| BackgroundPOCT(Point of Care Testing),as a new arising testing method in clinical laboratory field,it is increasingly receiving attention.In its draft POCT Consultation Paper,the National Institute of Clinical Biochemistry(NACB)defines POCT as"clinically or patient(self-testing)that is not clinically trained in clinical laboratory of the clinical test,POCT contains every test except the traditional,core or central laboratory".POCT is a kind of great potential testing technology,because of its quick and convenient characteristics,has been widely accepted by clinically medical workers,patients,to significantly reduce the examination and treatment time to the patient.Compared with the western developed countries,POCT is not applied in China for a long time and it lack of appropriate management experience,furthermore,POCT is vulnerable to instrument performance,operational proficiency and many other factors,POCT quality management is becoming increasingly important.Nowadays,POCT has been widely used in clinical technology for blood glucose testing,each of the clinical department conducts a large number of blood glucose testing every day,and blood glucose testing results will also affect the doctor's diagnosis and treatment results,if handled properly,and even endanger the health of patients.However,clinical POCT testing quality management still has more problems.For instance,clinical operating personnel does lack of relevant testing knowledge training,and they lack of the standard operating procedures of blood glucose testing process,did not pay attention to clinical operating personnel retrospective assessment and evaluation,clinical operating personnel lack of continue to improve awareness so on.Therefore,the study of POCT blood glucose testing quality management status,to explore management strategies,to protect the quality of clinical blood glucose testing,to reduce misdiagnosis rate,which has great significance to ensure the quality of medical safety.ObjectiveThe aim of this study is to construct a set of hospital POCT blood glucose testing quality management system which is in line with clinical actual needs,scientific,feasible and purposeful,and can be used at all class of hospital for reference and even for the health administrative departments to develop policy management documents.Methods1?Literature researchThis study mainly focused on the following two aspects of the literature search:First,the relevant POCT blood glucose testing management policies and regulations,the collection of relevant indicators;Second,by widely searched the China Knowledge Network,Wanfang and other databases to understand the POCT blood glucose at home and abroad Status,and the relevant content into the regulations clauses.2?Delphi methodIn this study used the Delphi method that designed the expert consultation questionnaire and selected 20 experts to evaluate the weights of the indicators at all levels through two rounds of formal investigation.In order to ensure the scientific nature and reliability of the management system,the reliability of the expert consultation results is measured in this study by the positive coefficient of the experts,the coercive coefficient and the coordination degree of the expert opinions.3?Statistical analysis(1)Descriptive statisticsDescribe the basic structure of the consultants' age structure,technical title,academic structure,working years,management duties and so on.(2)Expert positive coefficientThe positive coefficient of experts indicates that the degree of concern and attention of the experts in this study,which reflected by the recovery rate of the questionnaire in generally.The higher the recovery rate those mean the higher the positive coefficient of experts.The formula is:Cj=mj/m;in the formula,Cj is the expert positive coefficient,mj is the expert who involved in the evaluation,m is the total number of experts.(3)The degree of authority coefficientThe degree of expert authority is generally measured by the expert's judgment on the evaluation indicator and the expert's degree of familiarity with the indicator.The formula is:Cr=(Ca+Cs)/2(Cr is the author's degree of authority,Ca is the expert judgment coefficient,and Cs is the expert familiarity coefficient).(4)The coordination coefficients of expertsConsensus of expert opinion is reflected by Kendall's coordination coefficient.The W expresses that Kendall's coordination coefficient,W value is between 0 and 1,the value closes to 1 that means all experts on all indicators of the degree of coordination of the better.(5)The coefficient of variation(CV)The coefficient of variation is the ratio of variance to mean,and in general,the coefficient of variation is less than 0.25,indicating that the expert's opinion is relatively concentrated.In this study,the screening of the tertiary indicators,the coefficient of variation to take 0.25 as standard,more than 0.25 indicators to be deleted.Result1?The first round and the second round of the positive coefficient of experts are 100%,the efficiency is 100%.2?The authority of the experts is between 0.883 and 0.910,mean value is 0.911.3?In the first round of expert consultation,the total coordination coefficient of the primary and the secondary indicator is 0.466 and 0.561 respectively.The total coordination coefficient of the primary and secondary indicator is 0.684 and 0.636 in the second round of expert consultation,respectively,by the chi-square test,P<0.0004?In the first round of expert consultation,the coefficient of variation of the weight assignment of the primary indicator fluctuates between 0.1662 and 0.2359.The coefficient of variation of the weight assignment of the secondary indicator fluctuates between 0.1932 and 0.4668.The coefficient of variation is only "patient satisfaction" 0.4,and the rest is less than 0.4;the coefficient of variation of the weight assignment of the tertiary indicator fluctuates is between 0.0567 and 0.2606,and the full-scale distribution is between 0.40 and 0.95.According to the principle of indicator selection,delete one tertiary indicator.5?In the second round of expert consultation,the coefficient of variation of the weight assignment of the primary indicator fluctuates is between 0.0759 and 0.497;the coefficient of variation of the weight assignment of the secondary indicator fluctuates between 0.1776 and 0.4174;the coefficient of variation of the weight assignment of the tertiary indicator fluctuates is between 0.0789 and 0.2427 Fluctuation,full rate distribution between 0.20 and 0.90,according to the principle of indicator screening,delete two tertiary indicators.The coefficient of variation for the second round of expert consultation is generally smaller than the first round,indicating that the expert consensus is consistent.Through the literature analysis and expert advice,this study draws out the POCT blood glucose testing quality management system indicator pool,and through two rounds of expert consultation,to determine the weight of indicators at all levels:organizational management(0.29),the testing process(0.41)and the monitoring and monitoring(0.30),11 secondary indicators:organizational structure(0.25),personnel training(0.37),quality control management(0.38),instrument and paper(0.21),and clinical operation personnel(0.20),patient preparation(0.15),specimen collection(0.23),outcome report(0.21),patient satisfaction(0.29),file management(0.33),continuous improvement(0.38),and 37 tertiary indicators,respectively.ConclusionThis study focused on the hospital clinical POCT blood glucose testing reality need to build a hospital POCT blood glucose testing quality management system,and put forward a series of improvement measures,with good integrity,scientific and practical,not only can improve the clinical quality of POCT blood glucose testing Ability and level,and can provide new ideas and lessons for the management of other POCT test items,so as to promote the improvement of hospital management quality and medical service level,and have good economic and social benefits. |
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