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Article(id=1240972414117540074, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311316, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700236800000, receivedDateStr=2023-11-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800479678, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800479678, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800479678, creator=13701087609, updateTime=1773800479678, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1643, endPage=1648, ext={EN=ArticleExt(id=1240972414419529964, articleId=1240972414117540074, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on high quality development of tertiary public general hospitals in Guangxi based on coefficient of variation method and coupling coordination degree model, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the coupling and coordination relationship of high-quality development of tertiary public general hospitals in Guangxi, and to explore the path of high-quality development of tertiary public general hospitals, so as to provide a basis for related policy formulation.

Methods

The evaluation index system of high-quality development of tertiary public general hospitals in Guangxi was constructed from the four dimensions of medical quality, operational efficiency, sustainable development, and satisfaction evaluation. The coefficient of variation method and rank sum ratio method were used to comprehensively evaluate and classify the high-quality development level of the tertiary public general hospitals in 14 prefectures and cities in Guangxi in 2019, and the coupling coordination degree model was used to calculate the coupling and coordinated development level.

Results

Most of the sample hospitals were in the primary coordination stage, and the proportion of other coupling coordination types from high to low were intermediate coordination (22.73%), reluctant coordination (18.18%), on the verge of disorder (13.64%), and good coordination (4.55%). According to the principle of optimal classification, the tertiary public hospitals in Guangxi were divided into high, medium, and low grades. Most of the hospitals were in the middle level and there was much room for development and progress.

Conclusion

The coupling coordination degree of the tertiary public general hospitals in Guangxi is not high, and there are still some problems, such as uneven distribution of medical resources, large differences in medical quality, and lack of motivation for personnel training. It is necessary to improve the medical service system and improve the core competitiveness.

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目的

分析广西壮族自治区（简称广西）三级公立综合医院高质量发展耦合协调关系，探索三级公立综合医院高质量发展路径，为相关政策制定提供依据。

方法

从医疗质量、运营效率、可持续发展、满意度评价四个维度构建广西三级公立综合医院高质量发展评价指标体系，采用变异系数法和秩和比法对广西2019年14个地市的三级公立综合医院高质量发展水平进行综合评价、分档，并运用耦合协调度模型测算其耦合协调发展水平。

结果

发现大多数样本医院处于初级协调阶段，其他耦合协调度类型占比由高到低分别为中级协调、勉强协调、濒临失调和良好协调，分别为22.73%、18.18%、13.64%、4.55%。根据最佳分档原则，可将广西市属三级公立医院划分为“高、中、低”三个等级，绝大部分医院处在中等水平，发展进步空间大。

结论

广西三级公立综合医院耦合协调程度不高，仍存在医疗资源分布不均、医疗质量差异较大、人才培养动力不足等问题，需健全医疗服务体系，提高核心竞争力。

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高洪达，E-mail:
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阮楚婷（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

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阮楚婷（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

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Modern Hospitals, 2022, 22(9): 1317-1320, 1325., articleTitle=Analysis on the high-quality development strategy of Guangxi public hospitals during the "14th five-year plan" period, refAbstract=null)], funds=[Fund(id=1240986271196181415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, awardId=2023GXNSFBA026174, language=CN, fundingSource=广西自然科学基金青年科学基金项目(2023GXNSFBA026174), fundOrder=null, country=null), Fund(id=1240986271292650411, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, awardId=Zkybkt202309, language=CN, fundingSource=广西社科界智库重点课题(Zkybkt202309), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240986262052598322, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, xref=1., ext=[AuthorCompanyExt(id=1240986262056792627, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, companyId=1240986262052598322, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Information and Management, Guangxi Medical University, Nanning, Guangxi 530021, China), AuthorCompanyExt(id=1240986262065181236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, companyId=1240986262052598322, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西医科大学卫生与健康政策中心（广西高端智库建设培育单位），广西 南宁 530021)]), AuthorCompany(id=1240986262216176191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, xref=2., ext=[AuthorCompanyExt(id=1240986262232953407, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, companyId=1240986262216176191, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西医科大学信息与管理学院，广西 南宁 530021)])], figs=[ArticleFig(id=1240986268092396369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=EN, label=Figure 1, caption=Line chart of comprehensive index of tertiary public general hospitals in Guangxi, figureFileSmall=6q8eduBbgaOJxGb1Ha4rjg==, figureFileBig=/2ewHV8QuBvxiuRcSCqhXg==, tableContent=null), ArticleFig(id=1240986268662821722, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=图1, caption=广西三级公立综合医院各维度综合指数折线图, figureFileSmall=6q8eduBbgaOJxGb1Ha4rjg==, figureFileBig=/2ewHV8QuBvxiuRcSCqhXg==, tableContent=null), ArticleFig(id=1240986268805428067, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=EN, label=Table 1, caption=

Weight of evaluation indicators of tertiary public general hospitals

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标三级指标指标属性指标权重
医疗质量1.1医疗服务能力X1出院患者微创手术占比高优指标0.207 4
X2出院患者四级手术比例高优指标0.190 9
X3出院患者手术占比（手术率）高优指标0.107 8
1.2医疗安全X4手术患者并发症发生率低优指标0.075 2
X5I类切口手术部位感染率低优指标0.159 8
X6低风险组病例死亡率低优指标0.134 1
1.3合理用药X7抗菌药物使用强度低优指标0.124 4
运营效率2.1资源效率X8每名执业医师日均住院工作负担高优指标0.201 7
X9平均住院日中性指标0.136 8
2.2成本控制X10门诊次均费用增幅低优指标0.153 6
X11门诊次均药品费用增幅低优指标0.177 9
X12住院次均费用增幅低优指标0.146 8
X13住院次均药品费用增幅低优指标0.183 2
2.3收支结构X14医疗服务收入占医疗收入比例高优指标0.128 0
可持续发展3.1人员结构X15高级职称医务人员占比高优指标0.285 1
3.2人才培养X16医院住院医师首次参加医师资格考试通过率高优指标0.110 3
3.3学科建设X17每百名卫生技术人员科研项目经费高优指标0.604 4
满意度评价4.1患者满意度X18门诊患者满意度高优指标0.330 4
4.2医务人员满意度X19住院患者满意度高优指标0.162 0
X20医务人员满意度高优指标0.507 4
), ArticleFig(id=1240986269354881900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=表1, caption=

三级公立综合医院评价指标权重

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标三级指标指标属性指标权重
医疗质量1.1医疗服务能力X1出院患者微创手术占比高优指标0.207 4
X2出院患者四级手术比例高优指标0.190 9
X3出院患者手术占比（手术率）高优指标0.107 8
1.2医疗安全X4手术患者并发症发生率低优指标0.075 2
X5I类切口手术部位感染率低优指标0.159 8
X6低风险组病例死亡率低优指标0.134 1
1.3合理用药X7抗菌药物使用强度低优指标0.124 4
运营效率2.1资源效率X8每名执业医师日均住院工作负担高优指标0.201 7
X9平均住院日中性指标0.136 8
2.2成本控制X10门诊次均费用增幅低优指标0.153 6
X11门诊次均药品费用增幅低优指标0.177 9
X12住院次均费用增幅低优指标0.146 8
X13住院次均药品费用增幅低优指标0.183 2
2.3收支结构X14医疗服务收入占医疗收入比例高优指标0.128 0
可持续发展3.1人员结构X15高级职称医务人员占比高优指标0.285 1
3.2人才培养X16医院住院医师首次参加医师资格考试通过率高优指标0.110 3
3.3学科建设X17每百名卫生技术人员科研项目经费高优指标0.604 4
满意度评价4.1患者满意度X18门诊患者满意度高优指标0.330 4
4.2医务人员满意度X19住院患者满意度高优指标0.162 0
X20医务人员满意度高优指标0.507 4
), ArticleFig(id=1240986269480711026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=EN, label=Table 2, caption=

Classification criteria of coupling coordination degree

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合协调度D值区间协调等级耦合协调程度
(0.0～0.1)1极度失调
[0.1～0.2)2严重失调
[0.2～0.3)3中度失调
[0.3～0.4)4轻度失调
[0.4～0.5)5濒临失调
[0.5～0.6)6勉强协调
[0.6～0.7)7初级协调
[0.7～0.8)8中级协调
[0.8～0.9)9良好协调
[0.9～1.0)10优质协调
), ArticleFig(id=1240986269560402811, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=表2, caption=

耦合协调度等级划分标准

, figureFileSmall=null, figureFileBig=null, tableContent=
耦合协调度D值区间协调等级耦合协调程度
(0.0～0.1)1极度失调
[0.1～0.2)2严重失调
[0.2～0.3)3中度失调
[0.3～0.4)4轻度失调
[0.4～0.5)5濒临失调
[0.5～0.6)6勉强协调
[0.6～0.7)7初级协调
[0.7～0.8)8中级协调
[0.8～0.9)9良好协调
[0.9～1.0)10优质协调
), ArticleFig(id=1240986269690426242, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=EN, label=Table 3, caption=

Comprehensive index of quality development of tertiary public general hospitals in Guangxi in 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
医院医疗质量运营效率可持续发展满意度评价
H10.817 70.429 70.772 20.597 9
H20.578 20.343 50.174 20.430 6
H30.699 30.509 40.419 00.483 7
H40.559 50.408 20.304 80.343 3
H50.647 80.438 40.347 40.435 7
H60.479 10.824 30.479 30.368 2
H70.522 40.429 40.275 90.635 9
H80.548 80.590 20.475 50.826 1
H90.680 10.444 70.499 00.708 8
H100.680 60.458 50.190 30.477 4
H110.556 60.420 50.429 30.342 7
H120.504 70.361 30.249 70.321 4
H130.441 40.659 70.097 00.741 0
H140.540 70.267 30.114 30.223 3
H150.304 90.512 50.177 40.286 5
H160.492 50.328 30.132 80.490 5
H170.516 30.589 20.142 10.243 7
H180.520 30.292 60.113 00.832 9
H190.506 60.418 70.242 90.317 3
H200.551 90.347 80.119 50.234 6
H210.577 20.559 80.186 30.604 9
H220.207 40.448 70.022 30.438 1
), ArticleFig(id=1240986269933695878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=表3, caption=

2019年广西三级公立综合医院高质量发展各维度综合指数

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医院医疗质量运营效率可持续发展满意度评价
H10.817 70.429 70.772 20.597 9
H20.578 20.343 50.174 20.430 6
H30.699 30.509 40.419 00.483 7
H40.559 50.408 20.304 80.343 3
H50.647 80.438 40.347 40.435 7
H60.479 10.824 30.479 30.368 2
H70.522 40.429 40.275 90.635 9
H80.548 80.590 20.475 50.826 1
H90.680 10.444 70.499 00.708 8
H100.680 60.458 50.190 30.477 4
H110.556 60.420 50.429 30.342 7
H120.504 70.361 30.249 70.321 4
H130.441 40.659 70.097 00.741 0
H140.540 70.267 30.114 30.223 3
H150.304 90.512 50.177 40.286 5
H160.492 50.328 30.132 80.490 5
H170.516 30.589 20.142 10.243 7
H180.520 30.292 60.113 00.832 9
H190.506 60.418 70.242 90.317 3
H200.551 90.347 80.119 50.234 6
H210.577 20.559 80.186 30.604 9
H220.207 40.448 70.022 30.438 1
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Coupling coordination degree of high-quality development of tertiary public general hospitals in Guangxi in 2019

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医院耦合度C值协调指数T值耦合协调度D值协调等级耦合协调程度
H10.839 30.845 20.842 29良好协调
H20.730 00.560 80.639 97初级协调
H30.766 20.678 40.721 08中级协调
H40.769 20.612 70.686 57初级协调
H50.779 00.648 50.710 78中级协调
H60.481 20.768 90.608 37初级协调
H70.840 70.615 60.719 48中级协调
H80.654 80.757 90.704 48中级协调
H90.854 70.751 50.801 59良好协调
H100.695 20.624 00.658 77初级协调
H110.589 80.625 90.607 67初级协调
H120.610 50.554 70.582 06勉强协调
H130.324 40.664 00.464 15濒临失调
H140.630 00.309 90.441 95濒临失调
H150.551 10.550 90.551 06勉强协调
H160.761 20.534 60.637 97初级协调
H170.593 30.626 90.609 97初级协调
H180.712 80.603 30.655 87初级协调
H190.461 50.561 90.509 26勉强协调
H200.689 50.517 80.597 56勉强协调
H210.766 90.685 90.725 38中级协调
H220.512 80.375 50.438 85濒临失调
), ArticleFig(id=1240986270332154776, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=表4, caption=

2019年广西三级公立综合医院高质量发展耦合协调度

, figureFileSmall=null, figureFileBig=null, tableContent=
医院耦合度C值协调指数T值耦合协调度D值协调等级耦合协调程度
H10.839 30.845 20.842 29良好协调
H20.730 00.560 80.639 97初级协调
H30.766 20.678 40.721 08中级协调
H40.769 20.612 70.686 57初级协调
H50.779 00.648 50.710 78中级协调
H60.481 20.768 90.608 37初级协调
H70.840 70.615 60.719 48中级协调
H80.654 80.757 90.704 48中级协调
H90.854 70.751 50.801 59良好协调
H100.695 20.624 00.658 77初级协调
H110.589 80.625 90.607 67初级协调
H120.610 50.554 70.582 06勉强协调
H130.324 40.664 00.464 15濒临失调
H140.630 00.309 90.441 95濒临失调
H150.551 10.550 90.551 06勉强协调
H160.761 20.534 60.637 97初级协调
H170.593 30.626 90.609 97初级协调
H180.712 80.603 30.655 87初级协调
H190.461 50.561 90.509 26勉强协调
H200.689 50.517 80.597 56勉强协调
H210.766 90.685 90.725 38中级协调
H220.512 80.375 50.438 85濒临失调
), ArticleFig(id=1240986270550258589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=EN, label=Table 5, caption=

Ranking results of high-quality development of 22 tertiary public general hospitals in Guangxi in 2019

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等级百分位临界值ProbitRSR拟合值分档结果
低水平<15.866<4<0.359 6H6、H17、H19
中等水平15.866 ～4 ～0.359 6～<0.527 1H2、H21、H20、H14、H16、H13、H12、H11、H10、H7、H15、H5、H4、H3、H22
高水平84.134 ～6 ～≥0.527 1H1、H8、H9 、H18
), ArticleFig(id=1240986270671893409, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972414117540074, language=CN, label=表5, caption=

2019年广西22家三级公立综合医院高质量发展排序分档结果

, figureFileSmall=null, figureFileBig=null, tableContent=
等级百分位临界值ProbitRSR拟合值分档结果
低水平<15.866<4<0.359 6H6、H17、H19
中等水平15.866 ～4 ～0.359 6～<0.527 1H2、H21、H20、H14、H16、H13、H12、H11、H10、H7、H15、H5、H4、H3、H22
高水平84.134 ～6 ～≥0.527 1H1、H8、H9 、H18
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基于变异系数法和耦合协调度模型的广西三级公立综合医院高质量发展状况研究
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阮楚婷 1, 2 , 冯启明 1, 2 , 赵劲民 1, 2 , 于夫 1, 2 , 高洪达 1, 2
现代预防医学 | 卫生政策与管理 2024,51(9): 1643-1648
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现代预防医学 | 卫生政策与管理 2024, 51(9): 1643-1648
基于变异系数法和耦合协调度模型的广西三级公立综合医院高质量发展状况研究
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阮楚婷1, 2, 冯启明1, 2, 赵劲民1, 2, 于夫1, 2, 高洪达1, 2
作者信息
  • 1.广西医科大学卫生与健康政策中心（广西高端智库建设培育单位），广西 南宁 530021
  • 2.广西医科大学信息与管理学院，广西 南宁 530021

    • 阮楚婷（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

通讯作者:

高洪达，E-mail:
Study on high quality development of tertiary public general hospitals in Guangxi based on coefficient of variation method and coupling coordination degree model
Chu-ting RUAN1, 2, Qi-ming FENG1, 2, Jin-min ZHAO1, 2, Fu YU1, 2, Hong-da GAO1, 2
Affiliations
  • School of Information and Management, Guangxi Medical University, Nanning, Guangxi 530021, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202311316
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摘要
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目的

分析广西壮族自治区（简称广西）三级公立综合医院高质量发展耦合协调关系，探索三级公立综合医院高质量发展路径，为相关政策制定提供依据。

方法

从医疗质量、运营效率、可持续发展、满意度评价四个维度构建广西三级公立综合医院高质量发展评价指标体系，采用变异系数法和秩和比法对广西2019年14个地市的三级公立综合医院高质量发展水平进行综合评价、分档，并运用耦合协调度模型测算其耦合协调发展水平。

结果

发现大多数样本医院处于初级协调阶段，其他耦合协调度类型占比由高到低分别为中级协调、勉强协调、濒临失调和良好协调，分别为22.73%、18.18%、13.64%、4.55%。根据最佳分档原则，可将广西市属三级公立医院划分为“高、中、低”三个等级，绝大部分医院处在中等水平，发展进步空间大。

结论

广西三级公立综合医院耦合协调程度不高，仍存在医疗资源分布不均、医疗质量差异较大、人才培养动力不足等问题，需健全医疗服务体系，提高核心竞争力。

公立医院  /  三级公立综合医院  /  高质量发展  /  耦合协调度
Objective

To analyze the coupling and coordination relationship of high-quality development of tertiary public general hospitals in Guangxi, and to explore the path of high-quality development of tertiary public general hospitals, so as to provide a basis for related policy formulation.

Methods

The evaluation index system of high-quality development of tertiary public general hospitals in Guangxi was constructed from the four dimensions of medical quality, operational efficiency, sustainable development, and satisfaction evaluation. The coefficient of variation method and rank sum ratio method were used to comprehensively evaluate and classify the high-quality development level of the tertiary public general hospitals in 14 prefectures and cities in Guangxi in 2019, and the coupling coordination degree model was used to calculate the coupling and coordinated development level.

Results

Most of the sample hospitals were in the primary coordination stage, and the proportion of other coupling coordination types from high to low were intermediate coordination (22.73%), reluctant coordination (18.18%), on the verge of disorder (13.64%), and good coordination (4.55%). According to the principle of optimal classification, the tertiary public hospitals in Guangxi were divided into high, medium, and low grades. Most of the hospitals were in the middle level and there was much room for development and progress.

Conclusion

The coupling coordination degree of the tertiary public general hospitals in Guangxi is not high, and there are still some problems, such as uneven distribution of medical resources, large differences in medical quality, and lack of motivation for personnel training. It is necessary to improve the medical service system and improve the core competitiveness.

Public hospitals  /  Tertiary public general hospitals  /  High-quality development  /  Coupling coordination degree
阮楚婷, 冯启明, 赵劲民, 于夫, 高洪达. 基于变异系数法和耦合协调度模型的广西三级公立综合医院高质量发展状况研究. 现代预防医学, 2024 , 51 (9) : 1643 -1648 . DOI: 10.20043/j.cnki.MPM.202311316
Chu-ting RUAN, Qi-ming FENG, Jin-min ZHAO, Fu YU, Hong-da GAO. Study on high quality development of tertiary public general hospitals in Guangxi based on coefficient of variation method and coupling coordination degree model[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1643 -1648 . DOI: 10.20043/j.cnki.MPM.202311316
正文
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2019年国务院办公厅印发《关于加强三级公立医院绩效考核工作的意见》，2021年印发《关于推动公立医院高质量发展的意见》，随着政策文件密集出台，高质量发展逐渐成为我国公立医院发展改革的主旋律[1]。三级公立医院中，综合医院掌握了大量医疗资源，是推进改革发展、落实高质量发展的主力军[2]。其发展模式与发展水平不仅对健康中国战略实施进程具有重要意义，亦是推进我国卫生健康事业高质量发展的重要载体[3]。
目前，针对公立医院高质量发展研究主要围绕三个方面：公立医院高质量发展概念及内涵的探讨，资源与管理要素的应用以及相关模式的探索与路径分析[4-6]。然而，对于三级公立综合医院的评价研究尤其缺乏。耦合协调度可以体现各个子系统间协调状况的好坏，各子系统的协调配合有利于医院实现高质量发展。基于此，本文以“国考”指标为抓手，从高质量发展的“三个转变，三个提高”出发设置评价指标，综合运用变异系数法和耦合协调度模型对2019年广西壮族自治区（简称广西）14个地市的三级公立综合医院发展水平及耦合协调度进行分析，以期推动医疗服务高质量发展，以更好地满足人民日益增长的医疗卫生服务需要。
1　资料与方法
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1.1　数据来源
选择2019年广西14个地级市共22家三级公立综合医院作为样本，其中省属医院5家，市属医院17家。数据来源于广西壮族自治区卫生健康委员会卫生信息直报系统中的医保信息系统、卫生信息系统年报数据。
1.2　指标评价体系构建
本文基于邓清文[7]、李晓雨[8]等对公立医院高质量发展指标选取的研究经验，以及国家关于公立医院高质量发展评价指标体系等政策文件，经过文献资料整理和专家咨询，最终形成包括医疗质量、运营效率、可持续发展和满意度评价四个维度，共20项指标的评价指标体系，分别用X1～X20表示，见表1。该指标体系能够比较全面的体现三级综合医院各维度的综合情况。
1.3　研究方法
1.3.1　变异系数法
变异系数法（coefficient of variation method）是一种客观的赋权方法，直接利用各项指标所包含的信息,通过计算得到指标的权重[9]。此方法不受指标量纲不同的影响，同时又能反映出公立医院高质量发展水平的空间差异。具体计算方法如下：
（1）同趋化处理。为消除个指标量纲对测算结果的影响，对于各指标进行正向化和标准化处理[4]。
其中，Yij代表指标数据标准化后的值代表第i个评价对象第j个指标上的原始数值，max和min分别代表所选择年份原始数据中的最大值与最小值,为最理想值。
（2）计算权重。
其中，Vi和Wi分别表示变异系数和指标权重；和分别表示指标i的标准差和平均值。
（3）计算综合评价指数。
Wi代表各项指标的权重，Yij代表指标数据标准化后的值。
1.3.2　耦合协调度模型
耦合是指两个及以上的系统通过某种途径联合起来的现象，是相互促进和影响的动态关联关系[10]。耦合度能反映各子系统间互动的紧密性，而耦合协调度是在耦合度的基础上演变而来，用以反映系统在协调过程中的协调程度发展及相互作用[11]，其模型形式如下：
式中，C为耦合度；T代表各维度的发展的综合水平；D为耦合协调度，取值范围为[0,1]，取值越高代表各维度之间发展的协调程度越高；将医疗质量、运营效率、可持续发展和满意度评价分别记为、、，a、b、c、d对应为各变量的权重。参考相关研究[12]，可以将耦合协调度划分为十个等级，具体划分标准见表2。
1.3.3　秩和比法(RSR法)
RSR通过数据矩阵求秩，利用秩次替代原始数据，并基于评价结果的差异性进行分类[13]。
（1）对已经过同趋化处理的原始指标进行编秩，高优指标从小到大编秩,低优指标反之，相同秩次取平均值。
（2）根据公式计算秩和比RSR值,其中i=1,2…n, j=1,2…m，为第i行第j列指标上的秩;计算累计频数∑f、平均秩次及向下累计频率，参考《百分数与概率单位对照表》查找P*对应的概率单位Probit。
（3）以Probit值为自变量，RSR值为因变量，运用SPSS 26.0计算得出线性回归方程为RSR=0.025+0.084×Probit，具有统计学意义(F=455.122,P<0.001)，再根据RSR合理分档数表进行分档。
2　结果
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2.1　指标权重分析
根据变异系数法计算各个指标权重，见表1。从医疗质量权重分析结果来看，出院患者微创手术占比权重最高，为0.207 4，手术患者并发症发生率的权重最低，为0.075 2；从运营效率权重分析结果来看，各项指标权重差异不大，分布在0.128 0～0.201 7之间。可持续发展维度中的每百名卫生技术人员科研项目经费占权重最大，从中可以看出，每百名卫生技术人员科研项目经费对医院可持续发展影响较大。
2.2　广西三级公立综合医院高质量发展各维度分析
通过变异系数法计算原理，计算得到广西22家三级公立综合医院的医疗质量、运营效率、可持续发展和满意度评价的高质量发展指数，见表3、图1。整体来看，医疗质量和可持续发展维度排名最好的均为医院H1，而排名最末的均为医院H22；运营效率及满意度评价维度排名最好的分别为医院H6、H18，运营效率及满意度评价维度排名最末的均为医院H14。各维度之间医疗质量处于主导地位。
2.3　广西三级公立综合医院高质量发展的耦合协调分析
依照前述所构建的耦合协调度模型计算广西三级公立医院高质量发展的耦合协调度，结果见表4。根据表1的划分标准，发现大多数样本医院处于初级协调阶段，其他耦合协调度类型占比由高到低分别为中级协调、勉强协调、濒临失调和良好协调，分别占22.73%、18.18%、13.64%、4.55%，整体介于[0.42-0.84]之间。医院H1协调耦合水平较高，处于良好协调，而医院H13、H14、H22的协调耦合水平最低，已经到达濒临失调的程度，其余医院均为中级协调、勉强协调和初级协调的状态。
2.4　广西三级公立综合医院高质量发展排序分档结果
根据最佳分级原则并结合常用分级情况，对广西22家三级公立综合医院高质量发展水平进行分级，共分为高、中、低三级，具体分档情况见表5。其中，广西4家三级公立综合医院划入高水平，3家市属三级综合医院划入低水平外，其余大部分市属三级综合医院划入处于中等水平。
3　讨论
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3.1　广西公立综合医院耦合协调度存在总体失衡，
仍需提高医疗服务质量就耦合协调发展类型来看，医院H1处于良好协调发展阶段，领先于其他医院。这表明该所医院四个维度之间的发展程度存在较好的协调关系。而除耦合协调度较高的医院H1，及协调度较低的医院H13、H14、H22外，其余医院协调度差距不大，各地级市三级综合医院之间存在“总体失衡，局部均衡”的问题，耦合协调度空间差异明显，陈奎[12]等人对安徽省公立医院高质量发展水平的研究也得出类似结论。医疗质量、运营效率、可持续发展、满意度评价是公立医院高质量发展的一个综合的系统，因此，在广西公立医院高质量发展的过程中，需要高度重视各个系统的协调发展。
医疗服务质量与安全作为医院的“生命线”，是公立医院高质量发展的根基，也是发展和竞争的重要衡量要素[14]。没有好的医疗质量，患者安全就无从谈起，医院也无法长期可持续发展，因此改进医疗质量与安全是公立综合医院需要持续探索的[15]。从图1分析结果可知，耦合协调度较高的医院在医疗质量综合指数明显高于其他维度的综合指数，这说明在四个维度耦合协调关系不断加强过程中，医疗质量处于主导地位。而目前研究发现广西各三级公立综合医院在医疗质量指数仍存在较大差异，三级公立综合医院的医疗质量存在较大的提升空间。因此建议各医院可以通过建立健全对医院医疗质量的监督管理体系，积极落实质量与安全管理措施，严格执行相关医疗制度，对各科室医疗规范、是否合理用药等进行有效监督，健全医疗服务体系，提升医疗服务质量。
3.2　人才培养动力不足，需提高学科建设投入
研究发现，医院H22高质量发展排序处于中等水平，但耦合协调度却达到濒临失调的程度，主要是由于该医院可持续发展维度发展水平滞后，可能与其地处发展欠发达地区，难以吸引高水平卫生技术人员有关，同时也与政府财政拨款不足有关，学者刘芷含[16]等在研究中也有类似发现。同时根据变异系数法计算权重，结果显示“每百名卫生技术人员科研项目经费”指标的权重占比最高，说明该指标对于公立医院高质量发展较为重要。但是本研究中各个医院在指标“每百名卫生技术人员科研项目经费”上的投入差距却比较大，表明广西三级公立综合医院在学科建设、人才培养等方面发展程度参差不齐，存在较大提升空间。启示在学科建设方面，应逐步提高每百位卫生技术人员科研项目经费，鼓励医务人员开展科研，并提供更多外出学习与培训机会，有助于医疗技术水平提高和医院学术氛围的形成。
3.3　医疗资源分布不均，广西三级公立综合医院高质量发展进步空间大
从分档排序结果来看，处于高水平的医院有H1、H8、H9、H18，说明其高质量发展的综合情况较好；排名相对靠后的是医院H6、H17、H19，反映出这些医院的高质量发展有待提高。研究发现排名靠前的医院大都位于南宁、柳州等地，这也与骆宣良等人[17]研究认为公立医院高质量发展受卫生资源影响，而广西经济社会发展不平衡导致卫生资源多富集于南宁、柳州等经济社会发展总体较好的地级市相呼应。该类医院应积极发挥龙头作用，强化导向公立医院急危重症和疑难复杂疾病的诊治能力。被归为“中等水平”的医院共有15家，这表明广西三级公立综合医院高质量发展水平大多数处于中等水平，在医疗资源、医疗质量、技术人才等方面发展进步空间大。三级公立综合医院承载着所在地区开展区域医疗中心建设、推行上级决策、提高老百姓健康生活水平的重要职责和使命。建议针对这类医院，应明确各自管理重点，着眼于核心竞争力的提高，保持发展优势，重点弥补不足之处。
3.4　本研究的不足与今后改进措施
本研究在指标选取具有一定的不足。本研究在指标的设计与选取阶段，主要通过文献整理和专家咨询，对其进行整理筛选和数据的可获得性得出最终指标，因此，在选取评价指标时存在一定的局限性。在今后的研究中,可采取实证研究的方法对医院质量进行评价，科学和严谨的选取评价指标，使评价结果更具有科学性。
基金
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  • 广西自然科学基金青年科学基金项目(2023GXNSFBA026174)
  • 广西社科界智库重点课题(Zkybkt202309)
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202311316
  • 接收时间：2023-11-18
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-11-18
基金
广西自然科学基金青年科学基金项目(2023GXNSFBA026174)
广西社科界智库重点课题(Zkybkt202309)
作者信息
    1.广西医科大学卫生与健康政策中心（广西高端智库建设培育单位），广西 南宁 530021
    2.广西医科大学信息与管理学院，广西 南宁 530021

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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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