提交环节质量监控在病案终末质量控制中的作用  

The Role of Submit Link Quality Monitoring in Final Medical Records Quality Control

作　　者：陈祝萍[1] 陈丽娟[1] 杨丰[1] 林月琼[1] 

机构地区：[1]广东医学院附属医院,湛江市524001

出　　处：《中国病案》2009年第11期13-15,共3页Chinese Medical Record

摘　　要：目的加强病案提交环节质量监控,确保病案质量。方法从2008年1月始对每份提交的病案进行质量监控,并对2007年和2008年提交的病案进行质量对比分析。结果2007年提交病案38853份,缺陷病案1656份,缺陷率4.26%。2008年提交病案41979份,缺陷病案262份,缺陷率0.62%。经卡方检验,P<0.01,统计学有明显差异。2008年提交病案的各项目缺陷情况较2007年明显地减少。结论加强病案环节质量监控,能有效保证病案质量。Objective To strengthen quality monitoring of submit link and guarantee medical records quality. Methods Since Jam ary 2008, we had been monitored the quality of each submitted medical records, and done comparative analysis to quality of medical records submitted in 2007 and 2008. Results in 2007, there are 1656 medical records with defects in 38853 submitted medical records; tile defect rate was 4.26%. Of 41979 submitted medical records in 2008, 262 had defects with the defect rate was 0.62 %. Chi square test was done, P 〈 0.01, which meant significant statistical difference. Defects of each item in il edical records submitted in 2008 decreased obviously compared with 2007. Conclusions Strengthen quality monitoring of medical records link could guarantee medical records quality effectively.

关 键 词：病案质量 环节 缺陷 

分 类 号：R197.3[医药卫生—卫生事业管理]