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Objective:To study the changes of patient-related costs and the use of stents and other consumables before and after the centralized procurement of coronary stents.Methods:The inpatient medical insurance settlement case data of 1,973 patients with coronary stent implantation admitted to Daping Hospital of Army Medical University from December 2019 to October 2021 were selected.Among them,the data of 1,317 cases of percutaneous cardiovascular surgery and coronary stent implantation with serious or complications and accompanying disease group were slected according to disease diagnosis related groups(DRG),which were divided into the pre-centralized procurement group(667 cases)and the post-centralized procurement group(650 cases)according to the centralized procurement of coronary stents before and after.The costs of patients'medical consumables with the consumption of patients'medical consumables and the impact of the use of consumables such as coronary stents on the costs of medical consumables were compared.Results:There was no significant statistical difference in the hospitalization days and the average number of stents used in patients undergoing percutaneous cardiovascular procedures and coronary stent implantation with centralized procurement of coronary stents.There was a statistically significant difference in the total diagnosis and treatment cost,medical consumables cost,medicines and consumables cost and medicines cost between the pre-centralized procurement group and the post-centralized procurement group(Z=-22.316,-23.546,-22.917,-5.724,P<0.05).The cost of stents[16 260(13 300,32 272)yuan],the number of catheter guidewire balloon sheaths consumables[5(4,8)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[8 719(5 805,15 372)yuan]in the pre-collection group were collected.There were statistically significant differences in the stent cost[1 059(590,1 770)yuan],the number of catheter guidewire balloon sheaths consumables[8(7,12)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[5 708(3 392,12 871)yuan]between the two groups(Z=-30.452,16.582,-7.670,P<0.05).There was a statistical correlation between the cost of coronary stents and the cost of catheter guidewire balloon sheaths before and after centralized volume procurement on the cost of medical consumables for patients(r=0.903,0.473,0.785,0.953,P<0.05).The correlation coefficient between the cost of coronary stents and the cost of medical consumables for patients in the post-centralized procurement group decreased compared to the pre-centralized procurement group,the correlation coefficient between the cost of catheter guidewire balloon sheath and the cost of medical consumables for patients increased.Conclusion:The centralized procurement of coronary stents has a significant cost control effect on patients in the disease groups,and affects the cost structure of medical consumables.Combined with DRG reform,it can continuously improve the standardization and scientificity of clinical use of medical consumables.
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Objective:To explore the research hotspots and effective promotion paths of post market surveillance and supervise of medical consumables with non-active medical devices.Methods:Data mining methods were used to collect related journal literatures and documents from the websites of China regulatory institutions and the China National Knowledge Infrastructure(CNKI),order sub item data of medical device adverse event reports,extract the MeSH element words of literatures and documents,perform bibliometric analysis and visual display.Results:The number of medical devices adverse event reports in China has been increasing year by year,reaching 694 866 in 2022,in the four statistical years from 2019 to 2022,the number of reports on non-active medical devices and IVD reagents also showed a parallel increasing trend,accounting for about 65.00% of the total number of adverse event reports on medical devices in the year.The bibliometric analysis of journal literature shows that research in this field has received varying degrees of participation from regulatory institutions,universities,medical institutions,and enterprises.Regulatory institutions have contributed 46 articles,accounting for 56.79% of the total number of articles,followed by 28 articles from universities.The co-occurrence analysis shows that hot topic is focused in 5 clusters:quality management,risk management,international experiences discussion and adverse event surveillance and re-evaluation and real-world research.China regulatory institutions attach great importance to post market surveillance and supervise,and have issued more than 20 relevant documents since 2006,focusing on specific topics and gradually deepening around safety and effectiveness.Conclusion:The post market surveillance and supervise of medical devices,especially medical consumables based on non-active medical devices,need to be promoted synchronously in three dimensions:regulatory institutions,medical institutions,and enterprises.Universities,research institutes,and industry organizations should work in coordinating to strengthen the collection,identification,and active surveillance of risk signals based on adverse event surveillance,safety evaluation based on risk management,and conducting real-world research,research and develop risk control and corrective and preventive measures.
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Objective:To establish a data middle platform for data assets of medical consumables,to provide open data sharing services for the management and application development of medical consumables,and to reduce the risk of data silos.Methods:Based on the data resource management model of data middle platform,data aggregation and big data development technology were adopted to realize data loading,integration and quality control between multi-business systems.A hierarchical data management system was established through data warehousing and object modeling methods.A data assets management system was built based on the data governance process to provide functions of data standards and data lineage maintenance,metadata management,data permission control,and data lifecycle management for medical consumables data resources.A microservice architecture was adopted to provide functions such as data service generation,registration,discovery and subscription for medical consumables management.The front-end data application development workload of business data and application operation time before and after the application of data middle platform service of medical consumables were compared in the South Campus of the Fifth Medical Center of PLA General Hospital from March to May 2020.Results:The medical consumables data middle platform realized the connection between the front-end application interface and the back-end data service,and provided synchronized data services for the front-end pages.The workload of front-end data application development for data middle platform data services decreased from 64 person-months of traditional data warehouses to 6 person-months,and the operation time for testing applications reduced from 430 minutes to 16 minutes.Conclusion:The data middle platform management mode is helpful to improve the information management capabilities and efficiency of medical consumables management,and provides reference for the digital transformation of medical consumable management.
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In the context of high-quality development in medical institutions, the supply-processing-distribution(SPD) management mode has gradually been widely applied. The authors described in detail the procurement, supply, inventory, distribution, and settlement management of medical consumables and in vitro diagnostic reagents in a certain hospital under the SPD mode. It was found that SPD was conducive to strengthening the supervision of medical consumables and in vitro diagnostic reagents in the hospital, ensuring quality and safety of use, reducing hospital operating costs, and improving hospital′s competitiveness. However, attention should be paid to preventing data security risks, strengthening operational management, and improving the cost-benefit analysis of in vitro diagnostic reagents.
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Objective To explore the effect on management of high value dental implantable consumables based on SPD model(supply-processing-distribution),therefore to establish a new management model for clinical pratice.Methods Hstorical non-concurrent controlled pretest-posttest design method was used in the study.The conventional management mode was applied in the control group for high-value dental implantable medical consumables between June and August 2022,and the SPD mode was employed in the trial group for high-value dental implantable medical consumables between October and December 2022.Before and after the implementation of SPD mode,the time of storage for high-value dental implant consumables,the time of daily postoperative register of consumables,the time of monthly consumables usage summary and the accuracy of charging items for primary bone implanted high-value dental consumables in the two groups were collected.Results A comparison of the management time of various consumables between the two groups showed statistically significant difference(P<0.001).Also,the storage time of high-value consumables in the trial group,the time of daily postoperative register of consumables and the time of monthly consumables usage summary were all less than those in the control group.The accuracy of the two groups was compared and the trial group was,higher than that of the control group(P<0.01),with statistically significant difference.Conclusion Management of high value medical consumables for dental implants based on SPD can ensure the safety in high value dental consumables and improve the working efficiency.
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The medical insurance medical consumables were introuduced in terms of coding and standard implementation.A whole-process supervision method based on the codes of medical insurance medical consumbles was put forward to carry out catalog classification and selection,demand reporting and planned procurement,acceptance and storage management and use supervision,conditions monitoring and analysis and etc.The efficiency of various departments of clinical insitutitions was enhanced effectively for supervising clinical application of medical consumables,and the whole-process management of medical consumables was standardized.References were provided for the precision management of medical consumables.[Chinese Medical Equipment Journal,2023,44(9):74-77]
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The current situation and problems of the consumables management in the ward unit of the emergency medical team were introduced.An intelligent consumables management belt was prepared based on two-dimensional code technology to solve the problems of the ward unit in consumables positioning,storage,inconvenient access,management process and support cost,which enhanced the efficacy of the emergency medical team greatly.
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The problems during medical consumables selection were analyzed with a fishbone diagram.The selection process was optimized based on PDCA cycle,and a standardized selection plan for medical consumables was formulated by combining the practical experience of hospital management,and the practicability and feasibility of the selection plan was verified.References were provided for medical institutions to select cost-effective medical consumables.
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Purpose/Significance In order to coordinate and promote the high-quality development of hospitals,medical consuma-bles refined supply processing distribution(SPD)based on operational data repository(ODR)is built.Through ODR,cross-depart-mental data collaboration is realized,and an intelligent operation management system for medical consumables is established.Method/Process Through informatization design and application scenario analysis,the intelligent operation management architecture and service mode of consumables are constructed with data governance as the starting point.Result/Conclusion The intelligent operation system of medical consumables based on ODR will consolidate the fine management results under the SPD mode,strengthen hospital risk control,and further improve the scientific and standardized level of hospital operation and management.
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Objective:To construct a value evaluation framework for high-value medical consumables,providing a guidance for medical insurance access and hospital access management scenarios in China.Methods:It conducted literature review,qualitative in-terviews and quantitative surveys.A total of 12 experts were invited for qualitative interviews,while 100 experts from four fields of health technology assessment,medical insurance,hospital management,and clinical practice participated in the quantitative survey.Through those process,it generated the composition of the value framework and the scoring of each item.Differences in ratings be-tween different scenarios and experts were analyzed through chi-square tests.The recommendation level for each item was graded.Re-sults:A comprehensive value evaluation framework for high-value medical consumables was established,which included 6 core dimen-sions,comprised 16 items for secondary dimensions and 50 items for tertiary dimensions.It showed significant differences between the medical insurance access and hospital access scenarios,as well as among different fields of experts in the same scenario.furthermore,grading the items in two scenarios.The medical insurance access scenario had 8 highly recommended items,and the hospital access scenario had 24 highly recommended items.Conclusion:Value evaluation should encourage multi-dimensional assessments and inter-disciplinary participation,continually improving the management of high-value medical consumables in medical insurance and hospital access.
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To change the traditional hospital medical supplies rough management mode, the hospitals build an information material management platform which combines suppliers and hospitals, information systems and smart devices, clinical needs and professional operations innovatively. Finally, a lean management system called SPD is formed under the guidance of supply chain integration and supported by supply chain management theory and information technology. It has realized the whole process of consumables circulation information traceability, intelligent service in the hospital, and refined management of consumption settlement. The application of SPD in hospitals effectively improves the informatization level and overall operation efficiency of medical consumables management which is an important part of hospital information construction.
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Administration hospitalière , Hôpitaux , AllogreffesRésumé
OBJECTIVE@#To discuss how to implement and promote the lean management of medical devices life cycle through establishing medical device UDI.@*METHODS@#Discuss the application of UDI on medical consumables lean management by relying on the construction of medical device UDI system in our country, and summarize the pilot experience of implanted medical devices in Shanghai.@*RESULTS@#Improve the application value of UDI in medical device Internet of Things through analyzing the present situation of implanted medical device and further strengthen the UDI application standardization.@*CONCLUSIONS@#Form the interconnection and mutual recognition during medical device life cycle and reduce the input of product cost and resource consumption in our country through establishing a more standardized and effective UDI circulation system.
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Chine , Internet , Internet des objets , Prothèses et implantsRésumé
Objective:To establish a multicriteria value assessment index system, so as to provide reference for hospitals access of medical consumables.Methods:In May 2021, based on the paper previously published, the expert consultation method was used to finalize the index structure, index definitions and scoring standards, along with an importance grading of the indexes. And the index weights were calculated using the analytical hierarchy process. Then the assessment scale was designed by way of multi-criteria decision analysis and mini-HTA. With the linear cutting stapler used as an example, six clinicians, three hospital administrators and the medical consumable management committee made an empirical analysis and evaluation of its general value. The coefficient of variation and Kendall coefficient of concordance were used to test the consistency of clinicians′ scores.Results:Three rounds of expert consultations finalized an index structure with 4 level-1 and 11 level-2 indexes, and on such basis a multicriteria value assessment index system for hospital access of medical consumables was established. This system comprised the clinician evaluation scale, hospital administrator evaluation scale and medical consumable management committee evaluation scale. The first two of which were used for preliminary screening, and the third for a full-scale, detailed and quantitative evaluation of those selected, hence a decision was made in the end according to the weighted sum of the three scales. This scale system was used to evaluate a foreign brand and a domestic brand of linear cutting staplers, while the former and the latter scored 90.5 and 75.4 respectively. Statistical analysis of the six clinicians found a coefficient of variation CV<0.25, and the Kendall coefficient of concordance W=0.833, proving good consistency of the evaluation criteria and results. Conclusions:The multicriteria value assessment index system proves highly scientific, comprehensive and practicable, serving a good reference for hospitals to build their value-based mechanism to select medical consumables.
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OBJECTIVE To provid e reference and sugge stions for improving the volume-based procurement of drugs and medical consumables （hereinafter referred to as “consumables”）in China. METHODS The relevant policy documents of centralized volume-based procurement of drugs and consumables published from November 2018 to November 2021 were retrieved ； the implementation status and problems of centralized volume-based procurement of drugs and consumables in China were analyzed by using the policy analysis method and referring to relevant research literatures. RESULTS & CONCLUSIONS National health department and healthcare security administration guaranted the rational use of selected products in medical institutions through incentive and supervision measures ；healthcare security administration should optimize the way of medical insurance payment ， promote the medical institutions to control the fees by themselves ，and conduct the credit evaluation of bidding and procurement ； medical products administration should evaluate the consistency of drugs and supervise the quality of selected products. With the normalization of centralized volume-based procurement of drugs and consumables organized by the state and trans-regional alliance ， the drug varieties and dosage forms included in centralized procurement were increasingly in line with the demand of Chinese pharmaceutical market. The price of most selected drugs decreased by more than 50％，and the decrease of consumables was significantly higher than that of drugs. The selected enterprises were mainly domestic generic drug enterprises ，and domestic consumables had gradually become the competitors and substitute of imported consumables. However ，there were still some problems such as repeated bidding and procurement in various alliances and provinces （autonomous regions and municipalities ）， unclear construction of compensation mechanism in medical institutions ，inconsistent bidding and procurement rules and quality evaluation standards for consumables ，low localization rate of some consumables ，low innovation level and profitability of pharmaceutical enterprises and consumables manufacturers. Local centralized volume-based procurement should be encouraged ，and the bidding and procurement rules and quality evaluation standards of “one product ，one policy ”should be gradually established. Great importance should be paid to the construction of compensation mechanism of medical institutions ，standardize zhangqiuyu739632@126.com the dynamic adjustment of medical serv ice prices ；pharma- ceutical enterprises and consumables manufacturers should increase research and development investment to transform into innovative and diversified enterprises ，so as to improve the competitiveness of domestic drugs and consumables.
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The fixed number package management of medical consumables is an important content of SPD management mode. In the process of medical low-value consumables management, hospitals are generally faced with the problems of frequent access and low matching between push quantity and actual use quantity, resulting in complicated access operations of medical staff, shortage or hoarding of consumables and so on. In order to reduce the times of taking and using consumables and improve the comfort of medical staff, the authors dynamically adjusted the content and push quantity of fixed number packages according to the historical use data. The results showed that the adjusted fixed number setting could significantly reduce the average daily access times of medical staff, and reduce the probability of out of stock and hoarding.
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With the deepening of China′s healthcare reform, cost control of medical consumables has become an important means to alleviate the problem of " high medical cost" . Through analysis of the difficulties of medical consumables cost control and mechanism loopholes in such control, the authors proposed a whole-process control practice, in terms of assessment, procurement, use, supervision, assessment and evaluation, and recommend on formulating whole-process cost control measures at both government and hospital levels.
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Objective: To compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy. Methods: The patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups ( n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared. Results: There was no significant difference in gender, age, and disease classification between the two groups ( P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling ( t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition ( t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased ( P0.05). Conclusion: The total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.
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Objective To analyze the characteristics of “Mission Harmony” overseas medical services and medical consumable requisitions, so as to provide reasonable and scientific advice for preparing future “Mission Harmony”overseas medical consumables and to scientifically and reasonably design the proportions of the medical consumable for each department. Methods A retrospective analysis was made on the person times of medical services, medical consumable requisitions and distribution proportion of medical consumable for each department based on “Mission Harmony-2017” overseas medical services in eight countries and “Mission Harmony-2018” overseas medical services at 18 service sites in 10 countries. Results A total of 110 983 patients received diagnosis and treatment, 587 patients received surgical treatment, and 454 patients were hospitalized during the two missions. Department deployment before departure of the hospital ship was the peak period of medical consumable requisitions (43.80%, 241 543/551 510). The basic medical consumables were mainly applied during the overseas medical services (49.72%, 274 225/551 510). Specialized medical consumables were mainly applied during the department deployment period (11.43%, 63 046/551 510). The medical consumables were mainly applied by the General Department of the Outpatient Department (42.39%, 233 811/551 510), Operation Room (22.99%, 126 784/551 510), and the Ward (9.67%, 53 319/551 510), while Imaging Department was the main auxiliary department to apply (4.19%, 23 085/551 510). During the periods of department deployment and overseas medical services, there were significant differences in basic medical consumables and specialized medical consumables in the General Department, Stomatology Department, Ophthalmology Department, Gynecology Department, Laboratory Department, Special Examination Room, Imaging Department, Sterilization and Supply Department, Operation Room, Ward, and others (all P<0.01). During the department deployment period, the General Department, Gynecology Department, Laboratory Department, Special Examination Room, Operation Room, Ward, and others mainly applied for basic medical consumables, while Stomatology Department, Ophthalmology Department, Imaging Department and Sterilization and Supply Department mainly applied for specialized medical consumables. During the period of overseas medical services, the General Department, Stomatology Department, Ophthalmology Department, Gynecology Department, Laboratory Department, Special Examination Room, Sterilization and Supply department, Operation Room, Ward, and others mainly applied for basic medical consumables, while the Imaging Department mainly applied for specialized medical consumables. Conclusion Different departments have different requisitions on medical consumables at different task stages. It is necessary to strengthen the management of consumables and improve the pertinence of requisition and distribution of consumables. The consumption and distribution proportions of medical consumables in each department can provide reference for the preparation, requisition and distribution for future tasks.
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With the continuous improvement of the difficulty of surgery, we need to investigate and analyze the current situation, to understand the structure and related attributes of medical consumables. Rely on the information construction of medical consumables; Improve the supervision method and further improve the refined management effect; Establish multi-modal procurement management; Improve management methods; Maximize the benefits of transformation structure and study the trace management of medical consumables in the key areas of the hospital's full life process at the same time. Provide data decision-making services for hospitals through the early warning management of medical consumables based on clinical quality management, and use tools such as HB-HTA to further construct a reasonable evaluation system for medical consumables.
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Équipement et fournitures hospitaliers , Hôpitaux , Gestion des équipements et fournitures hospitaliersRésumé
The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.