摘要
目的分析重庆市低用血量医疗机构的管理差异,提出区域血液安全管理协同优化策略。方法采用改良德尔菲法设计半结构化问卷,涵盖宏观(输血科设置)-中观(质量管理体系运行)-微观(人员及设备配置)三级评估指标。采用整群抽样法,选取2022年度在重庆市血液中心取血量≤60U的医疗机构进行问卷调查。结果宏观层面:不同类型与级别医疗机构输血科设置情况差异均具有统计学意义(P均<0.05)。中观层面:不同类型与级别医疗机构在制度建设、操作规程和执行记录方面差异均无统计学意义(P均>0.05)。微观层面:不同级别医疗机构间专业技术人员职称分布差异具有统计学意义(P<0.05);在不同级别医疗机构中,血小板类设备配置差异具有统计学意义(P<0.05)。医疗机构级别是独立设置输血科的独立影响因素(二级vs未评级,OR=5.78,P<0.05)。医疗机构级别与高级职称人员比例(r_(s)=0.32)、血小板类设备配置率(r_(s)=0.38)以及独立输血科设置率(r_(s)=0.35)均呈显著正相关(P均<0.05)。结论低用血量医疗机构的临床用血管理存在结构性困境与系统性矛盾。应推行“制度驱动-能力建设-技术赋能”三级协同策略,以推动区域血液安全管理从标准化向精细化转型。
Objective To analyze the management disparities among medical institutions with low blood utilization in Chongqing and propose collaborative optimization strategies for regional blood safety management.Methods A modified Delphi method was employed to design a semi-structured questionnaire covering three-tier evaluation indicators:macro-level(establishment of blood transfusion departments),meso-level(operation of quality management systems),and micro-level(staffing and equipment allocation).Using cluster sampling,medical institutions that collected≤60 units of blood from the Chongqing Blood Center in 2022 were selected for the survey.Results At the macro level,statistically significant differences were observed in the establishment of blood transfusion departments across different types and levels of medical institutions(all P<0.05).At the meso level,no statistically significant differences were found in institutional systems,operational procedures,and implementation records among different types and levels of medical institutions(all P>0.05).At the micro level,statistically significant differences were identified in the distribution of professional titles among technical personnel(P<0.05)and in the allocation of platelet-related equipment(P<0.05)across different levels of medical institutions.The level of the medical institution was an independent influencing factor for the establishment of a dedicated blood transfusion department(secondary vs.unrated:OR=5.78,P<0.05).The level of the medical institution showed significant positive correlations with the proportion of senior professional titles(r_(s)=0.32),the allocation rate of platelet-related equipment(r_(s)=0.38),and the rate of dedicated blood transfusion department establishment(r_(s)=0.35)(all P<0.05).Conclusion Clinical blood management in medical institutions with low blood utilization faces structural dilemmas and systemic contradictions.A three-tier collaborative strategy of"system-driven,capacity-building,and technology-empowered"should be implemented to promote the transformation of regional blood safety management from standardization to refinement.
作者
廖雪君
李顺平
李军
LIAO Xuejun;LI Shunping;LI Ju(Chongqing Blood Center,Chongqing,400015,China;不详)
出处
《中国卫生质量管理》
2026年第3期I0003-I0003,1-5,19,共7页
Chinese Health Quality Management
基金
2022年重庆市科研项目(编号:2022ZDXM031)
2023年重庆市九龙坡区科研项目(编号:2023-03-017-Y)。
关键词
复杂系统理论
低用血量医疗机构
血液安全
多级协同机制
Complex Systems Theory
Medical Institutions with Low Blood Utilization
Blood Safety
Multilevel Collaborative Mechanism
