公立医院绩效资料的多层级可拓评价分析

<正>绩效评价是有效监督和管理医疗卫生机构的科学方法之一。公立医院作为我国医疗卫生服务体系的主体,担负着为广大人民群众提供基本医疗服务的社会职能。科学、合理的公立医院绩效评价是促进公立医院可持续发展的重要手段,也是新医改中保障公立医院改革成功的重要基础。公立医院绩效评价指运用科学、规范的管理学、财务学和数理统计学等方法,对公立医院一定时期内的经营管理效益,包括社会效益和经济效益,进行定量与定性的考核、分析,做出客观、公     

国民健康与公立医院宏观财务治理

我国公立医院是实施国家健康战略、保障人民健康权益和实现人类健康理想的重要角色。20世纪90年代以来,我国公立医院在市场化进程中竞争性行为加剧、逐渐偏离公益性,其症结根源在于过度强调微观财务治理效率、缺失了宏观财务治理约束。文章系统回顾全球公立医院发展进程、总结我国公立医院改革经验和展望人民健康需求发展趋势,提出了加强公立医院宏观财务治理建议:一是结合经济社会高质量发展要求、加强公立医院宏观财务治理理论研究;二是适应卫生健康协同发展趋势、丰富公立医院宏观财务治理内容;三是按照医药卫生体制改革方向、完善公立医院宏观财务治理体系;四是根据公立医院综合改革需要、探索实现公益性财政财务协作治理机制。     

科学搭建医院绩效评价体系

正绩效评价是绩效管理中的重要环节。在我国现行公立医院绩效评价体系中,存在着以传统的人事考核或以财务体系充当绩效评价体系等现象,绩效管理功能严重缺失,不能适应医改形势下现代医院管理制度的新要求。如何建设有效的医院内部绩效评价体系,不仅仅关乎医院自身发展,对政府落实公益性等医改核心内容,也有着很强的现实意义。因此,必须从政府外部评价、现行治理机制、公立医院内部制度等方面剖析,进而形成必要的政策保障和制度环境,构建科学有效的医院内部绩效管理     

公立医院智慧财务建设绩效评价体系研究

目的:以强化运营管理为战略导向,构建一套可操作、可推广的公立医院智慧财务建设绩效评价体系。方法:综合应用文献分析法、专家咨询法及问卷调查法来构建指标体系并确定其权重。结果:经过专家咨询,基于平衡计分卡理论最终构建了公立医院智慧财务建设绩效评价指标体系,其中包含财务层面、业务流程层面、患者和用户层面以及学习与成长层面4个一级指标、10个二级指标、28个三级指标。在指标体系构建基础上,采用权值因子法确定指标权重。结论:以强化运营管理为战略导向,构建公立医院智慧财务绩效评价指标体系,不但符合医院运营管理的客观要求,而且能够科学、全面地评价公立医院智慧财务建设状况,为医院智慧财务建设指明方向。     

公立医院财政补助支出预算绩效评价研究

预算绩效评价是新医改方案和新医院财务、会计制度对公立医院提出的要求。本文介绍了公立医院财政补助支出预算绩效评价的经济学和管理学理论基础,指出预算绩效评价公共选择理论、委托代理理论和新公共管理理论在公立医院财政预算管理中的应用。目前,预算绩效评价工作在公立医院处于起步阶段,管理制度体系不健全,需要加强理论研究,包括分项目绩效评价指标体系、评价方法,将评价结果作为以后年度财政预算安排的重要依据。     

公立医院财务治理绩效评价的实证研究

公立医院的财务治理,是指基于财务资本结构等制度安排,对公立医院财权进行合理配置,其目的就是要在利益相关者共同治理的前提下,在医院中形成有效的财务激励约束机制,实现公立医院财务决策的科学化[1].在当前形势下,对我国公立医院财务运行的现状及其绩效进行分析和评价,以此来反映我国公立医院财务治理的现状,有助于研究者进一步明确其中存在的深层次的体制和机制问题,进而为健全我国公立医院财务治理机制、提高财务治理水平提供实证依据.     

我国公立医院财务治理的实证分析：基于规模扩张视角

文章主要从床位规模、大型医疗设备配置及基本建设投资等规模扩张的3个方面对我国公立医院财务治理的现状进行了实证分析,发现公立医院的规模扩张在满足患者医疗需求的同时也增加了医院的运营风险,提出应不断优化公立医院财务治理环境和完善公立医院财务治理机制以提高公立医院财务治理的效能.     

公立医院财务治理研究现状及发展动态分析

文章从财务治理概念及公立医院财务治理目标与意义、评价指标、实践进展等方面对国内外公立医院财务治理研究的现状与发展动态进行了系统梳理和分析。     

我国公立医院财务治理问题分析??

“推进公立医院改革”是新医改方案确定的五项重点改革内容之一,也是医改的重中之重.文章分析了公立医院财务治理的背景及其内涵,并分析了当前我国公立医院财务治理内外部环节中存在的主要问题,提出公立医院财务治理的路径及其可操作的策略.     

典型国家公立医院财务治理经验及其对我国的启示

指出目前我国部分公立医院内部管理粗放,运行成本上升,需要建立科学规范的财务治理框架。通过对各国公立医院财务治理经验的分析,提出公立医院内部财务治理重在重大经济事项集体决策;财务收支合规合法;内部控制及预算绩效等方面,外部治理关键在于监管报告建立及信息透明等。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.