"technical support"(0.102),"cost control"(0.092),"talent support"(0.078),"service volume"(0.055),"income and expenditure structure"(0.023),"infrastructure"(0.016),and in the indicator stratum,"complication rate of surgical patients"(0.058),"antimicrobial drug use(DDDs)"(0.053),"incidence of hospital infections "(0.152),"per capita medical costs for outpatient and inpatient care"(0.149),"case fatality rate in low-risk group"(0.108),"medical-to-nursing ratio "(0.046),"actual consumption of inpatient antimicrobial drugs"(0.037),"percentage of unplanned reoperations"(0.026),"average hospitalization days "(0.024),and "per capita cost of drugs in outpatient or inpatient settings"(0.024)were the top 10 influencing factors with relatively high importance.(4)TOPSIS analysis results showed that the highest level of homogeneity of medical services in clinical departments was B(gynecology),and the lowest was I(neurosurgery).The RSR method evaluation results showed that the homogenization level of medical services in 11 clinical departments can be divided into three levels: high,medium,and low.Ci and its corresponding probability Probit linear regression equation had statistical significance(F=402.1,P<0.001).Among them,B(gynecology,Ci=0.816),K(oncology,Ci=0.696),E(orthopaedics,Ci=0.692),F(general surgery,Ci=0.678)had a high level of medical service homogenization,and clinical departments G(cardiovascular medicine,Ci=0.658),A(paediatrics,Ci=0.656),D(infectious diseases,Ci=0.651),J(cardiac vascular surgery,Ci=0.634)had a general level of medical service homogenization,clinical departments C(obstetrics,Ci=0.612),H(respiratory and critical medicine,Ci=0.599)I(neurosurgery,Ci=0.514)had a low level of medical service homogeneity.Conclusions: The evaluation index system established in this study is relatively comprehensive and the results are credible,which provides certain reference for the comprehensive evaluation of the homogenization effect of medical services in one hospital and multiple districts of Chinese public hospitals.Through empirical research,the index system constructed can reflect the real situation of the homogeneity of medical services in the same department in different hospitals,timely grasp the weaknesses of different hospitals,provide reference for accurate guidance of the same high-quality development of one hospital and multiple districts,and further promote the sustainable development of one hospital and multiple districts of public hospitals.In order to further optimize the homogenization level of medical services in one hospital and multiple districts of public hospitals,optimization strategies should be considered from the following perspectives:(1)Resource flow to improve collaborative accuracy;(2)Improving quality and efficiency to maintain collaborative sustainability;(3)Synergistic effectiveness of cultural construction.