At the end of 2019, the notice of performance appraisal of secondary public hospitals was issued, which caused a big ripple in the medical circle. Unconsciously, two years have passed, and the report card of the "National Examination" of the second-level public hospital has been revealed for the first time.
On January 6, 2022, the National Health Commission issued the "Circular on the Relevant Situation of the National Monitoring and Analysis of the Performance Appraisal of Secondary Public Hospitals in 2019" (hereinafter referred to as the "Circular").
The "Circular" pointed out that after the review and confirmation of the provincial health administrative departments, a total of 3074 second-level public hospitals (including 908 second-level public hospitals of traditional Chinese medicine) participated in the performance appraisal work of the first year (2019), accounting for about 53% of the total number of second-level public hospitals in the country.
3,074 hospitals participated, which is undoubtedly the largest number of "contestants" since the "unified examination" of public hospitals.
The length of the process indicates the difficulty of the process. A person close to the Medical Administration Bureau of the National Health Commission revealed that the statistical work of performance appraisal of secondary public hospitals is more difficult. Due to the poor information foundation of secondary hospitals, the initial data submitted had more problems and experienced many rounds of "rework".
Li Jidong, president of Jingxing County Hospital in Hebei Province, confirmed this statement. He told the health community that among the secondary hospitals, it belongs to the hospital with a high level of informatization, but the data is filled in 3 times before it passes. The reason is that when I first filled in the report, I experienced the process of "incorrect understanding and inaccurate understanding".
"This is the first time that the portrait of a secondary public hospital and the issues that need to be focused on have been fully unveiled, which is of great significance." The above-mentioned person told the health community.
The level of electronic medical records needs to be improved
Half are below level 2
A large amount of data from the "National Examination" comes from the first page of the case. Therefore, the completeness and accuracy of the data filling is the basis for the smooth development of the "National Examination".
This is closely related to the level of electronic medical records in hospitals. According to the "Circular", as of the end of 2019, among the second-level public hospitals participating in the assessment, a total of 1843 hospitals participated in the grading evaluation of the functional level of electronic medical record application, with a participation rate of 85.09% and an average grade of 2. Among them, 33.75% of the hospitals have reached the level of level 3 and above, which can achieve the requirements of interdepartmental data exchange; 51.34% of the hospitals are at the level of level 2 and below, and it is not yet possible to achieve interdepartmental data exchange within the hospital.
In contrast, there were 1874 tertiary public hospitals that participated in the grading evaluation of the application level of electronic medical records in 2019, with an participation rate of 99.36%, and the average level exceeded 3. Among them, 78.13% of the hospitals had an average level of Level 3 or above, and 4 hospitals were rated As Level 7.
It can be seen from this that the level of electronic medical records in secondary public hospitals is obviously inferior to that of tertiary hospitals, which inevitably affects the smoothness of the "national examination" process.
"In this process, the hospital has experienced difficulties in data capture and a lot of manual statistics, resulting in inaccurate and error problems." Rao Rui, secretary of the party branch and president of Ningxia Yanchi County People's Hospital, told the health community that later, the hospital solved the problem of data export by adding a case management system, a quality control system on the home page of the case, and an electronic medical record system to connect with the hospital's HIS and other related systems.
It is worth affirming that among the second-level hospitals participating in the assessment, there are also many "excellent students" in information construction - 5.7% of the hospitals have reached the level 4 level, which can realize the information sharing of the whole hospital and meet the primary medical decision support; 11 of the 1843 families have reached the level 5 level, which can realize unified data management and meet the intermediate medical decision support.
In addition, most of the secondary hospitals participating in the assessment performed the function of helping the grass-roots level through the information platform. 60.16% of secondary public hospitals have established telemedicine centers, which can provide remote consultation, remote imaging diagnosis, remote ECG diagnosis and other services to primary medical institutions. Among them, the proportion of secondary public hospitals that can provide remote consultation services (54.34%) or remote imaging services (48.57%) is relatively high.
Patient satisfaction is high
Compensation and benefits need to be improved
This report card shows that patient satisfaction in the country as a whole is at a high level, but the satisfaction of medical staff needs to be further improved.
In terms of satisfaction evaluation. In 2019, the satisfaction of outpatients in secondary public hospitals participating in the assessment was 84.43 points, the satisfaction of inpatients was 89.32 points, and the satisfaction of medical staff was 76.48 points.
Compared with the satisfaction of tertiary public hospitals in the same year, the satisfaction of outpatients, inpatients and medical staff in secondary public hospitals was 0.98 points, 1.69 points and 2.36 points lower, respectively.
"This shows that there is still a gap in the service quality of the secondary hospital compared with the tertiary hospital, and there is still a lot of room for improvement." Wang Dan, executive director of the Hospital Management Research Center of Chinese Min University, analyzed the health community.
From a specific perspective, the satisfaction of outpatients with "nurse communication", "doctor communication" and "medical staff response" is generally higher than that of tertiary hospitals.
"The medical staff of the secondary hospital are more patient and careful, and they are recognized by the patients." Wang Dan also mentioned that this may also be because patients' expectations for secondary hospitals are not as high as those of tertiary hospitals.
Environment and identity are dimensions that are not satisfactory to outpatients and inpatients in secondary hospitals. This suggests that secondary hospitals need to continue to work the construction of the medical environment.
Consistent with the satisfaction results of medical staff in tertiary hospitals, medical staff in secondary hospitals are also the least satisfied with compensation and benefits, work content and environment.
"Compensation and benefits are an important factor affecting the satisfaction of medical staff, and the mismatch between salary and benefits, coupled with greater work pressure and poor working environment, has led to the mutual influence of these two dimensions of satisfaction, becoming the two most dissatisfied dimensions of medical staff." Wang Dan believes that this requires relevant government departments and medical institutions to further establish and improve the salary and welfare system that meets the characteristics of the medical industry, while improving the working atmosphere and environment of medical staff, improving the practice experience, and ultimately improving the satisfaction of medical staff.
Image | Figureworm creative
Tertiary surgery accounted for 33.46%
Antimicrobial use is not up to standard
The low level of rational drug use is a prominent problem in the medical quality of secondary public hospitals.
In 2019, the antimicrobial use intensity of secondary public hospitals was 40.96 DDDs, which has not yet met the requirement that the intensity of antibacterial drug use in general hospital inpatients should not exceed 40DDDs, and there are still 44.64% of secondary general hospitals with antimicrobial use intensity of more than 40DDDs. In contrast, the intensity of antimicrobial use in tertiary public hospitals remained largely stable in 2019 and outperformed the national requirement of 40DDDs.
"Antimicrobials still have a certain blindness in clinical applications." Teng Hailong, director of the Department of Pharmacy of Mudanjiang Cardiovascular Disease Hospital in Heilongjiang, analyzed to the health community for three reasons:
On the one hand, it comes from the clinician's inaccurate grasp of the indications, the dosage is too large, and the combination of drugs is too much;
On the one hand, the function of clinical pharmacists is insufficient, and the implementation of the Guiding Principles for the Clinical Application of Antimicrobial Drugs is not thorough enough;
On the one hand, the leaders from medical institutions do not pay enough attention to it, and cannot mention the national normative requirements to the height of the core management of the hospital.
The development of minimally invasive surgery and tertiary surgery is an important embodiment of the level of medical technology. According to the Circular, the proportion of surgery in discharged patients in secondary public hospitals was 18.14%; among surgical patients, minimally invasive surgery accounted for 12.07%, and tertiary surgery accounted for 33.46%. Among them, minimally invasive surgeries such as laparoscopic cholecystectomy (84.90%) and laparoscopic appendectomy (81.95%) have been carried out in secondary public hospitals, and more than 80% of the hospitals participating in the assessment can be carried out.
On the basis of the tertiary surgery that was originally possible, in 2019, some secondary public hospitals carried out new technologies such as common carotid artery repair, endoscopic sphenoid artery ligation, partial excision of popliteal artery with artificial vascular replacement, and conjoined twin unequal dissection, etc., of which about 50% of the newly carried out tertiary surgeries were completed under the support and guidance of the corresponding support hospital.
The "National Examination" is also guiding the improvement of the level of specialty construction in secondary public hospitals. Li Jidong, president of The Hospital of Jingxing County in Hebei Province, said that in the past two years, in the process of preparing for and participating in the "national examination", under the role of the baton, the hospital has gradually clarified the development path: specialty, more detailed development. For example, the further development of sub-specialties, the establishment of gastroenterology, respiratory, thoracic surgery, orthopedic subdivision into joints, spine, orthopedics, etc., so that the hospital's service capacity and level continue to rise. And general practitioners have correspondingly sunk to the rural level.
There is still a lot of room for cages for birds
The task of operation and management of secondary public hospitals is still arduous.
In 2019, the average medical expenses of outpatient and inpatient drugs in secondary public hospitals increased by 6.75% and 6.08%, respectively, and the average cost of outpatient and inpatient drugs increased by 8.36% and 3.31%, respectively.
The increase in the average cost of inpatient drugs is lower than the average cost of inpatient drugs, which is a positive signal that the hospital's income structure has changed and the effect of drug management has been strengthened.
However, on the other hand, the proportion of personnel funds in secondary public hospitals is 38.45%, and the income from medical services (excluding drugs, consumables, and inspection and inspection income) accounts for 29.56% of medical revenue, which is not high, which shows that there is still a large space for price adjustment of medical service projects.
According to the announcement of the National Health Commission, the medical surplus rate of the 3074 secondary public hospitals participating in the assessment is 2.07%, but 16.88% of them have a negative medical surplus rate and a loss rate of 24.59%; in contrast, the average medical surplus rate of tertiary hospitals is 3.00%, and the loss rate is 17.61%.
At present, the asset-liability ratio of secondary hospitals is 49.39%, but among the loss-making hospitals, the asset-liability ratio of 3.22% of secondary public hospitals exceeds 100%, and the asset-liability ratio of 40.60% of secondary public hospitals exceeds 50%.
"The asset-liability ratio of public hospitals is greater than 50%, which does not fully explain the poor economic operation of hospitals, but to some extent reflects the asset-light operating model of public hospitals." Liu Hongwei, chief accountant of the People's Hospital of the Inner Mongolia Autonomous Region, once mentioned to the health community that from an academic point of view, it is generally reasonable for the asset-liability ratio of institutions in various industries to remain at about 60%.
It is worth mentioning that the operating cost of the second-level hospital is relatively higher than that of the tertiary hospital, and its income and energy consumption expenditure of 10,000 yuan are 125.31 yuan, while the third-level hospital is 95.71 yuan.
The ratio of care is up to 1:1.55
The construction of talent team is still difficult
The construction of talent teams has always been a relatively common problem and challenge faced by second-level hospitals. According to the Circular, second-level public hospitals accounted for 0.38% of the investment in talent training.
Li Jidong, president of Jingxing County Hospital in Hebei Province, said that in the past two years, the hospital has built a platform and improved treatment, making the talent team more stable than ever. However, if you want to recruit higher quality and more capable talents, you still need a process.
According to the "Circular", the structure of secondary hospitals in the construction of talent teams continues to be reasonable. In 2019, the medical care ratio of second-level public hospitals nationwide was 1:1.55, exceeding the target requirement of 1:1.25 in 2020 proposed in the planning outline of the national medical and health service system.
In addition, most secondary public hospitals account for about 3% to 5% of anesthesiologists, pediatricians account for about 3% to 8%, critical care physicians account for about 0.2% to 1%, pathologists account for about 0.4% to 1.6%, and traditional Chinese medicine physicians account for about 5% to 15%.
The "National Examination" also pointed out the direction for the construction of the talent team of the second-level public hospitals. After passing the national examination, Rao Rui, secretary of the party branch and president of Ningxia Yanchi County People's Hospital, found that the proportion of pathology and critical care physicians in his hospital was relatively low, and it was necessary to further strengthen the introduction and training of talents. He said that the next step of the hospital's work focus is to promote the construction of connotation, and work the introduction of high-level talents, the supply of medical services with high technology content, and the advanced scientific management concept.
The "National Examination" is a comprehensive "physical examination" and accurate "pulse check" for hospital work. Rao Rui said that with the announcement of the results of the first "national examination" for secondary public hospitals, the hospital will recognize its own problems in management and operation, so as to continuously improve and improve the management level.
According to the requirements, the national second-level public hospitals should be gradually included in the scope of performance appraisal within 3 years (2020 to 2022).
Sources | the health community
The author | Liu Wenyang Yang Ruijing
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