Objective To summarize and analysis the working experience of healthcare performance evaluation and reporting experience in local health administration department of Australia, and provide decision support to China on such work as establishing objective, scientific, effective healthcare performance evaluation system, strengthening government’s supervision over health service and improving healthcare system management efficiency. Methods Searching official networks and databases of Australia, and finding out relevant policy, reports, and documents on healthcare performance evaluation. Results Typical healthcare performance evaluation systems in Australian are as follos: National Health Performance Framework (NHPF), the National Healthcare Agreement（NHA）and Review of Government Service Provision. Conclusions These programs in Australian is enlightening to these work in China that performance evaluation should be the prior tool in health system to management and reform, the performance measurement indicators systems should emphasize the quality safety and health fair.We should set up scientific and flexible index inclusion criteria and open report and compare performance information.
Objectives Performance of critical injury treatment among extremely-hit areas after great earthquake was retrospectively analyzed to provide references for policy-making as reducing mortality and disable rate besides increasing rehabilitation rate for global post-quake medical relief. Methods Retrospective analysis, primary research and secondary research were comprehensively applied. Results 1.According to incomplete statistics datum, there were 30,620 self-save injured among extremely-hit areas in 72 post-quake hours. And, the number of critical injured took 22% of the total inpatient injured. 2. Mortalities decreased successively from that of municipal healthcare centers in extremely-hit areas to that municipal medical units in peripheral quake-hit areas and then to those of municipal, provincial and MOH-affiliated hospitals as 12.21%, 4.50%, 2.50% and 2.17% respectively. 3. Injured with fractures on body, limbs or unknown-parts, severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals were much more than those treated in first-line hospitals with more severe injuries. 4. Among 10,373 injured in stable conditions transferred to third-line hospitals, 99.07% were discharged off hospitals with mortality as 0.017% during 4 post-quake months. Conclusions The medical relief model as “supervising body helping subordinate unit, severely-stricken areas assisting extremely-hit ones, quake-hit areas supporting both extremely-hit and severely-stricken ones, and save-saving amp; mutual assistance applied between extremely-hit areas” is roughly established for injured from severely-stricken areas after Wenchuan earthquake. 2. “Four concentration treatment” principle for those injured in critical conditions did effectively reduce mortality（15.06%→2.9%）. 3. Timely, scientific and standard on-site triage and post-medical transfer under guidance of accurate injury information determine rescue effect for the injured, while there is large space to fulfill as for treatment for critical diseases among extremely-hit areas under extreme conditions after Wenchuan earthquake.
ObjectiveTo evaluate the current status of primary healthcare system reform in Xinjin county, in order to provide baseline data for improving the healthcare service system and population health in Chengdu. MethodsPrimary health care services and population health in Xinjin county were quantitatively described and compared. Resultsa) Eleven township hospitals (100%) and 89 village clinics (66.42%) were upgraded according to the national standards. The management of 60 village clinics were integrated with township hospitals. And 417 and 76 essential healthcare services were provided by township hospitals and village clinics, respectively. b) In 2010, the number of outpatients and inpatients in Xinjin county were increased by 24.2% and 46.3% respectively compared to those of 2009, while the costs per outpatient visit and inpatient discharge were reduced by 21.5% and 18.6% respectively. c) In 2010, health records of 98.2% of population in Xinjin county have been established; 96.3% of pregnant women were managed systematically; 98.8% of children immunization programs were implemented; 100% patients with severe mental disorders and about 78% with hypertension and diabetes were in follow-up and treatment; and 28.8% of total population got the free physical exams in 2010. d) The essential medicine accounted for 96.7% of total types of medicines and 97.8% of total expenditure of medicines in primarily healthcare institutions in Xinjin. The cost of medicine management was reduced from 8.5% to 4.2% while the medicine turnover rate was increased by 50%. e) Average life expectancy in Xinjin county was 77.97 years, infant mortality rate was 6.82‰ in 2010; and there was no maternal death in recent 8 years. f) The regional healthcare information system was established covering three-tier rural health care network spanning the county, township and village. Conclusiona) The primary healthcare system reform in Xinjin county improves the infrastructure of primary care system, the utilization of essential medical care, essential public health service, and essential medicines. b) Life expectancy, infant mortality rate and maternal mortality of Xinjin county are better than the average levels in Sichuan province and China. Xinjin county is a representative pilot county for healthcare service system reform in Chengdu city and a nice model to successfully promote healthcare system reform based on regional healthcare information system.
Objective To assess the public health impacts and needs, to evaluate performance of anti-epidemic efforts after Lushan earthquake, so as to provide references for the following anti-epidemic work. Methods The day of earthquake occurrence was defined as the first day after earthquake. We collected information and data from the Sichuan Provincial Government, the National Health and Family Planning Commission of the People’s Republic of China, the Health Department of Sichuan Province, Sichuan Center for Disease Control and Prevention, and then we compared the situations of disaster, public health situation in stricken area, emergency response, resource deployment, etc. with those after Wenchuan earthquake in 2008, in order to evaluate the performance of anti-epidemic response during 2 weeks, clarify current situations and demands, and offer a proposal for the following work. Results Emergency response was conducted immediately after the Lushan earthquake. The counterpart assistance was considered at the beginning of team arrangement. The number and professional structure of rescue participants were planned according to needs. Three days after earthquake, anti-epidemic staff arrived at every involved county, town, and even village, which achieved full rescue coverage of locations and interventions. The staff helped reconstruct disease surveillance system, protect source of drinking water and environmental hygiene, etc., which resulted in progressive achievement. Two weeks after the earthquake there were no outbreak and public health emergency event occurred in stricken area. Conclusion The anti-epidemic efforts after Lushan earthquake inherit and develop the lessons from Wenchuan earthquake in 2008. Emergency response is timely, orderly, scientific, and moderate. The deployment of policies, technologies and resources has already been completed during two weeks. Anti-epidemic efforts achieve preliminary results. We suggest that key issues of further work should be the implementation of policies, strategies and measures, such as health management at relocation sites, water and food hygiene, disease monitoring, prevention and control, mass vaccination, scientific disinfection, and health education, in order to improve long-efficacy mechanism and stabilize work performance.
ObjectiveTo improve the comprehensive service ability of the hospital, improve the satisfaction of medical care, implement the requirements of fine management, and enrich the connotation of hospital internal performance improvement.MethodsIn July 2017, based on the concept of approach-deployment-learning-integration, the internal performance improvement model of Children’s Hospital Affiliated to Fudan University was constructed to form a management closed loop.ResultsFrom 2016 to 2019, the average length of hospital stay was reduced from 6.90 d to 6.47 d, the patient satisfaction was elevated from 92.89% to 93.80%, the proportion of drugs was reduced from 35.25% to 30.44%, the proportion of materials was reduced from 23.35% to 18.55%, and the proportion of difficult operations of grade Ⅲ and Ⅳ was elevated from 66.98% to 67.68%.ConclusionThe improvement of key performance indicators depends on the implementation of external policies, the integration of scientific management elements, the cooperation of multiple subjects, and the construction of information system.
ObjectiveTo investigate the essential healthcare system performance in Xinjin county of Chengdu city from 2009 to 2010, so as to provide baseline data for further study. MethodsThe general information of the essential healthcare, such as the numbers of out and in-patients, service and profits were collected and then analyzed using the software of Microsoft Excel 2003 and SPSS 13.0. Resultsa) The results showed that the numbers of out and in-patients were in the rank of the county, township and community hospital. The numbers of out and emergency patients has been decreased 31.0% and 25.3% in the community hospital from 2009 to 2010, while patients in the county and township hospital has been increased. The numbers of in-patients has been increased by year; b) hospital bed occupancy has been increased by year, and the hospital bed occupancy of county hospitals was 8% lower than national level in 2009, 33.5% higher in 2010, the hospital bed occupancy of township hospitals from 2009 to 2010 was higher than national level, the ones of community hospital was lower than national level; c) there is an annual decreasing tendency for average days for hospitalization in county and community hospital, which were higher than national level; d) it was lower than national average rate; e) the inpatient fee per time was lower than national average rate; f) in the components of the in-patients expense, drug expense, operation expense and diagnose expense were constituted more than 86% in all eight costs; and g) the receipts and expenditure of Xinjin hospital throughout the year increased by years, the income and expenses showed 39.3% and 37.7%. ConclusionThe hospital bed occupancy, average hospitalization days and the inpatient fee per time in Xinjin county of Chengdu city during 2009-2010, were higher than national level. The overall health performance of hospitals in Xinjin county was satisfied. However, there was significant difference between the best and the worst. In order to distribute health resources, both benefit and efficient should be emphasized.
Regarding the working hours generated by clinical trial project services under the guidance of good clinical practice (GCP), taking the standard process of a cancer project screening period as an example, and relying on a standardized management model, this paper uses standard time measurement methods to calculate the standard time of the 12 regular tasks in the GCP project. On this basis, it analyzes the GCP project process in detail to find out the reasons for wasted performance hours, and proposes a series of improvement methods and suggestions, such as formulating and implementing a target assessment mechanism, developing standard format cards, using double-line operations research to carry out parallel operations, using quadrant method to divide tasks, using site management organization and resources of hospital departments to reduce coordination loss, and introducing big data management systems, so as to make the work process of clinical research coordinators more refined and professional.
ObjectivesTo explore the characteristics of the international clinical studies using objective performance criteria (OPC) and provide a reference to design clinical trials and determine external controls.MethodsPubMed, The Cochrane Library and EMbase databases were searched for all clinical studies which used OPC. Two reviewers independently screened literature, extracted data and descriptive analysis was then performed.ResultsA total of 51 English language articles were included. Merely one was published in 2001, and others were published between 2010 and 2018. Twenty-seven articles (27/51, 52.9%) were published between 2017 and 2018, with accumulated impact factors of 411. In the article referring to the reasons for using the objective performance criteria, reasons for using OPC study was primarily the difficulties of randomization and comparison (8/11, 72.7%). Articles with cardiovascular disease and peripheral vascular disease accounted for 86%, and articles on the effectiveness or safety of medical devices accounted for 76.5%. Single-arm trial (40), randomized controlled trials (2), case-control studies (2), case series (5) and diagnostic tests (2) were included. OPCs were mostly derived from the data of clinical trials of other similar products, national standards, specialist association standard and meta-analysis of multiple clinical studies. A total of 27 articles (27/51, 52.9%) used hypothesis testing to compare research results with objective performance goal, and 24 articles (24/51, 47.1%) used the confidence interval method.ConclusionsOPC studies are primarily used for safety intervention and effect evaluation. OPC studies are developing very rapidly, especially in the field of cardiovascular studies. Methodological details are reported reasonably sufficient. Reasons for using OPC study are primarily the difficulties of randomization and comparison. Factors such as source of the OPC, sample size, and comparison method should be taken into account. The application of the OPC can not only solve the difficulties of the implementation of numerous clinical research, but also provide new insights for solving the practical difficulties of clinical research in the real-world.
ObjectiveTo explore the parameter selection of different sample size estimation methods and the differences in estimation results in single-group target value clinical trials with rate as the outcome evaluation index. MethodsWe conducted a literature review to assess the method of target value selection for single-group target value clinical trials. Then, different values of target value (P0), clinical expected value (P1), and class II error level (β) were set through numerical simulation. Sample size results estimated using different sample size estimation methods were obtained using PASS software. The coefficient of variation, range/mean, analysis of variance and other methods were used to compare the differences between different methods. ResultsAnalysis of the data simulation results showed: when the expected value P1 was fixed, the sample size first decreased rapidly and then decreased slowly along with the increase or decrease of the targeted value P0 on both sides of the sample size limit value. When the difference between P0 and P1 was within 0.15, the ratio before and after correction could be controlled within 0.9. When the difference between P0 and P1 was more than 0.6, the ratio before and after correction approached 0.5. When P0+P1≈1, the ratio of different standard error choices (Sp0 or Sp1) to the estimated sample size was close to 1. When 0.65<P0+P1<1.35, the ratio of different standard error choices (Sp0 or Sp1) to the estimated sample size was about 3:1. When the confidence was 0.8, P0 and P1 were between 0.25 and 0.75 and between 0.20 and 0.80, respectively. We found little difference among the sample sizes estimated using these five methods (CV<0.10, range/mean<0.2). ConclusionThere are some differences among different sample size estimation methods, however, when P0 and P1 values are around 0.5, the differences between different methods are small, suggesting that appropriate methods should be selected for sample size estimation.
ObjectiveTo investigate the distribution of human resources in primary healthcare system of Xinjin county in Chengdu in 2010, so as to provide the evidence for appropriate allocation of health manpower. MethodsWe collected the data of human resources in the regional health information and management platform, and the list of health workers and their registration information. Microsoft Excel 2003 and SPSS 13.0 software were used to analyze data. Resultsa) A total of 1 551 health workers were in Xinjin primary healthcare system in 2010, including 1 124 in tenure position (accounting for 72.5%) and 427 in contract (accounting for 27.5%). b) In county-level hospital (CLH) or community healthcare centre (CHC) or township hospital (TH), the proportion of health professionals were 83.2%, 79.0% and 80.0% respectively; and 28.8%, 27.2% and 28.7% for registered & assistant doctors; 39.3%, 22.7% and 16.2% for registered nurses; 6.7%, 8.3% and 4.7% for technicians; and 5.9%, 6.8% and 6.9% for pharmacists, respectively. c) Health personnel per 1 000 population in CLH, CHC, and TH were 3.10, 1.98, and 1.92, respectively; health professionals per 1 000 population were 2.58, 1.58, and 1.54, respectively; registered & assistant doctors per 1 000 population were 0.89, 0.54, 0.55, respectively; and registered nurses were 1.22, 0.45, 0.31, respectively. The nurse-to-doctor ratios were 1.36, 0.83, and 0.56 nurses per doctor in CLH, CHC, and TH, respectively. The bed-to-nurse ratios were 0.59, 0.38, and 0.19 nurses per bed respectively. d) Most health professionals were junior professionals (about 60%), in college-level education (about 50%), between 25 to 44 years old (20%-70%), work experience between 5 to 19 years (40%-63%). e) Temporary employees in TH accounted for 46.4%, among which 86.6% younger than 35 years old, 23.4% in internship, and 64.1% at clinical position. Conclusiona) The shortage of health personnel is very obvious in Xinjin county with inappropriate proportions of health professionals; b) The stability of health personnel is challenging due to the large proportion of temporary employees in THs; c) health professionals in Xinjin county features a younger population, and in lower professional positions; d)Therefore, the related policies should be adjusted and innovated to enhance the education and training, to maintain the stability of health personnel and to promote the healthy and sustainable development of primary healthcare services.