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2021年国家医疗服务与质量安全报告——呼吸专业分册
$45.20
《国家医疗服务与质量安全报告—呼吸专业分册》(以下简称《报告》)是由国家卫生健康委医政司组织,国家呼吸医疗质量控制中心(以下简称“中心”)编写的年度报告,迄今,已连续完成 6年(2015 —2020年),是我国呼吸专业医疗服务和质量安全权威的文件。《报告》主要分析了由中心制定的呼吸专业管理指标,涉及社区获得性肺炎(community acquiredpneumonia,CAP)、慢性阻塞性肺疾病(简称“慢阻肺病”)、支气管哮喘、急性肺血栓栓塞症(pulmonarythromboembolism,PTE)等疾病,以及可弯曲支气管镜技术等 65个医疗质量控制指标。其中部分指标已纳入《2021年国家医疗服务与质量安全报告》的呼吸专业部分。为了让全国的呼吸同道更全面地了解全国及各地区的呼吸专业医疗服务与质量安全情况,能够有的放矢地持续改进,国家卫生健康委员会建议制定此单行本。一、报告数据范围和来源《报告》重点围绕我国内地二级以上医院 PCCM科医疗服务与医疗质量安全情况进行分析,主要截取 2020年 1月 1日—12月31日的相关数据。《报告》以呼吸专业质控指标为基础,在我国医疗质量管理与控制信息网(www.ncis.cn),采用网络年度抽样调查的形式进行数据收集。共收集 9268家医院数据,纳入标准及数据质量分析标准见表 1;医院抽样原则见表2。终共采纳全国 31个省(直辖市、自治区)及新疆生产建设兵团(以下简称“兵团”)的 2347家医院数据,其中,委属委管医院 22家,三级公立医院 772家(不包括委属委管医院),三级民营医院 98家,二级公立医院 1069家,二级民营医院 386家(图 1)。此次调查覆盖面广,医院类型全面,能较为充分地反映我国呼吸专业的基本医疗质量情况。分析各省(直辖市、自治区)数据时,三级综合医院包括委属委管医院、三级公立医院及三级民营医院;二级综合医院包括二级公立医院及二级民营医院。
章2021年国家呼吸专业医疗服务与质量安全报告 1节 医院运行管理类指标 1一、床位数 1(一)PCCM科床位数 1(二)PCCM科 ICU床位数 2(三)PCCM科 ICU床位数占 PCCM科床位数比例 4(四)PCCM科开放床位数占全院开放床位数的比例 5二、卫生技术人员统计 5(一)PCCM科卫生技术人员构成比 5(二)PCCM科 ICU护士人数占 PCCM科护士总人数比例 6三、工作负荷 7(一)PCCM科年均门诊人次 7(二)PCCM科床护比 8(三)PCCM科 ICU床护比 10四、工作效率 11五、患者负担 12六、呼吸专业常见技术年度工作量 13(一)年均肺功能检查例次 13(二)年均多导睡眠监测检查例次 14(三)年均有创机械通气治疗例次 16(四)年均无创机械通气治疗例次 17(五)年度体外膜肺氧合治疗总例次 18第二节呼吸专业常见病种的医疗质量现状分析 19一、成人社区获得性肺炎(CAP)医疗质量指标评估 19(一)住院成人 CAP患者诊治过程关键环节的质控情况 19(二)住院成人 CAP患者诊治过程关键结局的质控情况 26二、慢性阻塞性肺疾病(慢阻肺病)急性加重医疗质量指标评估 27(一)慢阻肺病住院患者诊治过程关键环节的质控情况 27(二)慢阻肺病住院患者诊治过程关键结局的质控情况 36
三、支气管哮喘医疗质量指标评估 38四、急性肺血栓栓塞症医疗质量指标评估 49(一)急性肺血栓栓塞症住院患者诊治过程关键环节的质控情况 51(二)急性肺血栓栓塞症住院患者诊治过程关键结局的质控情况 59五、肺结核医疗质量指标评估 60六、支气管镜检查医疗质量指标评估 61(一)可弯曲支气管镜检查关键环节的质控情况 61(二)可弯曲支气管镜检查关键结局的质控情况 64第三节 问题分析及工作重点 67一、质控工作总体问题及工作重点 67二、各疾病相关医疗质量问题及工作重点 67
第二章国家呼吸专业医疗质量控制指标(2019版) 70一、急性肺血栓栓塞症(PTE) 70指标一、急性 PTE患者确诊检查比例(RES-PTE-01) 70指标二、急性 PTE患者行深静脉血栓相关检查比例(RES-PTE-02) 70指标三、急性 PTE患者行危险因素分层相关检查比例(RES-PTE-03) 70指标四、住院期间行溶栓治疗的高危急性 PTE患者比例(RES-PTE-04) 71指标五、急性 PTE患者住院期间抗凝治疗比例(RES-PTE-05) 71指标六、急性 PTE 患者住院死亡率(RES-PTE-06) 71指标七、急性 PTE患者住院期间发生大出血比例(RES-PTE-07) 71二、慢性阻塞性肺疾病(慢阻肺病)急性加重 72指标一、慢阻肺病急性加重患者住院期间行动脉血气分析比例(RES-COPD-01) 72指标二、慢阻肺病急性加重患者住院期间胸部影像学检查比例(RES-COPD-02) 72指标三、慢阻肺病急性加重患者住院期间心电图检查比例(RES-COPD-03) 72指标四、慢阻肺病急性加重患者住院期间超声心动图检查比例(RES-COPD-04) 72指标五、慢阻肺病急性加重患者住院期间抗感染治疗前病原学送检比例(RES-COPD-05) 73指标六、慢阻肺病急性加重患者住院期间雾化吸入支气管扩张剂应用比例(RES-COPD-06) 73指标七、慢阻肺病急性加重患者住院死亡率(RES-COPD-07) 73指标八、使用有创机械通气的慢阻肺病急性加重患者死亡率(RES-COPD-08) 73三、住院成人社区获得性肺炎(CAP) 73指标一、住院成人 CAP患者行 CAP严重程度评估的比例(RES-CAP-01) 73指标二、住院成人低危 CAP患者住院比例(RES-CAP-02) 75指标三、住院成人 CAP患者住院期间抗感染治疗前病原学送检比例(RES-CAP-03) 75
指标四、住院成人 CAP患者住院病死率(RES-CAP-04) 75指标五、住院成人 CAP住院患者接受机械通气的比例(RES-CAP-05) 75
第三章国内外医疗质量控制体系现状分析 76一、医疗质量相关概念 76二、国际医疗质控体系 77(一)美国 77(二)英国 77(三)澳大利亚 78三、我国医疗质控体系 79(一)医疗质控历史 79(二)医疗质控体系 79(三)医疗质量管理工具 79(四)医疗质控现状 80
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