《国家医疗服务与质量安全报告》康复医学专业指标解读  

Interpretation of Rehabilitation Medicine Specialty Indicators in National Report on the Services,Quality and Safety in Medical Care System

作　　者：周谋望[1,2] ZHOU Mouwang(Department of Rehabilitation Medicine,Peking University Third Hospital,Beijing 100191,China;National Center for Healthcare Quality Management in Rehabilitation Medicine,Beijing 100191,China)

机构地区：[1]北京大学第三医院康复医学科,北京100191 [2]国家康复医学专业医疗质量控制中心,北京100191

出　　处：《康复学报》2022年第1期1-5,共5页Rehabilitation Medicine

基　　金：国家医疗质量控制中心工作经费。

摘　　要：自2016年北京大学第三医院受国家卫生健康委员会委托承担国家康复医学专业医疗质量控制中心工作,连续5年编制了《国家医疗服务与质量安全报告》(康复医学专业部分)(以下简称《报告》),弥补了我国康复医学相关数据的空白。本文旨在对《报告》所提取和分析的指标进行解读,以期不断提高康复医疗服务与质量安全调查的完整率和准确率,促进我国康复医疗质量的持续改进。指标由质量控制指标和资源消耗指标2类指标构成,其中质量控制指标包括结构指标、过程质量指标和结果质量指标,共16个大项149个分项。《报告》经由国家医疗质量管理与控制信息系统(NCIS)进行数据收集,数据报告质量、准确性和完整度将作为医院评审评价、重点专科设置等工作的参考依据。在NCIS指标中,数据采集形式分以下4种:首页自动提取、医疗相关记录提取、病历人工读取和相关部门提供。本文着重对早期康复介入率、ADL改善率、并发症等重点指标,结构指标和其他过程质量指标进行了解读。国家康复医学专业医疗质量控制中心近几年来的工作发现,康复医学科是否建立信息化系统是决定质控数据提取准确、便捷与否的重要因素。康复医疗和质控信息化系统正由"信息化"向"智能化"转变,信息化管理将结合人工智能自然语言分析等新兴技术,可以简化和精确化质控数据的提取过程,不断提升康复医学质控的效率。Since 2016, Peking University Third hospital has been entrusted by the National Health Commission to undertake the work of National Center for Healthcare Quality Management in Rehabilitation Medicine. For five consecutive years, it has compiled the National Report on the Services, Quality and Safety in Medical Care System(the section of rehabilitation medicine)(hereinafter referred to as the "report"), making up the gap in relevant data of rehabilitation medicine in China. This paper aims to interpret the indicators extracted and analyzed in the report, in order to continuously improve the integrity rate and accuracy rate of rehabilitation medical service and quality and safety investigation, and promote the continuous improvement of the quality of rehabilitation medical care in China. The index is composed of two kinds of indexes: quality control index and resource consumption index.The quality control index includes structure index, process quality index and result quality index, and consists of 16 major items and149 sub-items. The report is carried out by the National Clinical Improvement System(NCIS), and the quality, accuracy and completeness of the data report will be used as the reference for hospital evaluation and key specialty setting. In NCIS indicators, data collection can be divided into the following four forms: automatic extraction of home page, extraction of medical records, manual reading of medical records and provision of relevant departments. This paper focuses on the early rehabilitation intervention, ADL improvement rate, complications and other key indicators, structural indicators and other process quality indicators. In recent years,National Center for Healthcare Quality Management in Rehabilitation Medicine has found that whether the rehabilitation medicine department has established an information system is an important factor determining the accuracy and convenience of quality control data extraction. Rehabilitation medical treatment and quality control information system is changing f

关 键 词：康复医疗质量 医疗质量控制 质控报告 质控指标 早期康复介入 ADL改善率 并发症发生率 

分 类 号：R197.1[医药卫生—卫生事业管理]