北京地区重症医学科质量控制现状调查的流行病学研究  

Beijing region critical care medicine quality control survey

作　　者：周翔[1] 刘大为[1] 隆云[1] 丁欣[1] 刘晔[1] 汤铂[1] 杜微[1] 赵华[1] 何怀武[1] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院 重症医学科,北京100730

出　　处：《中国医刊》2013年第12期31-33,共3页Chinese Journal of Medicine

基　　金：卫生公益性行业科研专项经费项目(201202011)

摘　　要：目的了解北京地区重症医学科质量控制现状,发现薄弱环节,为下一步干预提供科学基础。方法采用随机抽样的方法将北京地区重症医学科分为三级医院和二级医院重症医学科两层随机抽样,抽取2012年度重症医学医疗质量控制的"结构-过程-结果"的评价系统指标数据。结果在结构指标中,除高级职称重症专科医师数量三级医院比二级医院多外,三级医院重症医学科与二级医院在资源配置上多数指标差距并不明显。在过程指标中,三级医院无论从患者标准化转出程序,多学科查房频度、继续教育开展频度及床位使用率等方面均明显优于二级医院。在结果指标上,北京地区三级医院重症医学科虽然在患者死亡率、标准化死亡比、意外拔管率及48小时内非计划再插管率都体现出高于二级医院的水平,但中心静脉导管感染率、呼吸机相关肺炎发生率都高于二级医院。结论资源配置上北京地区重症医学科三级医院与二级医院虽然相近,在过程管理、结果指标上三级医院整体优于二级医院,但三级医院中心静脉导管感染发生率及呼吸机相关肺炎发生率高于二级医院,提示这些方面是下一步重症医学质量控制重点环节之一。Objective To investigate current situation in Beijiug region critical care medicine quality control, to find out the weaknesses in critical care medicine quality control, establish a scientific basis for further intervention. Method Adopt stratified random sampling method in departments of critical medicine of Beijing third-grade class-A hospitals and second-grades hospitals, retrospective review the structure, process and outcomes quality control system parameters during 2012. Result There is not much difference between third-grade class-A hospitals and second -grades hospitals in structure parameters except 24-h availability of a consultant level intensivist. For process and outcomes quality control system parameters,third-grade class-A hospitals were better than second-grades hospitals except the rate of central venous catheter-related blood stream infection and the rate of ventilator-associated pneu- monia. Conclusion Although resource allocation gap is small between departments of critical medicine of Beijing third-grade class-A hospitals and second-grades hospitals, however second-grades hospitals should improve in process and outcomes quality control domain. Central venous catheter-related blood stream infection and ventilatorassociated pneumonia were still extremely important points in critical care medicine quality control for both third-grade class-A hospitals and second-grades hospitals.

关 键 词：重症医学 质量控制 "结构-过程-结果"医疗质量体系 

分 类 号：R605.971[医药卫生—急诊医学]