公立医院一院多区“同质-差异-协同”审方体系的构建  

The construction of the“homogeneity-difference-synergy”prescription review system in a public hospital with multiple districts

作　　者：李树 朱曼[1] 王天琳[1] 黄翠丽[1] 马亮[1] 李金斌[1] 韩亚亮[1] 汤智慧[1] 蔡乐[1] 张筱璇 夏天一 陈孟莉[1] LI Shu;ZHU Man;WANG Tianlin;HUANG Cuili;MA Liang;LI Jinbin;HAN Yaliang;TANG Zhihui;CAI Le;ZHANG Xiaoxuan;XIA Tianyi;CHEN Mengli(Department of Pharmacy,Medical Supplies Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院医疗保障中心药剂科,北京100039

出　　处：《中国医院药学杂志》2023年第20期2313-2317,共5页Chinese Journal of Hospital Pharmacy

基　　金：保健面上科研项目(编号:21BJZ36)。

摘　　要：目的:探索公立医院一院多区“同质-差异-协同”审方体系的构建,打造多院区同质化审方与差异化监管相兼容的智能化审方平台。方法:结合某院现有信息化基础条件及各院区临床诊疗特点,提出一院多区“同质-差异-协同”审方体系的构建思路,并通过知识图谱库的构建、同质化审核规则的制定、差异化监管需求的兼容、闭环式审核功能的协同实施及智能决策模块的探索实践5个步骤,形成了基于“一院多区”架构下同步联动、个性兼容的审方体系。结果:系统正式运行半年后,各院区的合理用药水平均有不同程度改善;平均系统弹框率从最初的19.35%下降到11.68%,而拒绝修改并提交的问题处方比率则由9.14%减少到4.75%;与系统上线前相比,平均处方合理率明显提升(84.23%vs.95.25%)。结论:一院多区“同质-差异-协同”审方体系的构建,充分考虑了公立医院改革整编的架构特点,为后续“区域化审方中心”的建设奠定同质化技术基础,也为其他大型医疗机构同类型工作的开展提供借鉴。OBJECTIVE To explore the construction of the"homogeneity-difference-synergy"prescription review system in a public hospital with multiple districts,and to create a plat form that compatible with multipledistricts homogeneous prescription audit and differentiated supervision.METHODS Combined with the information basic conditions of hospital and the characteristics of clinical diagnosis and treatment in each district,the construction idea of"homogeneity-difference-collaboration"prescription review system in a public hospital with multiple districts was put forward.With the construction of knowledge graph library,the formulation of homogenize review rules,the compatibility of differentiated supervision requirements,the coordinated implementation of closed-loop review function and the exploration of intelligent decision module,a review system based on synchronous linkage and personality compatibility under the framework of"a hospital with multiple districts"has been formed.RESULTS Half a year after the system went online,the level of rational drug use in all districts was improved,the average system bounce ratio decreased from initial 19.35%to 11.68%,and the rate of problem prescriptions submitted was reduced from 9.14%to 4.75%.Compared with before the system went online,the average prescription rationality rate was significantly improved(84.23%vs.95.25%).CONCLUSION Considering the characteristics of the reform and reorganization of the public hospital,the establishment of the"homogeneity-difference-synergy"prescription review system in a public hospital with multiple districts lays a homogeneous technical foundation for the subsequent construction of"regional prescription review center",also provides experience for other large medical institutions to carry out similar work.

关 键 词：处方前置审核 一院多区 “同质-差异-协同”审方体系 区域化审方中心 

分 类 号：R951[医药卫生—药学]