医院绩效管理政策文本量化分析

目的对中央政府层面出台的公立医院绩效管理相关政策文件进行分析,为优化政策体系提供参考。方法访问北大法宝网、国务院及相关部委官方网站,检索2009年1月1日-2021年7月21 日医院绩效管理相关政策文件,基于政策工具理论,构建医院绩效管理政策工具分析框架,采用内容分析法对政策文本进行量化分析。结果共纳入政策文件31份,归纳整理出供给型、需求型和环境型3个类别 22 种政策工具。供给型政策工具占 43.40%,需求型政策工具占 19.25%,环境型政策工具占 37.35%。政策条款频数较高的分别是“分级诊疗”“目标规划”及“收入分配”。结论政策工具要注重结构均衡性,坚持以人民健康为目标导向,强化需求方对医院绩效的影响力;关注医院绩效考核,促进区域医疗服务能力提升;强化政策执行力度,充分发挥政策叠加效应。     

农村妇女就医选择行为的影响因素——基于2018年CFPS数据分析

目的 为引导农村妇女合理有序就医,本文基于计划行为理论框架探索其就医选择行为的影响因素。方法 运用2018年中国家庭追踪调查数据,采用二元Probit回归、Bootstrap抽样方法对农村妇女就医选择行为的影响因素进行研究。结果 农村妇女的就医选择行为受到其主观态度、结构性因素和知觉行为控制因素的正向影响（β = 0.403,0.388,0.096,P＜0.05）,医疗自付费用支出在农村妇女主观态度及其就医选择行为间起部分中介作用（β = 0.135,95%CI: 0.026～0.054）。 结论 农村妇女就医选择行为受到主观态度、结构性因素和知觉行为控制因素的影响,应加大健康教育宣传力度;合理统筹医联体医保政策;夯实农村基层首诊制度,推进基层医院家庭医生签约服务,提升农村基层医疗卫生服务利用效率,对农村妇女就医选择行为进行有针对性的干预。     

表现主义:林语堂文学观的核心

林语堂是一个强调主体精神的作家 ,他认为文学艺术是自我的表现 ,并从克罗齐的表现主义和晚明的性灵说中为自己寻找理论依据。林语堂创作中所要表现的“自我” ,是主体特有的精神表记 ,自始至终伴随着主体的情感活动。在艺术发现阶段 ,他突出了感悟的作用 ;在艺术构思阶段 ,他看到了情感对创作动机的激发和推动 ;在艺术表达阶段 ,他提倡行于当行之时 ,止于不得不止处 ,随意而作 ,不拘格套。林语堂站在浪漫主义立场上接受“表现主义” ,强调“自我” ,也是时代精神使然。     

基于“气血”理论探讨中医治疗肺系疾病之思路

中医学认为,气血失和,百病丛生,气血是构成人体和维持其生命活动的物质基础。现基于气血理论探讨中医治疗肺系疾病的辨治思路,认为肺系疾病的发病与气血关系密切,系因机体气血功能异常,加之外邪侵袭,导致“肺气虚弱,肺虚络瘀,肺热瘀阻,热壅血瘀”,总结出主要病机是“气血亏虚为本,痰热瘀阻为标”,治疗上应以“调和阴阳、理顺气血”为主要原则,临床上辨证应用“补肺理气、养血活血、化痰逐瘀、清肺热、利肺气、止咳平喘、凉血”之法,为临床从气血角度论治肺系疾病提供新思路。     

Examining community pharmacists’ intention to provide pharmacist-driven vaccination services: A structural equation modelling

BackgroundThe evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists’ intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.ObjectiveConsidering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the “Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)” by using the theory of planned behavior (TPB).MethodsBased on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.ResultsIn the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.ConclusionResults of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.     

“课堂理论教学与临床实践教学相结合”的两步教学法理论与实践

阐述了山东大学医学院医学伦理学课程“课程理论教学与临床实践教学相结合”教学模式改革的设想提出过程,具体实施办法和实施效果。实践证明,这一教学法,对于培养医学生的医德信念和医学伦理决策能力是切实有效的,值得在实践中进一步完善和推广。     

Inter-organizational networks on the Dutch home health care market

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost.     

秩和的分布,区间估计和假设检验的探讨

目的 探讨秩和比的分布理论及建立区间估计和假设检验方法。方法 假设各变量相互独立,观察单位某变量取值是随机的,则其秩的分布为均匀分布,秩和的分布是m个独立同分布变量之秩的和。结果 当m和n较小时,如m<3,秩和的分布呈单峰对称分布;m和n不太小时,秩和的分布迅速逼近正态分布。结论 对秩和与秩和比可以应用正态分布理论作区间估计和假设检验。     

A Systemic and Value-Based Approach to Strategic Reform of the Mental Health System

Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us. This revised version was published online in July 2006 with corrections to the Cover Date.