北京两所医院运用VPSM进行住院病人满意和体验调查的结果比较

目的采用澳大利亚的病人满意和体验监测工具(VPSM),对住院病人满意度进行测量,检验该工具在中国医院质量改进过程中的适用性,并提示中国医疗服务质量的改进重点。方法北京两所医院按照VPSM方法学,独立地测量住院病人的满意和体验。结果统计学检验结果显示,两医院间满意度和各质量指数差别无显著性。两医院的结果均低于澳大利亚的测量结果,不排除被调查病人性别和年龄结构的影响。讨论VPSM在北京两医院的测量结果显示了其测量的稳定性及对医疗服务管理中薄弱环节的展示功能,是辅助医疗服务质量改进工作的有力工具。在机构间或国际间比较时,应该考虑到病人年龄、性别和付费方式的影响。     

Meta-Analysis 101: What You Want to Know in the Era of Comparative Effectiveness

In the era of “comparative effectiveness” research, each of the major stakeholders in healthcare—payors, patients, providers, and government—face a similar challenge. When making a decision about whether a new device, drug, or a diagnostic modality should be considered for use or coverage, what choices are best supported by the evidence? Medical evidence is defined by randomized controlled trials and by observational studies that vary greatly in their design, the accuracy of their analyses, and the relevance of their conclusions and recommendations. Hence, key decision makers increasingly rely on systematic reviews and meta-analyses to facilitate the interpretation and application of research evidence. Knowing how to evaluate meta-analyses and understanding the potential pitfalls of the method are crucial for those involved in designing drug benefits. The authors highlight the process, strengths, and weaknesses of meta-analysis and explain how to judge the value of the results.“Comparative effectiveness” research is the best tool available today for making decisions about which new medication, medical device, or diagnostic test is most supported by the evidence.1 The purpose of a systematic review is to synthesize the results of multiple primary studies using explicit and reproducible methods.2,3 Meta-analysis is a form of systematic review that goes one step further. Rather than qualitatively synthesizing the results of multiple studies, the purpose of a meta-analysis is to develop a quantitative summary of the evidence with the help of special statistical techniques. Whereas a systematic review may conclude that a certain drug is effective in preventing a morbid event, a meta-analysis will tell us that the drug is, say, 3.7 times more effective than a placebo in preventing that morbid outcome. Conceptually, the distinction between the 2 types of reviews is straightforward. Despite the appeal inherent in developing a quantitative synthesis, the decision to conduct, or to make decisions based on, a meta-analysis must be made carefully, with an understanding of the benefits and limitations of the method. This paper provides an overview of the meta-analysis process, highlights the strengths and weaknesses of the method, and offers guidance on how to interpret and judge the value of meta-analytic results.     

德国医院质量管理的新思维

德国医院非常重视质量管理。政府推动、法律保障、质量评审认证机构、医疗保险公司等社会监督体系、专业的领导决策层和科室管理人、专职的质量管理专员、质量管理委员会等,构成了德国医院的质量管理保证体系。信息化建设是提高质量管理水平的基础,在信息化的平台上实践BSC、KVP、CIRS和PDCA等管理新思维,才能真正实现管理质壁的持续改进。     

Leadership and Quality of Working Life in Home Health Care

Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behavior is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.     

《医疗质量管理办法》中医疗质量概念及相关问题探讨

采用文献复习和实证研究经验的方法对《医疗质量管理办法》中涉及的医疗质量概念及相关问题进行探讨。《医疗质量管理办法》中的医疗质量的定义存在重大缺失,没有涉及医疗服务的结果,特别是患者安全。医疗质量的定义应与国际相关权威机构保持一致,应高度重视医疗服务的结果,特别是患者安全。