phpinfo()
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PHP Version 5.6.40

System Windows NT iZ4r4b31413jd2Z 10.0 build 14393 (Windows Server 2016) AMD64
Build Date Jan 9 2019 15:05:36
Compiler MSVC11 (Visual C++ 2012)
Architecture x64
Configure Command cscript /nologo configure.js "--enable-snapshot-build" "--enable-debug-pack" "--disable-zts" "--disable-isapi" "--disable-nsapi" "--without-mssql" "--without-pdo-mssql" "--without-pi3web" "--with-pdo-oci=c:\php-sdk\oracle\x64\instantclient_12_1\sdk,shared" "--with-oci8-12c=c:\php-sdk\oracle\x64\instantclient_12_1\sdk,shared" "--with-enchant=shared" "--enable-object-out-dir=../obj/" "--enable-com-dotnet=shared" "--with-mcrypt=static" "--without-analyzer" "--with-pgo"
Server API CGI/FastCGI
Virtual Directory Support disabled
Configuration File (php.ini) Path C:\Windows
Loaded Configuration File D:\PHPWEB\php\php.ini
Scan this dir for additional .ini files (none)
Additional .ini files parsed (none)
PHP API 20131106
PHP Extension 20131226
Zend Extension 220131226
Zend Extension Build API220131226,NTS,VC11
PHP Extension Build API20131226,NTS,VC11
Debug Build no
Thread Safety disabled
Zend Signal Handling disabled
Zend Memory Manager enabled
Zend Multibyte Support provided by mbstring
IPv6 Support enabled
DTrace Support disabled
Registered PHP Streamsphp, file, glob, data, http, ftp, zip, compress.zlib, compress.bzip2, https, ftps, phar
Registered Stream Socket Transportstcp, udp, ssl, sslv3, tls, tlsv1.0, tlsv1.1, tlsv1.2
Registered Stream Filtersconvert.iconv.*, mcrypt.*, mdecrypt.*, string.rot13, string.toupper, string.tolower, string.strip_tags, convert.*, consumed, dechunk, zlib.*, bzip2.*
Zend logo This program makes use of the Zend Scripting Language Engine:
Zend Engine v2.6.0, Copyright (c) 1998-2016 Zend Technologies

Configuration

bcmath

BCMath support enabled
DirectiveLocal ValueMaster Value
bcmath.scale00

bz2

BZip2 Support Enabled
Stream Wrapper support compress.bzip2://
Stream Filter support bzip2.decompress, bzip2.compress
BZip2 Version 1.0.6, 6-Sept-2010

calendar

Calendar support enabled

cgi-fcgi

DirectiveLocal ValueMaster Value
cgi.check_shebang_line11
cgi.discard_path00
cgi.fix_pathinfo11
cgi.force_redirect00
cgi.nph00
cgi.redirect_status_envno valueno value
cgi.rfc2616_headers00
fastcgi.impersonate11
fastcgi.logging11

Core

PHP Version 5.6.40
DirectiveLocal ValueMaster Value
allow_url_fopenOnOn
allow_url_includeOffOff
always_populate_raw_post_data00
arg_separator.input&&
arg_separator.output&&
asp_tagsOffOff
auto_append_fileno valueno value
auto_globals_jitOnOn
auto_prepend_fileno valueno value
browscapno valueno value
default_charsetUTF-8UTF-8
default_mimetypetext/htmltext/html
disable_classesno valueno value
disable_functionsexec,system,passthru,popen,pclose,shell_exec,proc_open,dl,chmodexec,system,passthru,popen,pclose,shell_exec,proc_open,dl,chmod
display_errorsOffOff
display_startup_errorsOffOff
doc_rootno valueno value
docref_extno valueno value
docref_rootno valueno value
enable_dlOffOff
enable_post_data_readingOnOn
error_append_stringno valueno value
error_logsyslogsyslog
error_prepend_stringno valueno value
error_reporting022527
exit_on_timeoutOffOff
expose_phpOnOn
extension_dir./ext./ext
file_uploadsOnOn
highlight.comment#FF8000#FF8000
highlight.default#0000BB#0000BB
highlight.html#000000#000000
highlight.keyword#007700#007700
highlight.string#DD0000#DD0000
html_errorsOnOn
ignore_repeated_errorsOffOff
ignore_repeated_sourceOffOff
ignore_user_abortOffOff
implicit_flushOffOff
include_path.;C:\php\pear;D:\wwwroot\yyjg.net\wwwroot\core/Extend/Vendor/.;C:\php\pear
input_encodingno valueno value
internal_encodingno valueno value
log_errorsOnOn
log_errors_max_len10241024
mail.add_x_headerOnOn
mail.force_extra_parametersno valueno value
mail.logno valueno value
max_execution_time180180
max_file_uploads200200
max_input_nesting_level6464
max_input_time6060
max_input_vars10001000
memory_limit128M128M
open_basedirno valueno value
output_buffering40964096
output_encodingno valueno value
output_handlerno valueno value
post_max_size200M200M
precision1414
realpath_cache_size16K16K
realpath_cache_ttl120120
register_argc_argvOffOff
report_memleaksOnOn
report_zend_debugOnOn
request_orderCGPCGP
sendmail_fromno valueno value
sendmail_pathno valueno value
serialize_precision1717
short_open_tagOnOn
SMTPlocalhostlocalhost
smtp_port2525
sql.safe_modeOffOff
sys_temp_dirno valueno value
track_errorsOffOff
unserialize_callback_funcno valueno value
upload_max_filesize200M200M
upload_tmp_dirD:\PHPWEB\php\temp\D:\PHPWEB\php\temp\
user_dirno valueno value
user_ini.cache_ttl300300
user_ini.filename.user.ini.user.ini
variables_orderGPCSGPCS
windows.show_crt_warningOffOff
xmlrpc_error_number00
xmlrpc_errorsOffOff
zend.detect_unicodeOnOn
zend.enable_gcOnOn
zend.multibyteOffOff
zend.script_encodingno valueno value

ctype

ctype functions enabled

curl

cURL support enabled
cURL Information 7.59.0
Age 4
Features
AsynchDNS Yes
CharConv No
Debug No
GSS-Negotiate No
IDN Yes
IPv6 Yes
krb4 No
Largefile Yes
libz Yes
NTLM Yes
NTLMWB No
SPNEGO Yes
SSL Yes
SSPI Yes
TLS-SRP No
Protocols dict, file, ftp, ftps, gopher, http, https, imap, imaps, ldap, pop3, pop3s, rtsp, scp, sftp, smb, smbs, smtp, smtps, telnet, tftp
Host x86_64-pc-win32
SSL Version OpenSSL/1.0.2q
ZLib Version 1.2.7.3
libSSH Version libssh2/1.8.0

date

date/time support enabled
"Olson" Timezone Database Version 2016.10
Timezone Database internal
Default timezone PRC
DirectiveLocal ValueMaster Value
date.default_latitude31.766731.7667
date.default_longitude35.233335.2333
date.sunrise_zenith90.58333390.583333
date.sunset_zenith90.58333390.583333
date.timezonePRCPRC

dom

DOM/XML enabled
DOM/XML API Version 20031129
libxml Version 2.9.4
HTML Support enabled
XPath Support enabled
XPointer Support enabled
Schema Support enabled
RelaxNG Support enabled

ereg

Regex Library Bundled library enabled

exif

EXIF Support enabled
EXIF Version 1.4 $Id: cad29b729548e4206f0697710cc9e177f26fdff3 $
Supported EXIF Version 0220
Supported filetypes JPEG,TIFF
DirectiveLocal ValueMaster Value
exif.decode_jis_intelJISJIS
exif.decode_jis_motorolaJISJIS
exif.decode_unicode_intelUCS-2LEUCS-2LE
exif.decode_unicode_motorolaUCS-2BEUCS-2BE
exif.encode_jisno valueno value
exif.encode_unicodeISO-8859-15ISO-8859-15

filter

Input Validation and Filtering enabled
Revision $Id: 5b79667bd9a68977a9b4f7505223a8e216e04908 $
DirectiveLocal ValueMaster Value
filter.defaultunsafe_rawunsafe_raw
filter.default_flagsno valueno value

ftp

FTP support enabled

gd

GD Support enabled
GD Version bundled (2.1.0 compatible)
FreeType Support enabled
FreeType Linkage with freetype
FreeType Version 2.7.0
GIF Read Support enabled
GIF Create Support enabled
JPEG Support enabled
libJPEG Version 9 compatible
PNG Support enabled
libPNG Version 1.5.26
WBMP Support enabled
XPM Support enabled
libXpm Version 30512
XBM Support enabled
WebP Support enabled
DirectiveLocal ValueMaster Value
gd.jpeg_ignore_warning00

hash

hash support enabled
Hashing Engines md2 md4 md5 sha1 sha224 sha256 sha384 sha512 ripemd128 ripemd160 ripemd256 ripemd320 whirlpool tiger128,3 tiger160,3 tiger192,3 tiger128,4 tiger160,4 tiger192,4 snefru snefru256 gost gost-crypto adler32 crc32 crc32b fnv132 fnv1a32 fnv164 fnv1a64 joaat haval128,3 haval160,3 haval192,3 haval224,3 haval256,3 haval128,4 haval160,4 haval192,4 haval224,4 haval256,4 haval128,5 haval160,5 haval192,5 haval224,5 haval256,5

iconv

iconv support enabled
iconv implementation "libiconv"
iconv library version 1.14
DirectiveLocal ValueMaster Value
iconv.input_encodingno valueno value
iconv.internal_encodingno valueno value
iconv.output_encodingno valueno value

json

json support enabled
json version 1.2.1

libxml

libXML support active
libXML Compiled Version 2.9.4
libXML Loaded Version 20904
libXML streams enabled

mbstring

Multibyte Support enabled
Multibyte string engine libmbfl
HTTP input encoding translation disabled
libmbfl version 1.3.2
mbstring extension makes use of "streamable kanji code filter and converter", which is distributed under the GNU Lesser General Public License version 2.1.
Multibyte (japanese) regex support enabled
Multibyte regex (oniguruma) version 5.9.5
DirectiveLocal ValueMaster Value
mbstring.detect_orderno valueno value
mbstring.encoding_translationOffOff
mbstring.func_overload00
mbstring.http_inputno valueno value
mbstring.http_outputno valueno value
mbstring.http_output_conv_mimetypes^(text/|application/xhtml\+xml)^(text/|application/xhtml\+xml)
mbstring.internal_encodingno valueno value
mbstring.languageneutralneutral
mbstring.strict_detectionOffOff
mbstring.substitute_characterno valueno value

mcrypt

mcrypt supportenabled
mcrypt_filter supportenabled
Version 2.5.8
Api No 20021217
Supported ciphers cast-128 gost rijndael-128 twofish cast-256 loki97 rijndael-192 saferplus wake blowfish-compat des rijndael-256 serpent xtea blowfish enigma rc2 tripledes arcfour
Supported modes cbc cfb ctr ecb ncfb nofb ofb stream
DirectiveLocal ValueMaster Value
mcrypt.algorithms_dirno valueno value
mcrypt.modes_dirno valueno value

mhash

MHASH support Enabled
MHASH API Version Emulated Support

mysql

MySQL Supportenabled
Active Persistent Links 0
Active Links 1
Client API version mysqlnd 5.0.11-dev - 20120503 - $Id: 76b08b24596e12d4553bd41fc93cccd5bac2fe7a $
DirectiveLocal ValueMaster Value
mysql.allow_local_infileOnOn
mysql.allow_persistentOnOn
mysql.connect_timeout6060
mysql.default_hostno valueno value
mysql.default_passwordno valueno value
mysql.default_portno valueno value
mysql.default_socketno valueno value
mysql.default_userno valueno value
mysql.max_linksUnlimitedUnlimited
mysql.max_persistentUnlimitedUnlimited
mysql.trace_modeOffOff

mysqli

MysqlI Supportenabled
Client API library version mysqlnd 5.0.11-dev - 20120503 - $Id: 76b08b24596e12d4553bd41fc93cccd5bac2fe7a $
Active Persistent Links 0
Inactive Persistent Links 0
Active Links 0
DirectiveLocal ValueMaster Value
mysqli.allow_local_infileOnOn
mysqli.allow_persistentOnOn
mysqli.default_hostno valueno value
mysqli.default_port33063306
mysqli.default_pwno valueno value
mysqli.default_socketno valueno value
mysqli.default_userno valueno value
mysqli.max_linksUnlimitedUnlimited
mysqli.max_persistentUnlimitedUnlimited
mysqli.reconnectOffOff
mysqli.rollback_on_cached_plinkOffOff

mysqlnd

mysqlndenabled
Version mysqlnd 5.0.11-dev - 20120503 - $Id: 76b08b24596e12d4553bd41fc93cccd5bac2fe7a $
Compression supported
core SSL supported
extended SSL not supported
Command buffer size 4096
Read buffer size 32768
Read timeout 31536000
Collecting statistics Yes
Collecting memory statistics No
Tracing n/a
Loaded plugins mysqlnd,debug_trace,auth_plugin_mysql_native_password,auth_plugin_mysql_clear_password
API Extensions mysql,mysqli,pdo_mysql
mysqlnd statistics
bytes_sent 707352
bytes_received 15427792
packets_sent 13704
packets_received 105078
protocol_overhead_in 420312
protocol_overhead_out 54816
bytes_received_ok_packet 0
bytes_received_eof_packet 0
bytes_received_rset_header_packet 54684
bytes_received_rset_field_meta_packet 0
bytes_received_rset_row_packet 38685
bytes_received_prepare_response_packet 5110756
bytes_received_change_user_packet 10177700
packets_sent_command 6634
packets_received_ok 0
packets_received_eof 0
packets_received_rset_header 6076
packets_received_rset_field_meta 0
packets_received_rset_row 6308
packets_received_prepare_response 73974
packets_received_change_user 18284
result_set_queries 5967
non_result_set_queries 313
no_index_used 3400
bad_index_used 0
slow_queries 0
buffered_sets 5967
unbuffered_sets 0
ps_buffered_sets 0
ps_unbuffered_sets 0
flushed_normal_sets 0
flushed_ps_sets 0
ps_prepared_never_executed 0
ps_prepared_once_executed 0
rows_fetched_from_server_normal 12317
rows_fetched_from_server_ps 0
rows_buffered_from_client_normal 12317
rows_buffered_from_client_ps 0
rows_fetched_from_client_normal_buffered 12317
rows_fetched_from_client_normal_unbuffered 0
rows_fetched_from_client_ps_buffered 0
rows_fetched_from_client_ps_unbuffered 0
rows_fetched_from_client_ps_cursor 0
rows_affected_normal 91
rows_affected_ps 0
rows_skipped_normal 12317
rows_skipped_ps 0
copy_on_write_saved 25552
copy_on_write_performed 199329
command_buffer_too_small 0
connect_success 109
connect_failure 0
connection_reused 0
reconnect 0
pconnect_success 0
active_connections 18446744073709551509
active_persistent_connections 0
explicit_close 108
implicit_close 0
disconnect_close 0
in_middle_of_command_close 0
explicit_free_result 5966
implicit_free_result 0
explicit_stmt_close 0
implicit_stmt_close 0
mem_emalloc_count 0
mem_emalloc_amount 0
mem_ecalloc_count 0
mem_ecalloc_amount 0
mem_erealloc_count 0
mem_erealloc_amount 0
mem_efree_count 0
mem_efree_amount 0
mem_malloc_count 0
mem_malloc_amount 0
mem_calloc_count 0
mem_calloc_amount 0
mem_realloc_count 0
mem_realloc_amount 0
mem_free_count 0
mem_free_amount 0
mem_estrndup_count 0
mem_strndup_count 0
mem_estndup_count 0
mem_strdup_count 0
proto_text_fetched_null 0
proto_text_fetched_bit 0
proto_text_fetched_tinyint 20360
proto_text_fetched_short 67598
proto_text_fetched_int24 8722
proto_text_fetched_int 10681
proto_text_fetched_bigint 74
proto_text_fetched_decimal 0
proto_text_fetched_float 0
proto_text_fetched_double 0
proto_text_fetched_date 0
proto_text_fetched_year 0
proto_text_fetched_time 0
proto_text_fetched_datetime 0
proto_text_fetched_timestamp 0
proto_text_fetched_string 101594
proto_text_fetched_blob 0
proto_text_fetched_enum 693
proto_text_fetched_set 0
proto_text_fetched_geometry 0
proto_text_fetched_other 0
proto_binary_fetched_null 0
proto_binary_fetched_bit 0
proto_binary_fetched_tinyint 0
proto_binary_fetched_short 0
proto_binary_fetched_int24 0
proto_binary_fetched_int 0
proto_binary_fetched_bigint 0
proto_binary_fetched_decimal 0
proto_binary_fetched_float 0
proto_binary_fetched_double 0
proto_binary_fetched_date 0
proto_binary_fetched_year 0
proto_binary_fetched_time 0
proto_binary_fetched_datetime 0
proto_binary_fetched_timestamp 0
proto_binary_fetched_string 0
proto_binary_fetched_json 0
proto_binary_fetched_blob 0
proto_binary_fetched_enum 0
proto_binary_fetched_set 0
proto_binary_fetched_geometry 0
proto_binary_fetched_other 0
init_command_executed_count 0
init_command_failed_count 0
com_quit 108
com_init_db 109
com_query 6308
com_field_list 0
com_create_db 0
com_drop_db 0
com_refresh 0
com_shutdown 0
com_statistics 0
com_process_info 0
com_connect 0
com_process_kill 0
com_debug 0
com_ping 0
com_time 0
com_delayed_insert 0
com_change_user 0
com_binlog_dump 0
com_table_dump 0
com_connect_out 0
com_register_slave 0
com_stmt_prepare 0
com_stmt_execute 0
com_stmt_send_long_data 0
com_stmt_close 0
com_stmt_reset 0
com_stmt_set_option 109
com_stmt_fetch 0
com_deamon 0
bytes_received_real_data_normal 9878288
bytes_received_real_data_ps 0

odbc

ODBC Supportenabled
Active Persistent Links 0
Active Links 0
ODBC library Win32
DirectiveLocal ValueMaster Value
odbc.allow_persistentOnOn
odbc.check_persistentOnOn
odbc.default_cursortypeStatic cursorStatic cursor
odbc.default_dbno valueno value
odbc.default_pwno valueno value
odbc.default_userno valueno value
odbc.defaultbinmodereturn as isreturn as is
odbc.defaultlrlreturn up to 4096 bytesreturn up to 4096 bytes
odbc.max_linksUnlimitedUnlimited
odbc.max_persistentUnlimitedUnlimited

openssl

OpenSSL support enabled
OpenSSL Library Version OpenSSL 1.0.2q 20 Nov 2018
OpenSSL Header Version OpenSSL 1.0.2q 20 Nov 2018
Openssl default config c:/usr/local/ssl/openssl.cnf
DirectiveLocal ValueMaster Value
openssl.cafileno valueno value
openssl.capathno valueno value

pcre

PCRE (Perl Compatible Regular Expressions) Support enabled
PCRE Library Version 8.38 2015-11-23
DirectiveLocal ValueMaster Value
pcre.backtrack_limit10000001000000
pcre.recursion_limit100000100000

PDO

PDO supportenabled
PDO drivers mysql, odbc, pgsql, sqlite

pdo_mysql

PDO Driver for MySQLenabled
Client API version mysqlnd 5.0.11-dev - 20120503 - $Id: 76b08b24596e12d4553bd41fc93cccd5bac2fe7a $

PDO_ODBC

PDO Driver for ODBC (Win32)enabled
ODBC Connection Pooling Enabled, strict matching

pdo_pgsql

PDO Driver for PostgreSQLenabled
PostgreSQL(libpq) Version 9.6.2
Module version 1.0.2
Revision $Id: 0e858dd2051ca8c2fd3c781909a0670ab5fecd36 $

pdo_sqlite

PDO Driver for SQLite 3.xenabled
SQLite Library 3.8.10.2

pgsql

PostgreSQL Supportenabled
PostgreSQL(libpq) Version 9.6.2
PostgreSQL(libpq) PostgreSQL 9.6.2 (win32)
Multibyte character support enabled
SSL support enabled
Active Persistent Links 0
Active Links 0
DirectiveLocal ValueMaster Value
pgsql.allow_persistentOnOn
pgsql.auto_reset_persistentOffOff
pgsql.ignore_noticeOffOff
pgsql.log_noticeOffOff
pgsql.max_linksUnlimitedUnlimited
pgsql.max_persistentUnlimitedUnlimited

Phar

Phar: PHP Archive supportenabled
Phar EXT version 2.0.2
Phar API version 1.1.1
SVN revision $Id: 6e5cec2462a6ded53d4379ea9a69487a60d5c43c $
Phar-based phar archives enabled
Tar-based phar archives enabled
ZIP-based phar archives enabled
gzip compression enabled
bzip2 compression enabled
OpenSSL support enabled
Phar based on pear/PHP_Archive, original concept by Davey Shafik.
Phar fully realized by Gregory Beaver and Marcus Boerger.
Portions of tar implementation Copyright (c) 2003-2009 Tim Kientzle.
DirectiveLocal ValueMaster Value
phar.cache_listno valueno value
phar.readonlyOnOn
phar.require_hashOnOn

Reflection

Reflectionenabled
Version $Id: 5f15287237d5f78d75b19c26915aa7bd83dee8b8 $

session

Session Support enabled
Registered save handlers files user
Registered serializer handlers php_serialize php php_binary wddx
DirectiveLocal ValueMaster Value
session.auto_startOffOff
session.cache_expire180180
session.cache_limiternocachenocache
session.cookie_domainno valueno value
session.cookie_httponlyOffOff
session.cookie_lifetime00
session.cookie_path//
session.cookie_secureOffOff
session.entropy_fileno valueno value
session.entropy_length00
session.gc_divisor10001000
session.gc_maxlifetime14401440
session.gc_probability11
session.hash_bits_per_character55
session.hash_function00
session.namePHPSESSIDPHPSESSID
session.referer_checkno valueno value
session.save_handlerfilesfiles
session.save_pathD:\PHPWEB\php\temp\D:\PHPWEB\php\temp\
session.serialize_handlerphpphp
session.upload_progress.cleanupOnOn
session.upload_progress.enabledOnOn
session.upload_progress.freq1%1%
session.upload_progress.min_freq11
session.upload_progress.namePHP_SESSION_UPLOAD_PROGRESSPHP_SESSION_UPLOAD_PROGRESS
session.upload_progress.prefixupload_progress_upload_progress_
session.use_cookiesOnOn
session.use_only_cookiesOnOn
session.use_strict_modeOffOff
session.use_trans_sid00

SimpleXML

Simplexml supportenabled
Revision $Id: d7077fc935154236afb4fe70814ba358efdbdca4 $
Schema support enabled

SPL

SPL supportenabled
Interfaces Countable, OuterIterator, RecursiveIterator, SeekableIterator, SplObserver, SplSubject
Classes AppendIterator, ArrayIterator, ArrayObject, BadFunctionCallException, BadMethodCallException, CachingIterator, CallbackFilterIterator, DirectoryIterator, DomainException, EmptyIterator, FilesystemIterator, FilterIterator, GlobIterator, InfiniteIterator, InvalidArgumentException, IteratorIterator, LengthException, LimitIterator, LogicException, MultipleIterator, NoRewindIterator, OutOfBoundsException, OutOfRangeException, OverflowException, ParentIterator, RangeException, RecursiveArrayIterator, RecursiveCachingIterator, RecursiveCallbackFilterIterator, RecursiveDirectoryIterator, RecursiveFilterIterator, RecursiveIteratorIterator, RecursiveRegexIterator, RecursiveTreeIterator, RegexIterator, RuntimeException, SplDoublyLinkedList, SplFileInfo, SplFileObject, SplFixedArray, SplHeap, SplMinHeap, SplMaxHeap, SplObjectStorage, SplPriorityQueue, SplQueue, SplStack, SplTempFileObject, UnderflowException, UnexpectedValueException

sqlite3

SQLite3 supportenabled
SQLite3 module version 0.7-dev
SQLite Library 3.8.10.2
DirectiveLocal ValueMaster Value
sqlite3.extension_dirno valueno value

standard

Dynamic Library Support enabled
Internal Sendmail Support for Windows enabled
DirectiveLocal ValueMaster Value
assert.active11
assert.bail00
assert.callbackno valueno value
assert.quiet_eval00
assert.warning11
auto_detect_line_endings00
default_socket_timeout6060
fromno valueno value
url_rewriter.tagsa=href,area=href,frame=src,input=src,form=fakeentrya=href,area=href,frame=src,input=src,form=fakeentry
user_agentno valueno value

tokenizer

Tokenizer Support enabled

wddx

WDDX Supportenabled
WDDX Session Serializer enabled

xml

XML Support active
XML Namespace Support active
libxml2 Version 2.9.4

xmlreader

XMLReader enabled

xmlwriter

XMLWriter enabled

zip

Zip enabled
Zip version 1.12.5
Libzip version 0.11.2

zlib

ZLib Supportenabled
Stream Wrapper compress.zlib://
Stream Filter zlib.inflate, zlib.deflate
Compiled Version 1.2.7.3
Linked Version 1.2.7.3
DirectiveLocal ValueMaster Value
zlib.output_compressionOffOff
zlib.output_compression_level-1-1
zlib.output_handlerno valueno value

Additional Modules

Module Name

Environment

VariableValue
_FCGI_X_PIPE_ \\.\pipe\IISFCGI-92254e1e-0bc6-4221-87df-24565f35b2a2
PHP_FCGI_MAX_REQUESTS 10000
ALLUSERSPROFILE C:\ProgramData
APPDATA C:\Windows\system32\config\systemprofile\AppData\Roaming
APP_POOL_CONFIG C:\inetpub\temp\apppools\wwwroot\wwwroot.config
APP_POOL_ID wwwroot
CommonProgramFiles C:\Program Files\Common Files
CommonProgramFiles(x86) C:\Program Files (x86)\Common Files
CommonProgramW6432 C:\Program Files\Common Files
COMPUTERNAME iZ4r4b31413jd2Z
ComSpec C:\Windows\system32\cmd.exe
LOCALAPPDATA C:\Windows\system32\config\systemprofile\AppData\Local
NUMBER_OF_PROCESSORS 2
OS Windows_NT
Path C:\Windows\system32;C:\Windows;C:\Windows\System32\Wbem;C:\Windows\System32\WindowsPowerShell\v1.0\;D:\Program Files\Microsoft SQL Server\110\DTS\Binn\;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\Binn\;D:\Program Files\Microsoft SQL Server\110\Tools\Binn\;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\Binn\ManagementStudio\;C:\Program Files (x86)\Microsoft Visual Studio 10.0\Common7\IDE\PrivateAssemblies\;D:\Program Files (x86)\Microsoft SQL Server\110\DTS\Binn\;C:\sslctlw;C:\Windows\system32\config\systemprofile\AppData\Local\Microsoft\WindowsApps
PATHEXT .COM;.EXE;.BAT;.CMD;.VBS;.VBE;.JS;.JSE;.WSF;.WSH;.MSC
PROCESSOR_ARCHITECTURE AMD64
PROCESSOR_IDENTIFIER Intel64 Family 6 Model 85 Stepping 4, GenuineIntel
PROCESSOR_LEVEL 6
PROCESSOR_REVISION 5504
ProgramData C:\ProgramData
ProgramFiles C:\Program Files
ProgramFiles(x86) C:\Program Files (x86)
ProgramW6432 C:\Program Files
PSModulePath C:\Program Files\WindowsPowerShell\Modules;C:\Windows\system32\WindowsPowerShell\v1.0\Modules;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\PowerShell\Modules\
PUBLIC C:\Users\Public
SystemDrive C:
SystemRoot C:\Windows
TEMP C:\Windows\TEMP
TMP C:\Windows\TEMP
USERDOMAIN WORKGROUP
USERNAME iZ4r4b31413jd2Z$
USERPROFILE C:\Windows\system32\config\systemprofile
windir C:\Windows

PHP Variables

VariableValue
_REQUEST["aid"]12682
_REQUEST["_URL_"]
Array
(
    [0] => index
    [1] => view
    [2] => aid
    [3] => 12682
)
_GET["aid"]12682
_GET["_URL_"]
Array
(
    [0] => index
    [1] => view
    [2] => aid
    [3] => 12682
)
_SERVER["_FCGI_X_PIPE_"]\\.\pipe\IISFCGI-92254e1e-0bc6-4221-87df-24565f35b2a2
_SERVER["PHP_FCGI_MAX_REQUESTS"]10000
_SERVER["ALLUSERSPROFILE"]C:\ProgramData
_SERVER["APPDATA"]C:\Windows\system32\config\systemprofile\AppData\Roaming
_SERVER["APP_POOL_CONFIG"]C:\inetpub\temp\apppools\wwwroot\wwwroot.config
_SERVER["APP_POOL_ID"]wwwroot
_SERVER["CommonProgramFiles"]C:\Program Files\Common Files
_SERVER["CommonProgramFiles(x86)"]C:\Program Files (x86)\Common Files
_SERVER["CommonProgramW6432"]C:\Program Files\Common Files
_SERVER["COMPUTERNAME"]iZ4r4b31413jd2Z
_SERVER["ComSpec"]C:\Windows\system32\cmd.exe
_SERVER["LOCALAPPDATA"]C:\Windows\system32\config\systemprofile\AppData\Local
_SERVER["NUMBER_OF_PROCESSORS"]2
_SERVER["OS"]Windows_NT
_SERVER["Path"]C:\Windows\system32;C:\Windows;C:\Windows\System32\Wbem;C:\Windows\System32\WindowsPowerShell\v1.0\;D:\Program Files\Microsoft SQL Server\110\DTS\Binn\;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\Binn\;D:\Program Files\Microsoft SQL Server\110\Tools\Binn\;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\Binn\ManagementStudio\;C:\Program Files (x86)\Microsoft Visual Studio 10.0\Common7\IDE\PrivateAssemblies\;D:\Program Files (x86)\Microsoft SQL Server\110\DTS\Binn\;C:\sslctlw;C:\Windows\system32\config\systemprofile\AppData\Local\Microsoft\WindowsApps
_SERVER["PATHEXT"].COM;.EXE;.BAT;.CMD;.VBS;.VBE;.JS;.JSE;.WSF;.WSH;.MSC
_SERVER["PROCESSOR_ARCHITECTURE"]AMD64
_SERVER["PROCESSOR_IDENTIFIER"]Intel64 Family 6 Model 85 Stepping 4, GenuineIntel
_SERVER["PROCESSOR_LEVEL"]6
_SERVER["PROCESSOR_REVISION"]5504
_SERVER["ProgramData"]C:\ProgramData
_SERVER["ProgramFiles"]C:\Program Files
_SERVER["ProgramFiles(x86)"]C:\Program Files (x86)
_SERVER["ProgramW6432"]C:\Program Files
_SERVER["PSModulePath"]C:\Program Files\WindowsPowerShell\Modules;C:\Windows\system32\WindowsPowerShell\v1.0\Modules;D:\Program Files (x86)\Microsoft SQL Server\110\Tools\PowerShell\Modules\
_SERVER["PUBLIC"]C:\Users\Public
_SERVER["SystemDrive"]C:
_SERVER["SystemRoot"]C:\Windows
_SERVER["TEMP"]C:\Windows\TEMP
_SERVER["TMP"]C:\Windows\TEMP
_SERVER["USERDOMAIN"]WORKGROUP
_SERVER["USERNAME"]iZ4r4b31413jd2Z$
_SERVER["USERPROFILE"]C:\Windows\system32\config\systemprofile
_SERVER["windir"]C:\Windows
_SERVER["ORIG_PATH_INFO"]/index.php/index-view-aid-12682.html
_SERVER["URL"]/index.php
_SERVER["SERVER_SOFTWARE"]Microsoft-IIS/10.0
_SERVER["SERVER_PROTOCOL"]HTTP/1.1
_SERVER["SERVER_PORT_SECURE"]1
_SERVER["SERVER_PORT"]443
_SERVER["SERVER_NAME"]yyjg.net
_SERVER["SCRIPT_NAME"]/index.php
_SERVER["SCRIPT_FILENAME"]D:\wwwroot\yyjg.net\wwwroot\index.php
_SERVER["REQUEST_URI"]/index.php/index-view-aid-12682.html
_SERVER["REQUEST_METHOD"]GET
_SERVER["REMOTE_USER"]no value
_SERVER["REMOTE_PORT"]14403
_SERVER["REMOTE_HOST"]216.73.216.196
_SERVER["REMOTE_ADDR"]216.73.216.196
_SERVER["QUERY_STRING"]no value
_SERVER["PATH_TRANSLATED"]D:\wwwroot\yyjg.net\wwwroot\index.php\index-view-aid-12682.html
_SERVER["PATH_INFO"]/index-view-aid-12682
_SERVER["LOGON_USER"]no value
_SERVER["LOCAL_ADDR"]172.16.121.93
_SERVER["INSTANCE_META_PATH"]/LM/W3SVC/1
_SERVER["INSTANCE_NAME"]WWWROOT
_SERVER["INSTANCE_ID"]1
_SERVER["HTTPS_SERVER_SUBJECT"]CN=www.yyjg.net
_SERVER["HTTPS_SERVER_ISSUER"]C=PL, O=Asseco Data Systems S.A., CN=Certum DV TLS G2 R39 CA
_SERVER["HTTPS_SECRETKEYSIZE"]2048
_SERVER["HTTPS_KEYSIZE"]256
_SERVER["HTTPS"]on
_SERVER["GATEWAY_INTERFACE"]CGI/1.1
_SERVER["DOCUMENT_ROOT"]D:\wwwroot\yyjg.net\wwwroot
_SERVER["CONTENT_TYPE"]no value
_SERVER["CONTENT_LENGTH"]0
_SERVER["CERT_SUBJECT"]no value
_SERVER["CERT_SERIALNUMBER"]no value
_SERVER["CERT_ISSUER"]no value
_SERVER["CERT_FLAGS"]no value
_SERVER["CERT_COOKIE"]no value
_SERVER["AUTH_USER"]no value
_SERVER["AUTH_PASSWORD"]no value
_SERVER["AUTH_TYPE"]no value
_SERVER["APPL_PHYSICAL_PATH"]D:\wwwroot\yyjg.net\wwwroot\
_SERVER["APPL_MD_PATH"]/LM/W3SVC/1/ROOT
_SERVER["IIS_UrlRewriteModule"]7.1.0871.0
_SERVER["HTTP_USER_AGENT"]Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)
_SERVER["HTTP_HOST"]yyjg.net
_SERVER["HTTP_ACCEPT_ENCODING"]gzip, br, zstd, deflate
_SERVER["HTTP_ACCEPT"]*/*
_SERVER["HTTP_CONNECTION"]close
_SERVER["FCGI_ROLE"]RESPONDER
_SERVER["PHP_SELF"]/index.php/index-view-aid-12682.html
_SERVER["REQUEST_TIME_FLOAT"]1789631829.8141
_SERVER["REQUEST_TIME"]1789631829

PHP Credits

PHP Group
Thies C. Arntzen, Stig Bakken, Shane Caraveo, Andi Gutmans, Rasmus Lerdorf, Sam Ruby, Sascha Schumann, Zeev Suraski, Jim Winstead, Andrei Zmievski
Language Design & Concept
Andi Gutmans, Rasmus Lerdorf, Zeev Suraski, Marcus Boerger
PHP Authors
ContributionAuthors
Zend Scripting Language Engine Andi Gutmans, Zeev Suraski, Stanislav Malyshev, Marcus Boerger, Dmitry Stogov, Xinchen Hui, Nikita Popov
Extension Module API Andi Gutmans, Zeev Suraski, Andrei Zmievski
UNIX Build and Modularization Stig Bakken, Sascha Schumann, Jani Taskinen
Windows Port Shane Caraveo, Zeev Suraski, Wez Furlong, Pierre-Alain Joye, Anatol Belski
Server API (SAPI) Abstraction Layer Andi Gutmans, Shane Caraveo, Zeev Suraski
Streams Abstraction Layer Wez Furlong, Sara Golemon
PHP Data Objects Layer Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
Output Handler Zeev Suraski, Thies C. Arntzen, Marcus Boerger, Michael Wallner
SAPI Modules
ContributionAuthors
AOLserver Sascha Schumann
Apache 1.3 (apache_hooks) Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar, George Schlossnagle, Lukas Schroeder
Apache 1.3 Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar
Apache 2.0 Filter Sascha Schumann, Aaron Bannert
Apache 2.0 Handler Ian Holsman, Justin Erenkrantz (based on Apache 2.0 Filter code)
Caudium / Roxen David Hedbor
CGI / FastCGI Rasmus Lerdorf, Stig Bakken, Shane Caraveo, Dmitry Stogov
CLI Edin Kadribasic, Marcus Boerger, Johannes Schlueter, Moriyoshi Koizumi, Xinchen Hui
Continuity Alex Leigh (based on nsapi code)
Embed Edin Kadribasic
FastCGI Process Manager Andrei Nigmatulin, dreamcat4, Antony Dovgal, Jerome Loyet
ISAPI Andi Gutmans, Zeev Suraski
litespeed George Wang
NSAPI Jayakumar Muthukumarasamy, Uwe Schindler
phpdbg Felipe Pena, Joe Watkins, Bob Weinand
phttpd Thies C. Arntzen
pi3web Holger Zimmermann
Sendmail Milter Harald Radi
thttpd Sascha Schumann
tux Sascha Schumann
WebJames Alex Waugh
Module Authors
ModuleAuthors
BC Math Andi Gutmans
Bzip2 Sterling Hughes
Calendar Shane Caraveo, Colin Viebrock, Hartmut Holzgraefe, Wez Furlong
COM and .Net Wez Furlong
ctype Hartmut Holzgraefe
cURL Sterling Hughes
Date/Time Support Derick Rethans
DB-LIB (MS SQL, Sybase) Wez Furlong, Frank M. Kromann
DBA Sascha Schumann, Marcus Boerger
DOM Christian Stocker, Rob Richards, Marcus Boerger
enchant Pierre-Alain Joye, Ilia Alshanetsky
ereg Rasmus Lerdorf, Jim Winstead, Jaakko Hyvätti
EXIF Rasmus Lerdorf, Marcus Boerger
fileinfo Ilia Alshanetsky, Pierre Alain Joye, Scott MacVicar, Derick Rethans
Firebird driver for PDO Ard Biesheuvel
FTP Stefan Esser, Andrew Skalski
GD imaging Rasmus Lerdorf, Stig Bakken, Jim Winstead, Jouni Ahto, Ilia Alshanetsky, Pierre-Alain Joye, Marcus Boerger
GetText Alex Plotnick
GNU GMP support Stanislav Malyshev
Iconv Rui Hirokawa, Stig Bakken, Moriyoshi Koizumi
IMAP Rex Logan, Mark Musone, Brian Wang, Kaj-Michael Lang, Antoni Pamies Olive, Rasmus Lerdorf, Andrew Skalski, Chuck Hagenbuch, Daniel R Kalowsky
Input Filter Rasmus Lerdorf, Derick Rethans, Pierre-Alain Joye, Ilia Alshanetsky
InterBase Jouni Ahto, Andrew Avdeev, Ard Biesheuvel
Internationalization Ed Batutis, Vladimir Iordanov, Dmitry Lakhtyuk, Stanislav Malyshev, Vadim Savchuk, Kirti Velankar
JSON Omar Kilani, Scott MacVicar
LDAP Amitay Isaacs, Eric Warnke, Rasmus Lerdorf, Gerrit Thomson, Stig Venaas
LIBXML Christian Stocker, Rob Richards, Marcus Boerger, Wez Furlong, Shane Caraveo
mcrypt Sascha Schumann, Derick Rethans
MS SQL Frank M. Kromann
Multibyte String Functions Tsukada Takuya, Rui Hirokawa
MySQL driver for PDO George Schlossnagle, Wez Furlong, Ilia Alshanetsky, Johannes Schlueter
MySQL Zeev Suraski, Zak Greant, Georg Richter, Andrey Hristov
MySQLi Zak Greant, Georg Richter, Andrey Hristov, Ulf Wendel
MySQLnd Andrey Hristov, Ulf Wendel, Georg Richter, Johannes Schlüter
OCI8 Stig Bakken, Thies C. Arntzen, Andy Sautins, David Benson, Maxim Maletsky, Harald Radi, Antony Dovgal, Andi Gutmans, Wez Furlong, Christopher Jones, Oracle Corporation
ODBC driver for PDO Wez Furlong
ODBC Stig Bakken, Andreas Karajannis, Frank M. Kromann, Daniel R. Kalowsky
OpenSSL Stig Venaas, Wez Furlong, Sascha Kettler, Scott MacVicar
Oracle (OCI) driver for PDO Wez Furlong
pcntl Jason Greene, Arnaud Le Blanc
Perl Compatible Regexps Andrei Zmievski
PHP Archive Gregory Beaver, Marcus Boerger
PHP Data Objects Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
PHP hash Sara Golemon, Rasmus Lerdorf, Stefan Esser, Michael Wallner, Scott MacVicar
Posix Kristian Koehntopp
PostgreSQL driver for PDO Edin Kadribasic, Ilia Alshanetsky
PostgreSQL Jouni Ahto, Zeev Suraski, Yasuo Ohgaki, Chris Kings-Lynne
Pspell Vlad Krupin
Readline Thies C. Arntzen
Recode Kristian Koehntopp
Reflection Marcus Boerger, Timm Friebe, George Schlossnagle, Andrei Zmievski, Johannes Schlueter
Sessions Sascha Schumann, Andrei Zmievski
Shared Memory Operations Slava Poliakov, Ilia Alshanetsky
SimpleXML Sterling Hughes, Marcus Boerger, Rob Richards
SNMP Rasmus Lerdorf, Harrie Hazewinkel, Mike Jackson, Steven Lawrance, Johann Hanne, Boris Lytochkin
SOAP Brad Lafountain, Shane Caraveo, Dmitry Stogov
Sockets Chris Vandomelen, Sterling Hughes, Daniel Beulshausen, Jason Greene
SPL Marcus Boerger, Etienne Kneuss
SQLite 3.x driver for PDO Wez Furlong
SQLite3 Scott MacVicar, Ilia Alshanetsky, Brad Dewar
Sybase-CT Zeev Suraski, Tom May, Timm Friebe
System V Message based IPC Wez Furlong
System V Semaphores Tom May
System V Shared Memory Christian Cartus
tidy John Coggeshall, Ilia Alshanetsky
tokenizer Andrei Zmievski, Johannes Schlueter
WDDX Andrei Zmievski
XML Stig Bakken, Thies C. Arntzen, Sterling Hughes
XMLReader Rob Richards
xmlrpc Dan Libby
XMLWriter Rob Richards, Pierre-Alain Joye
XSL Christian Stocker, Rob Richards
Zip Pierre-Alain Joye, Remi Collet
Zlib Rasmus Lerdorf, Stefan Roehrich, Zeev Suraski, Jade Nicoletti, Michael Wallner
PHP Documentation
Authors Mehdi Achour, Friedhelm Betz, Antony Dovgal, Nuno Lopes, Hannes Magnusson, Georg Richter, Damien Seguy, Jakub Vrana, Adam Harvey, Peter Cowburn
Editor Philip Olson
User Note Maintainers Daniel P. Brown, Thiago Henrique Pojda
Other Contributors Previously active authors, editors and other contributors are listed in the manual.
PHP Quality Assurance Team
Ilia Alshanetsky, Joerg Behrens, Antony Dovgal, Stefan Esser, Moriyoshi Koizumi, Magnus Maatta, Sebastian Nohn, Derick Rethans, Melvyn Sopacua, Jani Taskinen, Pierre-Alain Joye, Dmitry Stogov, Felipe Pena, David Soria Parra, Stanislav Malyshev, Julien Pauli, Stephen Zarkos, Anatol Belski, Remi Collet, Ferenc Kovacs
Websites and Infrastructure team
PHP Websites Team Rasmus Lerdorf, Hannes Magnusson, Philip Olson, Lukas Kahwe Smith, Pierre-Alain Joye, Kalle Sommer Nielsen, Peter Cowburn, Adam Harvey, Ferenc Kovacs, Levi Morrison
Event Maintainers Damien Seguy, Daniel P. Brown
Network Infrastructure Daniel P. Brown
Windows Infrastructure Alex Schoenmaker

PHP License

This program is free software; you can redistribute it and/or modify it under the terms of the PHP License as published by the PHP Group and included in the distribution in the file: LICENSE

This program is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without even the implied warranty of MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.

If you did not receive a copy of the PHP license, or have any questions about PHP licensing, please contact license@php.net.

医院经营管理网

医管智库MEDICAL TUBE

首页>医管智库>行政管理
DRGs来了 如何做好病房护理?
提交者:九鼎医管发表时间:2020-1-3点击次数:5784来源:

医院管理


  疾病诊断相关分组(DRG)是一种病例组合方式。它以疾病诊断为主要分组依据,同时兼顾手术、操作以及患者年龄、并发症、伴随疾病等因素影响,既考虑了疾病的严重程度和复杂性,又考虑了医疗需要和医疗资源消耗量,将同质病例组合成组,同组病例可直接比较,不同组病例经过风险调整后也可进行比较 。在北京市平谷区新农合“疾病诊断相关分组-预付费制”试点取得初步成效的基础上,2016年1月北京怀柔医院启动了新农合患者按DRG付费改革工作。该院为适应按DRG付费改革,推行以DRG为驱动的病组管理,使病房护理工作面临了新挑战:如何适应科室工作模式调整,如何开展护理成本控制,如何配合抓好病案首页质量等。本研究结合该院实践,进行了总结与介绍。
  
  1引入DRG病组管理理念
  
  第一,梳理科室收治患者DRG病组情况,根据80/20法则,明确重点病组,针对性安排护理工作,强化了与疾病特点的结合。具体做法有:
  
  (1)明确重点病组。从肿瘤科2015年新农合病例涉及的57个DRG病组中,根据出院病例数占比,明确重点DRG病组12个。这12个DRG病组,仅占57个DRG病组的21%,但其出院病例数占科室全部新农合出院病例数的80%。
  

医院管理
  
  (2)修订临床路径。12个重点DRG病组均为可以择期诊治的病组,比较适合实施临床路径管理。其中,有7个DRG病组次均费用高于支付标准,即出现亏损,为此,科室医护骨干共同讨论修订了临床路径。同时,护理团队对12个重点DRG病组制定了临床护理路径。
  
  (3)12个重点DRG病组中,仅1个DRG病组没有合并症与伴随症,因此,护理中除关注肿瘤诊断治疗护理外,还要关注合并症与伴随症护理,同时有预见性地做好危重患者护理工作。
  
  第二,由于可以通过入院信息进行DRG预分组,故根据DRG病组信息,简化了与疾病特点结合安排护理工作的过程。具体做法有:
  
  (1)DRG分组规则兼顾疾病诊断、疾病治疗和患者个体特征3方面信息,根据DRG病组制定护理计划,相比仅按照疾病诊断制定护理计划,更加全面、周到。
  
  (2)各DRG病组的权重值直接反映医疗资源消耗情况,同时间接反映该组疾病诊治技术难度。因此,可以根据DRG病组权重值,安排相应能级的护理人员担任责任护士。
  
  2调整科室运营模式
  
  根据按DRG付费改革政策要求,本着提高运营效率与效益的原则,调整了部分DRG病组运营模式,推进了肿瘤化疗日间病房和肿瘤临终关怀病房工作。
  
  日间病房是集医疗、护理、医技、管理、服务和社会工作等为一体的集约化、高效率、低成本的现代医院运营管理手段。随着肿瘤化疗医疗与护理技术的成熟,国内外普遍开展了肿瘤化疗的日间病房工作。其收治对象通常是活动自如、神志清楚、具有明确的治疗方案且无严重并发症的患者。以肿瘤化疗日间病房工作为核心,利用门诊资源和信息化支持完成化疗前的辅助检查,利用医疗联合体资源完成化疗后的短期观察和长期照顾。通过这些资源的有效利用,降低了肿瘤内科病房的运营成本,提高了工作效率。在实践中,科室护理团队配合医疗制定了肿瘤化疗日间病房临床护理路径,在出入院服务、病情评估、健康宣教、出院随访、心理舒缓等方面形成了标准化护理。
  
  临终关怀病房集合了无痛病房、舒缓照顾和叙事医学等体现医学人文的医疗技术,可以帮助肿瘤终末期患者有尊严地、有家属陪伴地度过人生的最后阶段。对于城市远郊区域医疗中心而言,肿瘤终末期患者的临终关怀病房服务有较大市场需求。这项工作既可以充分利用日间病房节约资源,又可以为年龄较长的护理人员提供新的职业发展方向,同时还给医院带来了特需服务收入。在实践中,科室护理团队全员接受叙事医学培训,选派年龄较长的护理人员学习无痛病房规范、临终关怀技术,调整床位设置,开设临终关怀病房;医院配套修订了床位使用率、特需病房等绩效考核制度,鼓励科室调整运营模式。
  
  3选择适宜静脉输液技术
  
  静脉输液药物治疗是肿瘤内科最重要的治疗手段之一。静脉输液护理成本控制既要考虑建立成本,也要考虑维护成本;既要考虑静脉输液通路耗材成本,也要考虑护理人力成本;既要考虑正常状态所需成本,也要考虑处置患者输液不良反应和相关并发症成本,甚至要考虑处理护理人员出现针刺伤的成本等。
  
  基于肿瘤内科患者的特殊性、静脉输液技术的专业性以及静脉输液护理成本控制的复杂性,科室护理团队采取了以下措施:(1)根据患者个体特点,选择合适的静脉输液技术。例如:对病情稳定需要长期化疗患者,采用静脉输液港或PICC技术;在抢救患者时,需要开通多个静脉通路,可以选用单次静脉输液通道技术。(2)根据患者群体特殊性和控制成本复杂性,选择静脉输液各类耗材品种。(3)建立静脉输液耗材登记制度,减少浪费。(4)定期进行静脉输液各类耗材的数据分析,总结各类耗材品种的经济性、采用静脉输液技术的适宜性以及是否存在浪费现象等。
  
  4配合抓好病案首页质量管理工作
  
  病案首页信息是DRG分组的最重要的依据,也是按DRG病组付费的最重要的依据。病案首页信息中,诊断信息与手术治疗信息是最专业、最核心的部分,医师填写时容易忽略护理诊断(如压疮或跌倒)和护理操作(如PICC),需要责任护士与主治医师加强沟通;患者一般情况和基本就诊信息包含患者身份识别、支付类型、特殊治疗单元使用(如ICU和呼吸机)、患者转归和护理级别等,责任护士由于熟悉患者及其就诊过程,是最好的复核人员;医疗费用信息部分大多由医院医嘱信息系统导入,在医疗费用38项分类中,责任护士应关注并核对与护理相关的6类费用信息,即护理费、护理治疗费、监护及辅助呼吸费、治疗用一次性医用材料费、床位费和输氧费等。
  
  为了保证DRGs病组付费改革顺利运行,严格的病案首页督导必不可少。督导组根据医院报告的电子病案首页信息进行筛选,选取存疑病例从医院信息系统和纸质病案信息两方面进行核实。这就要求护理人员使用护理信息系统和书写护理病历时,认真核对信息,尤其是与病案首页相关的信息,避免出现病历未记载或信息不一致现象。这也成为护理文书设计与质控检查的新的关注点。
  
  5讨论
  
  支付方式改革会带来医疗服务供给改变,也会带来各方利益调整。科室新农合病例按DRG病组付费运营情况提示,医疗服务供给发生了改变。
  
  2016年与2015年相比,病例组合指数(CMI)提高0.03,说明收治患者疾病诊治技术难度提高;次均费用虽然有所增加,但对照11家同级别医院新农合病例同DRG病组均费,由高91元变为低568元,说明次均费用增长幅度低于同级别医院水平;次均费用对照新农合按DRG病组付费支付标准,由有亏损变为持平,说明次均费用增加仅是因为病组结构调整,同一DRG病组均费有所降低。
  
  虽然通过科室人员努力,医疗服务供给改变,促使运营情况趋好,但面对按DRG病组付费改革,病房护理管理仍有很多困惑。表现有3:
  
  第一,近年来,随着静脉输液技术、慢性伤口管理技术等护理技术的提升与护理设备的推广使用,护理耗材虽然单价低,但用量大、适用面广,造成其费用呈现快速增长趋势。在实践中,单纯追求应用廉价的护理耗材,患者护理质量可能受到影响,同时对护理技术提升造成一定阻碍。科室摸索了选择适宜静脉输液技术的经验,也借鉴了此领域的研究结果,但需要一段时间的总结、比较和分析,才能形成适合本地区政策与本科室业务特点的应用规范。
  
  本次按DRG病组付费改革政策是“全病组、全费用”,具体而言,就是即便患者愿意自费使用某些项目,住院总费用也不能超过支付标准。从基本医疗保险费用控制与减轻新农合患者疾病负担角度看,是有益的。但从少数经济条件较好的新农合患者角度看,可能限制了其选择更优医疗服务的机会。目前,按DRG病组付费改革尚未和补充型商业医疗保险衔接,且本地区的补充型商业医疗保险均采用团购形式,零散的新农合患者无法购买,建议在政策修订时可以考虑。
  
  第二,本次按DRG病组付费改革政策是“承认现状、结余留用、结构调整”,具体而言,就是既不考虑当前医疗服务价格体系存在的结构不合理,也不考虑不合理的医疗服务供给,仅按照当前的医疗服务费用水平进行支付;通过“结余留用”政策,调动医院管理者和医务人员的积极性,控制医疗服务成本;经过一段时间的医疗服务费用的“结构调整”,为医疗服务价格调整提供数据支持。在实践中,医护人员均担心费用控制到位后,政策部门对医疗服务价格调整没有及时跟进。而其他政策仍在持续,故医护人员积极性不能充分发挥。这需要政策部门尽快出台中长期政策和配套政策,进一步巩固与扩大改革效果。
  
  第三,在当前医疗服务价格体系中,护理人力收费项目少、价格低,护理人员数量占医务人员数量比例高,随着优质护理、同工同酬、带薪休假和二孩等政策的落地,护理人力成本成为医院人力成本中最主要的部分,这部分成本显然是护理收入远不能弥补的。因此,实施按DRG病组付费改革后,预期通过“结余留用”弥补护理收支不平衡造成的亏损,进而提高护理人员待遇。在实践中,由于护理行为多是遵照医嘱执行,能由护理人员主动发起的费用控制行为较少,仅能起到监督作用。医生的医疗行为,尤其在药品治疗和大型检查方面,还有改进空间。但由于其他因素牵制,医生团队也会有“医生控费,护士受益更多”的思想,医生团队通常是医院的领导团队,提高护理人员待遇的预期,仅靠医院内部调整很难达成,还需要通过护理价格调整固化改革成效。
  
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