网络环境下住院病人过程信息的统计分析及其利用
|
摘要
医院提高医疗服务质量，不仅要有宏观政策的正确引导，整体结构
的优化，而且质量管理应尽可能深入到医疗活动的各个环节，以便及时
发现问题，消除错误及浪费，达到医疗服务质量的持续改进。本研究借
助于网络版医院信息系统，采集并分析住院病人住院期间的费用过程信
息、诊疗过程信息及辅诊过程信息，目的在于发现医疗服务消费过程中
存在的规律与问题，为医疗服务质量的持续性改进提供参考依据。
利用SPSS和SPLM统计软件，分析了260例手术住院病人和572例
非手术住院病人在院期间的药品费用过程信息和诊疗过程信息，3427例
住院病人的辅诊检查过程信息，具体内容及结果如下：
1．手术病人日药费随住院时间的变化规律
按ICD-9-CM类目表的15个系统大类（解剖学分类）将住院手术病
人分为15组，分析了各系统手术病人住院期间日药品费用的变化规律，
结果显示：神经系统、肌肉骨骼系统、鼻口咽系统和女性生殖系统手术
的日药费中位数线图具有相似的变化规律：手术病人住院期间的日药费
硕士学位论文
中位数的峰值位于手术当日，且手术当日的日药费变异最大；术后住院
日的日药费中位数明显降低；术前住院日的日药费中位数很低；消化系
统和体被系统手术在手术当日及术后1～6天内的日药费中位数维持在较
高的水平。各系统手术平均日药费随住院时间变化的规律性，提示手术
病人药品费用的控制重点在于围手术期用药。
二．手术病人抗生素应用分析
使用频率最高的药品是调节水、电解质和酸碱平衡类药，占28．8％，
其次为抗感染药，占15．3％，第三位是维生素类药品，占9．8％。抗感染
类药物中，使用频率最高的药品是抗生素类药品，其使用频次占抗感染
类药使用频次的79刀％。各类药品的使用频率基本反映出手术病人的用
药原则：补液、抗感染、支持。
260例手术患者中，有63例使用了抗生素类药品，占24，2％，抗生
素费用占总药费的34二％。注射用青霉素钠、注射用氨节青霉素钠、注
射用头抱哇晰钠的使用频率较高，三项之和占抗生素使用频率的60％以
上，为抗感染治疗的主要药物。昂贵类抗生素的使用频率虽然不高
（9石％），但其费用却占有较大的比例（55．2％）。可见，如果昂贵类抗
生素使用不合理，必然导致药品费用剧增。预防性使用贵重及昂贵类抗
生素比例偏高，用药时间过长，是控制的重点。
3．住院手术病人中无效住院日的存在状况及其影响因素分析
无效住院日在住院手术病人中普遍存在，发生率为64．7％，主要分布
在术前lwt天内。逐步回归分析结果显示，影响无效住院日的因素有费
别、术前住院日和住院时间。若消除无效住院日，可使手术病人的平均
住院日缩短1．5天。
4．非手术住院病人日药品费用的分布及变化规律
80％以上的日药费在100元以下，其药费合计仅占总药费的16．3％。
－互互．
硕士学位论文
仅有7．5％的日药费在300元以上，而其费用合计却占总药费的63．7％。
日药费随住院时间的变化可归纳为三种类型：日药费变化平缓型、住院
中期上升型和出院前期上升型。三种类型在病人中常混合存在。
5．非手术病人出院带药分析
本文对出院带药予以界定。出院带药发生率为50．4％。有出院带药
的病人，其平均日药费和平均药费远高于无出院带药的病人。LOgistiC
口归分析结果显示，费别因素是出院带药的主要原因，出院带药的控制
重点应放在免费、治愈病人上。
6．辅诊检查时效分析
将检查按检查类别进行分类（特检、病理、放射、螺旋CT、磁共振、
内窥镜等），检查时间按流程分为申请一预约、预约一检查、检查一报告
三段。各类检查从申请到报告所需的时间呈偏态分布，且变异较大，非
参检验结果显示，各类检查从申请到报告所需的时间有显著性差异，特
检平均所需的时间较长，内窥镜检查平均所需时间最短。各类检查不同
环节所需时间有显著性差异，检查到报告之间平均所需时间最短，均在
1 小时之内，说明时间的延误可能不在该阶段。特检和放射两类检查从
申请到预约、预约到检查之间平均时间较长，其他各类检查从预约到检
查段的时间较长。
To promote the quality of hospital service, not only proper introduction of macro-policy and optimization of whole structure, but also quality management involved in all kinds of healthcare activities are needed so as to discover problems promptly and to eliminate mistakes and waste. For the purpose of discovering rules and problems existed in the process of consumption of healthcare service, we collected and analyzed the process information of cost, diagnosis and treatment, and diagnostic exams of inpatients during their hospitalization by means of Hospital Information System (HIS, network version). This study can provide foundations for continuous quality improvement of healthcare service.
We analyzed the process information of medicine cost and diagnosis and treatment of 260 operation inpatients and 572 non-operation inpatients, and diagnostic exams of 3427 inpatients with SPSS and SPLM software. The contents and results are as follows:
1. Regular pattern of daily medicine cost change of operation inpatients during hospitalization
Operation inpatients were divided into 15 groups according to ICD-9-CM. We analyzed the regular pattern of daily medicine cost change of operation inpatients during hospitalization in every group. The results indicated that the median line of daily medicine cost had similar regular pattern in operations on the nervous system, the musculoskeletal system, the nose, mouth, and pharynx system and the female genital organs system : the top of daily medicine cost median emerged on the day of operations; The median of daily medicine cost was low in the period after operation, and the lowest in the period before operation. The median line of daily medicine cost of operations on the digestive system and the integumentary system keeped at
a high level in the period of 1-6 days after operations. The regular pattern of daily medicine cost change showed that medicine cost control should be emphasized on the medicine use in perioperative period.
2. The analysis of applying antibiotic
The most frequently used medicines were those for balancing water, electrolite, acid and alkalescence (28.8%) in the body, and followed by anti-infection (15.3%) and vitamin (9.8%). Of anti-infection medicines, the frequency of antibiotic application was the highest (79.0%). The frequency of the use of these medicines showed the principles of medicine application were fluid infusion, anti-infection and health support.
In 260 operation inpatients, there were 63 inpatients applying anti-infection medicine (24.2%). The cost of anti-infection medicine accounted for 34.1% of total medicine costs. The frequency of applying Penicillin, Acillin and Cefamezin was quite high, representing more than 60% of all antibiotics. Obviously, they are the main medicines for infectious diseases. Although the expensive antibiotics were used only in a few inpatients (9.6%), their cost was higher. If expensive antibiotic application is unreasonable, it is certain to result in the rapid increase of medicine cost. The control should be emphasized on the following 2 points: expensive and valuable antibiotics were used too often for prophylactics, and the time of applying them was too long.
3. Analysis of the situation and influencing factors of inefficient hospitalization days of operation inpatients
Inefficient hospitalization days were prevalent in operation inpatients (incidence rate 64.7%), mainly distributing in the period of 1-4 days before operation. Stepwise regression analysis showed that the influencing factors on inefficient hospitalization days were fee type, hospitalization days before operation and length of stay. If the inefficient hospitalization days had been eliminated, average length of stay would be shortened by about 1.5 days.
4. The distribution and regular pattern of daily medicine cost change of non-operation inpatients
80% of daily medicine cost were less than 100 yuan, but the sum was just 16.3% of total medicine cost. 7.5% of daily medicine cost were more than 300 yuan, but the sum was 63.
的优化，而且质量管理应尽可能深入到医疗活动的各个环节，以便及时
发现问题，消除错误及浪费，达到医疗服务质量的持续改进。本研究借
助于网络版医院信息系统，采集并分析住院病人住院期间的费用过程信
息、诊疗过程信息及辅诊过程信息，目的在于发现医疗服务消费过程中
存在的规律与问题，为医疗服务质量的持续性改进提供参考依据。
利用SPSS和SPLM统计软件，分析了260例手术住院病人和572例
非手术住院病人在院期间的药品费用过程信息和诊疗过程信息，3427例
住院病人的辅诊检查过程信息，具体内容及结果如下：
1．手术病人日药费随住院时间的变化规律
按ICD-9-CM类目表的15个系统大类（解剖学分类）将住院手术病
人分为15组，分析了各系统手术病人住院期间日药品费用的变化规律，
结果显示：神经系统、肌肉骨骼系统、鼻口咽系统和女性生殖系统手术
的日药费中位数线图具有相似的变化规律：手术病人住院期间的日药费
硕士学位论文
中位数的峰值位于手术当日，且手术当日的日药费变异最大；术后住院
日的日药费中位数明显降低；术前住院日的日药费中位数很低；消化系
统和体被系统手术在手术当日及术后1～6天内的日药费中位数维持在较
高的水平。各系统手术平均日药费随住院时间变化的规律性，提示手术
病人药品费用的控制重点在于围手术期用药。
二．手术病人抗生素应用分析
使用频率最高的药品是调节水、电解质和酸碱平衡类药，占28．8％，
其次为抗感染药，占15．3％，第三位是维生素类药品，占9．8％。抗感染
类药物中，使用频率最高的药品是抗生素类药品，其使用频次占抗感染
类药使用频次的79刀％。各类药品的使用频率基本反映出手术病人的用
药原则：补液、抗感染、支持。
260例手术患者中，有63例使用了抗生素类药品，占24，2％，抗生
素费用占总药费的34二％。注射用青霉素钠、注射用氨节青霉素钠、注
射用头抱哇晰钠的使用频率较高，三项之和占抗生素使用频率的60％以
上，为抗感染治疗的主要药物。昂贵类抗生素的使用频率虽然不高
（9石％），但其费用却占有较大的比例（55．2％）。可见，如果昂贵类抗
生素使用不合理，必然导致药品费用剧增。预防性使用贵重及昂贵类抗
生素比例偏高，用药时间过长，是控制的重点。
3．住院手术病人中无效住院日的存在状况及其影响因素分析
无效住院日在住院手术病人中普遍存在，发生率为64．7％，主要分布
在术前lwt天内。逐步回归分析结果显示，影响无效住院日的因素有费
别、术前住院日和住院时间。若消除无效住院日，可使手术病人的平均
住院日缩短1．5天。
4．非手术住院病人日药品费用的分布及变化规律
80％以上的日药费在100元以下，其药费合计仅占总药费的16．3％。
－互互．
硕士学位论文
仅有7．5％的日药费在300元以上，而其费用合计却占总药费的63．7％。
日药费随住院时间的变化可归纳为三种类型：日药费变化平缓型、住院
中期上升型和出院前期上升型。三种类型在病人中常混合存在。
5．非手术病人出院带药分析
本文对出院带药予以界定。出院带药发生率为50．4％。有出院带药
的病人，其平均日药费和平均药费远高于无出院带药的病人。LOgistiC
口归分析结果显示，费别因素是出院带药的主要原因，出院带药的控制
重点应放在免费、治愈病人上。
6．辅诊检查时效分析
将检查按检查类别进行分类（特检、病理、放射、螺旋CT、磁共振、
内窥镜等），检查时间按流程分为申请一预约、预约一检查、检查一报告
三段。各类检查从申请到报告所需的时间呈偏态分布，且变异较大，非
参检验结果显示，各类检查从申请到报告所需的时间有显著性差异，特
检平均所需的时间较长，内窥镜检查平均所需时间最短。各类检查不同
环节所需时间有显著性差异，检查到报告之间平均所需时间最短，均在
1 小时之内，说明时间的延误可能不在该阶段。特检和放射两类检查从
申请到预约、预约到检查之间平均时间较长，其他各类检查从预约到检
查段的时间较长。
To promote the quality of hospital service, not only proper introduction of macro-policy and optimization of whole structure, but also quality management involved in all kinds of healthcare activities are needed so as to discover problems promptly and to eliminate mistakes and waste. For the purpose of discovering rules and problems existed in the process of consumption of healthcare service, we collected and analyzed the process information of cost, diagnosis and treatment, and diagnostic exams of inpatients during their hospitalization by means of Hospital Information System (HIS, network version). This study can provide foundations for continuous quality improvement of healthcare service.
We analyzed the process information of medicine cost and diagnosis and treatment of 260 operation inpatients and 572 non-operation inpatients, and diagnostic exams of 3427 inpatients with SPSS and SPLM software. The contents and results are as follows:
1. Regular pattern of daily medicine cost change of operation inpatients during hospitalization
Operation inpatients were divided into 15 groups according to ICD-9-CM. We analyzed the regular pattern of daily medicine cost change of operation inpatients during hospitalization in every group. The results indicated that the median line of daily medicine cost had similar regular pattern in operations on the nervous system, the musculoskeletal system, the nose, mouth, and pharynx system and the female genital organs system : the top of daily medicine cost median emerged on the day of operations; The median of daily medicine cost was low in the period after operation, and the lowest in the period before operation. The median line of daily medicine cost of operations on the digestive system and the integumentary system keeped at
a high level in the period of 1-6 days after operations. The regular pattern of daily medicine cost change showed that medicine cost control should be emphasized on the medicine use in perioperative period.
2. The analysis of applying antibiotic
The most frequently used medicines were those for balancing water, electrolite, acid and alkalescence (28.8%) in the body, and followed by anti-infection (15.3%) and vitamin (9.8%). Of anti-infection medicines, the frequency of antibiotic application was the highest (79.0%). The frequency of the use of these medicines showed the principles of medicine application were fluid infusion, anti-infection and health support.
In 260 operation inpatients, there were 63 inpatients applying anti-infection medicine (24.2%). The cost of anti-infection medicine accounted for 34.1% of total medicine costs. The frequency of applying Penicillin, Acillin and Cefamezin was quite high, representing more than 60% of all antibiotics. Obviously, they are the main medicines for infectious diseases. Although the expensive antibiotics were used only in a few inpatients (9.6%), their cost was higher. If expensive antibiotic application is unreasonable, it is certain to result in the rapid increase of medicine cost. The control should be emphasized on the following 2 points: expensive and valuable antibiotics were used too often for prophylactics, and the time of applying them was too long.
3. Analysis of the situation and influencing factors of inefficient hospitalization days of operation inpatients
Inefficient hospitalization days were prevalent in operation inpatients (incidence rate 64.7%), mainly distributing in the period of 1-4 days before operation. Stepwise regression analysis showed that the influencing factors on inefficient hospitalization days were fee type, hospitalization days before operation and length of stay. If the inefficient hospitalization days had been eliminated, average length of stay would be shortened by about 1.5 days.
4. The distribution and regular pattern of daily medicine cost change of non-operation inpatients
80% of daily medicine cost were less than 100 yuan, but the sum was just 16.3% of total medicine cost. 7.5% of daily medicine cost were more than 300 yuan, but the sum was 63.
引文
[1]仲剑平主编。疗护理技术操作常规(第四版)。人民军医出版社．北京，1999．
[2]朱士俊．董军主编．医院管理与信息利用．人民军医出版社。北京．2001．
[3]刘丽华，王素霞，医院信息系统建设与信息资源利用．医学信息．2001；14(1)：16-17．
[4]军卫一号工程技术组．军卫一号医院信息系统概念及数据流程．1996。11-19．
[5]余正华．信息网络管理现代化对医院管理的作用。医学信息．2000；13(10)：536-537．
[6]王晓钟．新形势下医院医疗质量模式转变与实践。解放军医院管理杂志．1999；6(6)：436-437．
[7]黎碧莹．医疗质量与质量保证．《国外医学》医院管理分册．1997；(1)：1-3．
[8]Editorial. Quality: Who cares? Health Action. Issue 15, 1996.
[9]Vicki Doyle et al. Making Quality Count. Health Action. Issue 15, 1996.
[10]包玉生．医疗质量的科学评价及其进展．《国外医学》医院管理分册，1995；(2)：63-65．
[11]田彦梅．医疗评价活动的国际动态．《国外医学》卫生经济分册．1998；15(2)：69-71．
[12]任真年．医院质量管理方法比较研究．中国医院管理。1993；13(6)：32-34．
[13]李馨．医疗质量管理方法研究与医疗质量保证的国际趋势．中国医院管理．2000：20(5)：76-78．
[14]吴淑萍．军队医院医疗质量标准化．解放军医院管理杂志．2000；7(1)：29-30．
[15]沈曙明．标准化管理与医疗质量控制．中华医院管理杂志．1993；9(9)521-524．
[16]李富荣，初元章．军队医院综合目标责任制管理研究与实践．中国医院管理．1995；15(5)：11-13。
[17]郭齐祥，苑国辉．病种费用及质量控制的研究．中国医院管理．2000；20(4)：42-43．
[18]张力，马健．病种质量费用监控系统管理．解放军医院管理杂志．1998；5(2)：158-160．
[19]宋聚．住院病人病种质量和费用控制研究现状．解放军医院管理杂志．1998；5(2)：198-199．
[20]任长方。医院评审方法初探．1992．(8)9；546-547．
[21]王凤梧，扬松．实施全程质量控制确保医院评审质量．中国医院管理．1995；15(2)：29-31．
[22]Ballinger W, Hepner JO. Total quality management and continous quality improvement: an introduction for surgeons Ballinger and Hepner surgery. 1993; 113(3): 1185.
[23]黄慧英．医疗质量保证的国际趋势．《国外医学》医院管理分册． 1995；(1)：1-5．
[24]En B Krichevsy., Bryan P Simmon. Continous quality improvement: Concepts and applications for physician care. JAMA. 1991; 266 (13): 1817-1822.
[25]谢长勇，郭琪．医疗服务持续性质量提高．解放军医院管理杂志．1999；6(1)：76-78．
[26]Lee KC, Lee JC. Effectiveness of a continous quality improvement program aiming to reduce unplaned extubation: a prospective study. Intensive Care Med. 1996; (22): 1269.
[27] Borst-F; Appel-R; Baud-R: Ligier-Y; Scherrer-JR. Happy birthday DIOGENE: a hospital information system born 20 years ago. Int-J-Med-Inf. 1999 Jun; 54(3): 157-67.
[28] Haruki-Y, Ogushi-Y, Okada-Y, Kimura-M, Kumamoto-I, Sekita-Y. Status and perspective of hospital information systems in Japan. MethodsInf-Med. 1999 Sep; 38(3): 200-206.
[29] Herbst-K, Littlejohns-P, Rawlinson-J, Collinson-M, Wyatt-JC. Evaluating computerized health information systems: hardware, software and human ware: experiences from the Northern Province, South Africa. J-Public-Health-med. 1999 Sep; 21(3): 305-10
[30]Bakker-AR, Leguit-FA Evolution of an integrated HIS in The Netherlands. Int-J-med-Inf. 1999 Jun; 54(3): 209-24
[31]Gardner-RM, Pryor-TA, Warner-HR. The HELP hospital information system: update 1998. Int-J-med-Inf. 1999 Jun; 54(3): 169-82.
[32]Honeyman-JC. Information systems integration in radiology. J- Digit-Imaging. 1999 may; 12(2 Suppl 1): 218-22.
[33]Osada-m; Nishihara-E Implementation and evaluation of workflow based on hospital information system/radiology information system/picture archiving and communications system.. J-Digit-Imaging. 1999 May; 12(2 Suppl 1): 103-5.
[34]Sakamoto-N. A practical object-oriented approach to a development of a next generation hospital information system, medinfo. 1998; 9 Pt 2: 957-61.
[35]Kim-JH; Lee-DH; Choi-JW; Cho-HI; Kang-HS; Yeon-KM; Hah-MC. Three-tiered integration of PACS and HIS toward next generation total hospital information system. Medinfo. 1998; 9 Pt 2: 1086-90.
[36]Stausberg-J; Kolke-O; Albrecht-K. Using a computer-based patient record for quality management in surgery, medinfo. 1998; 9 Pt 1:80-4
[37]Bates-DW; Pappius-E; Kuperman-GJ; Sittig-D; Burstin-H; Fairchild-D; Brennan-TA; Teich-JM. Using information systems to measure and improve quality. Int-J-med-Inf. 1999 Feb-mar; 53(2-3): 115-24
[38]金新政．中国卫生信息化建设的总体规划探讨．医学信息．2001；14(1)：38-40．
[39]余正华，陈克琴．信息网络管理现代化对医院管理的作用．医学信息．2000；13(10)：536-537．
[40]张红．医院信息系统．医学信息．2000；13(12)：666-667．
[41]俞思伟，喻革武．新一代医院管理信息系统的组织与开发．医学信息．2001；14(1)：43-44．
[42]刘之浩．医院信息系统给医院带来什么．《国外医学》医院管理分册．1995；12(1)：122-124．
[43]高筠，董军．医院信息系统的信息利用．中华医院管理杂志．2001：17(1)：20-22．
[44]何雨生．台湾医院信息系统发展前瞻性研究．中华医院管理杂志．1998；14(9)：555-557．
[45]周怡，唐大猷．网络规划在医疗过程管理中的应用．医学信息．2000；13(1)：6-7．
[46]Mcreadie RG. The Scottish sureg of old long-stay inpatients. Br J psychiatry, 1991; [158]:398-402.
[47]Martin Hensher. International trends in the provision and utilization of hospital care. BMJ, 1999; 319(25):845-848.
[48]尹冬梅，王庆民，胡善联．论有效医疗服务需求．中国卫生事业．1999；(2)：79-80．
[49]Emmett B, Keeler. A model of demand for effective care. Journal of Health Ecnomics. 1995; (14):231-238.
[50]彭晓双，吴凤祥，临床科室医疗质量评价体系的建立与应用探讨．中华医院管理杂志．1992；8(8)：471-474．
[51]陈定中．医疗环节质量控制初探．解放军医院管理杂志．1998；5(4)：340-344．
[52]陈明敏，王海涛．医疗环节质量关键点管理．解放军医院管理杂志．1998；5(4)：343-341．
[53]吴雁明，刘英，当前医院管理的重点和热点．中国医院管理．1995；15(1)：53-55．
[54]张音．军队住院病人“病例组合”研究及其应用．硕士学位论文．1998．
[55]胡静．1971例住院病人住院费用的递规模型，硕士学位论文．1997．
[56]雷海潮．中国卫生总费用的未来趋势及相关政策思考．中国卫生事业管理．1999；(3)：137-140．
[57]C. J. L. Murray, R. Govindaraj, P. Musgrove. National health expenditure. A global analysis. Bulletin of the WHO. 1994; 72 (4): 623-637.
[58]Light-DW. Good managed care needs universal health insurance [see comments]. Ann-Intern-Med. 1999 Apr 20; 130(8): 686-9.
[59]Chang-WY; Henry-BM. Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996. NutsRes. 1999 Mar-Apr; 48(2): 94-104.
[60]Ahrens-T. Outlier management. Influencing the highest resourceconsuming areas in acute and critical care. Crit-Care-Nurs-Clin-North-Am. 1999 Mar; 11(1): 107-16
[61]Rohrbach-JI. Critical pathways as an essential part of a disease management program. J-Nurs-Care-Qual. 1999 Oct; 14(1): 11-5
[62]Wickizer-TM; Lessler-D; Franklin-G. Controlling workers' compensation medical care use and costs through utilization management. J-Occup-Environ-Med. 1999 Aug; 41(8): 625-31.
[63]Issel-LM; Anderson-RA. Avoidable costs of comprehensive casemanagement. Health-Care-Manage-Rev. 1999 Summer; 24(3): 64-72
[64]Siles-Gutierrez-M; Garcia-Latorre-FJ; Abad-Diez-JM; Bazo-Fernandez-E; Camarena-Fuertes-Y; Munoz-Espilez-F. Potential impact of measures to minimize drug costs in Aragon's primary care system. Aten-Primaria. 1999 Apr 15; 23(6): 352-8
[65]Morgall-JM; Almarsdottir-AB. No struggle, no strength: how pharmacists lost their monopoly. Soo-Sci-Med. 1999 May; 48(9): 1247-58
[66]王敏．高费用军队伤病员医疗消耗统计分析及对策建议．博士论文．1998．
[67]雷海潮，胡善联．中国卫生总费用系统分析与评价．中国卫生经济．1997，16(12)：42-43．
[68]周绚．探讨有效控制医疗费用上涨的可行对策．中国卫生统计．1998；15(5)：32-33．
[69]王宏，陈育德．浅议我国疾病费用研究存在的问题及发展趋势．中国医院管理．1996：16(1)：21-22．
[70]何志高，陈洁．药物经济学及其在药品费用控制中的作用．中华医院管理杂志．1999：15(5)：290-293．
[71]王金健，董恒进．药物使用的调查研究．中华医院管理杂志．1998；14(11)：677-679．
[72]李六亿，巩军．外科病人抗均药物应用调查及合理性分析．中华医院管理杂志．2000；16(1)：42-44．
[73]魏淑英．围手术期预防性使用抗生素的调查和分析．中华医院管理杂志．1995；11(12)：726-727．
[74]易霞云，徐秀华．抗生素预防性使用管理成效分析．中华医院管理杂志．1999；15(6)：346-347．
[75]丁亚文，王乃兰．我院加强药品管理的几点体会．中国医院管理．1999；19(11)：16．
[76]周林古，董恒进．国内关于缩短平均住院日的影响因素及对策研究．中国医院管理。1999；19(10)：7-8．
[77]史玉环，康艳丽．主要单病种平均住院日质量控制的实验研究．中国医院管理．1998；18(7)：14-15．
[78]吴进军，谭天明．广东省平均住院日抽样调查及相关因素分析。中国医院管理．1995；15(6)：52-54．
[79]俞卓伟，袁克俭．缩短平均住院日成效分析．中国医院管理．1999；19(9)：28-29．
[80]卢放．从医技科室的建设谈其质量管理。解放军医院管理杂志．1998；5(1)：37-38．
[81]方亚，韩雷亚．武汉市医院住院患者检查费用及其影响因素．中国卫生事业管理．2000；(1)：14-17．
[82]卫勤一队医院管理兴趣小组．持续性质量提高在医技科室质量管理中的应用，《国外医学》医院管理分册．1999：(2)：52-55．
[2]朱士俊．董军主编．医院管理与信息利用．人民军医出版社。北京．2001．
[3]刘丽华，王素霞，医院信息系统建设与信息资源利用．医学信息．2001；14(1)：16-17．
[4]军卫一号工程技术组．军卫一号医院信息系统概念及数据流程．1996。11-19．
[5]余正华．信息网络管理现代化对医院管理的作用。医学信息．2000；13(10)：536-537．
[6]王晓钟．新形势下医院医疗质量模式转变与实践。解放军医院管理杂志．1999；6(6)：436-437．
[7]黎碧莹．医疗质量与质量保证．《国外医学》医院管理分册．1997；(1)：1-3．
[8]Editorial. Quality: Who cares? Health Action. Issue 15, 1996.
[9]Vicki Doyle et al. Making Quality Count. Health Action. Issue 15, 1996.
[10]包玉生．医疗质量的科学评价及其进展．《国外医学》医院管理分册，1995；(2)：63-65．
[11]田彦梅．医疗评价活动的国际动态．《国外医学》卫生经济分册．1998；15(2)：69-71．
[12]任真年．医院质量管理方法比较研究．中国医院管理。1993；13(6)：32-34．
[13]李馨．医疗质量管理方法研究与医疗质量保证的国际趋势．中国医院管理．2000：20(5)：76-78．
[14]吴淑萍．军队医院医疗质量标准化．解放军医院管理杂志．2000；7(1)：29-30．
[15]沈曙明．标准化管理与医疗质量控制．中华医院管理杂志．1993；9(9)521-524．
[16]李富荣，初元章．军队医院综合目标责任制管理研究与实践．中国医院管理．1995；15(5)：11-13。
[17]郭齐祥，苑国辉．病种费用及质量控制的研究．中国医院管理．2000；20(4)：42-43．
[18]张力，马健．病种质量费用监控系统管理．解放军医院管理杂志．1998；5(2)：158-160．
[19]宋聚．住院病人病种质量和费用控制研究现状．解放军医院管理杂志．1998；5(2)：198-199．
[20]任长方。医院评审方法初探．1992．(8)9；546-547．
[21]王凤梧，扬松．实施全程质量控制确保医院评审质量．中国医院管理．1995；15(2)：29-31．
[22]Ballinger W, Hepner JO. Total quality management and continous quality improvement: an introduction for surgeons Ballinger and Hepner surgery. 1993; 113(3): 1185.
[23]黄慧英．医疗质量保证的国际趋势．《国外医学》医院管理分册． 1995；(1)：1-5．
[24]En B Krichevsy., Bryan P Simmon. Continous quality improvement: Concepts and applications for physician care. JAMA. 1991; 266 (13): 1817-1822.
[25]谢长勇，郭琪．医疗服务持续性质量提高．解放军医院管理杂志．1999；6(1)：76-78．
[26]Lee KC, Lee JC. Effectiveness of a continous quality improvement program aiming to reduce unplaned extubation: a prospective study. Intensive Care Med. 1996; (22): 1269.
[27] Borst-F; Appel-R; Baud-R: Ligier-Y; Scherrer-JR. Happy birthday DIOGENE: a hospital information system born 20 years ago. Int-J-Med-Inf. 1999 Jun; 54(3): 157-67.
[28] Haruki-Y, Ogushi-Y, Okada-Y, Kimura-M, Kumamoto-I, Sekita-Y. Status and perspective of hospital information systems in Japan. MethodsInf-Med. 1999 Sep; 38(3): 200-206.
[29] Herbst-K, Littlejohns-P, Rawlinson-J, Collinson-M, Wyatt-JC. Evaluating computerized health information systems: hardware, software and human ware: experiences from the Northern Province, South Africa. J-Public-Health-med. 1999 Sep; 21(3): 305-10
[30]Bakker-AR, Leguit-FA Evolution of an integrated HIS in The Netherlands. Int-J-med-Inf. 1999 Jun; 54(3): 209-24
[31]Gardner-RM, Pryor-TA, Warner-HR. The HELP hospital information system: update 1998. Int-J-med-Inf. 1999 Jun; 54(3): 169-82.
[32]Honeyman-JC. Information systems integration in radiology. J- Digit-Imaging. 1999 may; 12(2 Suppl 1): 218-22.
[33]Osada-m; Nishihara-E Implementation and evaluation of workflow based on hospital information system/radiology information system/picture archiving and communications system.. J-Digit-Imaging. 1999 May; 12(2 Suppl 1): 103-5.
[34]Sakamoto-N. A practical object-oriented approach to a development of a next generation hospital information system, medinfo. 1998; 9 Pt 2: 957-61.
[35]Kim-JH; Lee-DH; Choi-JW; Cho-HI; Kang-HS; Yeon-KM; Hah-MC. Three-tiered integration of PACS and HIS toward next generation total hospital information system. Medinfo. 1998; 9 Pt 2: 1086-90.
[36]Stausberg-J; Kolke-O; Albrecht-K. Using a computer-based patient record for quality management in surgery, medinfo. 1998; 9 Pt 1:80-4
[37]Bates-DW; Pappius-E; Kuperman-GJ; Sittig-D; Burstin-H; Fairchild-D; Brennan-TA; Teich-JM. Using information systems to measure and improve quality. Int-J-med-Inf. 1999 Feb-mar; 53(2-3): 115-24
[38]金新政．中国卫生信息化建设的总体规划探讨．医学信息．2001；14(1)：38-40．
[39]余正华，陈克琴．信息网络管理现代化对医院管理的作用．医学信息．2000；13(10)：536-537．
[40]张红．医院信息系统．医学信息．2000；13(12)：666-667．
[41]俞思伟，喻革武．新一代医院管理信息系统的组织与开发．医学信息．2001；14(1)：43-44．
[42]刘之浩．医院信息系统给医院带来什么．《国外医学》医院管理分册．1995；12(1)：122-124．
[43]高筠，董军．医院信息系统的信息利用．中华医院管理杂志．2001：17(1)：20-22．
[44]何雨生．台湾医院信息系统发展前瞻性研究．中华医院管理杂志．1998；14(9)：555-557．
[45]周怡，唐大猷．网络规划在医疗过程管理中的应用．医学信息．2000；13(1)：6-7．
[46]Mcreadie RG. The Scottish sureg of old long-stay inpatients. Br J psychiatry, 1991; [158]:398-402.
[47]Martin Hensher. International trends in the provision and utilization of hospital care. BMJ, 1999; 319(25):845-848.
[48]尹冬梅，王庆民，胡善联．论有效医疗服务需求．中国卫生事业．1999；(2)：79-80．
[49]Emmett B, Keeler. A model of demand for effective care. Journal of Health Ecnomics. 1995; (14):231-238.
[50]彭晓双，吴凤祥，临床科室医疗质量评价体系的建立与应用探讨．中华医院管理杂志．1992；8(8)：471-474．
[51]陈定中．医疗环节质量控制初探．解放军医院管理杂志．1998；5(4)：340-344．
[52]陈明敏，王海涛．医疗环节质量关键点管理．解放军医院管理杂志．1998；5(4)：343-341．
[53]吴雁明，刘英，当前医院管理的重点和热点．中国医院管理．1995；15(1)：53-55．
[54]张音．军队住院病人“病例组合”研究及其应用．硕士学位论文．1998．
[55]胡静．1971例住院病人住院费用的递规模型，硕士学位论文．1997．
[56]雷海潮．中国卫生总费用的未来趋势及相关政策思考．中国卫生事业管理．1999；(3)：137-140．
[57]C. J. L. Murray, R. Govindaraj, P. Musgrove. National health expenditure. A global analysis. Bulletin of the WHO. 1994; 72 (4): 623-637.
[58]Light-DW. Good managed care needs universal health insurance [see comments]. Ann-Intern-Med. 1999 Apr 20; 130(8): 686-9.
[59]Chang-WY; Henry-BM. Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996. NutsRes. 1999 Mar-Apr; 48(2): 94-104.
[60]Ahrens-T. Outlier management. Influencing the highest resourceconsuming areas in acute and critical care. Crit-Care-Nurs-Clin-North-Am. 1999 Mar; 11(1): 107-16
[61]Rohrbach-JI. Critical pathways as an essential part of a disease management program. J-Nurs-Care-Qual. 1999 Oct; 14(1): 11-5
[62]Wickizer-TM; Lessler-D; Franklin-G. Controlling workers' compensation medical care use and costs through utilization management. J-Occup-Environ-Med. 1999 Aug; 41(8): 625-31.
[63]Issel-LM; Anderson-RA. Avoidable costs of comprehensive casemanagement. Health-Care-Manage-Rev. 1999 Summer; 24(3): 64-72
[64]Siles-Gutierrez-M; Garcia-Latorre-FJ; Abad-Diez-JM; Bazo-Fernandez-E; Camarena-Fuertes-Y; Munoz-Espilez-F. Potential impact of measures to minimize drug costs in Aragon's primary care system. Aten-Primaria. 1999 Apr 15; 23(6): 352-8
[65]Morgall-JM; Almarsdottir-AB. No struggle, no strength: how pharmacists lost their monopoly. Soo-Sci-Med. 1999 May; 48(9): 1247-58
[66]王敏．高费用军队伤病员医疗消耗统计分析及对策建议．博士论文．1998．
[67]雷海潮，胡善联．中国卫生总费用系统分析与评价．中国卫生经济．1997，16(12)：42-43．
[68]周绚．探讨有效控制医疗费用上涨的可行对策．中国卫生统计．1998；15(5)：32-33．
[69]王宏，陈育德．浅议我国疾病费用研究存在的问题及发展趋势．中国医院管理．1996：16(1)：21-22．
[70]何志高，陈洁．药物经济学及其在药品费用控制中的作用．中华医院管理杂志．1999：15(5)：290-293．
[71]王金健，董恒进．药物使用的调查研究．中华医院管理杂志．1998；14(11)：677-679．
[72]李六亿，巩军．外科病人抗均药物应用调查及合理性分析．中华医院管理杂志．2000；16(1)：42-44．
[73]魏淑英．围手术期预防性使用抗生素的调查和分析．中华医院管理杂志．1995；11(12)：726-727．
[74]易霞云，徐秀华．抗生素预防性使用管理成效分析．中华医院管理杂志．1999；15(6)：346-347．
[75]丁亚文，王乃兰．我院加强药品管理的几点体会．中国医院管理．1999；19(11)：16．
[76]周林古，董恒进．国内关于缩短平均住院日的影响因素及对策研究．中国医院管理。1999；19(10)：7-8．
[77]史玉环，康艳丽．主要单病种平均住院日质量控制的实验研究．中国医院管理．1998；18(7)：14-15．
[78]吴进军，谭天明．广东省平均住院日抽样调查及相关因素分析。中国医院管理．1995；15(6)：52-54．
[79]俞卓伟，袁克俭．缩短平均住院日成效分析．中国医院管理．1999；19(9)：28-29．
[80]卢放．从医技科室的建设谈其质量管理。解放军医院管理杂志．1998；5(1)：37-38．
[81]方亚，韩雷亚．武汉市医院住院患者检查费用及其影响因素．中国卫生事业管理．2000；(1)：14-17．
[82]卫勤一队医院管理兴趣小组．持续性质量提高在医技科室质量管理中的应用，《国外医学》医院管理分册．1999：(2)：52-55．
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |