(Reporter Xu Shiyu of People's Daily Health Client) On September 30, the performance evaluation results of the 2021 national third-level public hospitals were released. The assessment index system consists of four first-level indicators, medical quality, operational efficiency, sustainable development, and satisfaction evaluation, 14 second-level indicators, and 55+1 third-level indicators. It is known as the "national examination" of public hospitals across the country.
"This is the third time that the national examination results of a third-level public hospital are released. The national examination data shows the hospital's achievements in the national third-level public hospital performance evaluation index system. This data is a 'baton' of hospital management, pointing out the direction for the strategic development of third-level public hospitals." Qian Dongfu, deputy director of the Jiangsu Institute of Health of Nanjing Medical University, said in an interview with a reporter from the People's Daily Health Client that the "national examination" has an increasingly greater influence on society, and more local governments have begun to pay attention to the hospital's national examination results, and the results are gradually linked to the hospital's financial subsidies, medical insurance fund allocation, hospital leaders' assessment, and total performance salary. In the work of the health and health system, the results of the "national examination" will affect the hospital's application for national medical centers, regional medical center construction projects, etc.
Recently, the multidisciplinary diagnosis and treatment team of the Neurosurgery Department of Qilu Hospital and Epilepsy Diagnosis and Treatment Center were on the operation site. Qilu Hospital map
Medical quality is an important first-level indicator for the national examination, followed by operational efficiency, sustainable development and satisfaction evaluation
Qian Dongfu introduced that the "national examination" index system consists of four first-level indicators: medical quality, operational efficiency, sustainable development, satisfaction evaluation, 14 second-level indicators, and 55+1 third-level indicators, of which 26 indicators are national monitoring indicators. The national examination results are obtained based on these 26 monitoring indicators after weighted scores. The total score is 1,000 points. According to the scores of the third-level public hospitals participating in the assessment, they are divided into three levels A, B, and C. Among them, the third-level public comprehensive hospitals are grade three and ninth grade, and the highest level is A++. The evaluation results of third-level public specialty hospitals are A, B, and C, and the highest level is A.
The ratio of the four first-level indicators of tertiary public hospitals is roughly 4:3:2:1. Taking the third-level public comprehensive hospital as an example, the scores and proportions of its four first-level indicators in the total score of 1,000 are respectively: the medical quality is 430 points, the operational efficiency is 270 points, the sustained development is 180 points, and the satisfaction evaluation is 120 points, the proportion of 12%. It can be seen that medical quality is an important first-level indicator of the "national examination", followed by operational efficiency, sustainable development and satisfaction evaluation.
"The full scores of the 26 national monitoring indicators are also different. The size of their scores can also be judged by their scores." Qian Dongfu said that taking the third-level public comprehensive hospital as an example, the full scores of the three monitoring indicators, the proportion of discharged patients, the proportion of discharged patients' level 4 surgery, and the scientific research project funding for each hundred health technicians, are the highest, with 100 points. The full scores of the other monitoring indicators are not greater than 50 points, and the full scores of the seven monitoring indicators are only 20 points.
Therefore, the three monitoring indicators of discharged patients, the proportion of discharged patients with level 4 surgery, and the funding of scientific research projects per 100 health technicians are the key points that tertiary public comprehensive hospitals need to pay attention to. The proportion of discharged patients and the proportion of discharged patients with level 4 surgery are both in the category of functional positioning of medical quality. The funding of scientific research projects for every 100 health technicians falls within the scope of hospital discipline construction. The above three high-score indicators fully demonstrate that the national level requires third-level public comprehensive hospitals to focus on their functional positioning and key discipline construction. Third-level public comprehensive hospitals should focus on top medical technology, excellent medical quality, efficient medical services, and refined hospital management. As the hospital's development goals, their discipline construction should be aimed at the national clinical medicine peak, talent training leading base and scientific research results transformation highland.
Many hospitals have announced their national examination results, and 1,355 third-level public hospitals have participated in the
As of now, Shandong University Qilu Hospital, First Affiliated Hospital of China Medical University , Sichuan Provincial People's Hospital, Chengdu Fifth People's Hospital , etc. have announced their national examination results.
The First Affiliated Hospital of China Medical University ranked 13th in the country among the 1,355 third-level public hospitals participating in the evaluation, up 4 places from the previous year, entering the highest-level A++ sequence, ranking in the top 1% of the third-level public hospitals in the country (comprehensive Western medicine). This is the first time that hospitals in Northeast China have entered the first echelon of national third-level public hospital performance appraisal.
Shandong University Qilu Hospital tied for 13th in the country and entered the A++ ranks, among which the case combination index (CMI) ranked 6th in the country.
Chengdu Fifth People's Hospital ranks 124th among the 1,355 third-level public comprehensive hospitals in the country, entering the top 10% of the country, advancing to the A+ level.
Chengdu Fifth People's Hospital National Examination Results.
case combination index (CMI, Case-Mix Index) is an internationally recognized representative hospital's technical difficulty in diagnosing and treating cases of diseases and its ability to treat difficult and severe diseases. Qian Dongfu told the People's Daily Health Client reporter that CMI only represents the ability of tertiary public hospitals to diagnose and treat diseases and the ability to treat difficult and severe diseases, which is mainly reflected in the hospital's medical quality dimension.
Qian Dongfu analyzed that according to the "national examination" results just announced, Qilu Hospital ranked 13th in the assessment, in the top 1%, and was rated as A++ level, which shows that the hospital's comprehensive strength is quite strong. The hospital ranks 6th in CMI and ranks higher among participating hospitals, indicating that the hospital's technical ability to diagnose and treat difficult and critical cases has reached a leading level among participating hospitals.
How to increase the proportion of fourth-level surgery, minimally invasive surgery, and discharged patients' surgery, increase the CMI value, improve the operating efficiency indicators such as income and expenditure structure, and cost control are the key core of improving the national examination results
"National examination" has a distinct baton role. Qian Dongfu said that the goals pursued by the "national examination" mainly involve four aspects: "quality, efficiency, development and satisfaction". As everyone understands the rules and indicators of the national examination more and more clearly, the pressure on competition in the national examination will become greater and greater. At the beginning, some hospitals did not pay attention to informatization and data quality, and some mistakes in data transmission would greatly affect their rankings. With everyone's attention and data quality generally improves, the "national examination" must get high scores. How to increase the proportion of fourth-level surgery, minimally invasive surgery, discharged patients' surgery, increase the CMI value, and improve the operating efficiency indicators such as income and expenditure structure and cost control is the key core of improving the national examination results.
In terms of hospital management, Qian Dongfu suggested that first of all, basic quality management of personnel, technology, equipment, materials and information should be carried out from the structure, and access management should be strengthened from the source, sensing control and adverse event reports, etc., to improve the technical level and promote the development of disciplines and ensure medical safety with behavioral norms. Secondly, quality control should be carried out throughout the entire process of disease diagnosis and treatment, diagnosis, treatment, discharge, and follow-up. This requires hospital managers to strictly implement core systems and diagnosis and treatment standards, pay attention to the management of key departments, key links, and key indicators; strengthen clinical pathways and single disease management, and promote the homogeneity and standardization of quality management. Again, conduct final effect evaluation based on data and results. Hospitals can establish a performance appraisal medical indicator monitoring database, evaluate and analyze results indicators every quarter, and refer to tertiary hospital medical quality control indicators to continuously improve.
For patients, Qian Dongfu believes that doctor-patient satisfaction is the ultimate end point of the "national examination" and the hospital's high-quality development goals. There are 2 secondary indicators in the satisfaction evaluation index: patient satisfaction and medical staff satisfaction. Patient satisfaction is closely related to medical quality, service efficiency and level, and is positively related to the hospital's internal management level and the quality of medical staff. If the patient's satisfaction is low, the hospital's "national exam" scores cannot be very high. The results of the "national examination" have certain references for patients' medical treatment choices, but it should also be noted that the results of the "national examination" are not completely comparable at the national level. For example, a hospital has a large amount of investment and a large number of new recruits in the short term, which will have an impact on its operational efficiency and other relevant indicators. In addition, the specific implementation of the satisfaction survey is not unified by a third party, etc.
From the perspective of the construction of the public health system, the current "national examination" does not have direct assessment indicators for public health services. In the future, public hospitals can be included in the performance assessment indicator system, which will have a positive effect on promoting the integration and cooperation between the public health system and the medical system.
"Only by integrating the goals of the four dimensions of the national examination into the daily work of third-level public hospitals can we better make up for shortcomings, strengthen advantages, build peaks, and make every effort to improve the modernization level of the hospital's governance system and governance capabilities." Qian Dongfu said.
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