Establishment Of Quality Index System For Clinical Diagnosis And Treatment And Its Relationship With Biomedical Materials

Research PurposeRecent years,China's reform in the field of medicine and health has been pushed forward in an all-round way,and the linkage between medical treatment,medicine and medical insurance has been continuously strengthened.As the supplier of medical services,the reform of medical and health system puts forward higher requirements for medical institutions,especially in the evaluation and improvement of hospital medical quality.Hospital medical quality is also called hospital medical service quality,which not only includes hospital medical quality,but also includes hospital operation related medical efficiency,medical benefit,systematicness and safety.Medical quality is the foundation and source of hospital's sustainable survival and development,and also the embodiment of hospital's core competitiveness.The international research on hospital medical quality has been well developed.The main systems are JCI,IQIP,PATH,CIP and US Top 100 Hospital Evaluation System.The main medical quality systems in China include the Chinese Medical Quality Index System(CHQIS)and the tertiary general hospital accreditation standards.The above-mentioned medical quality evaluation system had different evaluation point of view and focuses,but they mainly followed the three-level theory of quality evaluation,namely,structure,process and results,and divides medical quality into three parts: quality foundation,quality of work process and quality outcome.Biomedical materials,also known as biomaterials,are a new class of high-tech materials used to diagnose,treat,repair or replace human tissues or organs or enhance their functions.With the development of science and technology and the progress of clinical diagnosis and treatment,medical polymer biomaterials,medical metal materials,medical bio-composites and medical bio-derived materials are more and more widely used in the medical field,changing the traditional medical mode and clinical pathway.In recent years,Southwest Hospital put forward the strategy of " strengthening the hospital with biology",which not only gave birth to medical high-tech biomaterial technologies such as biological stem cell therapy,3D printing,tissue engineering,etc.to improve the clinical medical level,but also promoted basic and clinical research and published a number of high-impact SCI papers,which have a certain foundation in this respect.At present,there are few studies on whether biomaterials affect the level of clinical diagnosis and treatment,and how to affect the level of clinical diagnosis and treatment.Based on the theoretical analysis of the role of biomaterials in improving the level of clinical diagnosis and treatment,this study tries to clarify the relationship between the use of biomaterials and the level of clinical diagnosis and treatment,and takes Southwest Hospital as an empirical research object,analyzes the development of biomaterials in Southwest Hospital and comprehensively evaluates its influence on the key elements constituting the level of clinical diagnosis and treatment by analyzing relevant data,and discusses the promotion of biomaterials to the level of clinical diagnosis and treatment,so as to provide a theoretical basis for the establishment of a new development model in the era of biotechnology.Research methodOn the basis of reference to domestic and foreign literatures,this study used focus group interview and Delphi expert consultation to establish a hospital clinical diagnosis and treatment quality evaluation index system,and used analytic hierarchy process to calculate the index weight.The impact of index system and biological materials on the quality of clinical diagnosis and treatment was evaluated by using empirical research data from Southwest Hospital.Factor analysis and Cronbach' s alpha coefficient calculation were used to evaluate the reliability and validity of the index system,and mathematical statistics methods such as GLM model and logistic regression were used to analyze the distinction between biological materials and the quality of clinical diagnosis and treatment.At last,the paper discusses the change trend and rationality of clinical diagnosis and treatment quality score in Southwest Hospital after using biological materials by using weighted cumulative comprehensive score method.Research resultsThrough a series of research activities,the research has finally achieved the following research results:(1)A hierarchical index system structured by three categories of indicators: quality basis,quality outcome and quality development,including three primary indicator s,six secondary indicators and 24 tertiary indicators.Among them,the quality foundation includes two secondary indicators of human resources and discipline construction,the quality outcome includes three secondary indicators of diagnosis and treatment intensity,diagnosis and treatment quality and diagnosis and treatment efficiency,and the quality development includes one secondary indicator of diagnosis and treatment innovation.(2)The weights of the primary,secondary and tertiary indicators were determined,including the weight of quality foundation 0.293,the weight of quality outcome 0.499,the weight of quality development 0.208,the weight of human resources 0.126,the weight of discipline construction 0.167,the weight of treatment intensity 0.125,the weight of treatment quality 0.166,the weight of treatment efficiency 0.208,and the weight of treatment innovation 0.208.(3)Factor analysis showed that six common factors were extracted according to the criterion that the characteristic root was greater than 1,and the cumulative variance contribution rate was 84.4 %.The first factor mainly reflects the strength and results of clinical services,the second factor mainly reflects the innovation ability of scientific research,the third factor mainly reflects the utilization efficiency of clinical resources,the fourth factor mainly reflects the human resources related to scientific research,the fifth factor mainly reflects the output of scientific research achievements,and the sixth factor mainly reflects the efficiency of diagnosis and treatment.The results of factor analysis are basically consistent with the construction of secondary indexes,and indicate that the response index system has good validity.(4)By calculating Cronbach's alpha coefficient,the Cronbach's alpha coefficient of the first grade index is " quality basis" 0.732," quality outcome" 0.807," quality development" 0.863,and the Cronbach's A coefficient of the second grade index is 0.426 for human resources,0.667 for discipline construction,0.884 for diagnosis and treatment intensity,0.964 for diagnosis and treatment quality,0.748 for diagnosis and treatment efficiency,0.863 for diagnosis and treatment innovation,and 0.879 for the third grade index.Overall,the reliability of the evaluation index system of clinical diagnosis and treatment level is good and the design of the index system is reasonable.(5)Studying the patient data of four departments in Southwest Hospital,the results show that the use of biological materials mainly reduces the hospital stay and operation time of patients.The average length of hospital stay for patients with gynecological uterine suspension surgery using biomaterials was 7.05 days and the operation duration was 1.57 hours,while the average length of hospital stay for patients without biomaterials was 7.51 days and the operation duration was 1.75 hours.The average length of hospital stay for orthopedic cases using biomaterials was 11.75 days,the operation duration was 3.67 hours,and the average length of hospital stay without biomaterials was 12.66 days and the operation duration was 3.99 hours.The average length of stay in neurosurgery with biomaterials was 28.85 days,while the average length of stay without biomaterials was 30.35 days.The average length of hospital stay for chest surgery patients using biomaterials was 13.59 days,the operation duration was 1.83 hours,the average length of hospital stay for patients not using biomaterials was 14.53 days,and the operation duration was 1.82 hours.(6)Evaluate the medical quality scores of the four departments.The quality scores of diagnosis and treatment in obstetrics and gynecology from 2008 to 2013 were 4.939,5.260,5.795,7.003,6.858 and 7.066.Orthopedic diagnosis and treatment quality scores from 2014 to 2016 were 5.752,4.958 and 5.270.The score of diagnosis and treatment quality in thoracic surgery from 2009 to 2011 was 2.406,3.008 and 2.938.The diagnosis and treatment quality scores of neurosurgery from 2011 to 2013 were 3.429,3.532 and 3.557.(7)The Pearson correlation coefficient between “quality of clinical diagnosis and treatment” and the number of biomaterials utilized was 0.55(P=0.065),which didn't reach a significant level.ConclusionBased on the above research,the following conclusions and suggestions are obtained:(1)The established clinical diagnosis and treatment quality index system covers a comprehensive range with good reliability and validity;(2)The selection method of evaluation index is reasonable;(3)The method of determining the index weight coefficient is scientific and the result is relatively accurate;(4)The score of diagnosis and treatment quality of clinical departments has a certain correlation with the use of biological materials.(5)The main mechanism for biomaterials to promote the quality of clinical diagnosis and treatment is to shorten the hospital stay and operation time,improve the efficiency and intensity of diagnosis and treatment,improve the scientific research level,discipline construction and personnel training of departments,improve the quality foundation and quality development,and thus improve the quality of medical treatment.