基于过程控制优化综合医院多学科诊疗模式研究  

Study on the Optimization of Multidisciplinary Diagnosis and Treatment Mode in General Hospitals Based on Process Control

作　　者：李钦慧 王钧慷[1] 罗树春[1] 谭代荣 胡锦梁[1] Li Qinhui(Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu,P.R.China)

机构地区：[1]四川省医学科学院·四川省人民医院,四川成都610072

出　　处：《中国卫生事业管理》2023年第6期418-421,共4页Chinese Health Service Management

基　　金：四川省科技计划软科学项目“‘一干多支五区协同’卫生健康服务区域创新体系建设研究”(2020JDR0282);成都市科技局2021年重点研发支撑项目“基于区块链技术的成都市传染病监测预警技术研究及应用”(2021-YF09-00061-SN)。

摘　　要：目的:为落实国家进一步改善医疗服务行动计划提出的“以病人为中心,推广多学科诊疗模式”要求,科学总结评价四川某三甲综合医院的做法经验,为医疗机构发展和优化多学科诊疗模式提供借鉴参考。方法:以四川某三甲综合医院2017~2019年的实践为案例,基于过程控制理论,从管理、质量、认知和信息化维度分析制约多学科诊疗模式(MDT)发展的因素,并实施针对性改进,评价改进前后的效果。结果:在管理方面,就诊流程得以优化,形成单病种、疑难重症和高新技术、医联体远程等三种MDT模式,面向患者开放前两种MDT号源;在质量方面,建立质量评价体系,以肺癌诊疗为例,经MDT收治入院患者的阳性确诊率更高(χ2=8.91,p=0.003);在认知方面,医生团队建设持续加强,患者满意度从69.97%提高至94.46%,诊疗方案依从性从74%提高至90%;在信息方面,通过信息化整合专家团队、细化质量考核、联动线上线下一体化诊疗,实现MDT智能化闭环管理。结论:MDT医疗业务拓展,收费、信息和发展环境等支撑保障条件将影响其实施的广度与深度,有效实施MDT将促进综合医院高新技术推广、诊疗能力提升和学科建设发展。Objective To scientifically summarize and evaluate the practice and experiences of multidisciplinary diagnosis and treatment(MDT)model in a tertiary general hospital in Sichuan,and provide references on the development and optimization of MDT for other institutions.Methods Taking the practice of a tertiary general hospital in Sichuan from 2017 to 2019 as a case,the factors restricting the development of MDT were analyzed from the dimensions of management,quality,cognition and informatization based on the theory of process control.Then targeted improvements were implemented.And the effects of the improvement were e-valuated finally.Results In terms of management,the medical treatment process has been optimized,with three types of MDT mod-els of single disease,difficult and severe cases and high-tech,and telemedicine.In terms of quality,a quality evaluation system was established.In terms of cognition,doctors'participation and team building continued to be strengthened,the rate of patient sat-isfaction increased from 69.97%to 94.46%,and the rate of compliance with diagnosis and treatment plans increased from 74%to 90%.In terms of information,integration of expert teams,detailed quality assessment,linkage of online and ofline integrated diag-nosis and treatment,and intelligent closed-loop management of MDT were realized through information technology.Conclusion The expansion of MDT medical business,charging,information,developmental environment and other supporting conditions will affect the breadth and depth of its implementation.Effective implementation of MDT will promote the promotion of high and new technolo-gy,the capacity of diagnosis&treatment and the development of discipline construction in general hospitals.

关 键 词：过程控制 多学科协作 诊疗模式 综合医院 

分 类 号：R197.323[医药卫生—卫生事业管理]