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Article(id=1240929927604786050, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202312343, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1702742400000, receivedDateStr=2023-12-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790350104, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790350104, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790350104, creator=13701087609, updateTime=1773790350104, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2030, endPage=2036, ext={EN=ArticleExt(id=1240929927982273444, articleId=1240929927604786050, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Evaluation of pilot hospital of modern hospital management system in Sichuan Province based on weighted TOPSIS and RSR, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the pilot hospitals of modern hospital management system in Sichuan Province, so as to provide reference for strengthening the construction of modern hospital management system. Methods The index weight, comprehensive evaluation, ranking and grading of the pilot hospitals were carried out by criteria importance through inter-criteria correlation (CRITIC), technique for order preference by similarity to ideal solution (TOPSIS), and rank-sum ratio (RSR). Results The range of RSR (Ci) of pilot hospitals in 2021 was 0.409 to 0.611, and 3, 14, 14, and 2 hospitals were graded as good, relatively good, average, and poor. The grading results were statistically significant, and the proportion of medical service income was the main influencing factor of the evaluation results. Conclusion The pilot project of modern hospital management system in Sichuan Province has achieved initial results, and the level of rational drug use in each pilot hospital has been improved, but there is still a gap in operation quality and safety, medical service price adjustment, and outpatient service management.

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目的 对四川省现代医院管理制度试点医院进行评价，为加强现代医院管理制度建设提供参考。方法 采用CRITIC、TOPSIS和RSR对试点医院进行指标赋权、综合评价和排序分档。结果 2021年试点医院RSR(Ci)范围为0.409～0.611，划分为好、较好、一般和差的有3、14、14和2家，分档结果具有统计学意义，医疗服务收入占比等指标是评价结果主要影响因素。结论 四川省现代医院管理制度试点成效初显，各试点医院合理用药水平等有所提升，但在手术质量安全、医疗服务价格调整、门诊服务管理等方面还存在差距。

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张成，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=t5OmaPbpBENC1FIY4xAizw==, magXml=2i+5tyMyTHaJOfGSGJladA==, pdfUrl=null, pdf=yTo5DQRlp3Wt/XVQzId+WA==, pdfFileSize=890503, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=NKhKhvF1ClPuIbfXNMS26g==, mapNumber=null, authorCompany=null, fund=null, authors=

张成（1992—），男，硕士，助理研究员，研究方向：医院改革政策与管理

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张成（1992—），男，硕士，助理研究员，研究方向：医院改革政策与管理

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张成（1992—），男，硕士，助理研究员，研究方向：医院改革政策与管理

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Evaluation of bed utilization efficiency with TOPSIS combined with RSR in Shenzhen public hospitals[J]. 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Research on the evaluation of medical service capacity of private hospitals in China based on TOPSIS method and RSR method[J].Journal of Nanjing Medical University(Social Sciences), 2023, 23(1): 62-67., articleTitle=Research on the evaluation of medical service capacity of private hospitals in China based on TOPSIS method and RSR method, refAbstract=null), Reference(id=1240929935540408853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=1994, volume=null, issue=1, pageStart=41, pageEnd=46, url=null, language=null, rfNumber=[14], rfOrder=26, authorNames=田凤调, journalName=中国医院统计, refType=null, unstructuredReference=田凤调.秩和比法在医院统计中的应用[J].中国医院统计，1994,（1）：41-46., articleTitle=秩和比法在医院统计中的应用, refAbstract=null), Reference(id=1240929935657849374, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=1994, volume=null, issue=1, pageStart=41, pageEnd=46, url=null, language=null, rfNumber=[14], rfOrder=27, authorNames=Tian FD, journalName=Chinese Journal of Hospital Statistics, refType=null, unstructuredReference=Tian FD. Application of rank-sum ratio method in hospital statistics[J].Chinese Journal of Hospital Statistics, 1994, (1): 41-46., articleTitle=Application of rank-sum ratio method in hospital statistics, refAbstract=null), Reference(id=1240929935754318371, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=2013, volume=32, issue=11, pageStart=76, pageEnd=78, url=null, language=null, rfNumber=[15], rfOrder=28, authorNames=赵宁, 张宗久, 范晶, journalName=中国卫生经济, refType=null, unstructuredReference=赵宁，张宗久，范晶，等.陕西榆林地区县级医院经济运营状况分析[J].中国卫生经济，2013，32（11）：76-78., articleTitle=陕西榆林地区县级医院经济运营状况分析, refAbstract=null), Reference(id=1240929935859175973, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=2013, volume=32, issue=11, pageStart=76, pageEnd=78, url=null, language=null, rfNumber=[15], rfOrder=29, authorNames=Zhao N, Zhang ZJ, Fan J, journalName=Chinese Health Economics, refType=null, unstructuredReference=Zhao N, Zhang ZJ, Fan J, et al. The analysis of economic operation status of County-Level hospitals in Yulin area of Shanxi[J]. Chinese Health Economics, 2013, 32(11): 76-78., articleTitle=The analysis of economic operation status of County-Level hospitals in Yulin area of Shanxi, refAbstract=null), Reference(id=1240929935930479147, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=1993, volume=null, issue=2, pageStart=26, pageEnd=28, url=null, language=null, rfNumber=[16], rfOrder=30, authorNames=田凤调, journalName=中国卫生统计, refType=null, unstructuredReference=田凤调.RSR法中的分档问题[J].中国卫生统计，1993,（2）：26-28., articleTitle=RSR法中的分档问题, refAbstract=null), Reference(id=1240929936014365231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, doi=null, pmid=null, pmcid=null, year=1993, volume=null, issue=2, pageStart=26, pageEnd=28, url=null, language=null, rfNumber=[16], rfOrder=31, authorNames=Tian FD, journalName=Chinese Journal of Health Statistics, refType=null, unstructuredReference=Tian FD. Classification problem in RSR method[J]. Chinese Journal of Health Statistics, 1993, (2): 26-28., articleTitle=Classification problem in RSR method, refAbstract=null)], funds=[Fund(id=1240929932130439463, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, awardId=21PJ123, language=CN, fundingSource=四川省卫生健康委员会医学科技项目(21PJ123), fundOrder=null, country=null), Fund(id=1240929932256268594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, awardId=null, language=CN, fundingSource=2022年四川省科技厅省级科研院所基本科研项目, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240929929081180172, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, xref=null, ext=[AuthorCompanyExt(id=1240929929089568779, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, companyId=1240929929081180172, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Sichuan Health Development Research Center, Chengdu, Sichuan 610042, China), AuthorCompanyExt(id=1240929929110540304, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, companyId=1240929929081180172, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川省卫生健康发展研究中心，四川 成都 610042)])], figs=[ArticleFig(id=1240929930695987354, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=EN, label=Table 1, caption=

Pilot evaluation index system of modern hospital management system

, figureFileSmall=null, figureFileBig=null, tableContent=
维度指标编号指标属性
功能定位门诊人次数与出院人次数比X1低优
出院患者手术占比X2高优
出院患者四级手术占比X3高优
医疗质量安全手术患者并发症发生率X4低优
低风险组病例死亡率X5低优
合理用药抗菌药物使用强度X6低优
基本药物采购品种数占比X7高优
国家集采中标药品使用比例X8高优
财务及后勤管理收支结余X9高优
资产负债率X10适度[15]
万元收入能耗支出X11低优
收支结构及员工积极性医疗服务收入占比X12高优
人员支出占比X13高优
医务人员满意度X14高优
便民惠民服务门诊患者平均预约诊疗率X15高优
门诊患者预约后平均等待时间X16低优
门诊次均费用增幅X17低优
住院次均费用增幅X18低优
门诊患者满意度X19高优
住院患者满意度X20高优
), ArticleFig(id=1240929930792456356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=CN, label=表1, caption=

现代医院管理制度试点评价指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
维度指标编号指标属性
功能定位门诊人次数与出院人次数比X1低优
出院患者手术占比X2高优
出院患者四级手术占比X3高优
医疗质量安全手术患者并发症发生率X4低优
低风险组病例死亡率X5低优
合理用药抗菌药物使用强度X6低优
基本药物采购品种数占比X7高优
国家集采中标药品使用比例X8高优
财务及后勤管理收支结余X9高优
资产负债率X10适度[15]
万元收入能耗支出X11低优
收支结构及员工积极性医疗服务收入占比X12高优
人员支出占比X13高优
医务人员满意度X14高优
便民惠民服务门诊患者平均预约诊疗率X15高优
门诊患者预约后平均等待时间X16低优
门诊次均费用增幅X17低优
住院次均费用增幅X18低优
门诊患者满意度X19高优
住院患者满意度X20高优
), ArticleFig(id=1240929930935062706, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=EN, label=Table 2, caption=

Weight of evaluation indicators of each pilot hospital from 2019 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标指标变异性sj 指标冲突性rij 信息量Cj 权重Wj（%）
2019年2020年2021年2019年2020年2021年2019年2020年2021年2019年2020年2021年
X10.2710.2540.28620.66519.41320.1745.5984.9285.7746.455.696.77
X20.2140.2090.21117.97519.10719.4173.8423.9954.0884.434.614.79
X30.2810.2610.23817.07017.68017.6954.7994.6094.2195.535.324.94
X40.1890.2530.24320.40919.82619.1833.8645.0184.6684.455.795.47
X50.2290.2240.22817.06617.89718.2143.9074.0164.1534.504.644.87
X60.2630.2330.18717.00818.03519.0474.4784.1963.5635.164.844.18
X70.2770.2450.23520.45319.85119.1995.6624.8734.5106.525.635.29
X80.2870.2660.21317.87217.17918.0875.1374.5763.8615.925.284.52
X90.2160.1870.22016.37818.03318.3213.5433.3764.0224.083.904.71
X100.2550.2920.28217.75916.54118.2134.5234.8315.1445.215.586.03
X110.2420.1880.23917.17817.63819.1134.1633.3134.5694.803.835.36
X120.2100.2430.23517.82117.22118.8293.7494.1874.4264.324.835.19
X130.2520.2450.23221.39220.34519.0125.4014.9924.4196.225.765.18
X140.2710.2630.22215.51116.61117.8474.2074.3633.9624.855.044.64
X150.3120.3070.28516.22518.14818.1315.0565.5715.1765.836.436.07
X160.2250.2060.27018.15718.25019.6184.0913.7625.3024.714.346.21
X170.1910.2800.22618.00319.45117.7303.4405.4374.0143.966.284.70
X180.1740.1750.15916.61017.85418.3612.8953.1172.9123.343.603.41
X190.2420.2490.19117.29216.96118.9584.1814.2273.6154.824.884.24
X200.2560.2030.16816.56115.91317.4514.2393.2312.9314.893.733.43
), ArticleFig(id=1240929931069280446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=CN, label=表2, caption=

2019—2021年各试点医院评价指标权重

, figureFileSmall=null, figureFileBig=null, tableContent=
指标指标变异性sj 指标冲突性rij 信息量Cj 权重Wj（%）
2019年2020年2021年2019年2020年2021年2019年2020年2021年2019年2020年2021年
X10.2710.2540.28620.66519.41320.1745.5984.9285.7746.455.696.77
X20.2140.2090.21117.97519.10719.4173.8423.9954.0884.434.614.79
X30.2810.2610.23817.07017.68017.6954.7994.6094.2195.535.324.94
X40.1890.2530.24320.40919.82619.1833.8645.0184.6684.455.795.47
X50.2290.2240.22817.06617.89718.2143.9074.0164.1534.504.644.87
X60.2630.2330.18717.00818.03519.0474.4784.1963.5635.164.844.18
X70.2770.2450.23520.45319.85119.1995.6624.8734.5106.525.635.29
X80.2870.2660.21317.87217.17918.0875.1374.5763.8615.925.284.52
X90.2160.1870.22016.37818.03318.3213.5433.3764.0224.083.904.71
X100.2550.2920.28217.75916.54118.2134.5234.8315.1445.215.586.03
X110.2420.1880.23917.17817.63819.1134.1633.3134.5694.803.835.36
X120.2100.2430.23517.82117.22118.8293.7494.1874.4264.324.835.19
X130.2520.2450.23221.39220.34519.0125.4014.9924.4196.225.765.18
X140.2710.2630.22215.51116.61117.8474.2074.3633.9624.855.044.64
X150.3120.3070.28516.22518.14818.1315.0565.5715.1765.836.436.07
X160.2250.2060.27018.15718.25019.6184.0913.7625.3024.714.346.21
X170.1910.2800.22618.00319.45117.7303.4405.4374.0143.966.284.70
X180.1740.1750.15916.61017.85418.3612.8953.1172.9123.343.603.41
X190.2420.2490.19117.29216.96118.9584.1814.2273.6154.824.884.24
X200.2560.2030.16816.56115.91317.4514.2393.2312.9314.893.733.43
), ArticleFig(id=1240929931182526661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=EN, label=Table 3, caption=

Evaluation results of CRITIC-TOPSIS in pilot hospitals from 2019 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
试点医院2019年2020年2021年
Ci排序结果Ci排序结果Ci排序结果
H10.65920.66530.5952
H20.51690.463320.49726
H30.56050.529220.52519
H40.64730.523230.53916
H50.69110.68810.6111
H60.57940.522240.50224
H70.490150.537200.52420
H80.457230.476290.47130
H90.52870.557140.54811
H100.449260.474300.54514
H110.499110.505270.5577
H120.507100.56690.50723
H130.52080.61050.5943
H140.467200.555160.49128
H150.423310.537210.5549
H160.473180.507260.50125
H170.494130.56970.53915
H180.53760.64440.5568
H190.459220.543180.47529
H200.431290.550170.52421
H210.452240.538190.5636
H220.444270.565120.54910
H230.494120.566100.52818
H240.460210.564130.54613
H250.483160.68520.5854
H260.481170.565110.54712
H270.432280.517250.49327
H280.353330.443330.40933
H290.493140.56780.5715
H300.452250.555150.52917
H310.397320.470310.52022
H320.430300.57560.46931
H330.470190.505280.44232
), ArticleFig(id=1240929931295772879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=CN, label=表3, caption=

2019—2021年试点医院CRITIC-TOPSIS评价结果

, figureFileSmall=null, figureFileBig=null, tableContent=
试点医院2019年2020年2021年
Ci排序结果Ci排序结果Ci排序结果
H10.65920.66530.5952
H20.51690.463320.49726
H30.56050.529220.52519
H40.64730.523230.53916
H50.69110.68810.6111
H60.57940.522240.50224
H70.490150.537200.52420
H80.457230.476290.47130
H90.52870.557140.54811
H100.449260.474300.54514
H110.499110.505270.5577
H120.507100.56690.50723
H130.52080.61050.5943
H140.467200.555160.49128
H150.423310.537210.5549
H160.473180.507260.50125
H170.494130.56970.53915
H180.53760.64440.5568
H190.459220.543180.47529
H200.431290.550170.52421
H210.452240.538190.5636
H220.444270.565120.54910
H230.494120.566100.52818
H240.460210.564130.54613
H250.483160.68520.5854
H260.481170.565110.54712
H270.432280.517250.49327
H280.353330.443330.40933
H290.493140.56780.5715
H300.452250.555150.52917
H310.397320.470310.52022
H320.430300.57560.46931
H330.470190.505280.44232
), ArticleFig(id=1240929931396436185, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=EN, label=Table 4, caption=

Estimates of RSR(Ci), Probit and RSR of pilot hospitals from 2019 to 2021

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试点医院2019年试点医院2020年试点医院2021年
RSR(Ci)ProbitRSR估计值RSR(Ci)ProbitRSR估计值RSR(Ci)ProbitRSR估计值
H280.3533.1190.356H280.4433.1190.439H280.4093.1190.441
H310.3973.4540.379H20.4633.4540.458H330.4423.4540.456
H150.4233.6650.394H310.4703.6650.471H320.4693.6650.465
H320.4303.8300.405H100.4743.8300.480H80.4713.8300.472
H200.4313.9720.415H80.4763.9720.488H190.4753.9720.478
H270.4324.0920.423H110.5054.1480.499H140.4914.0920.483
H220.4444.2000.431H330.5054.1470.499H270.4934.2000.488
H100.4494.3000.438H160.5074.3000.507H20.4974.3000.492
H210.4524.4410.447H270.5174.3960.513H160.5014.3960.496
H300.4524.4410.447H60.5224.4840.518H60.5024.4840.500
H80.4574.5680.456H40.5234.5680.523H120.5074.5680.503
H190.4594.6520.462H30.5294.6520.528H310.5204.6520.507
H240.4604.7310.467H70.5374.7670.535H70.5244.7690.512
H140.4674.8080.473H150.5374.7670.535H200.5244.7690.512
H330.4704.8870.478H210.5384.8870.541H30.5254.8870.517
H160.4734.9620.483H190.5434.9620.546H230.5284.9620.520
H260.4815.0380.489H200.5505.0380.550H300.5295.0380.524
H250.4835.1130.494H140.5555.1540.557H40.5395.1530.529
H70.4905.1920.499H300.5555.1540.557H170.5395.1530.529
H290.4935.2690.505H90.5575.2690.564H100.5455.2690.534
H170.4945.3910.513H240.5645.3480.568H240.5465.3480.537
H230.4945.3910.513H220.5655.4730.575H260.5475.4310.541
H110.4995.5160.522H260.5655.4730.575H90.5485.5160.544
H120.5075.6040.528H120.5665.6490.586H220.5495.6040.548
H20.5165.6990.534H230.5665.6490.586H150.5545.6990.552
H130.5205.7990.541H290.5675.7990.594H180.5565.7990.556
H90.5285.9080.549H170.5695.9080.601H110.5575.9080.561
H180.5376.0280.557H320.5756.0280.608H210.5636.0280.566
H30.5606.1700.567H130.6106.1700.616H290.5716.1700.572
H60.5796.3350.578H180.6446.3350.625H250.5856.3350.579
H40.6476.5480.593H10.6656.5480.638H130.5946.5480.589
H10.6596.8810.616H250.6856.8810.657H10.5956.8810.603
H50.6917.4090.652H50.6887.4090.688H50.6117.4090.626
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2019—2021年试点医院RSR(Ci)、Probit及RSR估计值

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试点医院2019年试点医院2020年试点医院2021年
RSR(Ci)ProbitRSR估计值RSR(Ci)ProbitRSR估计值RSR(Ci)ProbitRSR估计值
H280.3533.1190.356H280.4433.1190.439H280.4093.1190.441
H310.3973.4540.379H20.4633.4540.458H330.4423.4540.456
H150.4233.6650.394H310.4703.6650.471H320.4693.6650.465
H320.4303.8300.405H100.4743.8300.480H80.4713.8300.472
H200.4313.9720.415H80.4763.9720.488H190.4753.9720.478
H270.4324.0920.423H110.5054.1480.499H140.4914.0920.483
H220.4444.2000.431H330.5054.1470.499H270.4934.2000.488
H100.4494.3000.438H160.5074.3000.507H20.4974.3000.492
H210.4524.4410.447H270.5174.3960.513H160.5014.3960.496
H300.4524.4410.447H60.5224.4840.518H60.5024.4840.500
H80.4574.5680.456H40.5234.5680.523H120.5074.5680.503
H190.4594.6520.462H30.5294.6520.528H310.5204.6520.507
H240.4604.7310.467H70.5374.7670.535H70.5244.7690.512
H140.4674.8080.473H150.5374.7670.535H200.5244.7690.512
H330.4704.8870.478H210.5384.8870.541H30.5254.8870.517
H160.4734.9620.483H190.5434.9620.546H230.5284.9620.520
H260.4815.0380.489H200.5505.0380.550H300.5295.0380.524
H250.4835.1130.494H140.5555.1540.557H40.5395.1530.529
H70.4905.1920.499H300.5555.1540.557H170.5395.1530.529
H290.4935.2690.505H90.5575.2690.564H100.5455.2690.534
H170.4945.3910.513H240.5645.3480.568H240.5465.3480.537
H230.4945.3910.513H220.5655.4730.575H260.5475.4310.541
H110.4995.5160.522H260.5655.4730.575H90.5485.5160.544
H120.5075.6040.528H120.5665.6490.586H220.5495.6040.548
H20.5165.6990.534H230.5665.6490.586H150.5545.6990.552
H130.5205.7990.541H290.5675.7990.594H180.5565.7990.556
H90.5285.9080.549H170.5695.9080.601H110.5575.9080.561
H180.5376.0280.557H320.5756.0280.608H210.5636.0280.566
H30.5606.1700.567H130.6106.1700.616H290.5716.1700.572
H60.5796.3350.578H180.6446.3350.625H250.5856.3350.579
H40.6476.5480.593H10.6656.5480.638H130.5946.5480.589
H10.6596.8810.616H250.6856.8810.657H10.5956.8810.603
H50.6917.4090.652H50.6887.4090.688H50.6117.4090.626
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Classification results of pilot hospitals from 2019 to 2021

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年份（年）等级百分位数ProbitRSR估计值分档结果K-W值P
2019好>93.319>6.5>0.590H4、H1、H520.0550.001
较好50～93.3195～6.50.486～0.590H26、H25、H7、H29、H17、H23、H11、H12、H2、H13、H9、H18、H3、H6
一般6.681～<503.5～<50.383～<0.486H15、H32、H20、H27、H22、H10、H21、H30、H8、H19、H24、H14、H33、H16
差<6.681<3.5<0.383H28、H31
2020好>93.319>6.5>0.635H1、H25、H527.1300.001
较好50～93.3195～6.50.548～0.635H20、H14、H30、H9、H24、H22、H26、H12、H23、H29、H17、H32、H13、H18
一般6.681～<503.5～<50.461～<0.548H31、H10、H8、H11、H33、H16、H27、H6、H4、H3、H7、H15、H21、H19
差<6.681<3.5<0.461H28、H2
2021好>93.319>6.5>0.587H13、H1、H527.1160.001
较好50～93.3195～6.50.522～0.587H30、H4、H17、H10、H24、H26、H9、H22、H15、H18、H11、H21、H29、H25
一般6.681～<503.5～<50.458～<0.522H32、H8、H19、H14、H27、H2、H16、H6、H12、H31、H7、H20、H3、H23
差<6.681<3.5<0.458H28、H33
), ArticleFig(id=1240929931757146368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=CN, label=表5, caption=

2019—2021年各试点医院分档结果

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年份（年）等级百分位数ProbitRSR估计值分档结果K-W值P
2019好>93.319>6.5>0.590H4、H1、H520.0550.001
较好50～93.3195～6.50.486～0.590H26、H25、H7、H29、H17、H23、H11、H12、H2、H13、H9、H18、H3、H6
一般6.681～<503.5～<50.383～<0.486H15、H32、H20、H27、H22、H10、H21、H30、H8、H19、H24、H14、H33、H16
差<6.681<3.5<0.383H28、H31
2020好>93.319>6.5>0.635H1、H25、H527.1300.001
较好50～93.3195～6.50.548～0.635H20、H14、H30、H9、H24、H22、H26、H12、H23、H29、H17、H32、H13、H18
一般6.681～<503.5～<50.461～<0.548H31、H10、H8、H11、H33、H16、H27、H6、H4、H3、H7、H15、H21、H19
差<6.681<3.5<0.461H28、H2
2021好>93.319>6.5>0.587H13、H1、H527.1160.001
较好50～93.3195～6.50.522～0.587H30、H4、H17、H10、H24、H26、H9、H22、H15、H18、H11、H21、H29、H25
一般6.681～<503.5～<50.458～<0.522H32、H8、H19、H14、H27、H2、H16、H6、H12、H31、H7、H20、H3、H23
差<6.681<3.5<0.458H28、H33
), ArticleFig(id=1240929931836838153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=EN, label=Table 6, caption=

Results of stepwise regression analysis of influencing factors of Ci from 2019 to 2021

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年份（年）影响因素非标准化系数标准化系数t值P值
β标准误Beta
2019（常数）-0.1230.083—-1.4800.154
X30.0040.0010.2325.1340
X5-0.5100.176-0.114-2.9060.008
X6-0.0010-0.093-2.2390.036
X70.00200.2174.5310
X80.00200.71120.7340
X1100-0.107-2.4400.024
X120.0030.0010.1935.7450
X140.0010.0010.0861.9200.069
X15000.1753.8370.001
X16-0.0010-0.130-4.1490
X190.0040.0010.1934.9830
2020（常数）-0.4520.156—-2.9030.008
X4-0.0530.013-0.331-4.2320
X80.00100.3374.4620
X10-0.0010-0.306-3.8180.001
X120.0060.0010.4125.1040
X150.00100.2743.4000.002
X17-0.0030.001-0.328-4.0690
X200.0090.0020.4384.9770
2021（常数）0.1410.064—2.1960.040
X30.0030.0010.3885.2570
X4-0.0510.009-0.364-5.8720
X6-0.0040.001-0.328-5.8850
X70.00200.3305.8320
X8000.1182.2340.037
X90.0030.0010.2614.0670.001
X120.0020.0010.2234.4250
X140.0010.0010.1362.0820.050
X15000.2594.0390.001
X16-0.0020-0.370-7.4180
X17-0.0020-0.440-8.1830
X190.0020.0010.1893.0090.007
), ArticleFig(id=1240929931958472981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929927604786050, language=CN, label=表6, caption=

2019—2021年Ci值影响因素的逐步回归分析结果

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年份（年）影响因素非标准化系数标准化系数t值P值
β标准误Beta
2019（常数）-0.1230.083—-1.4800.154
X30.0040.0010.2325.1340
X5-0.5100.176-0.114-2.9060.008
X6-0.0010-0.093-2.2390.036
X70.00200.2174.5310
X80.00200.71120.7340
X1100-0.107-2.4400.024
X120.0030.0010.1935.7450
X140.0010.0010.0861.9200.069
X15000.1753.8370.001
X16-0.0010-0.130-4.1490
X190.0040.0010.1934.9830
2020（常数）-0.4520.156—-2.9030.008
X4-0.0530.013-0.331-4.2320
X80.00100.3374.4620
X10-0.0010-0.306-3.8180.001
X120.0060.0010.4125.1040
X150.00100.2743.4000.002
X17-0.0030.001-0.328-4.0690
X200.0090.0020.4384.9770
2021（常数）0.1410.064—2.1960.040
X30.0030.0010.3885.2570
X4-0.0510.009-0.364-5.8720
X6-0.0040.001-0.328-5.8850
X70.00200.3305.8320
X8000.1182.2340.037
X90.0030.0010.2614.0670.001
X120.0020.0010.2234.4250
X140.0010.0010.1362.0820.050
X15000.2594.0390.001
X16-0.0020-0.370-7.4180
X17-0.0020-0.440-8.1830
X190.0020.0010.1893.0090.007
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基于加权TOPSIS和RSR的四川省现代医院管理制度试点医院评价研究
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张成
现代预防医学 | 卫生政策与管理 2024,51(11): 2030-2036
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现代预防医学 | 卫生政策与管理 2024, 51(11): 2030-2036
基于加权TOPSIS和RSR的四川省现代医院管理制度试点医院评价研究
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张成
作者信息
  • 四川省卫生健康发展研究中心，四川 成都 610042

    • 张成（1992—），男，硕士，助理研究员，研究方向：医院改革政策与管理

通讯作者:

张成，E-mail:
Evaluation of pilot hospital of modern hospital management system in Sichuan Province based on weighted TOPSIS and RSR
Cheng ZHANG
Affiliations
  • Sichuan Health Development Research Center, Chengdu, Sichuan 610042, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202312343
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摘要
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目的 对四川省现代医院管理制度试点医院进行评价，为加强现代医院管理制度建设提供参考。方法 采用CRITIC、TOPSIS和RSR对试点医院进行指标赋权、综合评价和排序分档。结果 2021年试点医院RSR(Ci)范围为0.409～0.611，划分为好、较好、一般和差的有3、14、14和2家，分档结果具有统计学意义，医疗服务收入占比等指标是评价结果主要影响因素。结论 四川省现代医院管理制度试点成效初显，各试点医院合理用药水平等有所提升，但在手术质量安全、医疗服务价格调整、门诊服务管理等方面还存在差距。

TOPSIS  /  RSR  /  现代医院管理制度

Objective To evaluate the pilot hospitals of modern hospital management system in Sichuan Province, so as to provide reference for strengthening the construction of modern hospital management system. Methods The index weight, comprehensive evaluation, ranking and grading of the pilot hospitals were carried out by criteria importance through inter-criteria correlation (CRITIC), technique for order preference by similarity to ideal solution (TOPSIS), and rank-sum ratio (RSR). Results The range of RSR (Ci) of pilot hospitals in 2021 was 0.409 to 0.611, and 3, 14, 14, and 2 hospitals were graded as good, relatively good, average, and poor. The grading results were statistically significant, and the proportion of medical service income was the main influencing factor of the evaluation results. Conclusion The pilot project of modern hospital management system in Sichuan Province has achieved initial results, and the level of rational drug use in each pilot hospital has been improved, but there is still a gap in operation quality and safety, medical service price adjustment, and outpatient service management.

TOPSIS  /  RSR  /  Modern hospital management system
张成. 基于加权TOPSIS和RSR的四川省现代医院管理制度试点医院评价研究. 现代预防医学, 2024 , 51 (11) : 2030 -2036 . DOI: 10.20043/j.cnki.MPM.202312343
Cheng ZHANG. Evaluation of pilot hospital of modern hospital management system in Sichuan Province based on weighted TOPSIS and RSR[J]. Modern Preventive Medicine, 2024 , 51 (11) : 2030 -2036 . DOI: 10.20043/j.cnki.MPM.202312343
正文
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党的二十大指出“高质量发展是全面建设社会主义现代化国家的首要任务”，公立医院高质量发展目标就是要建立健全现代医院管理制度。2017年，国务院办公厅印发《关于建立健全现代医院管理制度的指导意见》，随后启动全国试点工作。目前，关于现代医院管理制度的研究主要集中在现代医院管理制度的内涵[1]、问题[2]、实施路径[3]和保障机制[4]以及现代医院管理制度下的智慧管理[5]、体系建设[6]、医院章程[7]等一般性观点陈述，而缺少对试点医院评价研究的实证分析。逼近理想解排序法（technique for order preference by similarity to ideal solution，TOPSIS）和秩和比法（rank-sum ratio，RSR）常常被联合用于评价公立医院的服务能力[8]、医疗质量[9]、经济运行[10]、床位效率[11]等，具有不用考虑指标单位和数量的优点，既实现对评价结果的分档排序，又能较好利用原始数据信息。同时，为充分考虑评价指标数据自身客观的差异性和相关性信息，采取标准间相关性法（criteria importance through inter-crieria correlation，CRITIC）进行指标赋权。本文基于建立健全现代医院管理制度重点任务构建评价指标体系，使用CRITIC加权、TOPSIS和RSR联合对2019—2021年四川省现代医院管理制度试点医院进行综合评价并分析影响因素，为进一步加强现代医院管理制度建设提供参考。
1　资料与方法
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1.1　资料来源
本文对四川省6家国家级和43家省级试点医院按照分层抽样、每层抽取50%数量的原则，分别选择3家国家级和22家省级试点医院；然后，为进一步提升研究样本代表性，充分反映全省整体试点情况，在分层抽样基础上，又采取简单随机抽样方式增选8家试点医院。最终共纳入33家研究样本医院，省部级、市级、县（区）级分别为2、18和13家，市（州）覆盖比例提升至90%。数据来源方式为样本医院自行填报和财务年报表获取等，时间为2019—2021年。
1.2　评价指标
本文基于建立健全现代医院管理制度14项改革发展重点任务，并充分考虑指标解释力、代表性和数据的可获得性、连续性，通过查阅文献、咨询专家，最终建立“功能定位、医疗质量安全、合理用药、财务及后勤管理、收支结构及员工积极性以及便民惠民服务”六个维度共计20个指标的评价体系。见表1。
1.3　研究方法
1.3.1　CRITIC
CRITIC是一种客观赋权法，以变异性和冲突性为基础，通过对高优、低优和适度指标进行同趋势化和无量纲化处理，分别计算指标变异性sj和冲突性rij再相乘即得最终权重Wj。变异性使用标准差表示，标准差越大说明波动越大，权重就越高；冲突性使用相关系数表示，相关系数值越大，说明冲突性越小，权重也就越低[12]。
1.3.2　TOPSIS
TOPSIS是系统工程中有限方案多目标决策分析、逼近理想解排序的常用方法，通过把综合评价的问题列出原始数据矩阵，基于归一化后数据矩阵Z找出有限方案中的最优解D+和最劣解D-，再分别计算各评价对象与最优解和最劣解的差距以及各评价对象与最优方案的相对接近程度Ci，从而得出综合评价排名[13]。
1.3.3　RSR
RSR是田凤调教授提出的集古典参数统计与近代非参数统计各自优点于一体的统计分析方法，被广泛应用于医疗卫生领域的多指标综合评价。通过对多项指标进行秩次转换获得无量纲的统计量RSR值，根据RSR值对评价对象的优劣进行排序和分档处理[14]。
2　结果
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2.1　CRITIC权重
先将33家试点医院2019—2021年原始数据进行无量纲化处理，得到新的评价矩阵；再分别计算得到2019—2021年各指标的变异性sj、冲突性rij、信息量Cj和权重Wj。见表2。
2.2　CRITIC-TOPSIS评价
将2019—2021年原始数据进行同趋势化和归一化处理后，分别得到矩阵Z2019、Z2020、Z2021。
计算2019—2021年的最优向量Z+和最劣向量Z-：
根据最优向量和最劣向量，将CRITIC计算得到的权重Wj代入，分别计算2019—2021年各评价指标到最优目标和最劣目标的距离D+、D-，根据D+、D-分别计算2019—2021年评价对象与最优目标的接近程度Ci，Ci越接近于1说明评价越好，2019—2021年排序结果见表3。
2.3　RSR分档结果
以加权TOPSIS得到的Ci代替RSR值并按从小到大进行排序，依次计算各RSR(Ci)值的频数、向下累计频数、平均秩次和向下累计频率，通过《百分比与概率单位对照表》将向下累计频率转换为对应的概率单位Probit值，以Probit值为自变量、RSR(Ci)值为因变量，计算得到2019—2021年的回归方程分别为：2019RSR(Ci)=0.141+0.069×Probit（R2=0.923, t=19.286, P<0.01）、2020 RSR(Ci)=0.258+0.058×Probit(R2=0.947,t=23.554,P<0.01)、2021RSR(Ci)=0.307+0.043×Probit(R2=0.958,t=26.449,P<0.01)。结果显示：回归方程拟好效果较好，Probit值均会对RSR(Ci)值产生显著的正向影响，将Probit值代入回归方程求得对应的RSR估计值。见表4。
根据最佳分档原则[16]，按照2019—2021年Probit值和RSR估计值将各试点医院分成好、较好、一般、差四档。Kruskal-Wallis非参数检验显示，2019—2021年各分档结果差异在检验水准α=0.001水平上具有统计学意义，可以认为分四档是合理的。见表5。
2.4　 Ci值影响因素逐步回归分析
以Ci值为因变量，2019—2021年评价指标值为自变量进行多元逐步回归分析，结果显示：2019年出院患者四级手术占比、低风险组病例死亡率等11个指标（4个反向指标）、2020年手术患者并发症发生率、国家集采中标药品使用比例等7个指标（3个反向指标）和2021年抗菌药物使用强度、基本药物采购品种数占比等12个指标（4个反向指标）是影响Ci值的主要因素，其中国家集采中标药品使用比例、医疗服务收入占比、门诊患者平均预约诊疗率连续三年均正向影响Ci值。见表6。
3　讨论
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从排序结果看，试点医院划分为好、较好、一般和差的有3、14、14和2家，其中H1、H5医院连续三年被评为好档，指标优势明显；而H3、H28医院同时作为国家和省级“双试点”医院，其Ci值呈现下降趋势，尤其是H28医院，连续三年被评为差档，其出院患者手术占比、出院患者四级手术占比、抗菌药物使用强度、资产负债率、万元收入能耗支出等指标远差于本文样本医院平均水平。试点医院中作为县级医院代表的H15、H21的Ci值均呈逐年上升趋势，档位排名逐年提高，甚至超过了不少市级试点医院，这说明公立医院综合改革乃至于高质量发展与医院层级规模、所处地区经济等客观因素关系不大，而是需要医院找准自身定位和发展方向，多措并举完成试点任务，获得改革红利。
从影响因素看，同档位间Ci值差距虽逐年减小但各档位结果仍具有显著性差异，2019—2021年分别有11、7和12个指标是Ci值的主要影响因素，其中国家集采中标药品使用比例、医疗服务收入占比、门诊平均预约诊疗率连续三年均显著影响Ci值。除了上述指标外还有抗菌药物使用强度、手术患者并发症发生率等5个指标有两年均影响Ci值，影响因素中国家集采中标药品使用比例、基本药物采购品种数占比、抗菌药物使用强度的权重逐年减小，说明通过试点各医院合理用药水平差距不断缩小，而医疗服务收入占比、手术患者并发症发生率、门诊患者平均预约诊疗率、门诊患者预约后平均等待时间等指标的权重逐年提高，说明各档位试点医院在医疗服务价格调整、手术质量安全、便民惠民服务上还存在明显差距。下一步工作建议：卫生健康行政部门一方面要对试点医院进行分档管理，发挥先行先试的示范效应，指导中低档医院对标好档位以及排序档位提升明显的医院找差距、补短板，提升医院内部管理和服务水平，努力缩小不同档位间、同档位内的差距；另一方面，要加强与医保部门沟通衔接，为试点医院积极争取医保政策支持，推动医疗服务价格改革与现代医院管理制度试点的同频共振，提升医疗服务收入占比。同时，各试点医院应进一步落实落细“手术质量安全提升行动”要求，加强术前评估、术中核查和术后管理，提升手术质量安全；借助信息化手段加强门诊服务管理，开展分时段预约诊疗和集中预约检查检验等多种预约模式，以改善患者就医体验。
基金
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  • 四川省卫生健康委员会医学科技项目(21PJ123)
  • 2022年四川省科技厅省级科研院所基本科研项目
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202312343
  • 接收时间：2023-12-17
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2023-12-17
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四川省卫生健康委员会医学科技项目(21PJ123)
2022年四川省科技厅省级科研院所基本科研项目
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    四川省卫生健康发展研究中心，四川 成都 610042

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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