从系统论看我国公共卫生体系建设 要求与差距

目的 :探讨高效公共卫生体系的理论要求及我国现有公共卫生体系与这些理论要求间的差距。方法 :我们在充分的文献复习及深入的问询与座谈的基础上 ,运用软系统分析方法构筑高效公共卫生体系的理论框架 ,并对照该框架检查现有公共卫生体系存在的问题。结果 :我们提出了由“目标规划、基础设施、信息系统、决策指挥和控制措施”五大相辅相成要素构成的公共卫生体系模型 ,并对比分析了我国现有公共体系在这五个方面所存在的主要问题与不足。结论 :从系统角度看 ,我国现有公共卫生体系从“目标规划”到“控制措施”的每个方面都有很多需要改进的地方 ,尤其是“目标规划”、“信息系统”及“决策指挥”方面更显得有些薄弱。     

Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems

Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the aggressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption.     

Laboratory evaluation of a low-cost,real-time,aerosol multi-sensor

Exposure to occupational aerosols are a known hazard in many industry sectors and can be a risk factor for several respiratory diseases. In this study, a laboratory evaluation of low-cost aerosol sensors, the Dylos DC1700 and a modified Dylos known as the Utah Modified Dylos Sensor (UMDS), was performed to assess the sensors’ efficiency in sampling respirable and inhalable dust at high concentrations, which are most common in occupational settings. Dust concentrations were measured in a low-speed wind tunnel with 3 UMDSs, collocated with an aerosol spectrometer (Grimm 1.109) and gravimetric respirable and inhalable samplers. A total of 10 tests consisting of 5 different concentrations and 2 test aerosols, Arizona road dust and aluminum oxide, were conducted. For the Arizona road dust, total particle count was strongly related between the spectrometer and the UMDS with a coefficient of determination (R²) between 0.86–0.92. Particle count concentrations measured with the UMDS were converted to mass and also were related with gravimetrically collected inhalable and respirable dust. The UMDS small bin (i.e., all particles) compared to the inhalable sampler yielded an R² of 0.86–0.92, and the large bin subtracted from the small bin (i.e., only the smallest particles) compared to the respirable sampler yielded an R² of 0.93–0.997. Tests with the aluminum oxide demonstrated a substantially lower relationship across all comparisons. Furthermore, assessment of intra-instrument variability was consistent for all instruments, but inter-instrument variability indicated that each instrument requires its own calibration equation to yield accurate exposure estimates. Overall, it appears that the UMDS can be used as a low-cost tool to estimate respirable and inhalable concentrations found in many workplaces. Future studies will focus on deployment of a UMDS network in an occupational setting.     

Multihospital System Membership and Patient Treatments, Expenditures, and Outcomes

Objective. To determine the relationship between hospital membership in systems and the treatments, expenditures, and outcomes of patients.
Data Sources. The Medicare Provider Analysis and Review dataset, for data on Medicare patients admitted to general medical-surgical hospitals between 1985 and 1998 with a diagnosis of acute myocardial infarction (AMI); the American Hospital Association Annual Survey, for data on hospitals.
Study Design. A multivariate regression analysis. An observation is a fee-for-service Medicare AMI patient admitted to a study hospital. Dependent variables include patient transfers, catheterizations, angioplasties or bypass surgeries, 90-day mortality, and Medicare expenditures. Independent variables include system participation, other admission hospital and patient traits, and hospital and year fixed effects. The five-part system definition incorporates the size and location of the index admission hospital and the size and distance of its partners.
Principal Findings. While the effects of multihospital system membership on patients are in general limited, patients initially admitted to small rural system hospitals that have big partners within 100 miles experience lower mortality rates than patients initially admitted to independent hospitals. Regression results show that to the extent system hospital patients experience differences in treatments and outcomes relative to patients of independent hospitals, these differences remain even after controlling for the admission hospital's capacity to provide cardiac services.
Conclusions. Multihospital system participation may affect AMI patient treatment and outcomes through factors other than cardiac service offerings. Additional investigation into the nature of these factors is warranted.