临床路径医疗管理模式的应用研究

对临床路径管理的现实需求、实施途径、问题与挑战等方面进行了论述。通过采用套餐的方式进行部署,以信息化平台作为实现手段是最为可行有效的办法。临床路径管理系统是多系统的集成平台,将会大大减少临床开医嘱时间;提高医务工作人员的工作效率;系统的预警功能将降低医疗差错的风险,确保医疗质量。在我国医药卫生体制改革和医疗保险制度逐步完善的背景下,临床路径具有巨大的实现价值和发展潜力。     

运用过程能力指数法改进急诊检验报告用时

目的通过把工业上的过程能力指数的方法移植到医疗质量和医疗安全管理上,定量地对其各个指标意义进行分析与说明,进而提出如何根据指标来确定改进办法。方法对某三甲医院急诊生化检验随机抽取84个样本,计算其过程能力指数,分析原因。结果过程能力指数法能直接有效地找到问题所在,并为制定改进措施,明确方向。结论过程能力分析是一种以数据和事实为决策依据的管理方法,它可以应用到医疗质量和医疗安全管理的各项具体工作中．帮助医院管理者提高医疗质量和服务质量。     

Quality assurance in health care. From a traditional towards a modern approach

This review article is about some recent developments in quality assurance in health care. A traditional and a modern approach are distinguished. The traditional approach is marked by a medical perspective and quality is defined as a property of medical care. Development of standards and criteria and inspection of conformance to them is the guiding principle for traditional medical quality assurance. The modern approach is marked by a strong influence of industrial principles on medical quality assurance. Industrial principles provide a new theory upon which medical quality assurance can be based. Aspects of care which are associated with the perceived quality are identified and are legitimate objects of medical quality assurance. The guiding principle is to influence experiences of (internal or external) customers by modelling the care according to clarified expectations. The university hospital of Maastricht provides an example of how modern principles of quality assurance are put into practice.     

医院开展患者就医体验管理的思考与展望

医院开展患者就医体验管理,有利于提升患者满意度,为此建议采取优化就医流程,改善医患沟通方式,加强医疗机构基础设施管理,优化电子信息平台等措施。针对公立医院面临的困惑和难题,提出提高医疗水平,保证医疗质量,重视网络评价,重视医疗人文关怀,提升医院文化水平等建议,以期改善服务质量,增强患者舒适度体验。     

Integrated case management: the 21st century challenge for HMO case managers: Part I

As HMOs approach the new millennium, their care and cost management strategies still will be under attack by policy-makers, legislative bodies, the media, American businesses, and the medical professions. The HMO industry will continue to be held accountable for the efficiency of its services, the quality of its care, and the performance and outcome measures that are the results of managing both the care and medical costs of its membership. This first of a two-part series put forward the concept of an integrated CM model to manage the total care of needs of HMO members at the turn of the century. This model consists of three care management approaches commonly used in mature HMOs: demand management, CM, and DM, as illustrated in Figure 1 and defined in Table 1. This article also described the new challenges facing HMOs, physicians, and nurse case managers and how they are navigating the difficult process of mapping demand management and CM approaches to the medical, social, and environmental needs of HMO members. With the costs of chronic conditions consuming 61% of the nation's annual health bill and increased numbers of the elderly joining HMOs, HMOs strongly need to implement DM approaches for economic survival reasons alone. Part two of this series will focus on the newest care management approach: disease state management.     

The German Quality Management System for Outpatient Care (Q-M-A) Checklist--an instrument for assessing quality management systems in outpatient care

Quality management systems had originally been designed for industrial purposes and were hardly applicable for small enterprises, there have been adjustments to the two main applications EFQM and ISO enabling utilisation also in ambulatory care. There are also different approaches like the Dutch Visitatiae concept which reflects the needs of GP's and is based on peer exchange. The presented paper gives an overview of existing quality management and certification systems and presents an instrument for evaluation. This checklist was developed by an interdisciplinary expert panel of the Agency for Quality in Medicine and serves as an aid for users and graders of quality management systems with regard to the feasibility of these systems.     

医疗质量管理现状分析及对策探讨

医疗质量是医院生存和发展的根本。结合医疗工作实际,分析了目前医疗质量存在的问题及影响医疗质量的主要原因,并从健全规章制度、实行标准化管理、重视引进高新技术和人才、加强学习培训等方面,提出了医疗质量持续改进的思路和方法。     

Stress management in large-scale establishments]

Due to a recent dramatic change in industrial structures in Japan, the role of large-scale enterprises is changing. Mass production used to be the major income sources of companies, but nowadays it has changed to high value-added products, including, software development. As a consequence of highly competitive inter-corporate development, there are various sources of job stress which induce health problems in employees, especially those concerned with development or management. To simply to obey the law or offer medical care are not enough to achieve management of these problems. Occupational health staff need to act according to the disease type and provide care with support from the Supervisor and Personnel Division. And for the training, development and consultation system, occupational health staff must work with the Personnel Division and Safety Division, and be approved by management supervisors.     

出院患者满意度调查分析

目的了解患者对医疗服务的认同程度及医院取得的成效和存在问题,进一步改进服务质量。方法围绕服务态度、医疗、护理质量、医患沟通、费用情况、后勤管理等进行问卷调查。结果患者对医疗、护理质量、服务态度、医患沟通、住院费用的满意度提高,而后勤管理方面尚存在一些问题需改进。     

工伤医疗保险管理现状及建议

本文从政府、医保经办机构、医疗机构三个层面,论述工伤医疗保险管理现状和存在的问题,并就促进我国工伤医保工作的健康良性运行提出改进建议。     

Self-Management Services

For people with chronic illness, day-to-day responsibilities for care fall most heavily on patients and their families. Organising healthcare to strengthen and support self-management in chronic illness while assuring that effective medical, preventative and health maintenance interventions take place is key to effective disease management.This paper discusses the behavioural principles and empirical evidence about healthcare designed to maximise positive patient participation in chronic disease care. Four main essential elements are key: (i) collaborative definition of problems, in which patient-defined problems are identified along with medical problems diagnosed by physicians; (ii) targeting, goal-setting and planning, where patients and providers together agree on realistic objectives and set an action plan for attaining them; (iii) availability of a continuum of self-management training and support options that teach patients the skills needed to carry out medical regimens, guide health behaviour change and provide emotional support; (iv) active and sustained follow-up during which patients are contacted at specified intervals to monitor health status and reinforce progress in meeting care plan objectives. These elements constitute a common core of services and approaches that do not need to be replicated for each chronic condition.     

Clinical outcomes management and disease staging

Clinical outcomes management includes multiple approaches for evaluating and improving the quality and cost effectiveness of medical care. The usefulness of outcomes assessments depends, in part, on how well the clinical issues have been specified and whether the analyses are sensitive to the diverse clinical characteristics of the patients receiving the medical care in question. Measures of severity of illness and, in particular, Disease Staging, have an important role in outcomes assessment by classifying diseases along dimensions that have prognostic significance. This article reviews current applications of Disease Staging for outcomes assessment and management.     

Qualitätssicherung und Qualitätsmanagement in der stationären Altenpflege

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.     

新医改背景下医务处职能的再认识

对医务处的传统职能进行了分析,指出当前医务处职能履行存在的问题,提出新医改背景下医务处应发挥统筹指挥职能、坚持发挥医疗质量管理职能,成为医疗信息系统的积极建设者、医务人员医疗技能的培训者、科室规范管理的推动者、上级部门医疗任务的坚决履行者.     

Teaching organization theory for healthcare management: three applied learning methods

Organization theory (OT) provides a way of seeing, describing, analyzing, understanding, and improving organizations based on patterns of organizational design and behavior (Daft 2004). It gives managers models, principles, and methods with which to diagnose and fix organization structure, design, and process problems. Health care organizations (HCOs) face serious problems such as fatal medical errors, harmful treatment delays, misuse of scarce nurses, costly inefficiency, and service failures. Some of health care managers' most critical work involves designing and structuring their organizations so their missions, visions, and goals can be achieved-and in some cases so their organizations can survive. Thus, it is imperative that graduate healthcare management programs develop effective approaches for teaching OT to students who will manage HCOs. Guided by principles of education, three applied teaching/learning activities/assignments were created to teach OT in a graduate healthcare management program. These educationalmethods develop students' competency with OT applied to HCOs. The teaching techniques in this article may be useful to faculty teaching graduate courses in organization theory and related subjects such as leadership, quality, and operation management.     

Client satisfaction in a health maintenance organization: providers' perceptions compared to clients' reports

This study seeks to compare clients' reports of satisfaction/dissatisfaction with an HMO and its medical care program to providers' perceptions of client satisfaction. The main conclusion is that providers are fairly aware of medical care system attributes with which clients are highly satisfied and dissatisfied. Those with direct patient contact, especially physicians and nurses, are most accurate in their perceptions. Personnel without direct patient contact are about equally accurate in their perceptions of client satisfaction, though personnel without patient contact perceive relatively more dissatisfaction than clients report. Most approaches to medical care evaluation examine costs and efficiency and, more recently, the technical quality of care. Less attention has been given to the assessment of client satisfaction, and almost no attention has been given to what providers perceive as the assessment of clients. Clearly, HMOs' viability is determined largely by their ability to identify and correct major problems affecting their enrollments.     

医疗设备质量控制管理面临的问题与对策

分析目前医院在医疗设备质量控制中存在的问题,找出合理的解决方案,按照行之有效的方法做好医疗设备质量控制管理工作。通过建立医疗设备质量控制体系,提高医院管理层和科室的质量管理意识,采取医护质量考核的监督方式,促进质量控制管理工作的发展。通过规范化管理不仅能够提高质量控制管理质量,还可提高医疗设备的利用率,保障医疗设备安全使用。医疗设备质量控制管理工作是医院管理的重要组成部分,建立医疗设备质量体系,能够确保医疗设备质量安全,充分发挥设备的效能、更好地服务于临床。     

医务人员对医疗服务质量的评价分析

目的研究医院医疗服务质量中存在的问题,为医院管理决策提供依据。方珐对医务人员进行问卷调查。调查问卷量表采用4点尺度法,区分为“好、较好、一般、差”,并根据答案进行评分。调查内容涉及：医务人员的基本情况、工作满意度以及其他的相关项目情况。结呆相关分析表明医疗技术评价密切相关的因素包括医护质量、服务态度和经济效益等方面,与医护质量评价密切相关的因素包括职称、院龄以及医疗技术评价等方面。结论提高医护质量的关键要素是提高医疗技术水平,从管理角度应该重视人才建设,做到人尽其才。     

规范书写 加强质控 努力提高病历质量

医院质量管理是永恒的主题,病历质量是医院医疗质量的重要组成部分。认真规范的书写,严格细致的质量控制是提高病历质量的关键。文章对病历的作用、质量的现状以及提高病历质量的措施等作一探讨,指出规范书写病疗文件是医师的基本技能;健全和完善病历的管理组织和质控网络,对病历实行全程质量控制;加强“缺项质控”、推行“病种质控”和“路径质控”;重视电子病历的管理和质量控制：以严格的要求和科学的管理,使病历质量持续稳步提高。     

A methodology for targeting hospital cases for quality of care record reviews.

We tested the efficacy of selected case characteristics in targeting quality of care problems for medical record review. The case characteristics, all of which apply to patients who die in a hospital, consist primarily of procedures and DRGs (diagnosis-related groups) for which death rarely occurs, and a set of complications of surgical care. All characteristics are obtainable from combinations of the principal and secondary diagnoses and procedures in the case, and are available from discharge abstracts. The presence of a quality of care problem is confirmed through a review of the medical record by a nurse and two or more physicians. A logistic regression model that controls for various patient and hospital variables is used as a measure of each of the proposed case characteristics. The results indicate that most of the characteristics are associated with higher percentages of quality of care problems than cases chosen at random, and that the methodology has promise as a tool for targeting cases for medical record review.