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病案质量是衡量临床医疗质量的重要标志,是医、教、研的宝贵资料,病案质量的高低直接反映出医院的医疗质量和管理水平。对病案质量的控制,是当今现代化管理的必然要求,抓制度的落实,环节质量的管理,提高质量意识,规范医疗行为,是提高医疗质量的一个有效途径。
The quality of medical records is an important indicator of the quality of clinical care. It is valuable information for medical, teaching, and research. The quality of medical records directly reflects the hospital’s medical quality and management level. The control of the quality of medical records is an inevitable requirement of modern management. Grasping the implementation of the system, the management of the quality of the links, raising the awareness of quality, and standardizing the medical behavior are an effective way to improve the quality of medical care.