The Research Of Hospital Medical Quality Evaluation System

PurposesIn last 20 years, as the undertaking of medical and health in China is in a unprecedented flourish and development stage, and the abilities of people to pay and to select doctor and hospital were increasing, management model of hospitals also experienced a change from extensive management to intensive management. One symbol about this change was that societies and hospitals paid more and more attention to medical service quality.But,In the medical service market of China, there were a series of serious problems existed in hospital administration system, hospital operation mechanism and hospital reimbursement mechanism, which make the hospitals competition mainly focus on medical techniques rather than on medical service quality.Although the improvement of medical techniques help to improve medical quality, the sustainable amelioration of hospitals'medical quality would lost the internal impetus if there was little stimulation to improving medical quality for hospitals.At present, country, people, and patient pay attention to medical quality for hospitals more and more. Because of the particularity of medical services, especially the asymmetry of medical knowledge, It is difficult to judge medical quality for hospitals for outsideness,which would result in function naturally restricting the hospital-choosing right of the public. State has no the basis of corresponding control measures to supervise hospitals, and cannot guarantee operation of medical services system in a safe and effective status. Therefore, it was urgent to develop a method to evaluate and supervise the hospitals'medical service quality.This study would employ the methods of literature review,expert consultation,historical data analysis to demonstrate the indicator system and its implemental method of medical service quality evaluation and supervision which has been implemented in Shanghai for 2 years. The major demonstrating content was reliability,validity and effectiveness to improve hospital's medical service quality.Content1. To judge the rationality and feasibility of every indicator in the indicator system by analyzing its content validity,reliability,ability to improve medical service quality and the reason of abnormal data. Every indicator would be argued whether it could be applied in other areas directly,or it's content should be amended,or its supervising method should be corrected,or it could be substituted.2. To judge the rationality and feasibility of every dimensionality of the indicator system by analyzing its construct validity,reliability and ability to improve medical service quality.3. To judge the rationality and feasibility of the whole indicator system by analyzing its construct validity,reliability and ability to improve medical service quality.Methods1. Data Collecting Method1.1 Literatures ReviewThe related literatures were collected from the Chinese Science and Technology Journal Database,the Chinese Academic Journal(CAJ) Full-text Database,Medine ,r elated research institutions web sites,government web sites of China,USA,etc.1.2 Secondary Data AnalysisThe indicator data in this report come from the supervision activities performed by Shanghai health bureau in 2004 and 2005. In these activities Shanghai health bureau gave score of clinical quality and nursing quality for 69 hospital according to two regulations:"The Basic Contents and Requirements of the Clinical Service Quality Management in Hospitals at and above District or County Level"and"The Basic Contents and Requirements of the Nursing Service Quality Management in Hospitals at and above District or County Level". These 69 hospitals included 19 comprehensive hospitals and 12 specialized hospitals at municipal level,30 comprehensive hospitals at district or county level,4 enterprise hospitals and 4 military hospitals. SPSS 11.0 was used to do descriptive analysis,correlation analysis (reliability test) and factor analysis (validity analysis) .1.3 Expert ConsultationFour focus group discussions have been organized to discuss dimensionality,indicator, as well as rationality,feasibility and improving suggestions of indicator scoring. 33 experts have been consulted,20 from hospitals,5 from health bureau and 8 from academic institutions.results and conclusion1 Indicators To Evaluate Medical Treatment1.1 Indicators Which Could Be Tentatively Applied In Other Areas Indicator to reflect whether all kinds of record book have been applied in practice, The indicator to reflect the activity of medical quality comment and appraise in terms of whole hospital, Indicator to express the doctors'qualification to serve outpatients, Indicator to express the management of emergency treatment room, Indicator to express the doctor's activity of three-tier room check, Indicator to express the discussion about specific cases, Indicator to express the brief summary and discussion prior to surgery operation, Indicator to express the visit prior to operation anaesthesia, Indicator to express the visit after operation anaesthesia, Indicator to express the conversation prior to surgery operation, The indicator to express announcement about blood transfusion, Indicator to express proxy file about illness statement announcement, Indicator to express system of room-check prior to off duty in afternoon, Indicator to express average hospitalization days of discharges Indicator to express hospital bed occupancy rate Indicator to express administrative punishment. Above indicators have good reliability and good effectiveness on supervision and behavior change. These indicators,their comment and corresponding supervision methods could be tentatively applied in other areas.1.2 Indicators Which Could Be Applied In Other Areas After Carefully RevisedIndicator to express the implementation of 39 systems about medical works should be carefully revised to improve reliability and sample representation. The major way is to increase number of examined clinic doctors,more than 4 doctors.Indicator to express the writing quality of outpatient's record should be carefully revised to improve reliability and sample representation. The major way is to increase number of examined outpatient's records,more than 6 records. 8 records and more would be feasible and the specialists should be fixed for the supervision of every years.Indicator to express the diagnosis consistent rate between charge and discharge should be carefully revised to improve sample representation. The major way is to increase number of examined discharge's end-records,more than 20 records. 30 records or more would be feasible.1.3 Indicators Which Should Be Argued After Revised Indicator to express medical quality control system in terms of hospital-level and department-level has lower reliability and lower effectiveness on supervision and behavior change. The content of this indicator should be condensed. The content concerning hospital internal quality control should be wiped off and make the residual supervision content satisfy the requirement of external evaluation.Indicator to express the ability which sampled doctor grasp basic clinical techniques has lower reliability and lower effectiveness on supervision and behavior change. It suggested to increase number of examined doctor,more than 4 persons,more than 6 person would be better. Meanwhile,for those unqualified hospital,doctors who are chosen by hospital according to a sampling principle of 1:10 should be sent to attend basic clinic techniques training class. If these doctors can't pass the class examination,they should be forbidden to practice.Indicator to express the system implementation of medical dissension recording has a reliability of. This indicator's effect to improve quality showed adverse trend for variation of indicator's content in 2005. Therefore,this indicator should be demonstrated in next study.1.4 Indicators Which Might Be SubstitutedIndicator to express the prevention and disposal of medical accident had lower reliability and lower effect to improve quality. Some other indicators should be considered to display medical safety.1.5 Dimensionalities of Medical Service Quality Indicator SystemDimensionality of hospital management had good stability(test-retest reliability was evaluated as),show little effect to improve quality(),has good construct validity.Dimensionality of clinic and emergency service management has ordinary stability (test-retest reliability was evaluated as),show strong effect to improve quality(),has bad construct validity.Dimensionality of process quality of medical service has good stability(test-retest reliability was evaluated as),show strong effect to improve quality(),has excellent construct validity.Dimensionality of hospital management had good stability(test-retest reliability was evaluated as),show adverse effect to improve quality(☆),has bad construct validity.Dimensionality of medical safety has ordinary stability (test-retest reliability was evaluated as),show adverse effect to improve quality(☆☆☆) ,has bad construct validity.1.6 Indicator System of Medical Service QualityThe whole indicator system of medical service quality had ordinary stability(test-retest reliability was evaluated as),show ordinary effect to improve quality(),has good construct validity. All the indicators can by reduced into 9 factors which could explain 73.5% of all the indicator's variation.2 Indicator System To Evaluate Nursing QualityThe indicator system to evaluate nursing quality still stayed at the phase of improvement in the context of Shanghai. Research team couldn't find integrate indicator system for evaluation and indicator optimization. The number of indicators which had the same name and put into practice in 2004 and 2005 is only 6. The content and supervision ways of 6 indicators varied much between 2004 and 2005. Therefore,there may be some distortions of study results if indicator data of 2004 and 2005 were directly used to calculate reliability and effect to improve quality. The verification of indicator's reliability and effect to improve quality had to be further studied in 2006. This report would focus on construct validity evaluation.Indicator system of nursing service quality in 2004 had 8 dimensionalities,in which,besides those indicators in dimensionality of"transfusion room service",indicators in other 7 dimensionalities could not reduce to relative dimensionality. It could be concluded that indicators in nursing service quality indicator system in 2004 were in chaos and should be simplified. In 2005,the indicators of nursing service quality had been condensed,from 8 dimensionalities 36 indicators to 6 dimensionalities 15 indicatorsThe construct validity of indicator system in 2005 was better than that of in indicator system 2004. Among 6 factors reduced from 15 indicators,2 factors could match with relative dimensionalities(first-level nursing service and examination of basic knowledge,basic theory and basic technique). However,indicators in other 4 dimensionalities still show the phenomenon of intercross.3 The Public Was Unable To Give Correct Judgment On A Given Hospital'S Medical And Nursing QualityThe score of all dimensionality or total indicator system had no significant relationship with the score of the public's subjective evaluation to hospital's medical quality,which suggested that medical quality of hospital was hard to be correctly recognized and compared for the public. The score of the public's subjective evaluation to hospital's medical quality has significant relationship with the level of hospital,which suggested that the public and patients mainly evaluate hospital's medical quality by hospital's level. What could be recognized by the public in nursing quality was emergency service,for example,devices equipment in ambulance.Research InnovationIn the past, It focused more on seeking expert advice to constitute the evaluation criteria of medical quality,or whether various indicators were a more comprehensive coverage of medical activities, However, the scientific of indicators'Categories and effective of indicators were not adequate tested and demonstrated. The innovation lies in full testing and demonstrating the validity and reliability of medical quality indicator system by Statistical methods and putting forward adjustments views and suggestions for medical quality indicators. It is a feature exploration for scientific constructing medical quality indicators.Innovative pointsShortcoming and further research neededShortcomings1,Because the time and outlay was limited, The samples of investigation was only in Shanghai. In view of our geographical, economic cultural differences , it is not entirely representative of the evaluation indicators of medical quality in the other areas'hospital.2,Because the time and ability was limited, subject only analyzed the existing evaluation indicators of hospital medical quality in Shanghai in the past, did not complete indicators,not use and validate filtered indicators,It will be researched on the future.Suggestion1,The survey regional would be expanded, and the researched evaluation indicators would be further validated. 2,Because some existed indicators were overlap and some important indicators(especially in relation to patients with medical safety)were lack, etc,after consulting experts, some key indicators would be added and then further validated in practice...