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Construction of Medical Quality Control Indicators System for Chinese Plastic and Aesthetic Major
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摘要:目的
建立中国整形美容专业医疗质量控制指标体系，为我国整形美容专业医疗质量控制工作奠定基础。
方法2023年2月，整形美容专业国家级质控中心成立工作小组，以“结构-过程-结果”质控理论为指导，借鉴其他专业相关指标，通过查阅文献、会议讨论及整合质控专家意见，拟定整形美容专业医疗质量控制指标，并通过德尔菲专家函询的方式最终确立整形美容专业医疗质量控制指标体系。
结果共实施两轮专家函询，问卷回收率均为100%，专家权威系数分别为0.854和0.857，第二轮函询一级指标的专家协调系数为0.387、二级指标的专家协调系数为0.425(P＜0.01)，最终确立包含3项一级指标和9项二级指标的整形美容专业医疗质量控制指标体系。
结论本研究构建的中国整形美容专业医疗质量控制指标体系具有一定的科学性和合理性，为我国整形美容专业医疗质量控制工作提供了借鉴和参考，指标体系需在实践应用中进一步改进和完善。
Abstract:ObjectiveTo construct a quality control indicators system for Chinese plastic and aesthetic major and lay foundation for medical quality control.
MethodsNational Quality Control Center of Plastic and Aesthetic Major established a working group in February 2023. Guided by the "structure-process-outcome" theory, the working group formulated medical quality control indicators for Plastic and Aesthetic major by learning from relevant indicators of other majors, reviewing literature, discussing in meetings, and combining opinions from quality control experts. The quality control indicators system was finally established by Delphi expert consultation.
ResultsDelphi survey was 100% of 2 rounds. The authorities of 2 rounds of expert consultation were 0.854 and 0.857. The harmonious coefficients were 0.387 of primary indicators and 0.425 of secondary indicators(P < 0.01). The finalized indicators system includes 3 primary indicators and 9 secondary indicators.
ConclusionsThe quality control indicators system established in this study for Plastic and Aesthetic major in China has a certain degree of scientificity and rationality, which offers reference for medical quality control of Plastic and Aesthetic major in China. However, this system should be improved and ameliorated in practical application.
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Keywords:
- plastic and aesthetic /
- medical quality control /
- indicators system
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作者贡献：张明子负责指标搜集、问卷设计、论文撰写及修改；斯楼斌负责指标搜集及问卷设计；黄久佐、俞楠泽、郑姣洁、陈洁负责数据整理及分析；王晓军、龙笑、熊伟负责项目指导。利益冲突：所有作者均声明不存在利益冲突
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表 1 函询专家的基本特征(n=23)
Table 1 Experts' basic characteristics(n=23)
类别 数值[n(%)] 性别 男 20(86.96) 女 3(13.04) 年龄(岁) 35~45 1(4.35) 46~55 3(13.04) 56~65 17(73.91) ＞65 2(8.70) 职称 正高 23(100) 文化程度 博士学位 23(100) 工作年限(年) 15~20 1(4.35) ＞20 22(95.65) 
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表 2 两轮函询专家权威程度
Table 2 Experts' authority level of two rounds
指标 第一轮 第二轮 专家评分系数 专家熟悉程度系数 专家权威系数 专家评分系数 专家熟悉程度系数 专家权威系数 一级指标 0.774 0.957 0.865 0.774 0.930 0.852 二级指标 0.748 0.939 0.843 0.774 0.948 0.861 均值 0.761 0.948 0.854 0.774 0.939 0.857
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表 3 两轮函询专家协调程度
Table 3 Experts' coordination level of two rounds
指标 第一轮 第二轮 W χ2 P W χ2 P 一级指标 0.387 8.909 0.003 0.387 8.909 0.003 二级指标 0.466 10.714 0.001 0.425 9.783 0.002
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表 4 整形美容专业医疗质量控制指标体系
Table 4 Medical quality control index system for plastic and aesthetic major
一级指标 二级指标 结构指标 电子病历系统应用率 过程指标 整形美容手术Ⅰ类切口围术期预防性抗生素使用率 皮瓣血管危象早期识别率 结果指标 整形美容手术切口甲级愈合率 假体植入术早期手术部位感染发生率 毛发移植术后早期毛囊炎发生率 重睑术后二次手术率 阴道紧缩术后直肠损伤发生率 皮瓣血管危象发生率
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表 5 皮瓣血管危象的临床表现及判断标准
Table 5 Clinical manifestation and diagnostic criteria of skin flap vascular crisis
观察指标 动脉危象 静脉危象 皮瓣颜色 苍白 紫黑 皮瓣温度 与正常组织温差＞2 ℃ 与正常组织温差＞2 ℃ 组织肿胀 不明显 肿胀加深 毛细血管充盈时间 时间＞3 s 时间＜1 s 针刺试验 少 迅速流出淤血
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