基于360度反馈评价法和犹豫模糊集理论的合理用药评价模型建立
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摘要
目的:建立全方位、多角度的医疗机构合理用药评价模型,为提高医疗机构的合理用药水平提供方法支持。方法:基于360度反馈评价法,以同级医院、上级监管机构、患者为多角度评价主体,针对医疗机构不合理用药现象及影响因素,构建包含3个评价主体、6个一级指标及15个二级指标在内的合理用药评价指标体系;同时结合犹豫模糊集理论对评价主体给出的模糊、不确定性评价语言信息进行综合量化处理,通过犹豫模糊数得分函数公式计算被评价医疗机构合理用药的总评价得分,并根据该分值的高低判定医疗机构合理用药水平(总评价得分越高,则合理用药综合水平越高)。结果:建立了全方位、多角度的医疗机构合理用药评价模型,该模型根据基于360度反馈评价法构建的评价指标体系,确定了评价主体、评价指标权重,划分了指标评分等级,集结了各级指标的犹豫模糊数并对一级指标进行加权,最终计算获得医疗机构合理用药的总评价得分;通过算例演示证明该模型可行。结论:基于360度反馈评价法和犹豫模糊集理论建立的医疗机构合理用药评价模型能更加全面、有效地对医疗机构合理用药水平作出评价,有助于医疗机构针对性地规范和改进临床用药行为。
OBJECTIVE:To establish a comprehensive and multi-angle evaluation model for rational drug use in medical institutions,and to provide support for rational drug use in medical institutions. METHODS:Referring to the phenomenon of irrational drug use and its influential factors in medical institutions,rational drug use evaluation indicator system,which contained 3 evaluation subjects,6 first-level indicators and 15 second-level indicators,was established on the basis of 360-degree Feedback Method,with hospitals at the same level,superior regulation department and patient as subjects of multi-angle evaluation. At the same time,the linguistic information of vague and uncertain evaluation given by the evaluation subject was comprehensively quantified by Hesitant Fuzzy Sets Theory. The total evaluation score of rational drug use in the evaluated medical institutions was calculated by using the score function formula of hesitant fuzzy number;the level of rational drug use in medical institutions was determined according to the score(the higher the total score,the higher the comprehensive level of rational drug use). RESULTS:An all-round and multi-angle evaluation model of rational drug use in medical institutions was established. According to the evaluation index system based on 360-degree feedback evaluation method, the evaluation subject and weight of evaluation index were determined,the grade of evaluation index was divided,the hesitant fuzzy numbers of each index were gathered,and the first-level index was weighted. Finally,the total evaluation score of rational drug use in medical institutions was calculated;the examples were set to prove the feasibility of the model. CONCLUSIONS:The established evaluation model for rational drug use in medical institutions based on 360-degree Feedback Method and Hesitant Fuzzy Sets Theory can comprehensively and effectively evaluate the rational drug use in medical institutions,and contribute to standardizing and improving clinical drug use behavior in medical institutions.
OBJECTIVE:To establish a comprehensive and multi-angle evaluation model for rational drug use in medical institutions,and to provide support for rational drug use in medical institutions. METHODS:Referring to the phenomenon of irrational drug use and its influential factors in medical institutions,rational drug use evaluation indicator system,which contained 3 evaluation subjects,6 first-level indicators and 15 second-level indicators,was established on the basis of 360-degree Feedback Method,with hospitals at the same level,superior regulation department and patient as subjects of multi-angle evaluation. At the same time,the linguistic information of vague and uncertain evaluation given by the evaluation subject was comprehensively quantified by Hesitant Fuzzy Sets Theory. The total evaluation score of rational drug use in the evaluated medical institutions was calculated by using the score function formula of hesitant fuzzy number;the level of rational drug use in medical institutions was determined according to the score(the higher the total score,the higher the comprehensive level of rational drug use). RESULTS:An all-round and multi-angle evaluation model of rational drug use in medical institutions was established. According to the evaluation index system based on 360-degree feedback evaluation method, the evaluation subject and weight of evaluation index were determined,the grade of evaluation index was divided,the hesitant fuzzy numbers of each index were gathered,and the first-level index was weighted. Finally,the total evaluation score of rational drug use in medical institutions was calculated;the examples were set to prove the feasibility of the model. CONCLUSIONS:The established evaluation model for rational drug use in medical institutions based on 360-degree Feedback Method and Hesitant Fuzzy Sets Theory can comprehensively and effectively evaluate the rational drug use in medical institutions,and contribute to standardizing and improving clinical drug use behavior in medical institutions.
引文
[1]World Health Organization.The pursuit of responsible use of medicines:sharing and learning from country experiences[EB/OL].(2012-03)[2018-06-15].http://www.who.int/medicines/areas/rational_use/en/.
[2]KEOHAVONG B,SYHAKHANG L,SENGALOUNDE-TH S,et al.Rational use of drugs:prescribing and dispensing practices at public health facilities in Lao PDR[J].Pharmacoepidemiol Drug Saf,2010,15(5):344-347.
[3]ATIF M,SARWAR MR,AZEEM M,et al.Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur,Punjab,Pakistan[J].J Pharm Policy Pract,2016,9(7):A524.
[4]MAHMOOD A,ELNOUR AA,ALI AA,et al.Evaluation of rational use of medicines(RUM)in four government hospitals in UAE[J].Saudi Pharm J,2016,24(2):189-196.
[5]WANG H,LI NN,ZHU H,et al.Prescription pattern and its influencing factors in Chinese county hospitals:a retrospective cross-sectional study[J].PloS One,2013,8(5):e63225.
[6]ARAVAMUTHAN A,ARPUTHAVANAN M,SUBRAM-ANIAM K,et al.Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India[J].J Pharm Policy Pract,2017.DOI:10.1186/s40545-016-0074-6.
[7]DE COSTA A,BHARTIYA S,ELTAYB A,et al.Patterns of drug use in the public sector primary health centers of Bhopal district[J].Pharm World Sci,2008,30(5):584-589.
[8]NAYIR T,OKYAY RA,YESILYURT H,et al.Assessment of rational use of drugs and self-medication in Turkey:a pilot study from Elaz?g and its suburbs[J].Pak JPharm Sci,2016,29(4 Suppl):1429-1435.
[9]陈丽.我国企业运用360度绩效考核法的可行性探析[J].现代商业,2010(35):173.
[10]邢振江,江志宇,王燕.360度绩效考核法在公务员绩效考核中的应用[J].中国人力资源开发,2011(1):41-43.
[11]邓世清.企业绩效考核的主要方法比较研究[J].科技创新导报,2011(6):208、210.
[12]ZADEH LA.Fuzzy sets[J].Information and Control,1965,8(3):338-353.
[13]TORRA V.Hesitant fuzzy sets[J].Int J Intell Syst,2010,25(6):529-539.
[14]TORRA V,NARUKAWA Y.On hesitant fuzzy sets and decision[C]//IEEE International Conference on Fuzzy Systems,2009.DOI:10.1109/FUZZY.2009.5276884.
[15]XIA M,XU Z.Hesitant fuzzy information aggregation in decision making[J].Int J Approx Reasoning,2011,52(3):395-407.
[16]彭张林,张爱萍,王素凤,等.综合评价指标体系的设计原则与构建流程[J].科研管理,2017(S1):209-215.
[17]李海涛,李士雪,夏慧,等.利用药物经济学评价指导临床合理用药的探讨[J].中国医药管理,2007,27(3):45-47.
[18]魏波,魏海浪.2009-2012年我院儿科门诊不合理用药情况研究[J].临床合理用药杂志,2013,6(3):7-8.
[19]杨淑桂,张相林,李淑芳.我院基本药物不合理用药处方分析[J].中国药房,2013,24(24):2268-2270.
[20]徐文彤,林海,皮瑶.我院不合理用药监测与分析[J].中国药房,2012,23(4):338-341.
[21]武星,卢红文.PIVAS不合理用药分析及干预[J].临床合理用药杂志,2014,7(12A):61-62.
[22]何抒帆,陈奇.PIVAS不合理化疗用药分析与干预[J].广东药学学报,2012,28(6):657-660.
[23]杜鸣.我院2011年静脉药物配置中心不合理用药回顾分析[J].临床合理用药杂志,2012,5(14):140-142.
[24]李宏.《药品不良反应信息通报》通报的抗微生物药的不合理应用情况分析[J].中国药房,2012,23(26):2474-2476.
[25]李颖琼.国务院办公厅关于巩固完善基本药物制度和基层运行新机制的意见[J].中国药房,2013,24(16):71-76.
[26]国家卫生和计划生育委员会.《关于进一步加强抗菌药物临床应用管理工作的通知》解读[J].中国实用乡村医生杂志,2015,22(21):2.
[27]周绿林,张婷婷,王森.医疗服务质量与患者满意度关系研究[J].中国卫生事业管理,2014,31(1):14-17.
[28]XU Z,XIA M.Hesitant fuzzy entropy and cross-entropy and their use in multiattribute decision-making[J].Int J Intell Syst,2012,27(9):799-822.
[2]KEOHAVONG B,SYHAKHANG L,SENGALOUNDE-TH S,et al.Rational use of drugs:prescribing and dispensing practices at public health facilities in Lao PDR[J].Pharmacoepidemiol Drug Saf,2010,15(5):344-347.
[3]ATIF M,SARWAR MR,AZEEM M,et al.Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur,Punjab,Pakistan[J].J Pharm Policy Pract,2016,9(7):A524.
[4]MAHMOOD A,ELNOUR AA,ALI AA,et al.Evaluation of rational use of medicines(RUM)in four government hospitals in UAE[J].Saudi Pharm J,2016,24(2):189-196.
[5]WANG H,LI NN,ZHU H,et al.Prescription pattern and its influencing factors in Chinese county hospitals:a retrospective cross-sectional study[J].PloS One,2013,8(5):e63225.
[6]ARAVAMUTHAN A,ARPUTHAVANAN M,SUBRAM-ANIAM K,et al.Assessment of current prescribing practices using World Health Organization core drug use and complementary indicators in selected rural community pharmacies in Southern India[J].J Pharm Policy Pract,2017.DOI:10.1186/s40545-016-0074-6.
[7]DE COSTA A,BHARTIYA S,ELTAYB A,et al.Patterns of drug use in the public sector primary health centers of Bhopal district[J].Pharm World Sci,2008,30(5):584-589.
[8]NAYIR T,OKYAY RA,YESILYURT H,et al.Assessment of rational use of drugs and self-medication in Turkey:a pilot study from Elaz?g and its suburbs[J].Pak JPharm Sci,2016,29(4 Suppl):1429-1435.
[9]陈丽.我国企业运用360度绩效考核法的可行性探析[J].现代商业,2010(35):173.
[10]邢振江,江志宇,王燕.360度绩效考核法在公务员绩效考核中的应用[J].中国人力资源开发,2011(1):41-43.
[11]邓世清.企业绩效考核的主要方法比较研究[J].科技创新导报,2011(6):208、210.
[12]ZADEH LA.Fuzzy sets[J].Information and Control,1965,8(3):338-353.
[13]TORRA V.Hesitant fuzzy sets[J].Int J Intell Syst,2010,25(6):529-539.
[14]TORRA V,NARUKAWA Y.On hesitant fuzzy sets and decision[C]//IEEE International Conference on Fuzzy Systems,2009.DOI:10.1109/FUZZY.2009.5276884.
[15]XIA M,XU Z.Hesitant fuzzy information aggregation in decision making[J].Int J Approx Reasoning,2011,52(3):395-407.
[16]彭张林,张爱萍,王素凤,等.综合评价指标体系的设计原则与构建流程[J].科研管理,2017(S1):209-215.
[17]李海涛,李士雪,夏慧,等.利用药物经济学评价指导临床合理用药的探讨[J].中国医药管理,2007,27(3):45-47.
[18]魏波,魏海浪.2009-2012年我院儿科门诊不合理用药情况研究[J].临床合理用药杂志,2013,6(3):7-8.
[19]杨淑桂,张相林,李淑芳.我院基本药物不合理用药处方分析[J].中国药房,2013,24(24):2268-2270.
[20]徐文彤,林海,皮瑶.我院不合理用药监测与分析[J].中国药房,2012,23(4):338-341.
[21]武星,卢红文.PIVAS不合理用药分析及干预[J].临床合理用药杂志,2014,7(12A):61-62.
[22]何抒帆,陈奇.PIVAS不合理化疗用药分析与干预[J].广东药学学报,2012,28(6):657-660.
[23]杜鸣.我院2011年静脉药物配置中心不合理用药回顾分析[J].临床合理用药杂志,2012,5(14):140-142.
[24]李宏.《药品不良反应信息通报》通报的抗微生物药的不合理应用情况分析[J].中国药房,2012,23(26):2474-2476.
[25]李颖琼.国务院办公厅关于巩固完善基本药物制度和基层运行新机制的意见[J].中国药房,2013,24(16):71-76.
[26]国家卫生和计划生育委员会.《关于进一步加强抗菌药物临床应用管理工作的通知》解读[J].中国实用乡村医生杂志,2015,22(21):2.
[27]周绿林,张婷婷,王森.医疗服务质量与患者满意度关系研究[J].中国卫生事业管理,2014,31(1):14-17.
[28]XU Z,XIA M.Hesitant fuzzy entropy and cross-entropy and their use in multiattribute decision-making[J].Int J Intell Syst,2012,27(9):799-822.