Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment_Chinese Journal of Evidence-Based Medicine

Authors：

JI Shuming ¹ , WANG Wei ¹ , ZHANG Pei ¹ , ZENG Cheng ¹ , LI Linjian ¹ , YU Fei ² ,  ZHOU Xiaoyuan ¹

1. West China School of Public Health and the Fourth West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Sichuan Tumor Hospital, Chengdu 610041, P.R.China;

Corresponding?author：

ZHOU Xiaoyuan, Email: zhouxyuan@scu.edu.cn

Keywords：

Graded diagnosis and treatment; Human resources; Spatial autocorrelation; Gini coefficient; Multiple regression

DOI：

10.7507/1672-2531.201911085

Video：

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Objectives To analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.Methods The Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.Results The distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s I_doctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s I_nurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.Conclusions Optimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.

Citation： JI Shuming, WANG Wei, ZHANG Pei, ZENG Cheng, LI Linjian, YU Fei, ZHOU Xiaoyuan. Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1004-1011. doi: 10.7507/1672-2531.201911085 Copy

1.	劉曉明. 轉型視角下醫院人力資源管理的現狀及對策探討. 中國集體經濟, 2017, (18): 86-87.
2.	李文先, 張向峰, 苗茂云, 等. 我國疾病預防控制中心衛生人力資源配置公平性分析. 中華疾病控制雜志, 2016, 20(9): 945-947.
3.	丁夏夏, 沈永祥, 董黎明. 新醫改背景下某公立醫院人力資源配置優化研究. 中華全科醫學, 2016, 14(12): 2107-2109, 2135.
4.	魏子檸, 王亞東. 我國新一輪醫藥衛生體制改革的回顧與啟示. 中華疾病控制雜志, 2019, 23(9): 1037-1040.
5.	胡彬. 國務院發布“十三五”深化醫改規劃. 中醫藥管理雜志, 2017, 25(2): 126-126.
6.	Cunha E Silva DC, Louren?o RW, Cordeiro RC, <italic>et al</italic>. Analysis of the relation between the spatial distribution of morbidities due to obesity and hypertension for the State of S?o Paulo, Brazil, from 2000 to 2010. Cien Saude Colet, 2014, 19(6): 1709-1719.
7.	Deltas G. The small-sample bias of the Gini coefficient: Results and implications for empirical research. Review of Economics & Statistics, 2003, 85(1): 226-234.
8.	鄭黎強, 紀超, 岳陽陽, 等. 我國三級綜合醫院人力資源現狀分析. 中國醫院, 2016, 20(8): 22-24.
9.	梁勇, 張檸. 國外醫療服務體系對完善我國分級診療體系的啟示與借鑒. 中國醫院, 2015, 19(8): 50-52.
10.	毛瑛, 王雪, 何榮鑫. 基于 TOPSIS 模型的公立醫院醫療服務能力評價研究. 中國衛生質量管理, 2016, 23(6): 99-103.
11.	Becker ER, Steinwald B. Determinants of hospital casemix complexity. Health Serv Res, 1981, 16(4): 439-458.
12.	Hedayet C, Valentin Z, Audrey L, <italic>et al</italic>. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter? Int J Prod Econ, 2014, 150: 74-82.
13.	Rosko MD, Chilingerian JA. Estimating hospital inefficiency: does case mix matter? J Med Syst, 1999, 23(1): 57-71.
14.	劉婉如, 張樂輝, 仇葉龍, 等. 病例組合指數在醫院績效評價中的調整方法與應用. 中華醫院管理雜志, 2015, 31(11): 843-845.
15.	Lingsma HF, Bottle A, Middleton S, <italic>et al</italic>. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res, 2018, 18(1): 116.
16.	Yang Y, Ma M. Green communications and networks. Dordrecht: Springer, 2012.
17.	姚偉, 陳興寶, 沈康, 等. 惡性腫瘤病人住院費用及其影響因素分析. 中國腫瘤, 2002, 11(9): 521-523.
18.	王力男, 丁玲玲, 方欣葉, 等. 老年人消耗的醫療資源分析: 基于上海市醫療機構數據. 中國衛生經濟, 2018, 37(4): 61-66.
19.	郝模, 馬紀良. 縣、區、鄉三級醫療機構手術能力研究. 中國醫院管理, 1991, 11(10): 19-22.
20.	張宗光, 王恩波, 王秋仙, 等. 農村衛生資源配置研究的新視角與城鄉衛生服務均等化的政策探討. 中國衛生經濟, 2013, 32(10): 35-37.
21.	周曄玲, 藍相潔, 司明舒, 等. 基于分級診療的廣西衛生人力資源配置分析. 中國衛生經濟, 2018, 37(7): 51-53.
22.	陳虹, 紀嬌, 高本林. 醫聯體建設助推分級診療實施策略. 現代醫院, 2018, 18(8): 1103-1104, 1108.
23.	陳煜, 易守寬. 醫生多點執業對新公立醫院改革的影響. 云南財經大學學報, 2010, 25(5): 117-118.
24.	高衛益, 趙列賓, 袁克儉. 區域衛生資源縱向整合的實踐與思考. 中國醫院, 2008, 12(3): 79-80.
25.	吳敏, 牟燕, 劉巖, 等. 鄉鎮衛生院醫療服務能力趨勢變化與問題探討—基于 2009-2015 年山東省鄉鎮衛生院醫療服務量的比較. 衛生軟科學, 2018, 32(1): 16-19.
26.	朱穎. 基層醫療機構加強衛生人才隊伍建設的探索. 中國衛生人才, 2015, 9: 74-78.
27.	朱瓏, 張克英. 3 年規范化培訓考核在提高新入職護士職業能力中的作用. 中華護理雜志, 2016, 51(7): 836-839.
28.	魏士軒, 尹愛田, 馬東平, 等. 全科醫生制度建設的人才問題及成因研究. 中國衛生資源, 2014, 17(3): 227-228.
29.	黃瑋. 論分級診療模式下公立醫院與社區衛生服務機構的協同發展. 中國醫學創新, 2016, 13(25): 76-79.
30.	高仕銘, 陸斌杰. 從醫師隊伍職稱結構變化趨勢看衛生人事制度改革. 中華現代醫院管理雜志, 2004, 2(8): 3-5.
31.	Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colonic surgery. Surgery, 2003, 133(3): 277-282.
32.	張燕, 楊勝文, 吳文富, 等. 黔南州基層醫療衛生機構護理人才隊伍現狀分析及對策研究. 黔南民族醫專學報, 2013, 26(3): 185-188.
33.	于長海, 李曉妹, 周晨霆. 基于 SWOT 分析的山東省內陸地區公立醫院人才高地建設策略研究—以某省級區域醫療中心為例. 中國初級衛生保健, 2019, 33(8): 9-10.
34.	謝春鷹, 譚加榮, 蘭利萍. 基層醫療衛生機構人才隊伍建設的探索. 中國衛生人才, 2015, 5: 52-55.

1. 劉曉明. 轉型視角下醫院人力資源管理的現狀及對策探討. 中國集體經濟, 2017, (18): 86-87.
2. 李文先, 張向峰, 苗茂云, 等. 我國疾病預防控制中心衛生人力資源配置公平性分析. 中華疾病控制雜志, 2016, 20(9): 945-947.
3. 丁夏夏, 沈永祥, 董黎明. 新醫改背景下某公立醫院人力資源配置優化研究. 中華全科醫學, 2016, 14(12): 2107-2109, 2135.
4. 魏子檸, 王亞東. 我國新一輪醫藥衛生體制改革的回顧與啟示. 中華疾病控制雜志, 2019, 23(9): 1037-1040.
5. 胡彬. 國務院發布“十三五”深化醫改規劃. 中醫藥管理雜志, 2017, 25(2): 126-126.
6. Cunha E Silva DC, Louren?o RW, Cordeiro RC, <italic>et al</italic>. Analysis of the relation between the spatial distribution of morbidities due to obesity and hypertension for the State of S?o Paulo, Brazil, from 2000 to 2010. Cien Saude Colet, 2014, 19(6): 1709-1719.
7. Deltas G. The small-sample bias of the Gini coefficient: Results and implications for empirical research. Review of Economics & Statistics, 2003, 85(1): 226-234.
8. 鄭黎強, 紀超, 岳陽陽, 等. 我國三級綜合醫院人力資源現狀分析. 中國醫院, 2016, 20(8): 22-24.
9. 梁勇, 張檸. 國外醫療服務體系對完善我國分級診療體系的啟示與借鑒. 中國醫院, 2015, 19(8): 50-52.
10. 毛瑛, 王雪, 何榮鑫. 基于 TOPSIS 模型的公立醫院醫療服務能力評價研究. 中國衛生質量管理, 2016, 23(6): 99-103.
11. Becker ER, Steinwald B. Determinants of hospital casemix complexity. Health Serv Res, 1981, 16(4): 439-458.
12. Hedayet C, Valentin Z, Audrey L, <italic>et al</italic>. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter? Int J Prod Econ, 2014, 150: 74-82.
13. Rosko MD, Chilingerian JA. Estimating hospital inefficiency: does case mix matter? J Med Syst, 1999, 23(1): 57-71.
14. 劉婉如, 張樂輝, 仇葉龍, 等. 病例組合指數在醫院績效評價中的調整方法與應用. 中華醫院管理雜志, 2015, 31(11): 843-845.
15. Lingsma HF, Bottle A, Middleton S, <italic>et al</italic>. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res, 2018, 18(1): 116.
16. Yang Y, Ma M. Green communications and networks. Dordrecht: Springer, 2012.
17. 姚偉, 陳興寶, 沈康, 等. 惡性腫瘤病人住院費用及其影響因素分析. 中國腫瘤, 2002, 11(9): 521-523.
18. 王力男, 丁玲玲, 方欣葉, 等. 老年人消耗的醫療資源分析: 基于上海市醫療機構數據. 中國衛生經濟, 2018, 37(4): 61-66.
19. 郝模, 馬紀良. 縣、區、鄉三級醫療機構手術能力研究. 中國醫院管理, 1991, 11(10): 19-22.
20. 張宗光, 王恩波, 王秋仙, 等. 農村衛生資源配置研究的新視角與城鄉衛生服務均等化的政策探討. 中國衛生經濟, 2013, 32(10): 35-37.
21. 周曄玲, 藍相潔, 司明舒, 等. 基于分級診療的廣西衛生人力資源配置分析. 中國衛生經濟, 2018, 37(7): 51-53.
22. 陳虹, 紀嬌, 高本林. 醫聯體建設助推分級診療實施策略. 現代醫院, 2018, 18(8): 1103-1104, 1108.
23. 陳煜, 易守寬. 醫生多點執業對新公立醫院改革的影響. 云南財經大學學報, 2010, 25(5): 117-118.
24. 高衛益, 趙列賓, 袁克儉. 區域衛生資源縱向整合的實踐與思考. 中國醫院, 2008, 12(3): 79-80.
25. 吳敏, 牟燕, 劉巖, 等. 鄉鎮衛生院醫療服務能力趨勢變化與問題探討—基于 2009-2015 年山東省鄉鎮衛生院醫療服務量的比較. 衛生軟科學, 2018, 32(1): 16-19.
26. 朱穎. 基層醫療機構加強衛生人才隊伍建設的探索. 中國衛生人才, 2015, 9: 74-78.
27. 朱瓏, 張克英. 3 年規范化培訓考核在提高新入職護士職業能力中的作用. 中華護理雜志, 2016, 51(7): 836-839.
28. 魏士軒, 尹愛田, 馬東平, 等. 全科醫生制度建設的人才問題及成因研究. 中國衛生資源, 2014, 17(3): 227-228.
29. 黃瑋. 論分級診療模式下公立醫院與社區衛生服務機構的協同發展. 中國醫學創新, 2016, 13(25): 76-79.
30. 高仕銘, 陸斌杰. 從醫師隊伍職稱結構變化趨勢看衛生人事制度改革. 中華現代醫院管理雜志, 2004, 2(8): 3-5.
31. Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colonic surgery. Surgery, 2003, 133(3): 277-282.
32. 張燕, 楊勝文, 吳文富, 等. 黔南州基層醫療衛生機構護理人才隊伍現狀分析及對策研究. 黔南民族醫專學報, 2013, 26(3): 185-188.
33. 于長海, 李曉妹, 周晨霆. 基于 SWOT 分析的山東省內陸地區公立醫院人才高地建設策略研究—以某省級區域醫療中心為例. 中國初級衛生保健, 2019, 33(8): 9-10.
34. 謝春鷹, 譚加榮, 蘭利萍. 基層醫療衛生機構人才隊伍建設的探索. 中國衛生人才, 2015, 5: 52-55.

Chinese Journal of Evidence-Based Medicine

Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment

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