基本医疗保险异地就医管理服务研究——以江苏某三甲综合医院为例

城镇化进程中人口流动催生了异地就医行为,本研究结合医保日常管理工作,梳理了当前异地就医管理服务机制的现状,分析了异地就医管理服务机制中存在的患者对异地就医政策的知晓度不高,医保政策的差异性制约异地就医管理服务,异地就医服务的管理成本大、难度高等问题。提出了进一步加强异地就医政策的宣传工作,健全沟通机制、简化相应的异地就医备案手续,完善异地就医信息系统、提升医保异地就医结算效率等对策建议,以期逐渐完善异地就医管理服务,进一步提升异地就医患者的满意度。     

我院现行门急诊服务流程的情景分析

通过收集HIS中存储的2006年医院门急诊工作相关数据,分析了服务量、病人到达率、各窗口服务率、就医环节和就医有效时间等情况。结果显示门急诊就医环节多,病人有效就诊时间少,优化门急诊就医流程迫在眉睫。     

新业态下构建医患双满意门诊服务体系的实践探索

公立医院门诊就医体验差,员工工作负荷重。通过构建新业态下的双满意门诊服务体系,以患者服务、现场服务、线上服务、一体化预约服务等方面构建患者服务体系,以门诊无纸化就医、医护服务、门诊运营等方面构建医务人员服务体系,有效提升了医院患者就医体验和职工满意度,改进了门诊医疗服务质量。     

欧盟跨境就医管理模式对中国跨省异地就医的经验借鉴

随着欧洲一体化进程的深入,如何有序管理公民在各成员国之间跨境就医成为欧盟一项重要议题。多年来欧盟社会医疗保险在保障患者跨境就医上已建立一套较为完善的管理模式并受到全世界关注,其社会保障的实践对我国跨省异地就医管理具有借鉴意义。本研究通过系统梳理欧盟跨境就医管理模式,并着重比较欧盟与中国在异地就医对象、异地就医授权、服务机构、就医服务类型、异地医保报销五个方面的异同,为进一步完善我国跨省异地就医管理提供经验借鉴。本研究建议,各省应同步推进跨省就医政策,加快相关工作的落实;增强参保地医保管理机构的审核权限和能力以构建有序就医秩序;同时,在严格审核下拓宽更加合理的跨省就医服务机构网络;最后,鉴于医保对异地就医机构行为缺乏了解,应通过国家异地就医网络,加强医疗机构提供异地就医服务中的监管。     

试论微信改善患者就医体验的作用

"以病人为中心"的患者就医体验,需要医院始终把人性化的医疗服务贯穿于医疗工作的全过程,积极创新服务举措,改进就医流程。微信作为国内第一大移动社交应用,有着庞大的用户群和开放平台接口。医院建立微信公众平台,与医院信息系统对接,立足于患者需要,对内部进行服务举措、就医流程的拓展和改造,从而为患者就医提供优质高效便捷的医疗服务。     

基于信息系统便捷就医通道的建立

数字化医院建设要以病人服务为中心,建立基于信息系统的便捷就医通道。建立持书就医系统,推出银医联名卡;建立自助服务系统,提升就诊速度;建立预约服务系统,进行精细化管理;建立排队叫号系统,创造良好的诊疗环境;建立信息发布系统,及时反馈就诊信息;建立病患关系管理系统,提供全程关怀服务。通过优化就医流程,改善患者的就医环境和就医体验,提高服务水平,为病人提供更加人性化服务。     

突破异地就医管理瓶颈

正有3个关键点需要特别关注,分别是:异地就医经办服务能力不足问题;异地就医诊疗行为监管难问题;顺畅异地就医管理服务与有序就医秩序之间的矛盾问题。根据人社部、财政部、国家卫生计生委联合文件,2015年我国基本实现地市级和省(区、市)范围内异地就医住院费用的直接结算,2016年将全面实施跨省异地安置退休人员住院医疗费用直接结算。当前,医保经办机构提供的异地就医管理服务主要包括地市、省和跨     

科学就医健康教育核心信息及释义

<正>一、科学就医是指合理利用医疗卫生资源,选择适宜、适度的医疗卫生服务,有效防治疾病、维护健康。科学就医与每个人的健康都息息相关,涉及生命过程的各个阶段,有助于更便捷、经济、有效地解决自身所面临的健康问题。公众应重视科学就医,切实维护自身及他人健康。科学就医就是要树立预防为主的健康理念,合理利用医疗卫生资源(公共卫生服务、诊疗服务、     

安徽省某三甲医院创建老年友善医疗机构的实践与思考△

目的：探讨安徽省某三甲医院老年友善医疗机构建设路径,为其他医院创建老年友善医疗机构提供一定参考。方法：通过营造老年就医友善文化氛围,制定老年就医友善诊疗流程,完善老年就医友善便民服务,构建老年就医友善诊疗路径,开展老年就医友善能力培训,加大老年友善环境建设等实践,积极建设老年友善医疗机构。结果：“尊老、爱老、助老”理念不断深入,老年患者就医服务明显改善,老年患者就医体验明显增强。结论：创建老年友善医疗机构是一项系统性工程,营造老年就医友善文化氛围是创建的良好前提,改善就医服务增强就医体验是创建的必要路径,打通老年患者就医“绿色通道”是创建的关键环节。医院应以创建工作为契机,积极应对人口老龄化带来的就医格局变化。     

分级诊疗制度下考虑患者偏好的医疗服务资源纵向整合研究

分级诊疗制度是现阶段改善患者无序就医、合理配置医疗资源、促进基本医疗服务均等化的重要举措。本文界定了个人可支配收入、年龄、自感疾病严重程度及医疗机构门诊价格、服务容量等多因素影响的患者理性就医行为的效用函数,构建了基于患者就医偏好的就医选择动态博弈模型,通过将理性就医偏好下虚拟行动仿真的秦皇岛医疗机构患者分布与实际统计数据进行比较,验证了所建模型的合理性。研究结果表明:患者在基层医疗机构与高水平医疗机构间的就医行为较理性,在二三级医院间却较不理性。因而分级诊疗制度下医疗服务资源优化的重点在于建立患者按需就医的整合型医疗服务体系。     

Impact of Guidelines on Healthcare from the Patient and Payor Perspective

Clinical practice relies on structured learning that is applied to a patient care setting. Patients present with symptoms and providers try to fit these complaints into known disease categories. Providers depend on memorized algorithms to direct diagnosis and treatment. Well thought-out guidelines developed by professional societies and based on the best available evidence have become the standard in modern medical care. Guidelines are developed to assist practitioners in making appropriate healthcare decisions, to help standardize medical care and improve quality. Guidelines attempt to change practice behavior towards an established norm when evidence is available or toward a consensus opinion when randomized trials are lacking. Patients seeking medical care expect that their practitioner is providing up-to-date, quality medical care. The payors of this care are also interested in quality but must pay attention to medical costs. Both the patient and the payor are invested in providers who use the best available evidence in providing care that is clearly based on guideline development and dissemination.The American Pain Society (APS) has written three practice guidelines, the most recent of which is the Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, published in 2002. Based on high quality research, when available, and consensus opinion from opinion leaders, these guidelines are endorsed throughout the world’s medical community. Like any other guidelines, the goal is to standardize care and improve quality.The future will bring more development of guidelines like those from the APS. As studies improve and trials show more effective treatment paradigms, well researched, appropriately designed guidelines will emerge which are structured for busy practices. But this will not be enough; providers need to be made aware of the guidelines, educated on their use, shown appropriate studies documenting efficacy, given simple strategies to implement these guidelines, repeatedly reminded of the appropriate care and, finally, monitored for compliance. For guidelines to be effective they must be tested, disseminated, and their impact on healthcare outcomes must be assessed.Payors want evidence of the value for their expenditures and guidance by professional societies in allocating limited resources. At the same time, payors are struggling with quality issues. Guidelines can help standardize care that may also be more cost effective as well as satisfy quality concerns from regulatory agencies and the public. Understanding where guidelines make an impact and why resistance develops to well meaning, expert based documents will help us in our disease management efforts.     

Presidential address: Preventive medical practice

Review of national programs in the past decade suggests that there is a developing consensus regarding the need for preventive services, but the proportion of them that physicians provide is decreasing. As teachers of preventive medicine, we should have a particular concern with the physician's performance in providing preventive services. Specialization, practice organizations, and comprehensiveness of payment for medical care appear to be related to the volume of preventive services provided. Organized primary care practice sites, where other health professionals are available, seem especially well-suited to providing preventive services. A review of several effective preventive activities involving physicians (child and adult immunizations, early detection and treatment of PKU infants, and stroke prevention) indicates that current prevention practice is less than desirable. Better performance can be attained through successful national and community programs of consumer and physician education. Implications of these observations for medical undergraduate and graduate education in prevention are discussed.     

Providing medical care to methadone clinic patients: referral vs on-site care.

OBJECTIVES. Intravenous drug users are at high risk for medical illness, yet many are medically underserved. Most methadone treatment programs have insufficient resources to provide medical care. The purpose of this study was to test the efficacy of providing medical care at a methadone clinic site vs referral to another site. METHODS. Patients with any of four target medical conditions were randomized into an on-site group offered medical care at the methadone treatment clinic and a referred group offered medical care at a nearby clinic. Entry to treatment and use of medical services were analyzed. RESULTS. Of 161 intravenous drug users evaluated, 75 (47%) had one or more of the target medical conditions. Fifty-one were randomized. In the on-site group (n = 25), 92% received medical treatment; in the referred group (n = 26), only 35% received treatment. CONCLUSIONS. Providing medical care at a methadone treatment program site is more effective than the usual referral procedure and is a valuable public health intervention.     

Workers' compensation managed care: Preliminary findings

The cost of providing care that is effective to return injured workers to the workplace has risen in recent years in a manner that appears to be out of control in the workers' compensation system. In turn, medical care costs are an important component of the rapidly increasing costs of workers' compensation insurance. A model of health care delivery that emphasizes early intervention and return to work is presented. This model focuses on providing aggressive treatment of injuries that historically have been reported to be extraordinarily expensive. This paper is a case study of a managed care treatment model and presents costs of treatment in the first year of utilization. Medical care costs of 295 cases are compared with state and national figures and are found to be substantially better, especially with regard to soft tissue injuries and injuries that involve days lost from work.     

“五师服务临床”的理念与实践

现代医疗不仅是治病,应该是集预防、治疗、康复、药理、心理、饮食等就医全过程、全方位的医疗服务。本院提出"五师服务临床"理念,即"医师、护师、临床药师、临床营养师和心理咨询师"共同为临床患者服务,取得了很好的综合治疗、康复疗效,创新医疗服务模式,加强医疗质量内涵建设,提高患者就医满意度。     

城市家庭病床实施健康教育的探讨

随着现代医学模式的转变,城市初级卫生保健工作的展开,社区医疗、全科医疗站、家庭医疗的发展受到社会的重视。而日臻完善的城市家庭病床为开展社区健康教育提供良好的场所。它主动适应了现代医学模式转变的需要,它是促进社区健康教育和推进城市初级卫生保健工作的有效途径。在城市家庭病床实施健康教育对实现“2000年人人享有卫生保健”,适应城市人口老龄化和贯彻落实新时期卫生工作方针有着重要的现实意义。     

Health care of homeless families. A growing challenge for family medicine

The number of homeless families in the United States is growing at an alarming rate. Homeless families are at an increased risk for numerous medical conditions and have complex health and psychosocial needs. In response to the growing crisis, policymakers have generally focused on families' immediate needs rather than developing a comprehensive long-term response. Health programs have been challenged to develop effective methods of providing outreach and comprehensive, continuous, coordinated services. Family medicine is uniquely qualified to meet the health care needs of homeless families and can play an important role in providing clinical service, designing medical education, developing research, and defining a national advocacy agenda.     

我国公立医院社会公益性缺失的根源及对策

一段时期以来,部分公立医院逐步由提供基本医疗服务、预防为主、追求社会公益等非营利性行为向提供特殊医疗服务、治疗为主、追求经济利益等营利性行为转变。这一转变带来的最大危害可能是造成我国医疗费用的过快上涨。因此,如何保证公益性就成为公立医院改革的突破口。     

条形码技术推进医院贵重卫生材料的动态管理

近年来，信息技术帮助医院在改进和优化医疗、护理、药品管理等工作流程中，取得了很好的成效。为了更好地解决病人看病贵的问题，加强医疗过程中卫生材料使用的监管，尤其是贵重卫生材料的监管非常迫切。如何进行实时高效的卫生材料管理，北京天坛医院率先在贵重医疗耗材管理流程中试用推行了斑马技术公司提供的条码管理系统，将其应用于贵重耗材的库房管理、科室管理与职能部门的监控和预瞀，实现了对其贵重卫生材料的动态管理和实时监控功能。提高了医疗质量和工作效率，降低了医疗成本。为医院探索建立科学管理的长效机制提供了有力的支持。     

Education as a means of reducing medical expenses

In treating patients with infectious diseases, key knowledge and experience are essential in making appropriate clinical decisions. Medical students in Japan receive limited tuition in clinical pharmacology and microbiology in their undergraduate curriculum. Education and guidance in these fields are not always provided, even during postgraduate training. To help overcome this problem, we have devised a quick medical reference system to support antimicrobial chemotherapy, and this has been operating in our hospital since May 1994. This system is integrated in order to convey the maximal significance of test results by providing detailed information on various kinds of pathogens and antibiotics immediately on every computer display. This is a unique system in Japan, and aims to help doctors provide effective therapy. Using this system, we have succeeded in reducing medical expenditure for antimicrobials by around 10%.