区域性大型医用设备优化配置研究

【作者】 于弘；

【导师】 伍瑞昌；

【作者基本信息】 中国人民解放军军事医学科学院 ， 卫生防护防疫技术与装备， 2012， 博士

【摘要】 大型医用设备是卫生资源的重要组成部分，是各级医疗机构开展医疗工作、提高医疗水平重要辅助手段，一定程度上代表着医疗机构的技术水平。随着我国经济社会和医疗科技水平的快速发展，大型医用设备大量引进，卫生行政管理机构制定配置规划的方法却相对滞后，区域内设备超负荷运转或重复购置，存在一定的医疗安全隐患，并造成了医疗资源的严重浪费。对大型医用设备配置的微观和宏观分析，合理优化配置大型医用设备成为现代医院管理的一个重要课题。本课题以国家和地区大型医用设备的配置规划为参照，以大型医用设备的配置过程为主线，将大型医用设备的配置过程分为现状评价、需求预测、单个医疗机构的设备配置和区域设备配置四部分，对大型医用设备配置理论与方法进行分析研究，并结合乙类大型医用设备布局规划实例，将相关的理论研究成果与实际情况相比较进行验证，从而为大型医用设备的优化配置提供理论与方法支持。本文的主要研究工作和结论如下：（1）分析了大型医用设备的控制机制。从国家和地区大型医用设备的相关管理政策入手，选定甲、乙两类大型医用设备中的乙类大型医用设备（以下简称大型医用设备或设备）为研究对象，按照国家对乙类大型医用设备规划制定权限，选定直辖市为研究区域，根据区域大型医用设备配置规划的指导思想，确定与区域经济、功能定位等协调的配置基本原则，明确了临床机构配置大型医用设备必须具备的基本条件，为下一步的研究明确了研究对象和研究主要方向。（2）从设备配置的公平性、经济性、使用效率和配套性，对设备配置现状进行了综合评价。从公平的角度，依照公平理论和健康公平的理念，采用Lorenz曲线、基尼系数和Theil-L指数分析了大型医用设备配置的公平性；从经济学的角度，按照客观合理性、经济性和实用性的原则，根据设备折旧、成本、收益等指标，选用静态投资回收期、投资利润率、内部收益率、净现值的计算方法，分析了大型医用设备的经济现状；从设备使用效率的角度，依据年检查人次、日均检查人次、人均占机时间、年均开机天数和日均开机时间等设备使用统计数据，分析了大型医用设备使用效率现状。按照客观性、独立性、可比性等指标选取准则，以设备配置的公平、经济和使用效率、医院设施人员配套性为第一层指标，建立了大型医用设备配置评价指标体系，概述了层次分析法、模糊综合评价等常用评价方法的优缺点，根据评价指标体系中指标数量较多、多为定量指标的特点，采用主成分分析法对现状进行了综合评价，通过综合评价发现存在的问题，为下一步的设备配置提供参考。（3）对区域大型医用设备的检查需求进行了预测。从地区社会经济和医院自身两个方面总结了大型医用设备检查的影响因素，介绍了需求预测的步骤、原则和常用方法，决定采用自回归分析法对各影响因素进行预测，运用影响因素的历史数据和预测结果，采用多元线性回归法进行了大型医用设备检查量的预测，同时采用指数平滑法进行了设备检查量的预测，为了增加预测的可信度，将两种方法预测结果的平均值作为最终的设备检查需求。参照相关研究中确定的乙类大型医用设备合理年检查人次，对大型医用设备的基底配置数量进行了粗略估计。（4）从微观层面对单个医疗机构大型医用设备进行了优化配置研究。分析了患者排队检查的过程和排队系统的特征，确定了检查的排队规则，以某医院的MRI检查为例，根据不同部位检查时间统计数据得出了设备平均检查时间，分单个队列和两个队列两种情况，采用M/M/1模型和M/M/C模型，计算得出了不同排队方式下排队系统的指标，结果显示，单个队列的各个指标优于两个队列的情况，并运用SIMIO仿真工具进行了排队系统的仿真，验证了计算结果的可信性，讨论了不同到达率对排队系统指标的影响。简要探讨了成立MRI区域检治中心对排队系统的影响，证明成立检治中心能够提高设备的工作效率，缩短患者检查等待时间。（5）从宏观角度建立了区域大型医用设备优化配置模型。以提高配置的公平性和覆盖人口最大化为目标，以配置的成本等为约束条件，建立了区域大型医用设备最大覆盖优化配置模型，采用主观赋权法将多目标优化问题转化为单目标优化问题来求解，并对模型中最短路径、患者选择该设备的概率、设备价格、检查需求和设备的最大覆盖距离参数的确定进行了探讨。以提高配置的公平性和设备效益，降低配置成本为目标，以基尼系数和设备使用效率以及建设时序为约束条件，建立了区域大型医用设备时序优化配置模型，并选用遗传算法求解该问题。本文的主要创新点包括以下几点：（1）综合设备配置的公平性、经济性、设备使用效率和相关配套条件四个方面，建立大型医用设备配置现状评价指标体系，为跟踪研究大型医用设备规划后的使用情况提供了方法。（2）从微观层面，采用排队论的模型和模型，分析了单个医疗机构中设备的配置问题，得出了成立区域检治中心将降低患者检查的等待时间的结论，证明成立区域检治中心的必要性。（3）从宏观层面，以提高配置的公平性和覆盖人口最大化为目标，建立了区域大型医用设备最大覆盖优化配置模型；以提高配置的公平性和设备效益，降低配置成本为目标，建立了区域大型医用设备时序优化配置模型，为大型医用设备的区域规划提供了方法。更多还原

【Abstract】 Large medical equipment is a significant part of health resources, which is thematerial foundation and important auxiliary means at all levels of clinical institutions tocarry out medical work. It improves the level of medical treatment. With the developmentof our country Socioeconomic and medical science, a large number of large medicalequipment is introduced. However, the method of configuration planning which developedby health administrative agencies is lagging behind, and Decision-making with obviousblindness. The repeated purchase and low utilization rate of equipments result in a seriouswaste of medical resources in the region. Analysis large medical equipment configurationin the microscopic and the macroscopic, optimal allocate large medical equipment is animportant task in modern hospital management.This paper takes large medical equipment configuration planning of the countries andareas as reference, and the large medical equipment configuration process as the main line.The large medical equipment configuration process is divided into four parts. They arecurrent situation evaluation, demand forecasting, single medical configuration and areaequipment configuration. The theory and method of configuration of large medicalequipment are analyzed. Combined with the example of B-large medical equipmentconfiguration planning, the results of theoretical research are verified with the actualsituation. Theory and method supports optimal configuration of large medical equipmentare provided. The main research work and conclusion are as follows:(1)Control mechanism of large medical equipment is analyzed. From the relatedmanagement policies of the countries and regions of large medical equipment, SelectB-large medical equipment from A and B large medical equipment as the research object.In accordance with the state of B-large medical equipment planning permission, selectmunicipalities as the study area. According to the guiding ideology of the regionalconfiguration program of large medical equipment, identify the configuration principlesuch as coordination with region economy, function orientation, and so on. The basicconditions that clinical institution must have to configure large medical equipment areclear. Explicit object and research directions of study for future research.(2)From angle of equipment configuration fairness, economy and efficiency, thecomprehensive evaluation of the equipment status is carried out. In accordance with thetheory of fairness and equity in health concept, Lorenz curve, Gini coefficient and Theil-Lindex are used to of analysis the large medical equipment fair situation from the view offairness; In accordance with the principle of objective rationality, economic and practical, according to the equipment depreciation, cost, income and other indicators, Methods ofstatic investment payback period, the profit rate of investment, net present value, internalrate of return are chose to analysis the current economic situation of large medicalequipment from the angle of economics; From the efficiency angle, the use efficiencysituation of the large medical equipment are analyzed, based on statistical data such asYear inspection trips, daily inspection trips, per capita of machine time, the annual boottime, the average starting time. In accordance index selection criteria of objectivity,independence, comparability, the evaluation index system of configuration of largemedical equipment is established, which first layer index including equity, economic,efficiency and supporting of hospital facilities and staff. The advantages and disadvantagesof the commonly used evaluation methods are overviewed. The number of evaluationindexes is much, and most of which are quantitative indicators. Principal componentanalysis is used to evaluate status. Problems are found out through the comprehensiveevaluation, which provide reference for the next step of configuration.(3)The inspection requirements of large medical equipment in the region are predicted.The impact factor of large medical equipment inspection is summarized from two aspectswhich include the regional socio-economic and hospitals. The procedures, principles andcommon methods for demand prediction are introduced. Auto-regression analysis methodis chosen to predict each factor,The inspection amount of large medical equipment is predicted by multiple linearregression method which bases on the historical data and predict results. And exponentialsmoothing method is used to predict the amount of equipment checks. Regard the averageof predict results by two ways as final equipment inspection requirements in order toincrease the credibility of the prediction. A rough the number of the base configuration oflarge medical equipment is estimated which reference to reasonable check passengers of Blarge medical equipment one year in related studies.（4） Optimal configuration of large medical equipment is researched frommicrocosmic aspect. The patients’ inspection process in line and queuing systemcharacteristics are analyzed. The rule of inspection queue is determined. The article takesMRI examination of a hospital as an example. The average inspection time is calculatedaccording to the check time of different position. The queue is divided into single queueand a two queue. The M/M/1model and M/M/Cmodel are used to calculate queuesystem indexes of different queue. The result shows that indexes of two queues aresuperior to single queue. Simulation tool of SIMIO is used to simulate queue system. The credibility of the results is validated. The effect of different arrival rates to queuing systemis discussed. The effect of queuing system to establish check and treat center of MRI in thearea is discussed briefly. The result demonstrates that the formation of check and treatcenter can improve efficiency of the equipment. Waiting time of patient examination isshorten.（5）The model of optimal configuration of regional large medical equipment isestablished from the macro aspect. The maximum coverage optimization configurationmodel of regional large medical equipment is established. The goals of the model areimproving configuration fairness and maximizing covering population. The constraints ofthe model include the cost of configuration, and so on. The multi-objective optimizationproblem is transform into single objective optimization problem by subjective weightingmethod. The parameters of the model are discussed. They are the shortest path, theprobability of patients selecting the equipment, equipment prices, check of demand andequipment’s maximum coverage distance. Timing optimization model of area large scalemedical equipment is established. The goals of the model are improving the fairness andefficiency of equipment, and reducing distribution cost. The constraints of the modelinclude Gini coefficient, the efficiency of the equipment and the construction of timing.Genetic algorithm is adopted to solve the problem.The main innovations of this paper are as follows:(1) Status evaluation index system of configuration of large medical equipmentestablished which integrates four aspects. They are equipment configuration fairness,economic, the use efficiency and related conditions. Method is provided for tracking thesituation of large scale medical equipment planning. It provides convenience to find out theproblems existing in the original planning.(2)The equipment configuration in individual medical institutions is analyzed frommicrocosmic aspect, which using a M/M/1model and M/M/Cmodel in queuingtheory. The conclusion is drawn that the establishment of the regional check and treatcenter will reduce the waiting time of patient examination. It also proves that theestablishment of area check and treat central is necessity.(3)The model of optimal configuration of regional large medical equipment isestablished from the macro aspect in order to improving configuration fairness andmaximizing covering population. Timing optimization model of area large scale medicalequipment is established in order to improving the fairness and efficiency of equipment,and reducing distribution cost. It offers the method for large medical equipment planning.更多还原