Study On The Necessity And Feasibility Of Transfusion Restriction Management In Children’s Outpatient Department In The Reform Of Public Hospitals

Objective:Taking Yunnan Province as an example,this paper evaluates the initial effect of outpatient infusion restriction management in a 3A children’s hospital since December 2016,understands the economic and social benefits of outpatient infusion management in public hospitals under the background of new medical reform,and collects the evaluation and suggestions of both doctors and patients on this management.Combined with the evaluation results,this paper discusses the necessity and feasibility of implementing transfusion restriction management in children’s outpatient service in public hospitals,makes up the application gap of transfusion restriction management in pediatrics,and provides reference for standardizing children’s transfusion behavior,reducing transfusion risks,ensuring children’s medical quality and safety,and strengthening and establishing a long-term mechanism for children’s rational drug use.Mmethods:1.Evaluation on the implementation effect of transfusion restriction management in children’s outpatient service:A hospital that implements transfusion restriction management in children’s outpatient service is taken as a "trial hospital",and another hospital that has not implemented transfusion restriction management in children’s outpatient service and has comparable basic information and close visiting population is selected as a "control hospital",and cross-sectional investigation and dynamic reporting are adopted to collect data.Two years after the implementation of children’s outpatient infusion restriction management,dynamic series(DS)was used to analyze the changes of outpatient infusion ratio,outpatient visits and average cost of outpatient visits before and after the implementation of outpatient infusion restriction management in pilot hospitals.The ratio of transfusion,the average cost of outpatients and the ratio of antibacterial drugs used in outpatients of pilot hospitals and control hospitals were compared horizontally by conventional statistical methods.2.Outpatients and medical staffs cognition and evaluation of transfusion restriction management in children’s outpatient service.Taking Yunnan Province as an example,the questionnaire was collected by multi-stage stratified cluster sampling method,the reliability of the questionnaire was tested by Cronbach’s coefficient split-half reliability,and the validity was tested by KMO and Bartlett ball test.To understand the attitudes of outpatients and medical staff towards the necessity and feasibility of transfusion restriction management in children’s outpatient clinic,and to explore the influence of mass transfusion knowledge cognition on transfusion behavior by using structural equation model(SEM),so as to reduce unreasonable transfusion behavior by interfering with mass transfusion cognition.According to the initial results of transfusion restriction management in children’s outpatient service and the attitudes of medical staff and outpatients,the necessity and feasibility of transfusion restriction management in children’s outpatient service in public hospitals were comprehensively analyzed and discussed.The structural equation model fitted well:CFI=0.97,NFI=0.96,IFI-0.97,RFI=0.96,RMSEA=0.096(90%CI=0.092-0.100).The model showed that the influence coefficient of infusion attitude on infusion behavior was 0.72(P=0.05).Results:1.Evaluation on the effect of restriction management of children’s outpatient service:the pilot hospital has achieved good results in the past three years:the total number of outpatient transfusion people is decreasing year by year,and the difference is statistically significant(P<0.001);The total number of outpatient visits increased year by year,but there was no statistical difference(P=0.072).Outpatient infusion ratio decreased year by year,and the difference was statistically significant(P<0.001).Overall,the average cost of outpatient visits did not increase significantly,but the difference was statistically significant(P=0.004).The number of drug-related adverse reactions in outpatient infusion decreased year by year.Horizontal comparison showed that the infusion ratio,average cost of outpatients and the proportion of antibiotics used in outpatients in the trial hospitals were lower than those in the control hospitals,and the differences were statistically significant(P<0.05).2.Subjective questionnaire evaluation:A questionnaire survey was conducted among 319 pediatric medical staff and 872 outpatients in Kunming,Baoshan and Wenshan in Yunnan Province from August to October 2020.The overall reliability and validity of the questionnaire were good(Cronbach a coefficient of outpatient respondents was 0.836,KMO value of validity test was 0.890,Bartlett test was χ2)Cronbach a coefficient of medical staff questionnaire was 0.747,KMO value of validity test was 0.837,Bartlett testχ 2 value=19993.403,P<0.001).Necessity of transfusion restriction management in children’s outpatient service:65.83%(210)of medical staff and 59.40%(518)of outpatient respondents believe that transfusion restriction management in children’s outpatient service is necessary.Feasibility of transfusion restriction management in children’s outpatient service:67.71%(216)of medical staff think that the hospital or the measure that has implemented transfusion restriction management in children’s outpatient service is feasible on the whole,and 49.40%(430)of patients think that the management is feasible on the whole.The 187 medical staff of the hospital that implemented the transfusion restriction management in children’s outpatient service evaluated the hospital before and after the implementation of this measure,and the overall evaluation of the medical staff on the implementation of this measure was positive.Conclusions:Initial results have been achieved in the management of transfusion restriction in children’s outpatient service.The total number of outpatient transfusion and the ratio of outpatient transfusion decreased year by year,the number of adverse reactions related to drugs decreased year by year,and the total number of outpatient visits increased year by year.More than half of the medical staff(65.83%)and outpatient respondents(59.40%)supported the limited administration of transfusion in children’s outpatient service.The management of transfusion restriction in children’s outpatient service is necessary on the whole.Based on the feasibility of improving the management of transfusion restriction in children’s outpatient service by both doctors and patients,the ratio of transfusion in outpatient service should be included in the performance appraisal of various departments and individuals in hospitals;Strengthen targeted education of infusion knowledge,reduce unreasonable infusion behavior and improve patients’ cognitive level of infusion.