某市社区卫生机构与大中型综合医院的关系模式研究

目的:了解某城市社区卫生服务机构与大中型综合医院之间关系现状,探讨建立两者之间合理关系的策略。方法:文献研究、案例研究和关键知情人访谈。发现:我国医疗机构与行政管理级别对应,使得大医院和基层卫生服务机构之间关系松散,缺少联系;在发展和改革过程中,大医院和社区卫生服务机构之间的服务提供内容界定并不清楚;虽然出台了不少加强两者之间联系的政策措施,但这些新政策尚没有抓住关键环节。某市两类机构的关系主要有三种类型:大医院办社区、契约或托管、松散关系。研究表明,两者之间自身利益关系越密切,越能够顺利地实现相互联系,此外,还有很多方面会影响二者之间的关系。结论:需要明确两类机构的角色与功能,加大社区卫生服务的发展力度,特别是人才培养,在一定程度上限制大医院的规模;对于大医院办社区的模式,需要谨慎对待。     

医疗联合体荔湾模式探索与研究

目的探索医疗联合体的建立及运行模式。方法自2013年广州市荔湾区社区卫生服务机构与附近二、三级医院建立医疗联合体,比较医联体实施前后的社区卫生服务中心门诊人次、培训次数和社区居民的满意度。结果实行医联体后,社区卫生服务中心门诊人次、培训次数和社区居民的满意度明显提高。结论通过建立医联体可以有效提高社区卫生服务中心服务能力水平,确保医疗工作的质量,提高社区居民的满意度。     

政府与大医院共建共管社区卫生服务新模式的探索——以广州市越秀区政府与中山大学附属第一医院合作为例

政府与大医院共建共管社区卫生服务的模式,有利于形成三级医疗机构网络,实现区域卫生资源优势互补;提高社区.医疗服务质量,落实社区卫生服务功能.要加强政府行政监管,理顺三级管理机构的关系,维护政府、社区居民、大医院和社区卫生机构多方满意共赢的局面,不断完善共建共管社区卫生服务新模式.     

医院集团中的社区卫生服务机构与医院的协调

我国城市社区卫生服务发展的障碍之一是城市社区卫生服务机构与医院存在功能冲突。两者功能冲突表现在由于双方利益冲突、社区卫生服务机构自身不健全、缺乏双向转诊的技术标准、缺乏外部监督和约束而导致的双向转诊制度的失败。在市场作用基础上,政府引导建立集团化模式的协调机制,运用利益协调、组织协调、程序协调和战略协调,能够较好地解决两者功能冲突,促进社区卫生服务发展。     

武汉市综合医院与社区卫生服务机构协作模式运行现状与效果研究

目的了解武汉市综合医院与社区卫生服务机构协作的各种模式．提出推动城市两级医疗机构分工协作的建议措施。方法运用快速评估方法,进行定性和定量研究。结果武汉市两级医疗机构的协作模式主要有大医院托管、直管、直接举办和对口帮扶。2007-2009年,各协作模式社区卫生服务中心的服务提供情况、双向转诊工作完成情况都得到一定程度的改善。结论综合医院大力扶持社区卫生服务中心人员医技水平的提升,是实施有效分工协作的重要基础。     

不同举办主体社区卫生服务机构员工满意度调查

目的:了解不同举办主体社区卫生服务机构员工满意度情况.方法:员工座谈与问卷调查相结合.结果:政府、医院、企业与个人举办的机构员工满意度分别为24.23%、43.60%、44.01%和62.98%.结论:不同举办主体社区卫生服务机构的员工待遇不同,满意度水平差异显著,政府与医院举办的机构尽管在待遇上具有较大优势,但是员工满意度较低;个人举办的机构,虽然"先天"处于劣势,员工的满意度却最高.建议:改革政府与医院举办的社区卫生服务机构的人事管理制度,使个人与企业举办的社区卫生服务机构人员享有公平待遇,同时改变机构的软硬件务件,提高员工的满意度水平.     

基于区域性医疗集团下的双向转诊模式探讨——以"北京复兴模式"与"大庆模式"为例

由于医疗机构间缺乏行之有效的双向转诊制度,导致城市大医院人满为患,而社区卫生服务机构却少人问津,造成了卫生资源的严重浪费。通过组建区域性医疗集团,形成基于集团内的双向转诊模式,可以理顺大医院与社区卫生服务机构的经济关系,形成利益共同体、实现信息资源的沟通与共享,从而提高卫生服务的公平性和可及性。对以北京复兴医院集团和大庆石油总医院集团为代表的区域性医疗集团的相关文献进行整理分析,提炼出基于区域性医疗集团下的双向转诊模式的优越性及其推广、完善的思路。     

公共服务产业理论视野下农村社区卫生服务模式的构建

目的：探讨农村社区卫生服务机构和新型服务模式的构建。方法：应用公共服务产业理论对农村社区卫生服务模式进行探讨与构建。结果：农村公共卫生服务体系应形成政府、公共卫生组织和农村居民三方相互制衡机制。政府以购买的方式向公共卫生组织购买公共卫生服务。公共卫生组织成为独立机构,作为＂第三部门＂的姿态出现。农村社区服务机构是最为可能的第三部门,将以＂六位一体＂的方式开展公共卫生和医疗服务工作,同时居民将与政府一同对社区卫生机构评估和监督。结论：公共服务产业理论框架下的此种模式以及其实践性应展开进一步研究。     

天津医务人员和患者双向转诊知晓度及意愿性的调查

目的 了解天津市医务人员和患者对社区卫生服务及双向转诊的知晓利用情况;调查医患双方对双向转诊实施的意愿性,分析其影响因素,为顺利实施双向转诊制度提供依据.方法 采用目的抽样方法,抽取天津市内6区3家三级医院和8家社区卫生服务机构的1 8周岁及以上的医务人员和患者进行问卷调查,整理录入问卷并分析.结果 (1)医患双方对双向转诊的认知度低.(2)科室、职称和工作年限3个因素是医务人员参与双向转诊意向的影响因素.(3)医务人员在进行双向转诊遇到的问题:转诊标准不统一、医疗机构缺乏信息交流、经济利益驱使、医疗保险政策影响、病人不接受.结论 天津市医务人员和患者对社区卫生服务内容、双向转诊知晓情况普遍较低,但是大部分比较赞同开展双向转诊.应加强对双向转诊制度的宣传和医院与社区机构的沟通交流,平衡医疗机构间的经济利益,并且坚持以病人为中心,政府在推动医院和社区卫生服务机构双向转诊发展过程中发挥主导作用.     

北京市社区卫生服务运行机制改革状况定性评价研究

目的:了解北京市社区卫生服务运行机制改革状况,探索改进城市社区卫生服务发展的模式与运行机制.方法:采用第三方评估的方式,通过立意抽样的方法,对北京市社区卫生服务机构开展了定性研究.结果:所采取的系列改革措施正在逐步推进.北京市所辖18区(县)政府举办社区卫生服务机构全部实施了收支两条线管理;共有1.2万余人次医务人员下社区,已有610名专家到社区工作;93家二级以上医院支援社区卫生服务,建立了双向转诊制度:所调研的7个区县已基本完成社区卫生服务机构的标准化建设.结论:北京城市社区卫生服务运行机制改革状况总体良好,社区卫生服务机构健康地运行与发展,社区居民对社区卫生服务的满意度提高.但在人才培养方面,还应继续探索适应社区卫生服务发展的培养模式.     

实施优质护理服务在护理管理中的实践与作用

目的：探讨实施优质护理服务活动的实践方法与效果。方法：在全院范围宣传开展“优质护理服务”的意义,先确定4个科室为“优质护理服务示范病区”,然后在全院范围内开展优质护理服务活动,采取的措施包括实施护士责任制包干;提高护理人力资源的合理利用;推行亲情护理服务;不断完善护士激励机制。结果：提高了护理人员的整体素质、护理工作质量及患者满意度。结论：开展优质护理服务,能达到令患者、医院、社会、政府都满意的效果。     

关于乡镇卫生院公共卫生管理若干问题探讨与对策

目的关于乡镇卫生院公共卫生管理若干问题探讨与对策。方法选取2018年6-12月期间收入该院进行治疗的88例患者为例,均分为对照组(n=44)、观察组(n=44),对照组实施常规管理,观察组在对照组的基础上实施公共卫生管理,对比两组患者对护理满意度以及预防保健完成情况。结果通过实施不同的管理模式,观察组责任意识(82.58±7.63)分、专业技术(84.36±6.35)分、服务态度(81.59±7.58)分,显著好于对照组责任意识(71.25±6.35)分、专业技术(70.56±6.38)分、服务态度(72.08±5.36)分,差异有统计学意义(P<0.05)。且观察组预防保健完成情况95.45%显著好于对照组68.18%,差异有统计学意义(P<0.05)。结论实施公共卫生管理,可提高患者满意度,且促进卫生院预防保健工作的顺利开展,值得应用和推广。     

公立医院的公益性及其保障措施

本文提出了公立医院公益性的内涵和保障措施。公立医院的公益性,是指公立医院的行为和目标与政府意志相一致,进而与社会福利最大化的目标相一致;公立医院除了遵循一般医院和一般非营利医院的管理制度之外,还要在维护医疗服务和筹资的公平性、提高医疗服务的宏观和微观效率、承担政策性职能等三个方面,体现公益性。政府是保障公立医院公益性的主体,要从明确公立医院的定位和管理目标、保障充足的财政支持和适宜的财务制度、建立考核问责监督机制以及建立符合公益性要求的内部管理制度等四个方面保障公立医院的公益性。     

Staff views of a hospital at home model implemented in a Scottish care setting

PurposeDemographic and financial challenges mean prioritising a shift in healthcare provision from acute to community settings. One well-evidenced model encapsulating this is ‘hospital at home’, however limited research has examined staffs'' views on its implementation, which may inform service development and increase job satisfaction. The aim within was to explore the staff perspective of implementing a ‘hospital at home’ model in a Scottish care setting which can inform service provision and ultimately increase job satisfaction.MethodsThe ‘Acute Care @ Home’ (AC@H) service had a multi-disciplinary team. Referrals were predominantly received from a geriatric hospital ward. Inclusion criteria were older adults with geriatric syndromes and who required care input for a duration between one to seven days. In-depth staff interviews (N = 13) were conducted and analysed thematically to understand barriers and facilitators to implementation. These were supplemented with questionnaires assessing constructs of interest including training, communication and overall satisfaction.ResultsSeveral themes urged from our study: inter-team and intra-team collaboration, service development and operation, and scaling considerations. High job satisfaction was reported (mean score 73%), particularly due to a perceived non-hierarchical team structure and inclusive management style. Staff attributed positive outcomes through better identifying patients'' needs at home compared to in hospital. Continuity of care facilitated rapport building. Recruitment challenges restricted the acuity and volume of patients the team were able to care for.ConclusionsThis qualitative methodology could be useful for future implementation of intermediate care resources for the future health and care system building. Patient assessments at home, as opposed to in hospital, in conjunction with care continuity by staff, may mitigate against hospital risks and better facilitate reablement. Where recruitment challenges are present, agile models of care delivery should be considered.     

杭州市公立医院财政投入分析

本文以市属公立医院财政投入为例,根据政府对医疗卫生财政投入、对公立医院投入、固定资产投资、经济运行补偿结构和成本费用数据进行分析,认为政府财政投入依据相对简单,提出政府应综合考虑医院成本核算、医疗服务价格和补偿机制等问题,有计划、科学地进行财政投入,并与医院综合考核结果相结合。     

甘肃省社区卫生服务提供及财政状况调查研究

目的了解甘肃省社区卫生服务机构服务提供及财政状况基本现状,为发展甘肃省社区卫生服务提供决策依据。方法采用统一问卷,调查分析甘肃省98所城市社区卫生服务中心和264所社区卫生服务站的服务提供情况及财政状况。结果甘肃省城市社区卫生服务机构医疗服务利用率较低,公共卫生服务不完善且质量较差。40.01%的社区卫生服务中心和26.07%的社区卫生服务站财政支出大于收入,政府财政对社区卫生服务机构的投入不足。结论建议转变服务模式,加强公共卫生服务能力培训,加大政府投入,建立收支两条线的财务政策。     

A new financial budgetary system for community health services institutions in China

The separation of revenue and expenditure budgets (SREB) is a new financial budgetary system that is being implemented in community health services (CHS) institutions in some areas in China. Through literature review, it was found that, derived from the traditional separation of revenue and expenditure budgets (TSREB) implemented in administrative public services units, SREB and TSREB have something in common and yet many more differences. On the basis of some quantitative and qualitative data that were collected by field survey, it was also found that implementation of SREB in CHS institutions brings positive outcomes in terms of the quantity, quality and efficiency of services; residents' satisfaction; and the behavior of CHS institutions. The conclusion can be suggested that SREB, as a system having impact upon the incentives facing CHS institutions and the nature of governmental responsibility for developing CHS in China, will promote CHS institutions to fulfill basic service functions if implemented well. Therefore, it is a system that is worth further development and evaluation.     

The effects of hospital-physician integration strategies on hospital financial performance.

STUDY QUESTION. This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships. DATA SOURCES AND STUDY SETTING. Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990). STUDY DESIGN. The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity. DATA COLLECTION/EXTRACTION. Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses. PRINCIPAL FINDINGS. Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration. CONCLUSIONS. The findings support the validity of hospital-physician financial integration efforts, and to a lesser extent the involvement of physicians in hospital governance. The results lend considerably less support for strategies built around direct physician ownership in hospitals, particularly since PPS implementation. RELEVANCE/IMPACT. These findings challenge prior studies that found few financial benefits to hospital-physician integration prior to PPS implementation in 1983. The results imply that financial benefits of integration may take several years after implementation to emerge, are most salient in a managed care or managed competition environment, and vary by hospital size and multihospital system membership.     

不同类型社区卫生服务中心公共卫生服务功能分析

目的:分析武汉市30家不同举办主体社区卫生服务中心公共卫生服务功能的发挥情况。方法:利用加权秩和比法和数据包络分析分别从公共卫生服务的开展情况和提供效率两个方面对社区卫生服务中心进行评价。结果:(1)政府办、社会办和医院办社区卫生服务中心平均WRSR值分别为0.525、0.481和0.539(经检验,差别无统计学意义),3类社区卫生服务中心公共卫生服务总体开展情况差异不大;(2)3类社区卫生服务中心在不同公共卫生服务项目开展上各有侧重,并且各项基本公共卫生服务工作落实情况不同,居民健康档案建档工作开展率高于0~6岁儿童和65岁以上老年人健康管理率。(3)政府办社区卫生服务中心公共卫生服务提供综合效率(0.770)高于社会办和医院办社区卫生服务中心(0.705和0.698)。结论:鼓励和支持社会办社区卫生服务中心发展,通过合理监管,促进其公共卫生服务职能有效发挥;卫生行政部门应完善公共卫生服务考核方式,引导各类社区卫生服务中心公共卫生服务工作均衡开展;社会办和医院办社区卫生服务中心应进一步改善公共卫生服务效率,提高技术水平,在合理配置资源的基础上适度增加投入。     

The 2017 reform of the hospital sector in Poland – The challenge of consistent design

Beginning in October 2017 a system of basic hospital service provision, popularly called the ‘hospitals network’ was implemented in Poland. It covered 594 hospitals out of a total number of approx. 920 operating in 2017. The regulation’s official objectives were to: “(1) improve the organization of services delivered by hospitals; (2) improve access to hospital care; (3) optimize the number of specialist wards; (4) improve coordination of in- and out-patient care; (5) facilitate hospital management”. The aim of this paper is to describe the background of the reform planning and its formal objectives, content and implementation process, as well as to assess the preliminary results and discuss the possible limitations and implications. Although the official term ‘hospitals network’ is used to describe the reform, in practice it does not involve an element of cooperation between hospitals. The regulation’s main feature was changing the financing methods for a pre-defined scope of services (from per-case to global budget).The reform was planned and implemented on a rather ad-hoc basis while its major controversy is the lack of quality of care, health outcome and population health need measures in the network inclusion criteria. The assessment of the reform’s impact on service provision requires long-term analysis and access to detailed quantitative data.