摘要
目的了解海南省二、三级医院超声医学科质量控制指标和医疗服务质量现状,为超声诊断质量持续改进和提升提供参考。方法海南省超声医学质量控制中心于2024年1月收集2023年1月1日至12月31日海南省46家二、三级医院(其中二级医院21家,三级医院25家)超声诊断专业质控指标数据,包括结构质量分析指标(超声医师月均工作量、超声仪器质检率、超声科医患比、超声医师数与诊断仪数比)、过程质量分析指标[住院超声检查48 h内完成率、超声危急值10 min内通报完成率、超声报告书写合格率、乳腺病变超声报告进行乳腺影像报告和数据系统(BI-RADS)分类率]和结果质量分析指标(门急诊超声报告阳性率、住院超声报告阳性率、超声筛查中胎儿重大致死性畸形的检出率、超声诊断符合率、乳腺占位超声诊断准确率)。采用秩和检验比较二级医院与三级医院各指标的差异。结果结构质量分析指标方面,三级医院超声医师月均工作量明显大于二级医院[795.75(551.86,972.45)人次/月vs 461.63(347.00,597.23)人次/月],三级医院医患比较二级医院低[1.04(0.86,1.51)人/万人次vs 1.80(1.39,2.40)人/万人次],差异具有统计学意义(U=135.00、134.50,P均=0.005);超声仪器质检率及超声医师数与诊断仪数比二项指标比较差异均无统计学意义(P均>0.05)。过程质量分析指标方面,三级医院超声危急值10 min内通报率、乳腺病变超声报告进行BI-RADS分类率高于二级医院[100(100,100)%vs 100(100,100)%;99.46(97.30,100)%vs 95.06(88.88,99.12)%],差异均具有统计学意义(U=212.50、130.50,P=0.024、0.003);超声报告书写合格率和住院超声检查48 h内完成率比较,差异均无统计学意义(P均>0.05)。结果质量分析指标方面,三级医院门急诊超声报告阳性率、超声诊断符合率、乳腺占位超声诊断准确率、超声筛查中胎儿重大致死性畸形的检出率均高于二级医院[76.75(65.51,81.96)%vs 64.86(54.30,72.21)%;92.08(88.84,94.34)%vs 85.30(83.20,90.44)%;86.29(79.03,92.07)%vs 79.63(76.12,85.00)%;0.03(0.00,0.08)%vs 0.00(0.00,0.00)%],差异均具有统计学意义(U=153.00、116.50、103.00、109.00,P=0.016、0.009、0.046、0.004);二、三级医院住院超声报告阳性率比较,差异无统计学意义(P>0.05)。结论海南省二、三级医院超声医学科多项质量控制指标存在一定差异,海南省超声医学质量控制中心基于海南省二、三级医院超声科的发展现状,尤其是二级医院较三级医院超声诊断符合率低的现状,将进一步完善质量控制体系、程序、标准和计划,规范开展质量控制与改进工作,以实现海南省超声医学专业的规范化、标准化和同质化。
Objective To investigate the current status of quality control indicators and medical service quality in ultrasound medical departments of secondary and tertiary hospitals in Hainan Province,in order to provide reference for the continuous improvement and enhancement of ultrasound diagnostic quality.Methods The Hainan Ultrasound Medical Quality Control Center collected data on ultrasound diagnostic quality control indicators from 46 secondary and tertiary hospitals in Hainan Province(including 21 secondary hospitals and 25 tertiary hospitals)from January 1,2024 to December 31,2023.The indicators investigated included structural quality analysis indicators(monthly average workload of ultrasound physicians,ultrasound instrument quality inspection rate,ultrasound doctor-patient ratio,and ratio of ultrasound physicians to diagnostic instruments),process quality analysis indicators(completion rate of inpatient ultrasound examination within 48 hours,completion rate of ultrasound critical value report within 10 minutes,qualification rate of ultrasound report writing,and classification rate of breast imaging reporting and data system(BI-RADS)for ultrasound report of breast lesions),and result quality analysis indicators(positive rate of outpatient ultrasound reports,positive rate of inpatient ultrasound reports,detection rate of major fatal fetal malformations in ultrasound screening,ultrasound diagnostic compliance rate,and accuracy rate of breast mass ultrasound diagnosis).The rank sum test was used to compare the differences in various indicators between secondary and tertiary hospitals,and P<0.05 was considered statistically significant.Results In terms of structural quality analysis indicators,the average monthly workload of ultrasound physicians in tertiary hospitals was significantly higher than that in secondary hospitals[795.75(551.86,972.45)person times/month vs 461.63(347.00,597.23)person times/month,U=135.00,P=0.005],and the ultrasound doctor-patient ratio in tertiary hospitals was significantly lower than that in secondary hospitals[1.04(0.86,1.51)person times/10000 person times vs 1.80(1.39,2.40)person times/10000 person times,U=134.50,P=0.005].There was no statistically significant difference in the quality inspection rate of ultrasound instruments,the number of ultrasound physicians,or the number of diagnostic instruments(P>0.05).Regarding process quality analysis indicators,the reporting rate of ultrasound critical values within 10 minutes[100(100,100)%vs 100.00(100,100)%,U=22.50,P=0.024]and the BI-RADS classification rate of breast lesions[99.46(97.30,100.00)%vs 95.06(88.88,99.12)%,U=130.50,P=0.003]were significantly higher in tertiary hospitals than in secondary hospitals.There was no statistically significant difference in the qualified rate of ultrasound report writing or the completion rate of inpatient ultrasound examination within 48 hours(P>0.05).With regard to quality analysis indicators,the positive rate of ultrasound reports in outpatient and emergency departments[76.75(65.51,81.96)%vs 64.86(54.30,72.21)%,U=153.00,P=0.016],the ultrasound diagnostic accuracy[92.08(88.84,94.34)%vs 85.30(83.20,90.44)%,U=116.50,P=0.009],the ultrasound diagnostic accuracy for breast masses[86.29(79.03,92.07)%vs 79.63(76.12,85.20,90.47)%,U=103.00,P=0.046],and the detection rate of major fatal malformations in ultrasound screening[0.03(0.00,0.08)%vs 0.00(0.00,0.00)%,U=109.00,P=0.004]were significantly higher in tertiary hospitals than in secondary hospitals.There was no significant difference in the positive rate of in-patient ultrasound reports in secondary and tertiary hospitals(P>0.05).Conclusion There are differences in multiple ultrasound quality control indicators between secondary and tertiary hospitals in Hainan Province.Based on the development status of ultrasound departments in secondary and tertiary hospitals in Hainan Province,especially the low compliance rate of ultrasound diagnosis in secondary hospitals compared to tertiary hospitals,the Hainan Ultrasound Medical Quality Control Center will further improve the quality control system,procedures,standards,and plans,and carry out quality control and improvement work in a standardized manner to achieve standardization and homogenization of ultrasound medicine in Hainan Province.
作者
张亚庆
黄旴宁
许珊珊
刘小蓝
Yaqing Zhang;Xuning Huang;Shanshan Xu;Xiaolan Liu(Hainan Ultrasonic Medical Quality Control Center,Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2024年第7期681-685,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
2021年度海南省卫生健康行业科研项目(21A200202)。
关键词
超声医学
质量控制
指标
Ultrasound medicine
Quality control
Indicator
