| [Purpose]This study is based on the mature medical service performance appraisal system at home and abroad,based on the elaborating management,for obstetric this specialized subject with special risk,to construct China’s national conditions of tertiary public general hospital obstetric definition of the concept of performance evaluation system framework and dimension.in turn,first draft screening formed characteristic index system,by adopting the combination of qualitative and quantitative methods,reasonable selection of index and index weight coefficient setting,eventually to build a scientific and reasonable tertiary public general maternity performance appraisal system.Sample hospital maternity in a given area to make use of this system performance evaluation,comprehensive evaluation of local obstetric service situation,analysis the key links of each hospital obstetric medical services and weak part,which provide improvement strategy for hospital obstetric medical services,to promote its services to ascend,and better meet the demand of local medical services,and also give reference to other hospitals and departments of fine management.[Methods]1.Qualitative research methods(1)literature research: literature on obstetric performance evaluation at home and abroad was collected by using Pubmed,Web of Science and other English databases,CNKI,wanfang and other Chinese journal websites to understand the current situation and trend of obstetric performance research.(2)personal in-depth interview: The in-depth interview was conducted on 8 key insiders including relevant personnel of the health administrative department,hospital management experts and sample obstetric medical staff,to understand their cognition of obstetric operational goals,key links of performance,development strategies and other issues.(3)expert consultation method: through the designing the expert consultion table,two rounds of consultation were conducted for 18 relevant experts to screen the obstetrics performance appraisal indicators of tertiary public general hospital.2.Field investigation methodTo a region of central China three sample tertiary public general hospital obstetric onsite investigation,to collect information about its foundation in 2015-2017(department personnel allocation situation,scale,capital investment,services,and scientific research ability)and 2015-2017 sample tertiary public general e hospital obstetric medical record home page information(age,on admission,the hospital diagnosis,outcome,hospitalization days,main diagnostic disease name and code,secondary(several)name and code,the main operation and name,all kinds of fees).3.Quantitative analysis method(1)analytic hierarchy process: the analytic hierarchy process is used to construct the judgment matrix,and the weight of the first,second and third indexes is calculated according to the hierarchy,and the final combination weight is obtained by multiplying.(2)Topsis method and gray correlation analysis: the weighted Topsis method and gray correlation analysis were combined to conduct comprehensive performance assessment,calculate the relative closeness and give the performance ranking;(3)statistical analysis: descriptive analysis was used to analyze the basic obstetric data of the sample hospitals in this study,reflecting the obstetric operation between 2015 and 2017.Excel 2016 and R were used to conduct data screening,data cleaning and abnormal value processing for the first page of obstetrical records of three sample hospitals in 2017.Logistic regression model was used to make risk adjustment for related quality indexes of pregnant women,and the quality index value after risk adjustment was obtained.[Results]1.Establishment of performance appraisal system for obstetrics department of tertiary public general hospitalsTertiary public general hospital obstetrics "three vertical and two horizontal" performance evaluation system,including the medical quality and safety,efficiency,sustainable development,and staff for the center with maternal five first-level indicators,13 second class indexes and 28 third class indexes,two rounds of expert consultation Kendall coefficient,p < 0.001,has a good consistency.The highest weight is given to medical quality and safety,with maternal as the center.2.Demonstration of obstetrics performance in tertiary public general hospitalsMedical record home page of each sample hospital obstetric risk adjustment,the different hospital adverse outcome numerical changes before and after risk adjustment,cesarean section rate and neonatal adverse outcome rate,maternal birth injury rate,the rate of postpartum hemorrhage and nosocomial infection risk adjustment model in perinatal AUC were 0.933,0.764,0.738,0.740 and 0.662,indicating a good fitting.Topsis method was used to calculate the relative closeness degree of the obstetrics department of the three sample hospitals,which was 0.5101,0.4899 and 0.5657.According to this method,the obstetrics department of C hospital had the best performance.By combining relative closeness degree with grey correlation analysis,it is calculated that the comprehensive closeness degree of the obstetrics department of the three sample hospitals is 0.5048,0.4961 and 0.5292,and the result is still the best performance of the obstetrics department of hospital C,indicating that the performance appraisal system has good applicability.The performance improvement problems faced by the sample obstetrics department are as follows:(1)cesarean section rate is still at a high level,the incidence of adverse events is high,which affects maternal health and wastes medical resources at the same time;(2)the rise in costs has not been stopped,the hospitalization cost per time is higher,there is unreasonable cost transfer;(3)bed work efficiency to be improved,there are too high and too low phenomenon,suggesting that the distribution of resources is unreasonable;(4)the enthusiasm of the staff to enhance the constraints of more factors,the unreasonable distribution of pay makes the staff easy to produce dissatisfaction,the lack of platform for further study;(5)comprehensive service ability needs to be further improved,the obstetrics research ability of sample hospitals is relatively low,and the talent structure needs to be developed.3.Performance improvement strategy of obstetrics in tertiary public general hospitalsThree-level comprehensive public hospitals should improve their performance from the following aspects: strengthening medical quality management,ensuring medical safety,and improving relevant systems;Actively carry out team communication and training,targeted continuing education,training safety culture and humanistic doctors;Pay attention to maternal’s feeling of going to hospital,reasonably plan the layout and process of consultation room,and improve the satisfaction;Pay attention to the enhancement of scientific research ability,accelerate the transformation of all kinds of achievements,and promote the development of integrated medicine and prevention;We will improve the personnel compensation system and motivate medical personnel.4.Improvement strategies for performance assessment of obstetrics department in tertiary general public hospitalsThe work of government performance assessment needs to be further improved,from the hospital performance assessment to the department performance assessment.The promotion strategy includes the following aspects: clear performance assessment objectives and strengthen strategic guidance;Improve performance appraisal standards,adapt to local standards,select department characteristic indicators,and ensure their scientificity and sensitivity;Pay attention to the disclosure of evaluation results,timely feedback on the results,build an incentive mechanism,and link the evaluation results with government financial input and other aspects;Introducing third-party review bodies to ensure the impartiality of the results;Establish a perfect and unified information platform,ensure the availability of data and unified caliber,and improve the efficiency of assessment.[Conclusions]1.The performance appraisal system of obstetrics in tertiary public general hospitals has sufficient theoretical basis and is divided into three levels to ensure its operability.The selected indicators are representative and systematic,and the weight calculation is relatively scientific.This model is scientific and can provide a reference for the practice of obstetrics performance appraisal intertiary public general hospitals in China.2.The improvement of obstetrics performance in tertiary general hospitals is a process of multi-stakeholder game.Obstetric still exist at present stage cesarean section rate is too high,the health education consciousness weak,uneven regional development and other issues,such as members of the government,medical institutions should act together to government from several aspects to strengthen performance appraisal work,comprehensive tertiary public hospital obstetrics and their effective performance management in order to jointly promote tertiary comprehensive public hospital obstetric performance improvement,promote the level of maternal and child health care undertakings in our country. |
