上海市农村基层医疗机构诊疗技术使用现状及合理性评价  

Status Quo and Reasonableness Evaluation of Clinics Technical Usage in Shanghai Rural Primary Medical Institutions

作　　者：王海银 张安 林海 杨晓娟 胡苑之 王剑萍[3] 陈洁 

机构地区：[1]上海市卫生技术评估研究中心,上海200032 [2]上海市卫生工作者协会,上海200032 [3]上海市卫生局科教处,上海200032

出　　处：《中国卫生质量管理》2013年第1期69-73,共5页Chinese Health Quality Management

摘　　要：目的掌握2011年上海市农村基层医疗机构住院病例常见病诊疗技术使用情况,并提出需淘汰和更新的技术清单,为政府推广卫生适宜技术和规范临床诊疗提供依据。方法分层选取上海市郊区两家二乙医院,采用系统抽样法调查2011年15种常见病、多发病住院病例使用的药物、检验、影像、化验、手术、康复及其它治疗措施。选取各病种临床和管理专家,咨询卫生技术应用和配置的合理性,了解需要淘汰或增加的卫生技术。结果共调查600例,男女比例约为1.2:1;冠心病、高血压、脑梗塞及慢性阻塞性肺病平均年龄大、住院时间长;正常分娩平均年龄、住院天数、平均费用均为最低值;病例主要为自费病人。卫生技术利用主要表现为药物和化验;药物的应用比例平均约为50%。慢性肾炎、脑梗塞及冠心病应用的技术种类位居前3位;平均每种化验技术使用人数均高于检查。基本需要的卫生技术约占实际应用的50%。需淘汰的种类数量为13种,需增加的为64种。其中淘汰和增加的卫生技术主要为药物。结论基层医院使用的卫生技术基本合理,但应用种类和数量较多,部分卫生技术可能需要淘汰和增加。政府应进一步加强卫生适宜技术的推广和临床诊疗技术的规范管理。Objective To understand the health technologies of common diseases that treated in inpatient clinics in Shanghai rural primary health care institutions and propose phase -out and update health technology so as to provide basis for the government to promote health appropriate technology and regulate the clinical diagnosis and treatment. Methods two primary hospitals in suburbs of Shanghai were selected by stratified method, health technology usage such as drug, testing, imaging, laboratory, surgery, rehabilitation and other thera- peutic measures for 15 kinds of common and frequently -occurring disease hospitalized patients were investigated by systematic sampling racthod. Experts of survey disease and administration were selected randomly and consulted for the rationality in health technology and con- ltgttration. The health technologies needed to be eliminated or increased were analyzed. Resul~ A total of 600 cases were investigated, m,!,~ t,~ female ratio was 1.2 ：l; average age of comrmry heart disease, hypertension~ cerebral infarction and chn）nic obstructive pulmonary ,~a^cs was older with a longer hospital stay; while the average age, length of stay, average costs for normal delivery were the lowest than oth- er diseases; hospital cost was mainly paid by patients themselves. Health technologies mainly were drug and laboratory with an average of drug application of about 50%. The number of technology application for chronic nephritis, cerebral infarction, and coronary heart disease was the top three; average number of each type of laboratory use of technology was higher than the check. Basic needs of health technologies account for about 50% of the actual application and 13 species were suggested to be eliminated while 64 to be increased. Conclusion The use of health technology in the primary hospital was basically rational, but a large type and number was used. Some health technologies may be required to be phased out and increased; the Government should further enhance the promotion of appropriate heal

关 键 词：农村 基层医疗机构 卫生技术 评价 

分 类 号：R197.62[医药卫生—卫生事业管理]