Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment_Chinese Journal of Evidence-Based Medicine

Authors：

JI Shuming ¹ , WANG Wei ¹ , ZHANG Pei ¹ , ZENG Cheng ¹ , LI Linjian ¹ , YU Fei ² ,  ZHOU Xiaoyuan ¹

1. West China School of Public Health and the Fourth West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Sichuan Tumor Hospital, Chengdu 610041, P.R.China;

Corresponding author：

ZHOU Xiaoyuan, Email: zhouxyuan@scu.edu.cn

Keywords：

Graded diagnosis and treatment; Human resources; Spatial autocorrelation; Gini coefficient; Multiple regression

DOI：

10.7507/1672-2531.201911085

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.Methods The Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.Results The distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s I_doctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s I_nurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.Conclusions Optimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.

Citation： JI Shuming, WANG Wei, ZHANG Pei, ZENG Cheng, LI Linjian, YU Fei, ZHOU Xiaoyuan. Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1004-1011. doi: 10.7507/1672-2531.201911085 Copy

1.	刘晓明. 转型视角下医院人力资源管理的现状及对策探讨. 中国集体经济, 2017, (18): 86-87.
2.	李文先, 张向峰, 苗茂云, 等. 我国疾病预防控制中心卫生人力资源配置公平性分析. 中华疾病控制杂志, 2016, 20(9): 945-947.
3.	丁夏夏, 沈永祥, 董黎明. 新医改背景下某公立医院人力资源配置优化研究. 中华全科医学, 2016, 14(12): 2107-2109, 2135.
4.	魏子柠, 王亚东. 我国新一轮医药卫生体制改革的回顾与启示. 中华疾病控制杂志, 2019, 23(9): 1037-1040.
5.	胡彬. 国务院发布“十三五”深化医改规划. 中医药管理杂志, 2017, 25(2): 126-126.
6.	Cunha E Silva DC, Lourenço RW, Cordeiro RC, <italic>et al</italic>. Analysis of the relation between the spatial distribution of morbidities due to obesity and hypertension for the State of São Paulo, Brazil, from 2000 to 2010. Cien Saude Colet, 2014, 19(6): 1709-1719.
7.	Deltas G. The small-sample bias of the Gini coefficient: Results and implications for empirical research. Review of Economics & Statistics, 2003, 85(1): 226-234.
8.	郑黎强, 纪超, 岳阳阳, 等. 我国三级综合医院人力资源现状分析. 中国医院, 2016, 20(8): 22-24.
9.	梁勇, 张柠. 国外医疗服务体系对完善我国分级诊疗体系的启示与借鉴. 中国医院, 2015, 19(8): 50-52.
10.	毛瑛, 王雪, 何荣鑫. 基于 TOPSIS 模型的公立医院医疗服务能力评价研究. 中国卫生质量管理, 2016, 23(6): 99-103.
11.	Becker ER, Steinwald B. Determinants of hospital casemix complexity. Health Serv Res, 1981, 16(4): 439-458.
12.	Hedayet C, Valentin Z, Audrey L, <italic>et al</italic>. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter? Int J Prod Econ, 2014, 150: 74-82.
13.	Rosko MD, Chilingerian JA. Estimating hospital inefficiency: does case mix matter? J Med Syst, 1999, 23(1): 57-71.
14.	刘婉如, 张乐辉, 仇叶龙, 等. 病例组合指数在医院绩效评价中的调整方法与应用. 中华医院管理杂志, 2015, 31(11): 843-845.
15.	Lingsma HF, Bottle A, Middleton S, <italic>et al</italic>. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res, 2018, 18(1): 116.
16.	Yang Y, Ma M. Green communications and networks. Dordrecht: Springer, 2012.
17.	姚伟, 陈兴宝, 沈康, 等. 恶性肿瘤病人住院费用及其影响因素分析. 中国肿瘤, 2002, 11(9): 521-523.
18.	王力男, 丁玲玲, 方欣叶, 等. 老年人消耗的医疗资源分析: 基于上海市医疗机构数据. 中国卫生经济, 2018, 37(4): 61-66.
19.	郝模, 马纪良. 县、区、乡三级医疗机构手术能力研究. 中国医院管理, 1991, 11(10): 19-22.
20.	张宗光, 王恩波, 王秋仙, 等. 农村卫生资源配置研究的新视角与城乡卫生服务均等化的政策探讨. 中国卫生经济, 2013, 32(10): 35-37.
21.	周晔玲, 蓝相洁, 司明舒, 等. 基于分级诊疗的广西卫生人力资源配置分析. 中国卫生经济, 2018, 37(7): 51-53.
22.	陈虹, 纪娇, 高本林. 医联体建设助推分级诊疗实施策略. 现代医院, 2018, 18(8): 1103-1104, 1108.
23.	陈煜, 易守宽. 医生多点执业对新公立医院改革的影响. 云南财经大学学报, 2010, 25(5): 117-118.
24.	高卫益, 赵列宾, 袁克俭. 区域卫生资源纵向整合的实践与思考. 中国医院, 2008, 12(3): 79-80.
25.	吴敏, 牟燕, 刘岩, 等. 乡镇卫生院医疗服务能力趋势变化与问题探讨—基于 2009-2015 年山东省乡镇卫生院医疗服务量的比较. 卫生软科学, 2018, 32(1): 16-19.
26.	朱颖. 基层医疗机构加强卫生人才队伍建设的探索. 中国卫生人才, 2015, 9: 74-78.
27.	朱珑, 张克英. 3 年规范化培训考核在提高新入职护士职业能力中的作用. 中华护理杂志, 2016, 51(7): 836-839.
28.	魏士轩, 尹爱田, 马东平, 等. 全科医生制度建设的人才问题及成因研究. 中国卫生资源, 2014, 17(3): 227-228.
29.	黄玮. 论分级诊疗模式下公立医院与社区卫生服务机构的协同发展. 中国医学创新, 2016, 13(25): 76-79.
30.	高仕铭, 陆斌杰. 从医师队伍职称结构变化趋势看卫生人事制度改革. 中华现代医院管理杂志, 2004, 2(8): 3-5.
31.	Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colonic surgery. Surgery, 2003, 133(3): 277-282.
32.	张燕, 杨胜文, 吴文富, 等. 黔南州基层医疗卫生机构护理人才队伍现状分析及对策研究. 黔南民族医专学报, 2013, 26(3): 185-188.
33.	于长海, 李晓妹, 周晨霆. 基于 SWOT 分析的山东省内陆地区公立医院人才高地建设策略研究—以某省级区域医疗中心为例. 中国初级卫生保健, 2019, 33(8): 9-10.
34.	谢春鹰, 谭加荣, 兰利萍. 基层医疗卫生机构人才队伍建设的探索. 中国卫生人才, 2015, 5: 52-55.

1. 刘晓明. 转型视角下医院人力资源管理的现状及对策探讨. 中国集体经济, 2017, (18): 86-87.
2. 李文先, 张向峰, 苗茂云, 等. 我国疾病预防控制中心卫生人力资源配置公平性分析. 中华疾病控制杂志, 2016, 20(9): 945-947.
3. 丁夏夏, 沈永祥, 董黎明. 新医改背景下某公立医院人力资源配置优化研究. 中华全科医学, 2016, 14(12): 2107-2109, 2135.
4. 魏子柠, 王亚东. 我国新一轮医药卫生体制改革的回顾与启示. 中华疾病控制杂志, 2019, 23(9): 1037-1040.
5. 胡彬. 国务院发布“十三五”深化医改规划. 中医药管理杂志, 2017, 25(2): 126-126.
6. Cunha E Silva DC, Lourenço RW, Cordeiro RC, <italic>et al</italic>. Analysis of the relation between the spatial distribution of morbidities due to obesity and hypertension for the State of São Paulo, Brazil, from 2000 to 2010. Cien Saude Colet, 2014, 19(6): 1709-1719.
7. Deltas G. The small-sample bias of the Gini coefficient: Results and implications for empirical research. Review of Economics & Statistics, 2003, 85(1): 226-234.
8. 郑黎强, 纪超, 岳阳阳, 等. 我国三级综合医院人力资源现状分析. 中国医院, 2016, 20(8): 22-24.
9. 梁勇, 张柠. 国外医疗服务体系对完善我国分级诊疗体系的启示与借鉴. 中国医院, 2015, 19(8): 50-52.
10. 毛瑛, 王雪, 何荣鑫. 基于 TOPSIS 模型的公立医院医疗服务能力评价研究. 中国卫生质量管理, 2016, 23(6): 99-103.
11. Becker ER, Steinwald B. Determinants of hospital casemix complexity. Health Serv Res, 1981, 16(4): 439-458.
12. Hedayet C, Valentin Z, Audrey L, <italic>et al</italic>. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter? Int J Prod Econ, 2014, 150: 74-82.
13. Rosko MD, Chilingerian JA. Estimating hospital inefficiency: does case mix matter? J Med Syst, 1999, 23(1): 57-71.
14. 刘婉如, 张乐辉, 仇叶龙, 等. 病例组合指数在医院绩效评价中的调整方法与应用. 中华医院管理杂志, 2015, 31(11): 843-845.
15. Lingsma HF, Bottle A, Middleton S, <italic>et al</italic>. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res, 2018, 18(1): 116.
16. Yang Y, Ma M. Green communications and networks. Dordrecht: Springer, 2012.
17. 姚伟, 陈兴宝, 沈康, 等. 恶性肿瘤病人住院费用及其影响因素分析. 中国肿瘤, 2002, 11(9): 521-523.
18. 王力男, 丁玲玲, 方欣叶, 等. 老年人消耗的医疗资源分析: 基于上海市医疗机构数据. 中国卫生经济, 2018, 37(4): 61-66.
19. 郝模, 马纪良. 县、区、乡三级医疗机构手术能力研究. 中国医院管理, 1991, 11(10): 19-22.
20. 张宗光, 王恩波, 王秋仙, 等. 农村卫生资源配置研究的新视角与城乡卫生服务均等化的政策探讨. 中国卫生经济, 2013, 32(10): 35-37.
21. 周晔玲, 蓝相洁, 司明舒, 等. 基于分级诊疗的广西卫生人力资源配置分析. 中国卫生经济, 2018, 37(7): 51-53.
22. 陈虹, 纪娇, 高本林. 医联体建设助推分级诊疗实施策略. 现代医院, 2018, 18(8): 1103-1104, 1108.
23. 陈煜, 易守宽. 医生多点执业对新公立医院改革的影响. 云南财经大学学报, 2010, 25(5): 117-118.
24. 高卫益, 赵列宾, 袁克俭. 区域卫生资源纵向整合的实践与思考. 中国医院, 2008, 12(3): 79-80.
25. 吴敏, 牟燕, 刘岩, 等. 乡镇卫生院医疗服务能力趋势变化与问题探讨—基于 2009-2015 年山东省乡镇卫生院医疗服务量的比较. 卫生软科学, 2018, 32(1): 16-19.
26. 朱颖. 基层医疗机构加强卫生人才队伍建设的探索. 中国卫生人才, 2015, 9: 74-78.
27. 朱珑, 张克英. 3 年规范化培训考核在提高新入职护士职业能力中的作用. 中华护理杂志, 2016, 51(7): 836-839.
28. 魏士轩, 尹爱田, 马东平, 等. 全科医生制度建设的人才问题及成因研究. 中国卫生资源, 2014, 17(3): 227-228.
29. 黄玮. 论分级诊疗模式下公立医院与社区卫生服务机构的协同发展. 中国医学创新, 2016, 13(25): 76-79.
30. 高仕铭, 陆斌杰. 从医师队伍职称结构变化趋势看卫生人事制度改革. 中华现代医院管理杂志, 2004, 2(8): 3-5.
31. Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colonic surgery. Surgery, 2003, 133(3): 277-282.
32. 张燕, 杨胜文, 吴文富, 等. 黔南州基层医疗卫生机构护理人才队伍现状分析及对策研究. 黔南民族医专学报, 2013, 26(3): 185-188.
33. 于长海, 李晓妹, 周晨霆. 基于 SWOT 分析的山东省内陆地区公立医院人才高地建设策略研究—以某省级区域医疗中心为例. 中国初级卫生保健, 2019, 33(8): 9-10.
34. 谢春鹰, 谭加荣, 兰利萍. 基层医疗卫生机构人才队伍建设的探索. 中国卫生人才, 2015, 5: 52-55.

Chinese Journal of Evidence-Based Medicine

Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment

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