目的:对护理敏感质量指标进行系统评价,为进一步完善指标体系提供参考依据。方法:以Donabedian模型为理论基础,系统检索PubMed、EMbase、Web of Science、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献数...目的:对护理敏感质量指标进行系统评价,为进一步完善指标体系提供参考依据。方法:以Donabedian模型为理论基础,系统检索PubMed、EMbase、Web of Science、the Cochrane Library、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中的相关文献,检索时限为建库至2023年7月15日。由2位研究者独立对纳入文献进行数据提取,使用JMP 13.1和Tableau对数据进行整合。结果:共纳入30篇文献,出现频率前10位的结构指标为注册护士护理时数、护理总时数、注册护士护理时数比例、不良事件、护患比、本科及以上学历占比、加班时长、执业护士数、工作年限、注册护士占比;出现频率前10位的结局指标为死亡率、跌倒发生率、抢救失败率、医院获得性压力性损伤发生率、医院获得性尿路感染、医院获得性呼吸道感染/肺炎、住院时长、用药错误、护士满意度、病人医疗成本。结论:护理质量在病人结局方面起到了积极的促进作用,护理质量结构指标的定义需进一步标准化,我国学者需对死亡率及抢救失败率等直接反映病人结局的指标进行分析,为政策制定者提供参考依据。展开更多
Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with prim...Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.展开更多
文摘Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.
