It’s just statistical analysis!
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1. Overview
1. Statistics and hospital statistics concepts
Statistics It is a discipline that uses the principles and methods of probability theory and mathematical statistics to study the collection, sorting, analysis, and inference of digital data to grasp the objective laws of things. It is an important tool for understanding the quantitative characteristics of social and natural phenomena. Correct statistical analysis can help people correctly understand the regularity of objective things, be aware of the situation, carry out work in a targeted manner, and improve the quality of work. Hospital statistics is an activity that uses statistical principles and methods to accurately, timely, systematically and comprehensively reflect the quantity and quality of hospital work. Provide statistical basis for hospital managers to understand the situation, make decisions, guide work, formulate and check the implementation of plans.
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2. The nature and role of hospital statistics
Hospital statistics are an important part of health service statistics. Its purpose is to serve the scientific management of hospitals. Long-term practice has proven that only by relying on statistical means can hospitals truly achieve scientific and quantitative management. Hospital statistics are based on collecting and sorting out relevant statistical information, using statistical theories and methods to reflect the hospital's disease prevention and control work, describe the internal laws of hospital medical service activities, analyze and evaluate the quality and effectiveness of medical services, and point out the work of medical services existing problems and propose improvement measures.
Hospital statistics help hospital leaders implement the Party’s health work principles and policies, formulate and inspect medical work plans, rationally allocate and utilize medical and health resources, continuously improve the social and economic benefits of medical services, and carry out in-depth The hospital's teaching and scientific research work not only plays an information service role, but also plays a consulting and supervisory role.
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3. The main tasks of hospital statistical work
(1) Seriously study and implement the Party’s health work policy Policies and strict implementation of the "Statistics Law of the People's Republic of China", the health statistics work system and the health statistics report system. Accurately, timely and comprehensively carry out hospital statistical survey tasks assigned by superior health administrative departments, help superior health administrative departments understand the status of medical services and health resource utilization, understand the social, military and economic benefits of medical services, and improve the level of hospital macro-management , providing scientific basis.
(2) Summarize and inspect work for hospital leaders, grasp the work progress of each department, formulate medical work plans, improve medical quality and efficiency, improve hospital management, and provide guidance on various tasks focusing on medical services Comprehensive statistics.
(3) Use statistical theories and methods to observe and study the occurrence, development, changes and distribution patterns of various diseases in the population, and provide data for medical treatment, prevention, health care, teaching and scientific research.
(4) Use ready-made hospital statistical data to carry out statistical analysis, conduct regular or irregular special investigations, write special investigation reports, and implement statistical consultation and statistical supervision.
(5) The collected quantity and quality indicators of the work of each department will be collected and analyzed, and then systematically fed back to the department regularly or irregularly, so that the department can not only understand the status of its own work completion, but also horizontally contrast.
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4. The establishment, staffing and responsibilities of the hospital statistics agency
Hospital statistics are an element of the hospital information system First, it should be set up in the hospital information department (such as the Information Department). The National Ministry of Health's "Notice on Implementing the State Council's Decision on Strengthening Statistical Work and Enriching Statistical Agencies" stipulates that "all types of hospitals with more than 300 beds and less than 300 beds with research institutes must be equipped with full-time statistics 2 to 4 personnel. All types of hospitals with less than 300 beds without a research institute should be equipped with 1 to 2 part-time statisticians (excluding medical record management personnel)."
The responsibilities of hospital statisticians include: ① Responsible for the collection, registration, sorting, classification and storage of various statistical data in the hospital.
② Supervise all departments to complete medical registration and statistics and provide guidance and assistance. ③ Regularly conduct statistical analysis of medical work efficiency and medical quality and report to leaders. ④ According to the regulations of superiors, make various statistics in a timely manner, check them accurately and completely, and report them on time after approval by the hospital leaders. ⑤Collect and keep relevant medical statistics. ⑥ Responsible for the printing, storage and distribution of medical and nursing forms in the hospital, and often understand the usage and opinions of the department.
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5. Hospital statistical work regulations, systems and requirements
"Statistics Law of the People's Republic of China and the People's Republic of China" " stipulates that in order to ensure the accuracy, objectivity and scientificity of statistical data, statistical departments at all levels and all walks of life must conscientiously implement statistical laws and regulations, and those who make false reports, conceal reports, forge or tamper with statistical figures must be severely dealt with in accordance with the law. .
In order to ensure the completion of the hospital’s statistical work tasks, the hospital statistics department must have a strict working system: ① According to the needs of the hospital’s modern scientific management and report filling, stipulate the types, formats, and reporting of reports for internal use in the hospital Procedures and deadlines. ② For the meaning of nouns in the report and the calculation formula of the indicators, supplementary provisions may be made in addition to those already provided by superiors. ③ Develop the format of main medical documents, registration books and notices, etc., and stipulate the filling, statistics and archiving procedures in conjunction with medical work procedures. ④Inspection and review system for registration, statistics and statements. ⑤Systems for the management, use and compilation of data.
Hospital statistical staff must support the principle of seeking truth from facts, truthfully reflect objective reality, and ensure that statistical figures are accurate and reliable; they must proactively provide statistical information to leaders, based on hospital reform, central work, leadership intentions, and existing conditions. Conduct timely investigation, analysis, and prediction of major issues as well as emerging new issues and situations to provide useful information for hospital leaders to make scientific decisions. In addition, statistical data must not only be complete, but must also be matched. That is to say, a valuable statistical data must include both macro and micro information; both vertical and horizontal information; and both quantitative and quantitative information. information, and qualitative information; both regular information and typical and thematic information.
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2. Procedures and contents of hospital statistical work
The procedures of hospital statistical work can be roughly divided into statistical data There are four steps: collection of statistical data; compilation of statistical data; analysis of statistical data; and application of statistical data. The work content of each step is described below.
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1. Collection of statistical data
The collection of statistical data is based on the statistical tasks and purposes, using scientific The investigation method and the whole process of collecting data in an organized manner are the basis of statistical work. Through the collection of statistical data, we should obtain rich rather than fragmentary, accurate rather than erroneous original data.
The main sources of statistical data include: report cards of original records of medical work, statistical reports and special surveys.
(1) Original records and registration of medical work The original records of medical work include the medical records of patients and various original registrations recorded by each department according to the corresponding registration system.
Medical records (including outpatient medical records and inpatient medical records) are the main basis for collecting hospital statistical data, especially the home page of inpatient medical records. In addition to meeting the project requirements of various reports required by the General Logistics and Health Department, In addition, relevant projects can also be added according to the management requirements of the hospital. In order to facilitate the input of the contents of the home page of medical records into the computer for statistical analysis, relevant items must be coded reasonably and scientifically. For example, the name of disease diagnosis should use the International Disease Code (ICD-9), and the name of surgery can be coded using the surgical classification recommended by the General Logistics Department and the Ministry of Health. coding. In addition, department and physician codes must be established.
(2) Fill in statistical reports and establish a monthly report system in all departments of the hospital (some departments must establish a daily report system). It cannot be limited to a few statistical figures. Only fill in the statistical figures without text content. Conducive to understanding the situation and conducting statistical analysis. Therefore, a "text monthly summary item" should be opened in the monthly report, including work achievements, existing problems, patient feedback, suggestions and opinions, etc.
All medical departments should carefully fill in the monthly medical report.
(3) Special investigation In order to understand certain problems in hospital management, hospital managers often need to conduct special investigations. Thematic surveys can take the form of regular or irregular comprehensive surveys, sample surveys, key surveys, typical surveys, etc.
When collecting hospital statistical data, no matter what form is used, the original data must be filled in strictly in accordance with the prescribed form content, required standards, completion time, etc., and reviewed and verified when necessary. The data collected in this way can be used as a basis for sorting and analysis.
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2. Compilation of statistical data
The original data only shows the specific situation of each survey object and is scattered. A system is an intricate representation of something, a certain aspect of something, the external connection of something, or even an illusion that is completely contrary to the mainstream or essence of something. Only through scientific statistical sorting can it be possible to draw correct analytical conclusions. . According to different survey contents and research tasks, statistical data collection can be divided into regular statistical data collection, special statistical data collection and historical statistical data collection.
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3. Analysis of statistical data
Analyzing statistical data is an important step in statistical work, and its task is to apply Materialist dialectical viewpoints and methods, combined with professional knowledge, are used to study the collated data and make analyzes that are consistent with objective facts, expose contradictions in things, discover problems, find out laws, and put forward opinions that are consistent with the actual situation. Statisticians can carry out statistical analysis from the following aspects:
(1) Investigate and analyze the interrelationship, interdependence, mutual influence and mutual restriction between various things, grasp the development laws of things, and strive to Initiative at work. For example, when analyzing surgical work conditions, one should consider the situation of surgical outpatient clinics, the number and usage of surgical ward beds, the equipment conditions of the operating room, the technical capabilities and coordination of surgeons, and the technical strength and equipment conditions of other medical departments. For all aspects of surgical work and existing problems, statistical analysis is required to discover problems and find ways to solve them to achieve the expected results.
(2) Investigate and analyze the internal composition of things: For example, by understanding the composition of the number of patients treated in each department of the outpatient clinic, the workload of doctors in each department, and analyzing the work status of each department in the outpatient department, it will be helpful to solve the "three long-term problems" of the outpatient department. "One short" contradiction; from the composition of various staff in the hospital, analyze whether the various personnel structures are reasonable, etc.
(3) Investigate and analyze the mean of things: The mean is the representative value of a set of variables, reflecting the central tendency and average level of things. When performing mean analysis, attention should be paid to the homogeneity and comparability of the data. If dissimilar things are mixed together, erroneous conclusions will be drawn.
(4) Investigate and analyze the development dynamics of things: By paying close attention to the movement changes of things and observing the statistical index values ??in different periods, we can clearly understand the scale, level and efficiency of hospital medical services in different periods. Especially when comparing two things, no problem can be seen in individual comparisons. Only through longer-term observation can we more easily draw correct conclusions.
(5) Investigate and analyze the implementation of plan indicators: After formulating plan indicators based on statistical data, statistical analysis methods must be used to regularly inspect and supervise the implementation of the plan, and assist hospital leaders in timely adjustment of manpower and material resources. Mobilize all favorable factors to promote the realization of plan targets.
(6) Comprehensive analysis of statistical indicators: Use multiple statistical indicators to comprehensively analyze the overall situation of things from several relevant aspects. For example, when studying hospital business income and medical expenses, it is necessary to combine economic management with the social benefits of medical services for analysis. We must not only consider economic indicators while ignoring medical service volume and medical quality indicators. Only by comprehensively analyzing the economic and social benefits of hospital work can we truly provide effective basis for hospitals to deepen reforms, strengthen scientific management and improve medical service levels.
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4. Application of statistical information
Hospital statistical work should serve as a good consultant for hospital leaders and serve as a guide for hospital leaders. It provides a scientific basis for decision-making, and at the same time, it also serves all departments in the hospital. It provides timely feedback to all departments at the grassroots level in the statistical processed information, giving full play to the supervision and guidance role of the hospital's statistical work. Common forms of application and feedback of statistical information are:
(1) Regular analysis According to the provisions of the "Hospital Statistical Reporting System", statisticians should also submit statistical analysis reports after regularly submitting regular reports to leaders. The "Hospital Statistical Analysis Report" should be sent to leaders at or above the functional departments (offices) of the hospital as soon as possible for reference, so that they can keep abreast of the hospital's work trends and study and solve work problems.
(2) Thematic analysis: In view of the more prominent problems in hospital management, conduct in-depth investigations into various departments, correctly select the main contradictions among them for centralized analysis, and put forward suggestions and methods to solve the contradictions.
(3) Statistical briefing: Conduct irregular statistical analysis based on the important situations occurring in the hospital staff and medical work. Statistical briefings are time-sensitive and widely distributed, so they require concise text and rapid issuance, while at the same time paying attention to the content and its impact.
(4) Compilation of annual statistical report: Compile all aspects of the hospital's annual statistical data to comprehensively reflect the hospital's medical services. It is compiled once a year and continues to be accumulated. It has both practical reference significance and historical statistical data. The compilation should not only include statistical tables and data, but should also be accompanied by appropriate statistical charts and text analysis, so that both pictures and texts are included.
3. Single indicator analysis of hospital work
1. Medical work quality analysis
Medical work quality analysis is mainly medical quality analysis. The main basis for evaluating the quality of hospital medical care is whether the diagnosis is correct, rapid and comprehensive; whether the treatment is effective, timely and thorough; whether there is unnecessary pain and damage to the sick and injured, etc.
(1) Analysis of diagnostic quality The level of diagnostic quality is an important aspect that reflects the quality of hospital medical care. Generally speaking, the consistency rate between initial clinical diagnosis and clinical diagnosis, the consistency rate between clinical diagnosis and autopsy diagnosis, the consistency rate between pre- and post-operative diagnosis, and the average time from admission to diagnosis can reflect the quality of diagnosis. The first three reflect whether the diagnosis is correct, while the latter reflects whether the diagnosis is rapid. As for whether the diagnosis is comprehensive, it refers to whether the major and minor diseases of a patient's body can be fully detected. If only minor diseases are detected and major diseases are missed, it is not a problem of incompleteness, but a diagnostic error.
① The coincidence rate between initial clinical diagnosis and clinical diagnosis: It reflects the hospital’s initial diagnosis level when the patient is admitted, that is, the diagnostic technology level of the treating physician.
②The coincidence rate between clinical diagnosis and pathological diagnosis and the coincidence rate between clinical diagnosis and autopsy diagnosis: They are the most reliable and fair basis for determining whether the clinical diagnosis is wrong. Therefore, hospitals should increase the autopsy rate as much as possible to promote the improvement of diagnostic quality.
③Concordance rate of diagnosis before and after surgery: Cases treated by surgery can generally get a positive diagnosis after surgery. Therefore, this indicator is an important basis for judging the quality of surgical diagnosis. In order to analyze the quality of diagnosis of various diseases, the diagnostic compliance rate before and after surgery can be calculated by disease type.
④The average number of days from admission to diagnosis: It is an indicator that reflects whether the diagnosis is timely. It can not only display the work of treating doctors and superior doctors, but also reflect the cooperation of medical and technical departments. This kind of indicator does not need to be done for all patients, but only for certain major diseases.
When using the above indicators for diagnostic quality analysis, the following points should be noted: ① Since any indicator can only reflect one aspect of the problem, several indicators must be applied comprehensively. ② When analyzing indicators, we should not only focus on the level of compliance, but also pay attention to the non-compliance, so as to find out the reasons for low diagnostic quality and seek ways to improve diagnostic quality. ③ Not only the overall analysis must be carried out, but also different types of diseases must be analyzed separately. It is necessary to analyze a large number of common diseases as well as rare diseases.
2. Hospital work efficiency analysis
Use statistical indicators to analyze and evaluate hospital work efficiency (i.e. more, less, fast, slow), you can understand hospital personnel, equipment, technology, The utilization and potential of materials reflect the effectiveness and problems of hospital management and are of great significance to improving hospital management.
There are many contents that reflect the work efficiency of the hospital and involve a wide range of aspects, such as the proportion of various types of hospital personnel, whether the number of people and the workload are suitable, whether the beds are fully utilized, whether the use of important medical equipment is reasonable, etc. The utilization of beds is an important indicator reflecting the efficiency of the hospital.
(1) Analysis of bed utilization "Bed" is the basic equipment unit used by the hospital to accommodate patients. It is also the calculation unit of the hospital's work scale. It determines the hospital's staffing, allocates health fees, allocates equipment and important basis for materials, etc. The main indicators reflecting bed utilization are:
①Average bed working days: It is the average number of working days per bed within a certain period (usually 1 year), reflecting the usage of beds. Due to repair, disinfection or other reasons, each hospital bed cannot be used every day, that is, the average hospital bed working day does not reach 365 days in a year. Under normal circumstances, it is generally more appropriate to use 340 days as the standard time (this is for the entire hospital, and each department is different). If it exceeds 340 days, it means that the bed load is too heavy, which will have an adverse impact on hospital management and medical quality; if there are too few working days for hospital beds, it means that the hospital beds are idle.
②Actual bed utilization rate: It reflects the ratio of average daily beds used to actual beds. A high utilization rate means that the hospital beds are fully used; on the contrary, it means that there are many empty hospital beds. The bed utilization rate is generally 90 to 93. If it exceeds 93, it means that the hospital beds are overburdened.
③The number of bed turnovers: The number of bed turnovers is an indicator of the speed of hospital bed turnover. The average bed working day and bed utilization rate can only indicate the general workload of the bed, but cannot indicate the work efficiency of the bed. When analyzing the work efficiency of hospital beds, it should be noted that within a certain period of time, the number of turnovers is high, which means the turnover speed is fast, the utilization of hospital beds is good, and the average length of stay of patients is shorter.
④Bed turnover interval: It is the number of days between the discharge of one patient and the admission of the next patient, and is a value calculated for each bed. Short surrounding intervals mean that the beds are empty for fewer days. If the hospital bed workload is too heavy, the bed utilization rate is too high, the turnover rate is too fast, and the turnover interval is too short, the ward will not be able to meet the requirements for sanitary treatment, thus affecting hospital management and medical quality.
⑤Average occupied bed days before surgery: It reflects preoperative diagnosis: preoperative preparation, operating room size and management. This indicator can be classified into disease statistics.
⑥Average hospitalization days: This indicator is an indicator that has attracted much attention in recent years. In June 1993, the Ministry of Health convened some major domestic hospitals to discuss the issue of "deepening hospital reform by shortening the average length of stay" and believed that shortening the length of stay as a breakthrough and taking a quality-benefit path was the key to deepening hospital reform. One of the important tasks. At present, the potential to shorten hospitalization days is great and is an important means to develop hospital bed resources. Through in-depth analysis of hospitalization days, we can find the factors that affect various aspects of hospitalization days. On the premise of ensuring medical quality, shortening the average hospitalization days can not only save bed investment, but also make full and effective use of existing health resources and make the hospital more efficient. The technological advantages of the hospital have been fully utilized, which has increased revenue for the hospital. It has also played an important role in alleviating the contradiction between difficulty in seeing a doctor and hospitalization in big cities, and has produced huge social benefits.
The above indicators are not only different, but also interconnected and restrictive. The two indicators of average bed working days and actual bed occupancy have different forms. The former is expressed as an average and the latter is expressed as a percentage, but the essence is the same, both reflect the bed load. It is restricted by the number of bed turnovers and the turnover interval. Under normal circumstances, beds are turned over once a week, and there will be a certain turnover interval. If the number of turnovers is small and the turnover interval is long, there will be more opportunities for empty beds, the average bed working days will be fewer, and the bed utilization rate will be low. Bed turnover is inversely proportional to the average length of stay for discharged patients.
(2) Analysis of workload and its proportions The measurement units of medical workload are mainly the number of diseases, the number of inpatients, and the number of outpatients. By analyzing the workload and proportion of hospital beds, inpatients, outpatients and medical technology departments, it reflects whether the hospital's human, material and technical effects are being used normally. The greater the workload, the more tasks are completed; the more difficult diseases are treated, the higher the effectiveness of the technology.
① Analysis of hospitalization workload and its proportion: including the number of hospitalizations, the composition ratio of the number of hospitalizations in each department, the classification of hospitalization diseases and their composition ratio.
The number of hospitalizations indicates whether the hospital is completing its admissions tasks normally. Normal number of residents = actual number of beds × normal bed utilization rate × normal bed turnover times. If the actual number of hospitalizations is equal to or higher than the normal admission number, it means that the admission task has been completed or exceeded; if it is lower than the normal admission number, the specific reasons should be found out.
The classification of inpatient diseases and their composition ratio can reflect whether the hospital is performing its normal technical performance. The so-called normal technical efficiency means that the types and quantities of diseases treated are consistent with the technical level of the hospital, ensuring that patients who are urgently needed and need to be hospitalized can be hospitalized in a timely manner. If a hospital with good technical conditions admits many general chronic patients and mild patients and occupies a large number of beds, the better technical conditions will not be fully utilized.
② Analysis of outpatient workload and proportions: including the number of outpatients and composition ratios of each department, outpatient disease classification and composition ratios. The Ministry of Health stipulates that the ratio of the number of beds in urban general hospitals to the number of outpatients is 1:3. If this ratio exceeds this ratio, it means that the outpatient service workload is overloaded, which will have a negative impact on outpatient management and outpatient quality.
③Analysis of workload and composition ratio of medical technology departments: mainly the workload of each medical technology department and its internal composition ratio (such as the number of operations in the operating room and the composition ratio of major, medium and minor surgeries; Pharmacy Department The number of prescriptions and the composition ratio of Chinese and Western medicine prescriptions, etc.), the workload ratio of the same clinical department (such as outpatient fluoroscopy rate, outpatient prescription rate, outpatient examination rate, etc.).
④Medical instrument workload: including instrument usage rate, instrument working days and deployment rate.
3. Analysis of the number of various types of staff in the hospital and their proportions
The analysis is mainly based on the following indicators: the number of hospital staff and the composition ratio of the number of various types of staff, the number of medical staff and the proportion of each type of staff respectively. Number of beds, average number of outpatients per day, ratio of inpatients, staff attendance rate and sickness, accident and maternity leave rates. Workload per staff member. Physicians can be calculated based on the number of beds each resident physician bears and the number of outpatient visits per hour by outpatient doctors; ward nurses can be calculated based on the number of beds burdened; medical technology departments can be calculated based on the number of beds burdened by each person, or they can also be calculated based on the number of beds per person per day. It is calculated based on the number of prescriptions, number of tests, number of fluoroscopy sessions, number of physiotherapy sessions, etc.
4. Comprehensive evaluation of hospital work efficiency
A hospital is a complex system with multiple factors that are interconnected and interact with each other. A single statistical indicator only reflects the quantitative characteristics of a certain part, but cannot comprehensively summarize the overall comprehensive situation. In order to obtain an overall and comprehensive understanding, a scientific and reasonable comprehensive evaluation index system must be constructed to ensure a comprehensive and objective understanding of hospital work.
Comprehensive evaluation of work effectiveness is a process of establishing and measuring the hospital work evaluation index system, constructing a comprehensive evaluation model, obtaining the comprehensive evaluation value, and finally performing statistical analysis of comparison and ranking. Through comprehensive evaluation, we can have a comprehensive understanding of the quantitative characteristics of a certain aspect of the hospital's work, and we can also compare and rank the comprehensive evaluation results between different hospitals and different work contents. Although the use of statistical indicators to evaluate hospital work is an after-the-fact inspection and evaluation, it can play the role of information feedback and quality control, and is in line with the ideas of modern hospital management. Since the evaluation is mainly based on the level of each indicator value, the authenticity and accuracy of the original data is a prerequisite for good evaluation work.
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