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目的 探讨应用量化指标以及信息化技术,提高区域体检质量控制标准化管理水平的实践方法与手段.方法 将《北京市医疗机构健康体检质量管理与控制指标》依照标准化原则转化分解为可以量化评分的二级、三级词条,并维护在区域信息化平台(北京市体检信息平台)下的《体检质控综合管理系统》中.质量检查活动中,专家下载安装《体检质控综合管理系统》APP,并在检查现场应用.选取上述方法应用前后的两组检查数据进行对比,其中,应用前数据来源于2014年度北京市医疗机构健康体检质量检查取得有效检查分值的185家机构数据,所有原始检查资料为检查现场专家填写的纸质表格;应用后数据来源于2016年度北京市医疗机构健康体检质量检查数据,入组标准:将2014年的185家机构按照三级、二级、一级及以下分为3类,每类中按照得分0～360、361～480、481～600再分为3组,每组随机抽取7家,共63家;专家应用手机《体检质控综合管理系统》APP进行检查.对两组进行对比,分析区域内医疗机构体检质量提升情况,以及质量检查专家在进行质量检查活动中的一致性的变化.结果 一级及以下医疗机构质量总分2016年[(510.02±42.95)分]高于2014年[(483.16±79.06)分],差异有统计学意义(t=2.431,P＜0.05),二级和三级医疗机构2014年和2016年分值差异均有统计学意义.不同级别医疗机构在两次质量检查活动中“实验室室内质控及室间质评”指标得分均有提升(P＜0.05),而“健康体检质量管理组织”指标仅在一级及以下医疗机构中显示分值提高(P＜0.05).应用《体检质控综合管理系统》后,质量检查专家一致性评分变化幅度降低,三级医疗机构、一级及以下医疗机构的差异有统计学意义(P＜0.05),而二级机构一致性评分变化差异无统计学意义(P=0.840).结论 量化检查指标以及信息化技术在区域体检质量标准化管理中有效,值得进一步在实践中应用探索.

Objective To explore the methods and means to improve standardized management of regional quality control using quantitative indicators and information technology.Method The Quality Management and Control Indicators for Beijing health and medical institutions were converted into secondary and tertiary entries for quantitative scoring in accordance with the principles of standardization and management in the Integrated Management System of Health Examination under the regional information platform (Beijing Physical Examination Information Platform).APP was downloaded and applied in the on-site quality inspection.The data were obtained in paper forms completed on-site at 185 medical institutions with valid quality inspection scores in Beijing in 2014 and from the 2016 Beijing medical institutions' physical examination quality inspection.The inclusion criteria were as follows:185 institutions were divided into three groups (Level 3,Level 2,Level 1 and below),and each group was further divided into three subgroups with scores of 0-360,361-480,and 481-600;a total of 63 institutions were randomly selected from seven subgroups.Experts used the Integrated Management System of Health Examination Quality Control mobile app for the inspection.The two data groups were compared to check for quality improvement and the consistency of the quality inspection experts.Results The total quality score of medical institutions at Level 1 and below in 2016 (510.02±42.95) was higher than that in 2014 (483.16±79.06),and the difference was statistically significant (t=2.431,P＜0.05).There was no statistically significant difference between Level 2 and Level 3 medical institutions in 2014 and 2016.The scores of institutions at different levels are higher in the laboratory internal quality control and external quality assessment,and the difference was statistically significant (P＜0.05),whereas the score of physical health examination quality management organization only improved in the medical institutions at Level 1 and below,with statistically significant difference (P＜0.05).The changes of scores in the consistency of quality inspection experts was reduced after the application of the system,and the difference in institutions at Level 3 and Level 1 and below was statistically significant (P＜0.05),while not statistically significant in institutions at Level 2 (P=0.840).Conclusion Quantitative indicators and information technology are effective in regional standardized management of physical examination quality,and worthy of further exploration.