随着信息技术发展，传统报账模式难以满足现代医院精细化管理与内部控制要求，公立医院报账现状存在财务定位不准确、重核算轻管理，顶层规划不足、信息孤岛现象严重，内部控制不完善、运营风险高，核算效率不高、职工满意度低等诸多问题。如何有效应对传统报账弊端，推动医院管理模式转变并实现高质量发展是公立医院面临的课题。公立医院智慧报账体系建设需重视顶层设计，基于内部控制要求结合智慧化手段优化流程，以达成提升财务战略地位、系统互通、效率提升、提高职工满意度和内控风险可控的目标，案例医院的智慧报账系统建设实践可为其他医院提供参考借鉴。
As information technology advances，traditional accounting models are increasingly inadequate for the refined management and internal control needs of modern hospitals．Public hospitals encounter several challengesincluding inaccurate financial positioning，an emphasis on accounting over management，insufficient top-level planning，seriousinformation silos，weak internal controls，high operational risks，low accounting efficiency，and low employee satisfaction．Effectivelyaddressingthe shortcomings of traditional accounting practices and transforming hospital management models for high-quality development isa pressing challenge．The development of an intelligent accounting system in public hospitals should prioritize top-level design，optimize processes in line with internal control requirements，and integrate intelligent technologies．This approach aims to enhancethe strategic role of finance，improve system interoperability，increase efficiency，boost employee satisfaction，and ensuremanageable internal control risks．The practical implementation of the intelligent accounting system in the case hospital can providevaluable insights for other hospitals．
目的 对入住重症监护病房（ICU）重症孕产妇患者的病种特征和住院费用进行分析。方法 从医院信息管理系统中搜索2009—2019年广州市某省级重症孕产妇救治中心ICU的重症孕产妇住院病例，对病例资料进行描述性流行病学分析。结果 2009—2019年该救治中心ICU共收治重症孕产妇1 616例，病种排名前五位依次为心血管疾病430例（26.61%）、血液及造血器官疾病310例（19.18%）、妊娠期特定并发疾病287例（17.76%）、消化系统疾病218例（13.49%）、呼吸系统疾病110例（6.81%）。患者经济负担中位数排名前五位依次为肌肉骨骼系统和结缔组织疾病（62 252.60元）、消化系统疾病（61 684.41元）、感染性疾病（42 945.70元）、血液及造血器官疾病（40 403.52元）、神经系统疾病（40 055.93元）。结论 入住ICU内的重症孕产妇以心血管疾病、血液及造血器官疾病为主，经济学分析表明肌肉骨骼系统和结缔组织疾病造成的经济损失较大。
Objective To analyze the disease characteristics and hospitalization expenses of severe maternal patients in intensive care unit（ICU）．Methods Hospitalized cases of severe maternal disease in ICU of a provincial critical care center in Guangzhou from 2009 to 2019 were searched from the hospital information management system，and case data was analyzed by descriptive epidemiology．Results From 2009 to 2019，a total of 1616 critically ill maternal patients received intensive care treatment at this center．The predominant diseases observed were cardiovascular disorders（26.61%），blood and hematopoietic organ diseases（19.18%），specific pregnancy-related complications（17.76%），gastrointestinal ailments（13.49%），and respiratory disorders（6.81%）．Among the top five patient groups，the median economic burden was the highest in musculoskeletal system and connective tissue diseases（62 252.600 yuan），followed by digestive system diseases（61 684.410 yuan），infectious diseases（42 945.700 yuan），blood and hematopoietic organ diseases（40 403.515 yuan），and nervous system disorders（40 055.930 yuan）Furthermore，a discernible correlation between hospitalization cost and length of stay was identified．Conclusions Cardiovascular diseases and disorders of blood and hematopoietic organs are the primary causes for maternal admissions to ICU．Economic analysis shows that musculoskeletal system and connective tissues diseases cause bigger economic loss ．
当前公立医院面临的内外部环境十分复杂，各种不确定因素影响公立医院健康运营。引入内部控制理念，建立健全采购与付款环节是必要的。文章对目前公立医院采购与付款业务管理中存在的问题进行分析，从改善内部环境建设、建立起有效的风险评估体系、加强采购与付款业务控制活动、巩固监督检查体系、加强信息沟通建设五个方面提出相应策略，优化公立医院采购与付款环节内部控制，从而减少风险带来的不确定性，保障医院运行的效率效益，助力医院高质量持续发展。
Public hospitals are currently navigating a complex internal and external environment，where various uncertainties can impact their effective operation．The introduction of internal control concepts and the establishment of robust procurement and payment processes are essential．This paper analyzes the issues present in the management of procurement and payment operations within public hospitals．It proposes strategies across five key areas：enhancing the internal environment，establishing an effective risk assessment framework，strengthening control activities in procurement and payment processes，reinforcing the supervision and inspection system，and improving information communication．These strategies aim to optimize internal controls，reduce uncertainty associated with risks，ensure operational efficiency，and support the sustainable，high-quality development of public hospitals．
目的 分析结核专科医院医学生特征及管理配合度影响因素，为进一步提升医学生管理配合提供参考。方法 选择在院511名医学生进行基本情况采集及问卷调查，以问卷打卡次数及打卡时间评估医学生的管理配合度，并进一步分析其影响因素。结果 进修生、研究生及实习生的性别构成比较差异无统计学意义（P＞0.05），而年龄、专业及学历比较差异有统计学意义（P＜0.05）。医学生的学历与管理配合度无关，而不同年龄、性别、类别、专业医学生的管理配合度比较差异有统计学意义（P＜0.05）。结论 针对结核病专科医院医学生的类别、专业、年龄等不同特征，调整专科医院教学管理方法并实行相应的管理措施，对加强专科教学医院的医学生管理工作具有一定的价值。
Objective To analyze the characteristics and the influencing factors of management cooperation of medical students in tuberculosis specialized hospital，providing reference for further improving the cooperation of medical students in management．Methods Five hundred and eleven medical students were selected in the specialized hospital for basic information collection and questionnaire survey，the management cooperation of medical students were evaluated from the frequency and time of questionnaire check-in，and the influencing factors were further analyzed．Results According to the classification as continuing education students，graduate students and interns，there was no statistical difference in gender，but there were differences in age，major，and education degree（P＜0.05）．Age，gender，type，and major of the students were all related to management cooperation（P＜0.05），while the education degree was not related to it． Conclusions According to the different characteristics of medical students in tuberculosis specialized hospitals，such as their categories，majors and ages，adjusting the teaching management methods in specialized hospitals and implementing management measures have certain reference value for strengthening the management of medical students in specialized teaching hospitals．
目的 评估医院-社区-家庭一体化康复护理模式对慢性创面患者生活质量及创面愈合的潜在影响。方法 选择2023年1月—2024年6月在广州市第一人民医院接受治疗的慢性创面患者80例作为研究对象，所有患者在住院期间均接受基于溃疡面积、深度及是否合并感染等因素的综合治疗，包括彻底清创、创缘处理、负压治疗、感染控制等治疗，并接受常规护理。出院前，通过随机数字表法将患者分为两组，每组40例。两组患者在住院期间均接受常规护理，出院后，对照组接受延续护理并定期复查。干预组40例患者在出院后接受医院-社区-家庭一体化康复护理模式。入组时及护理3个月后，使用生活质量调查表（SF-36）对患者生活质量和创面愈合率进行评估。结果 干预组创面愈合率为（32.61±4.26）%，高于对照组（11.48±1.04）%，差异具有统计学意义（t=19.473，P＜0.05）。两组患者在护理3个月后的数字评定量表评分和创面疼痛频率评分均较入组时降低（P＜0.05）。其中干预组护理3个月后的创面VAS评分为（1.82±0.17）分，创面疼痛频率评分为（1.28±0.25）分；而对照组分别为（3.91±0.22）分和（2.63±0.37）分，干预组低于对照组（P＜0.05）。此外，干预组在护理后3个月的总体健康、生理功能、生理职能、精神健康、情感功能、社会功能评分均高于对照组（P＜0.05）。在居家3个月期间，干预组的感染发生率为5.00%，而对照组为17.50%，干预组感染发生率低于对照组（χ 2 =3.781，P＜0.05）。结论 本研究表明，医院-社区-家庭一体化康复护理模式干预能够促进慢性创面患者的创面愈合，降低居家期间感染的风险，并提升患者的生活质量。
Objective To assess the potential impact of the integrated hospital-community-home rehabilitation nursing model on the quality of life and wound healing in patients with chronic wounds．Methods A total of 80 patients with chronic wounds treated at the Guangzhou First People’s Hospital from January 2023 to June 2024 were selected as the study subjects．All patients received comprehensive treatment during their hospital stay，including thorough debridement，edge treatment，vacuum therapy，infection control and routine nursing care．Prior to discharge，the patients were randomly divided into two groups using a random number table，with 40 patients in each group．Both groups received routine nursing care during their hospital stay，and the control group received continuing nursing care and regular follow-up after discharge．Forty patients in the intervention group received the integrated hospital-community-home rehabilitation nursing model after discharge．Quality of life（QoL）and wound healing rates were assessed using the Short Form 36（SF-36）questionnaire at the time of enrollment and 3 months after nursing．Results The wound healing rate in the intervention group was significantly higher than that in the control group （［32.61±4.26］% vs ［11.48±1.04］%），with a statistical difference（t=19.473，P＜0.05）．The numerical rating scale（NRS）scores and frequency of wound pain scores decreased in both groups 3 months after nursing compared to the enrollment period（P＜0.05）．Specifically，the VAS score for wound pain in the intervention group 3 months after nursing was（1.82±0.17），and the frequency of wound pain was（1.28±0.25），in the control group，these scores were（3.91±0.22）and（2.63±0.37），respectively，with the intervention group scoring significantly lower than the control group（P＜0.05）．Furthermore，the scores for overall health，physical function，role physical，mental health，emotional function，and social function in the intervention group were higher than those in the control group 3 months after nursing（P＜0.05）．During the 3-month home recovery period，the incidence of infection in the intervention group was 5.00%，whereas it was 17.50% in the control group，with the intervention group showing a lower incidence of infection（χ 2 =3.781，P＜0.05）．Conclusions This study demonstrates that the hospital-community-home integrated rehabilitation care model intervention can promote wound healing in chronic wound patients，reduce the risk of infection during home care，and significantly improve patients’ quality of life．
目的 面向采血人群的“智慧服务”是智慧医院构建的重要内容，引进智能采血管理系统有助于采血“智慧服务”的实现。文章介绍了广州市属大型三甲医院应用智能采血管理系统的实践，并对于系统出现的问题进行整理及分析，以找出有效解决对策。方法 将采血系统出现故障后的解决对策改良前后分为对照组和观察组，记录采血过程中出现故障的原因及次数，采血故障解决对策改良后的数据为观察组。结果 观察组相较于对照组各项故障的发生率显著降低。结论 在智慧医院构建背景下引进智能采血系统可有助于实现采血“智慧服务”，但在实施过程中应做好新旧采血方式的衔接并落实问题收集和对策制定。
Objective Intelligent Service for blood collection crowd is an important content of intelligent hospital，the introduction of intelligent blood collection management system is conducive to the implementation of “Intelligent Service” blood collection．This paper introduces the application of Intelligent Blood Collection Management System in Guangzhou first-class Hospital，collectis and analyses common systematic problems，to effectively find out the solutions．Materials and methods The patients were divided into control group and observation group before and after the improvement of the countermeasures after the failure of the blood collection system，the reasons and times of the failure were recorded，and the data after the improvement of the countermeasures were taken as the observation group．Results The incidence of various faults in the observation group was significantly lower than that in the control group．Conclusions The introduction of intelligent blood collection system under the background of the construction of smart hospital can help realize the “intelligent service” of blood collection，but in the implementation process，it is necessary to do a good job in the connection of old and new blood collection methods and implement the problem collection and countermeasures．
目的 旨在通过实证了解广东省青年中医人才岗位胜任力现状，探讨青年中医人才岗位胜任力素质特征，为青年中医人才培养提供策略。方法 通过专家咨询制定《青年中医人才岗位胜任力评价框架》并开展问卷调查，采用SPSS 26.0进行数据分析。结果 构建了包含8个一级指标、76个二级指标的《青年中医人才岗位胜任力评价框架》；广东省青年中医人才岗位胜任力自评总分整体处于及格以上水平。女性在职业价值和职业素养、临床技能、交流与沟通技能、管理能力和团队合作、批判性思维与学术科研能力的评分高于男性；不同职称在其他附加维度的评分比较具有统计学差异（P＜0.05）。结论 构建的评价框架能够有效评估青年中医人才岗位胜任力；广东省青年中医人才岗位胜任力整体处于及格水平，需重视补强短板；女性青年中医人才岗位胜任力多个维度的得分优于男性，着重提升各人群的弱项维度岗位胜任力；进一步建立健全职称评聘制度，以破五唯为导向构建符合不同级别职称的青年中医人才评价机制。
Objective To understand the current job competence status of young TCM talents in Guangdong Province through empirical research，to explore the characteristics of job competence and quality of young TCM talents，providing strategy for cultivating young talents in TCM．Methods The “Competency Evaluation Framework for Young TCM Talents” was developed through expert consultation and a questionnaire survey was conducted．SPSS 26.0 was used for data analysis．Results “Job Competency Evaluation Framework for Young TCM Talents” was constructed，which included 8 primary indicator items and 76 secondary indicator items．The overall self-evaluation score of the overall job competence of young TCM talents in this study was above the passing level．Female score was higher than male in terms of professional value and professional ethics，clinical skills，communication and interpersonal skills，management ability and teamwork，critical thinking and academic research ability．There were statistically significant differences in the scores of different job titles in other additional dimensions（P＜0.05）．Conclusions The constructed evaluation framework can effectively assess the job competence of young TCM talents．The overall competence of young TCM talents in Guangdong Province is at a passing level，and attention should paid to strengthening their weaknesses．Female young TCM talents have better multidimensional scores in job competence than males，and efforts should be made to focus on improving the weak dimensional job competence of various groups of people．The professional title evaluation and appointment system needs to be established and improved．A talent evaluation mechanism should be built for young TCM talents that meets different levels of professional titles，guided by the principle of breaking the five criteria．
目的 对医疗损害责任纠纷案的法庭审理进行分析，探究医疗损害责任纠纷案件的处理现状，对此过程中医疗机构应当关注的问题进行分析总结，以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法 对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果 93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中，71例鉴定结论被法院采信，采信率达90%。有29例案件鉴定人出庭（占比36.7%），其中有25例鉴定意见被法院采信，采信率为86.2%，仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任占比为73.4%。鉴定结论为责任范围的，法院最后判决偏向于取最高值和中间值（43例出具责任范围的案例中，14例为最高值，13例为中间值）。结论 医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识，高度重视医疗损害鉴定工作，尤其加强尸体解剖告知及病历书写管理，充分利用好鉴定人和专家辅助证人出庭两种手段。
Objective To analyze the court trial of medical damage liability disputes，to explore the current situation of medical damage liability disputes，to analyze and summarize the problems encountered in dealing with medical damage disputes，so as to provide some references for hospitals to deal with medical damage disputes．Methods Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District，Guangzhou from 2015 to 2021．Results In 93 cases，79 cases had expertise of medical malpractice．In 79 expertise，71 of them were adopted，and the acceptance rate was 90%．Among the 29 cases in which the appraisers appeared in court，25 expert opinions were accepted by the court，the acceptance rate was 86.2%．In only 7 cases，the parties applied for expert witnesses to appear in court．In most cases，hospitals ultimately took secondary and lower responsibilities，accounting for 73.4%．If the appraisal conclusion falls within the scope of responsibility，the court’s final judgment tends to take the highest and middle values．Conclusions Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification．Attach great importance to the identification of medical malpractice，especially strengthen the management of autopsy notification and medical record writing，make full use of two methods：appraisers and experts witnesses appearing in court．
目的 识别医院在医患沟通、服务态度、医疗服务和医疗质量方面存在的问题，研究提升医院医疗质量与安全的对策。方法 通过收集和整理2024年1-6月某三甲医院医患沟通科处理的医疗诉求数据，包括患者投诉、咨询、建议及求助调查结果，采用定性分析和定量分析相结合的方法，对134件医疗诉求数据进行详细分类和统计，深入分析投诉事由，并结合实际有责投诉量与诊疗总人数，计算投诉千人发生率。投诉千人发生率与2023年同期对照。结果 共处理医疗诉求134件，其中投诉116件（占86.56%）、求助11件（8.21%）、咨询5件（3.73%）、建议2件（1.5%）。投诉中，医患沟通不畅和服务态度问题占42%，医疗服务问题32%，医疗质量问题占26%。实际有责投诉量为63件，投诉千人发生率约为0.12‰。通过对诉求数据的深入分析，识别出医疗服务过程中的薄弱环节和改进点。结论 针对分析结果及同期对照，提出相应的对策建议，包括加强医患沟通培训，改善服务态度，优化医疗服务流程，并对投诉高发科室进行特别关注和改进等措施，以提高患者满意度和医院整体医疗质量。
Objective To identify issues in hospital communication, service attitude medical services, and medical quality and to explore strategies for enhancing hospital medical quality and safety. Methods By collecting and organizing medical appeal data processed by the Medical Communication Department of a tertiary hospital from January to June 2024, including patient complaints, inquiries, suggestions, and requests for help. A combined qualitative and quantitative analysis was conducted on 134 medical appeal cases. Detailed classification and statistics were performed on these cases, and an in-depth analysis of the reasons for complaints was carried out. Furthermore, the actual number of responsible complaints was compared with the total number of treated patients to calculate the complaint rate per thousand people. This complaint rate was then compared with the same period in 2023. Results A total of 134 medical appeals were processed including 116 complaints（accounting for 86. 56%）, 11 requests for help（8. 21%）, 5 inquiries（3. 73%）, and 2 suggestions（1. 5%）. Among the complaints, issues related to poor communication between doctors and patients and service attitude accounted for 42%, medical service issues accounted for 32%, and medical quality issues accounted for 26%. The actual number of responsible complaints was 63, and the complaint rate per thousand people was approximately 0. 12‰. Through in-depth analysis of the appeal data, weak links and improvement points in the medical service process were identified. Conclusions Based on the analysis results and comparisons with the same period, corresponding countermeasures and suggestions are proposed, including strengthening communication training between doctors and patients, improving service attitude, optimizing medical service processes, and paying special attention to and improving departments with high complaint rates in order to improve patient satisfaction and overall hospital medical quality.
