绩效管理是公立医院高质量发展的重要支撑。DS医院通过建立RBRVS(以资源为基础的相对价值比率)绩效管理方案,构建医师工作量RBRVS规则体系和绩效成本RBRVS规则体系,特别是采用体现医务人员劳务价值的诊疗组模式,为资深带组医师带来了更...绩效管理是公立医院高质量发展的重要支撑。DS医院通过建立RBRVS(以资源为基础的相对价值比率)绩效管理方案,构建医师工作量RBRVS规则体系和绩效成本RBRVS规则体系,特别是采用体现医务人员劳务价值的诊疗组模式,为资深带组医师带来了更高的声誉和激励,形成良好的“医学研”生态竞争模式。在医师工作量RBRVS规则体系方面,医院将参与医疗绩效管理的科室分为六类,对研判、执行、服务量进行分类评价,借鉴美国联邦医疗保险对医师支付口径的项目统计方式,比照CPT(cost per treatment,每次治疗费用)编码对不同资源消耗的项目赋予相应点值。在绩效成本RBRVS规则体系方面,DS医院的成本核算可分为四类。一是人力成本。二是不计入患者承担费用的卫生材料成本。三是固定资产折旧、商品和服务支出等其他执业成本。四是床单元成本。这一系统化的考核和分配方式促进了考核标准的多维度结合,初步达成了精细化管理的目标。展开更多
Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric sur...Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons. All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The χ2 test was used for nominal data and the Student’s t test was used for continuous variables. Probabilities were calculated based on a logistic regression model. Of 20, 545 eligible hernia repairs, 50.3%were performed by pediatric surgeons and 49.7%were performed by general surgeons. Pediatric surgeons operated on 62.4%of children younger than 2 years, 51.8%of children aged 26 years, and 37%of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10%vs 0.45%, P <.001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons. Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.展开更多
文摘绩效管理是公立医院高质量发展的重要支撑。DS医院通过建立RBRVS(以资源为基础的相对价值比率)绩效管理方案,构建医师工作量RBRVS规则体系和绩效成本RBRVS规则体系,特别是采用体现医务人员劳务价值的诊疗组模式,为资深带组医师带来了更高的声誉和激励,形成良好的“医学研”生态竞争模式。在医师工作量RBRVS规则体系方面,医院将参与医疗绩效管理的科室分为六类,对研判、执行、服务量进行分类评价,借鉴美国联邦医疗保险对医师支付口径的项目统计方式,比照CPT(cost per treatment,每次治疗费用)编码对不同资源消耗的项目赋予相应点值。在绩效成本RBRVS规则体系方面,DS医院的成本核算可分为四类。一是人力成本。二是不计入患者承担费用的卫生材料成本。三是固定资产折旧、商品和服务支出等其他执业成本。四是床单元成本。这一系统化的考核和分配方式促进了考核标准的多维度结合,初步达成了精细化管理的目标。
文摘Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons. All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The χ2 test was used for nominal data and the Student’s t test was used for continuous variables. Probabilities were calculated based on a logistic regression model. Of 20, 545 eligible hernia repairs, 50.3%were performed by pediatric surgeons and 49.7%were performed by general surgeons. Pediatric surgeons operated on 62.4%of children younger than 2 years, 51.8%of children aged 26 years, and 37%of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10%vs 0.45%, P <.001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons. Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.
