基于一体化托管模式与TOPSIS法的县级医院病案管理质量提升效果评价OA

Objective This study aims to evaluate the effectiveness of an integrated trusteeship model implemented by a provincial tertiary hospital.Methods A county hospital in Henan Province was selected as the study site.Monthly data on med-ical record management were collected for 9 months before trusteeship(January-September 2023)and 15 months after trusteeship(October 2023-December 2024).An evaluation system comprising 24 indicators was constructed across four dimensions:timeli-ness of medical record documentation,completeness rate of diagnostic and therapeutic behavior documentation,compliance rate of diagnosis and treatment behavior records,and medical documentation archiving quality.The entropy weight-TOPSIS method was used for comprehensive evaluation,combined with an independent samples t-test and contribution analysis for verification and in-depth interpretation.Results The comprehensive evaluation score for medical record management significantly increased from 0.432±0.103 before trusteeship to 0.531±0.095 after trusteeship(P=0.026).Contribution analysis indicates that the medi-cal record archiving quality dimension(contribution 50.512％)and the dimension of diagnostic and therapeutic behavior docu-mentation completeness(contribution 47.745％)were the main contributors to quality improvement.Specifically,significant im-provements(P＜0.05)were observed in indicators such as the accuracy rates of principal diagnosis documentation and coding,the accuracy rate of principal procedure documentation and coding,the archiving rate of discharged medical records archiving,the compliance rate of CT/MRI examination records,and the completeness rate of surgery-related records.However,no significant changes were found in the indicators of the timeliness of medical record documentation dimension before and after trusteeship.Conclusion The study demonstrates that the integrated trusteeship model can effectively enhance the quality of medical record management in county hospitals,achieving notable results particularly in the connotation of medical record archiving and the docu-mentation of key diagnosis and treatment behaviors.It provides empirical evidence and practical reference for optimizing the medical record management assistance mechanism for county hospitals under the hierarchical diagnosis and treatment system in China.