"五习惯"医患沟通评价量表的构建及信效度研究

背景 医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前，我国对医务人员医患沟通能力的评价研究较少，缺乏信效度良好的评估工具。 目的 构建"五习惯"医患沟通评价量表（5HCS），检验其信度和效度。 方法 2014年3月，采用Brislin翻译法在"四习惯"医患沟通评价体系（4HCS）的基础上，形成5HCS初稿；2014年4—6月，采用德尔菲法，使用问卷分两轮征求专家意见，根据专家意见修订条目后形成5HCS定稿；2018年3月，使用新构建的5HCS对127名住院医师的医患沟通能力进行评估，通过分析其评价数据，检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。 结果 正式版5HCS包含5个维度（"尊重示善，融洽关系""采集信息，引导观点""表达共情，建立信任""风险告知，知情同意""提供诊断，协商决策"），21个条目。量表的Cronbach's α系数为0.716，各维度与量表总分的r值为0.524~0.692，各条目的内容效度指数（I-CVI）≥0.81，量表总分的评价者间信度r值为0.912，组内相关系数（ICC）=0.912，标准关联效度以中文版医患沟通技能评价量表（SEGUE）为标准，两个量表总分之间的r值为0.377（P<0.01）。 结论 5HCS具有良好的信度和效度，可将其作为我国住院医师医患沟通能力测评工具加以推广应用。     

Mise à jour des croyances et congruence à l'humeur dans le trouble dépressif

Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.     

病案首页与编码质量对病种付费的影响

目的探究病案首页与编码质量对病种付费产生的影响。方法2019年1—12月纳入研究的1056例病案首页均为该院产科、颅脑外科、普通外科、肿瘤科及心外科5个科室所收纳,依照回顾性分析方式进行平均分组,病案首页均经针对性措施解决病案首页问题,并经校对手段质控编码确认无误(试验组,n=528),重新编码前病案首页(对照组,n=528),分析两组数据差异及变化情况。结果试验组的病种付费质量包括医院数据统计分数、病案信息利用分数、疾病分组准确分数及医院经济效益分数评估均显著高于对照组,试验组中出现病案内容与病案首页不符、遗漏诊断、不完整诊断和不正确诊断的病案不良事件发生概率显著低于对照组,试验组发生漏填、错填的缺陷问题发生率显著低于对照组,组间数据差异有统计学意义(P<0.05)。结论分析病案首页质量,对影响病案首页的因素进行分析,进行针对性的改进,有利于提升病案质量,降低病案与编码质量对病种付费产生的不良影响。     

Effect of change in coding rules on recording diabetes in hospital administrative datasets

AimDuring 2008–2011 Australian Coding Standards mandated a causal relationship between diabetes and inpatient care as a criterion for recording diabetes as a comorbidity in hospital administrative datasets. We aim to measure the effect of the causality mandate on recorded diabetes and associated inter-hospital variations.MethodFor patients with diabetes, all admissions between 2004 and 2013 to all New South Wales acute public hospitals were investigated. Poisson mixed models were employed to derive adjusted rates and variations.ResultsThe non-recorded diabetes incidence rate was 20.7%. The causality mandate increased the incidence rate four fold during the change period, 2008–2011, compared to the pre- or post-change periods (32.5% vs 8.4% and 6.9%). The inter-hospital variation was also higher, with twice the difference in the non-recorded rate between hospitals with the highest and lowest rates (50% vs 24% and 27% risk gap). The variation decreased during the change period (29%), while the rate continued to rise (53%). Admission characteristics accounted for over 44% of the variation compared with at most two per cent attributable to patient or hospital characteristics. Contributing characteristics explained less of the variation within the change period compared to pre- or post-change (46% vs 58% and 53%). Hospital relative performance was not constant over time.ConclusionThe causality mandate substantially increased the non-recorded diabetes rate and associated inter-hospital variation. Longitudinal accumulation of clinical information at the patient level, and the development of appropriate adoption protocols to achieve comprehensive and timely implementation of coding changes are essential to supporting the integrity of hospital administrative datasets.     

Evaluating provider communication in pediatric chronic kidney disease care using a global coding system

ObjectiveAmong adolescents and young adults (AYAs) with chronic illness, effective provider communication is essential for patient-centered care during a sensitive developmental period. However, communication in chronic illness care for AYAs is not well studied. Our objectives were to describe the provider communication skills in pediatric chronic kidney disease (CKD) care visits; and determine if communication skills differ by AYA characteristics.MethodsWe adapted a global consultation rating system for pediatric subspecialty care using audiotaped clinic encounters of 18 pediatric nephrologists with 99 AYAs (age M(SD) = 14.9(2.6)) with CKD stages 1–5 and 96 caregivers. We hypothesized that provider communication skills would differ by AYA characteristics (age, gender, and race).ResultsThe strongest provider skills included initiating the session and developing rapport; lowest rated skills were asking patient’s perspective and checking understanding. Communication scores did not consistently differ by AYA age or race, but were rated higher with female AYAs in several domains (ps<0.05).ConclusionsPediatric providers generally had adequate or good communication scores with AYAs, but improvement in certain skills, particularly with male AYAs, may further support patient-centered care.Practice implicationsTo achieve consistent, patient-centered communication with AYAs, an observation-based global assessment may identify areas for provider improvement.     

Changing Physical Activity Behavior in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Objectives

To (1) systematically review the literature on behavioral interventions for people with multiple sclerosis (MS) that aim to change physical activity (PA) behavior; and (2) explore whether these interventions are clinically effective in improving PA, are theory based, and use established behavior change techniques (BCTs).

产科疾病编码常见问题分析

通过列举具体疾病,分析产科疾病编码中常见的三类问题,包括出现在孕产期不同时期的同一疾病名称,其疾病诊断命名和疾病编码不同;引发同一种疾病状态的致病因素很多,在产科疾病编码过程中必须要具体区分引发疾病产生的具体原因;某些疾病临床表现近似,诊断编码归类时容易混淆.初步探讨了产科疾病编码的一些特点,分析产生编码错误的原因并且提出了减少编码错误的措施,希望能够减少在产科疾病编码过程中出现类似错误,提高产科疾病编码的正确率.     

Magnitude of Impact,Overall and on Subspecialties,of Transitioning in Radiology from ICD-9 to ICD-10 Codes

PurposeConverting the nation’s International Classification of Diseases (ICD) diagnosis coding system, from 14,025 ICD-9 to 69,823 ICD-10 codes, is projected to have enormous financial and operational implications. We aimed to assess the magnitude of impact that this code conversion will have on radiology claims.MethodsThe most frequently billed ICD-9 diagnosis codes for 588,523 radiology claims from five hospitals and affiliated outpatient sites during a 12-month period were mapped to matching ICD-10 codes using a Medicare-endorsed tool. The code-conversion impact factor was calculated for the entire radiology system, and each individual subspecialty division.ResultsOf all ICD-9 codes, only 3,407 (24.3%) were used to report any primary diagnosis. Of all claims, 50% were billed using just 37 (0.3%) primary codes; 75% with 131 (0.5%), and 90% with 348 (2.5%). Those 348 ICD-9 codes mapped onto 2,048 ICD-10 codes (5.9-fold impact), representing just 2.9% of all ICD-10 codes. By subspecialty, the conversion impact factor varied greatly, from 1.1 for breast (11 ICD-9 to 12 ICD-10 codes) to 28.8 for musculoskeletal imaging (146 to 4,199). The community division, reflecting a general practice mix, saw a conversion impact factor of 5.8 (254 to 1,471).ConclusionsFewer than 3% of all ICD-9 and ICD-10 codes are used to report an overwhelming majority of all radiology claims. Although the number of commonly used codes will expand 5.9-fold overall, musculoskeletal imaging will experience a projected 28.8-fold explosion. Radiology practices should target their ICD educational and operational conversion efforts in an evidence-based manner.     

Data Representation,Coding, and Communication Standards

The immense volume of cases signed out by surgical pathologists on a daily basis gives little time to think about exactly how data are stored. An understanding of the basics of data representation has implications that affect a pathologist’s daily practice. This article covers the basics of data representation and its importance in the design of electronic medical record systems. Coding in surgical pathology is also discussed. Finally, a summary of communication standards in surgical pathology is presented, including suggested resources that establish standards for select aspects of pathology reporting.