绍兴市城区老年人医疗服务需求状况及其影响因素调查

目的 了解经济发达地区老年人的医疗服务需求情况及影响因素，为卫生行政部门及医疗机构提供决策依据。方法 采用随机整群抽样方法，对绍兴市城区568名60岁以上的老年人进行现场问卷调查。结果 绍兴市城区老年人的文化程度总体不高，经济来源以离退休金居多，收入水平较好，医疗费用支付以自费为主。分析显示，老年人的性别、年龄、文化程度、经济来源和月收入水平等因素对其医疗服务需求有不同程度的影响。结论 采用多种方式进行老年医疗保健知识的宣传和教育；针对不同老年人群的特点，提供多形式、全方位的医疗服务，不断改善他们的健康状况；须大力提倡建立社会、集体、家庭和个人共同承担老年医疗保障制度。     

开展社区老年患者医疗服务提高医学生综合素质

我院社区服务工作开展较早，经过多年的实践，医院院前和院后宣教、服务和管理等工作，尤其是社区医疗健康档案的建立、社区健康宣教、慢性病防治讲座和体检、送医下乡等工作得到了有序开展，形成相对稳定又不断拓展的良好局面，基本形成家庭-社区-医院-社区-家庭的管理模式，体现了“以人为本”的服务理念。在这一有利的条件下，我们坚持积极引导、安排医学生参加社区医疗实践活动。从2002年开始组织温州医学院临床医学本科见习生开展社区（敬老院等）医疗实践活动。     

深化文明行业建设提高医疗服务水平

近年来，我院不断深化文明行业建设，有力地推动了医院的改革和发展，先后被省文明委授予“文明行业示范点”，被省卫生厅授予“文明服务示范医院”，被国家卫生部、中医药管理局、总后勤部卫生部授予“全国百佳医院”。１　加大文明建设力度，认真解决热点难点１．１　以缩短平均住院日为突破口，努力减轻患者经济负担。我院扩建了第二手术室，手术台由原来的５个增加到９个，１９９８年手术量达７０５５例。门诊成立了日间手术中心，缩短了择期手术病人的等候时间。医技科室取消了辅助检查的预约规定，化验、投照、特检随到随做，明确各种…     

北京大学人民医院心脏中心成立

北京大学人民医院心脏中心于2007年3月20日正式成立，这次将原有心血管内科、高血压科、心脏外科、血管外科整合在一起建立心脏中心，并与老年科、急诊科等相关科室建立了良好的合作。这种多学科的专业整合，突破原先各科室之间的专业壁垒，一是有利于保护患者利益，二是有利于内外科合作互动，促进学科发展。中心根据循证医学原则，切实为患者选择更加合理更加科学的治疗方案，有利于减少或者避免重复医疗和过度医疗，保证各种医疗资源的高效应用，缓解医患之间的供需矛盾，从而促进和谐医疗。新建立的北京大学心脏中心将更加注重医疗服务模式的探索，“变被动医疗服务为主动医疗服务”，深入基层和病人中去，通过“生命网”和“心桥病友会”宣教互动活动，加强疾病的一级预防和二级预防，保证患者长期稳定的治疗效果，建立和谐医患关系。同时大力该倡导大城市综合医院的医疗技术人员，通过“健康从心做起”和“救助先天性心脏病”这样的大型公益性活动，深入全国贫困县乡，传播技术，培训基层医疗技术人员，在一定程度上缓解基层百姓缺医少药的局面。     

队属医院医疗欠费患者46例原因分析

医疗欠费是患者接受医疗服务，即占有医护人员的劳动及消耗医疗物化劳动，而未能及时支付相应费用所形成的一种经济关系。二炮队属医院要走“优质、高效、低耗”的建设发展之路，积极开展对外有偿服务，就要加强医疗欠费的管理和研究。我们对46例欠费患者病历中医护质量调查问卷进行回顾性分析，寻求医疗欠费的原因和解决问题的方法。     

丰宁县突发事故及危重症院前死亡病例分析

丰宁满族自治县是河北省承德市北部据北京市最近的、北连内蒙古、张家口的经济、金融贸易、旅游中心。然而，各种意外突发事故、急危重症时有发生，直接威胁着全县50万及来丰宁大批投资、旅游人员的健康及生命。自2000-2007年我院急救中心共出120急诊13000人次，其中院前死亡780人（5．5％），现总结分析如下。     

缺少医疗服务肺结核病人的经济地理因素分析

目的分析影响新涂阳结核病人中缺少医疗服务病人比例和经济地理因素，并提出了相应干预措施意见，以减少缺少医疗服务病人的比例。方法通过问卷调查获得36个县缺少医疗服务病人比例，同时与人均GDP、结防机构医疗服务半径、地形特征分别进行卡方检验分析。结果不同人均GDP的各组中缺少医疗服务病人比例构成无显著性差异（X^2=1，P〉0．2）。不同医疗服务半径的各组中其缺少医疗服务病人比构成有显著性差异（X^2=8．236，P〈0．002）；30km以上组比25～30km组其缺少医疗服务病人比例高（X^2=7．063，P〈0．05）；30km以上组比小于25km组其缺少医疗服务病人比例高（X^2=7．469，P〈0．05）。不同地形的3组中其缺少医疗服务病人比例的构成有显著性差异（70=8．800，P〈0．001）；山区组比丘陵组其缺少医疗服务病人比例高（X^2=6．085，P〈0．05）；山区组比平原组其缺少医疗服务病人比例高（X^2=4．5，P〈0．05）。结论不同人均GDP的地区其缺少医疗服务比例之间没有差异；医疗服务半径越大的地区其缺少医疗服务病人比例越大；缺少医疗服务病人比例山区组高于丘陵组和平原组。在现有各项活动资金得到保障的前提下，适当给予病人一定的激励。首先考虑面积大，山区等交通不便的地区，其次再考虑经济人口等别的因素。     

脑出血院前急救处理体会

脑出血是“120”急救工作中常见的急症之一。发病急，病情重，死亡率高。院前的及时、准确的处理是降低死亡率，挽救生命最重要的保障。本文总结分析了2004年1月～2005年1月院前救治的80例脑出血患者救治体会，现报道如下。     

医疗服务失误的补救

医疗失误是医疗纠纷的源头，由于医学科学技术的高速发展，以及疾病的复杂性、人体的个体差异性、医疗活动的多环节性和风险性，导致医疗服务失误难以避免，如何避免和减少医疗服务失误发生及发生后及时给予补救，对于减少医疗纠纷的发生，起着重要的作用。     

成体干细胞衰老的研究进展

随着社会的进步，人民生活水平和医疗水平的提高，长寿已经在全世界成为一种普遍的现象。这对社会进步、经济发展和医疗服务等领域都产生了深远的影响。     

Age, resource consumption, and outcome for medical patients at an academic medical center

At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.     

Benefits of profit centers for cardiology medical groups.

This article describes the benefits that profit centers provide to cardiology medical groups in the areas of pricing strategy, cost management, and quality enhancement, plus shows how an annual profit objective can also be implemented to internally generate funds for making capital investments.     

Beyond the medical record

BACKGROUND: Studies before and since the 1999 Institute of Medicine report have noted the limitations of using medical record reporting for reliably quantifying and understanding medical error. Quantitative macro analyses of large datasets should be supplemented by small-scale qualitative studies to provide insight into micro-level daily events in clinical and hospital practice that contribute to errors and adverse events and how they are reported. DESIGN: The study design involved semistructured face-to-face interviews with residents about the medical errors in which they recently had been involved and included questions regarding how those errors were acknowledged. OBJECTIVE: This paper reports the ways in which medical error is or is not reported and residents' responses to a perceived medical error. PARTICIPANTS: Twenty-six residents were randomly sampled from a total population of 85 residents working in a 600-bed teaching hospital. MEASUREMENTS: Outcome measures were based on analysis of cases residents described. Using Ethnograph and traditional methods of content analysis, cases were categorized as Documented, Discussed, and Uncertain. RESULTS: Of 73 cases, 30 (41.1%) were formally acknowledged and Documented in the medical record; 24 (32.9%) were addressed through Discussions but not documented; 19 cases (26%) cases were classified as Uncertain. Twelve cases involved medication errors, which were acknowledged in different categories. CONCLUSIONS: The supervisory discussion, the informal discussion, and near-miss contain important information for improving clinical care. Our study also shows the need to improve residents' education to prepare them to recognize and address medical errors.     

Value of medical technics in the medical management of elderly patients

The patient enters the hospital with a certain attitude of expectation. In this context we discuss the suppositions and tasks for physicians and nurses in connection with the medical technique in the carc-regime for patients (diagnosis, therapy and nursing). The medical technique receives a stabil place in the process of improvement of sensoric and affective possibilities of the physician. It remains a mile-stone of diagnosis and therapy. We take into consideration the economical aspects, psychic reservations of patient, but also aims, necessities and application-limits of medical technique.     

The advanced life support base hospital audit for medical control in an emergency medical services system

A large California county uses an audit of its advanced life support (ALS) base hospitals to maintain medical control of prehospital care and to improve the county emergency medical services. The audit is a rigorous, semi-annual evaluation of ALS base hospital performance using objective, written criteria. The county emergency medical service district and the base hospitals have benefited from the data that have resulted from the audits. The base hospital audit is an excellent method of assessing medical control in an emergency medical services system.     

某三级甲等传染病医院医疗纠纷特点浅析

通过总结某三级甲等传染病医院近12年的医疗纠纷情况,分析该专科医院医疗纠纷的特点,总结该专业相关问题的个性化调处经验。     

Administrative procedures in cases of medical errors: the jurisdiction of the hospitalist

The administrative jurisdiction is, with the exception of free practice within hospitals, that which judges whether actions of hospital doctors are at fault, and evaluates the harm done to the plaintiff. After a reminder of the fundamentals of medical liability as regards the administration, a short update on private practice in hospital, and the notion of fault being separate from the hospital function, the author analyses the important elements such as the concept of the preliminary decision and the status of the expert, and then a number of characteristic elements of this type of procedure, stressing in particular the absolute necessity of a perfectly kept hospital medical record.     

Collaboration between a local medical community and a university hospital

Here we report the current status and problems in collaboration between a local medical community and a university hospital. It is important for the university hospital to clearly define its role in the local medical community, collaborate with local medical and welfare institutes and establish a local medical and care network that supports patients and their families. For this purpose, the social service department is expected to play a role as a coordinator between the university hospital and the local medical community so that the patients can make the best use of medical and care resources.     

Intensivist-to-bed ratio: association with outcomes in the medical ICU

OBJECTIVE: With an increasing number of critical care beds, a shortage of critical care physicians, and pressure from purchasers, there is a need to define the optimal intensivist-to-ICU bed ratio. The objective of this study was to determine if there are any associations between the intensivist-to-ICU bed ratio and the outcome of patients admitted to the medical ICU. DESIGN: Retrospective cohort study. SETTING: A tertiary care medical center. PATIENTS: All critically ill patients admitted to a medical ICU between December 8, 2001, and July 14, 2003. INTERVENTIONS: None. MEASUREMENTS: Demographics, APACHE (acute physiology and chronic health evaluation) III-predicted mortality, ICU length of stay (LOS), hospital LOS, and ICU and hospital mortality rates. Four time periods based on intensivist-to-ICU bed ratios of 1:7.5, 1:9.5, 1:12, and 1:15 were identified. Regression analyses were performed to develop customized models to predict ICU and hospital LOS and mortality. The ICU LOS ratio, defined as the ratio of the observed to predicted LOS, and standardized mortality ratio (SMR) were calculated for each of the four periods. RESULTS: A total of 2,492 patients were included in the study. There was no difference in the severity of illness at the time of ICU admission among the four periods. The mean ICU LOS ratio was longer for an intensivist-to-ICU bed ratio of 1:15 compared to the other periods. The ICU and hospital SMR did not differ significantly among the four periods. CONCLUSION: Differences in intensivist-to-ICU bed ratios, ranging from 1:7.5 to 1:15, were not associated with differences in ICU or hospital mortality. However, a ratio of 1:15 was associated with increased ICU LOS.     

Cost-effectiveness of coronary angioplasty versus medical treatment: the impact of cost-shifting

Background: Coronary angioplasty (PTCA) offers improved symptom control over medical treatment in patients with stable angina and single-vessel disease. However, it is uncertain if PTCA is more cost-effective. Cost-shifting could also influence the provision of PTCA. Methods: Data from the only randomised trial comparing PTCA to medical therapy (ACME study) were used with costs from an Australian teaching hospital to estimate the costs and freedom from angina in 100 patients over three years. The incremental cost-effectiveness of PTCA, and the potential for cost-shifting were also examined. Results: Although the total cost of treating 100 patients over three years with PTCA ($678,978) was higher than a medical strategy ($631,078), PTCA was more cost-effective ($10,930 versus$12,682 per patient free of angina). The incremental cost-effectiveness of PTCA ($3875 per extra patient free of angina) was also substantially less than the cost of the medical strategy. These should be considered crude estimates as they were based on limited data on resource use. The hospital could reduce costs by pursuing a medical strategy, but 54% of the savings would result from shifting the cost of treating patients to the Federal Government and patients. By performing PTCA on privately insured rather than Medicare patients, die hospital could shift $29,876 per 100 patients to the Federal government and private insurance funds. Conclusions: From society's perspective, PTCA may be more cost-effective than a medical strategy. However, the financial interests of the hospital are best served by limiting PTCA or restricting PTCA to privately insured patients. Cost-shifting may have a major impact on the provision of PTCA. The costs of providing medical services need to be weighed against the cost of not providing them.