How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

废弃物处理——一个刻不容缓的问题

介绍了香港环保署通过１０年努力的完整的固体废弃物收运，处理及处置系统，以及他们为实现废弃物减量化和资源化所采取的策略与行动。由此提出上海浦东新区在固体废弃物管理和环卫设施建设上应加强关注；逐步按规划实施；采用多种形式设计，建造，营运环卫设施以及开展全方位宣传教育活动的建议。     

Egg-sharing in assisted conception: ethical and practical considerations

The present acute shortage of eggs for donation cannot be overcomeunless adequate guidelines are set to alleviate the anxietiesregarding payments, in cash or kind, to donors. The currentHuman Fertilisation and Embryology Authority (HFEA) guidelinesdo not allow direct payment to donors but accept the provisionof lower cost or free in-vitro fertilization (IVF) treatmentto women in recognition of oocyte donation to anonymous recipients.Egg-sharing achieved in this way enables two infertile couplesto benefit from a single surgical procedure. However, the practicalguidelines related to this approach are ill-defined at the presenttime leading to some justifiable uncertainty. A pilot studywas therefore undertaken in order to establish the place ofegg-sharing in an assisted conception programme. The currentHFEA guidelines on medical screening of patients, counselling,age and rigid anonymity between the donor and recipient werefollowed. The study involved 55 women (25 donors and 30 recipients)in 73 treatment cycles involving fresh and frozen-thawed embryos.Donors were previous IVF patients who, regardless of their abilityto pay, shared their eggs equally with matched anonymous recipients.They paid only for their consultations and tests right up tothe point of being matched with a recipient The sole recipientpaid the cost applicable in egg donation of a single egg collection,although both received embryo transfers. The results indicatethat although the recipients were older than the donors (41.4± 0.9 versus 31.6 ± 0.5 years), and there wasno difference in the mean number of eggs allocated, the percentagefertilization rates, or the mean number of embryos transferred,there were more births per patient amongst recipients than amongstdonors (30 versus 20%). We conclude that providing the donorsare selected carefully, this scheme whereby a sub-fertile donorhelps a sub-fertile recipient is a very constructive way ofsolving the problem of the shortage of eggs for donation. Thereare also the advantages of including a group of women who wouldotherwise be denied treatment Problems related to ‘patientcoercion’ can, in our view, be fully overcome by the applicationof strict common-sense safeguards. The ideal of pure altruismis not without its medical and moral risk. The success of egg-sharingdepends on shared interests and a degree of altruism betweenthe donor, the recipient and the centre. The current HFEA guidelinesshould be applauded for enabling a highly effective conceptof mutual help to develop.     

学术期刊关联数据出版与共享中的信息安全管理

【目的】 对我国学术期刊关联数据出版与共享中的信息安全管理的概念、政策及其存在的问题进行梳理,有助于科学数据出版与共享工作的推进。【方法】 基于我国科学数据出版与共享的演化过程,以及地理资源期刊在科学数据共享方面的现状与发展情况,对期刊论文关联数据出版和安全管理情况进行分析,对平台间合作的模式进行探讨。【结果】 为实现科学数据的价值最大化,中国自上而下建立起了科学数据共享系统,包括网络基础设施、数据库、数据中心、数据服务平台等,制定了一系列数据获取和管理规范,并制定了保障科学数据信息安全的相关法律。【结论】 科学数据出版与共享应建立在安全的基础上。经过初期的大规模建设后,数据出版与共享及其安全管理应走向“提质增效”阶段,要注重高新技术的注入和专业人才的培养。在管理措施上要以保证数据安全为基础,以数据质量为核心,从而提升信息安全管理水平,提高数据再应用效率。     

ICU护理人力资源配置对脓毒症休克集束化治疗完成率的影响

目的调查分析我国重症医学科不同护理人力资源配置对脓毒症休克集束化治疗完成率的影响。方法基于全国重症医学质量控制大数据平台,调查全国1 065家医院重症医学科护理人力配置情况,比较不同省份（自治区、直辖市）ICU护理人力配置状况下脓毒症休克3 h内和6 h内集束化治疗完成率。结果3 h内集束化治疗完成率79.0%,6 h内集束化治疗完成率69.5%。护床比在≤1.5:1、1.5:1～2.0:1、≥2.0:1情况下,脓毒症休克3 h内集束化治疗完成率分别为0.69、0.79、0.83,6h内集束化治疗完成率分别为0.45、0.70、0.75。结论ICU护床比影响脓毒症休克集束化治疗完成率。护床比增加,脓毒症休克集束化治疗完成率提高。建议适当提高重症医学科护理人力资源配比,以提高脓毒症休克患者救治质量。     

多学科协作诊疗直肠癌1例分析及体会

直肠癌术后并发症是外科临床医生经常面临的问题,多学科协作诊疗模式的出现,避免了既往单一学科诊疗的局限性。如何更好、更高效地集合不同学科的医生一起为患者拟定诊疗方案,是当下我们医护人员对于结直肠癌患者诊疗的关注点。现择取中国中医科学院西苑医院多学科协作诊疗的1例直肠癌病案,整理分析以供同道参考。     

基于共享理念的急诊CTA应急平台构建与效果评价

目的基于共享理念的急诊CTA应急平台构建与效果评价。方法选取2019年1—9月急诊CTA检查患者为对照组,2019年11月—2020年8月急诊CTA检查患者为观察组。对照组采用常规急诊值班制,观察组建立急诊CTA应急平台。对申请检查科室、检查项目进行描述性统计,比较两组CTA检查时间及入院患者预后转归情况。结果申请科室以急诊内科为主,检查项目以头颅、胸腹部为主,急诊CTA检查时间对照组中位数为46 min,观察组中位数为20 min,两组对比差异有统计学意义(P<0.05),对照组37例患者中有8例(21.7%)致残,观察组103例患者中有8例(7.8%)致残,两组对比差异有统计学意义(P<0.05)。结论组建急诊CTA应急平台能缩短急诊CTA影像学检查时间,降低致残率,提高患者生活质量,优化护理人力资源,值得临床推广。     

基于加权秩和比法评价广东省公共卫生资源配置

目的 评价2019年广东省不同地市（除中山市）的公共卫生资源配置状况。方法 从《2019年广东省卫生健康统计年鉴》中选取专业公共卫生机构数、专业公共卫生机构床位数、专业公共卫生机构执业(助理) 医师数、专业公共卫生机构注册护士数和每万人口公共卫生人数五个评价指标,利用加权秩和比法综合评价广东省不同地市的公共卫生资源配置差异。结果 WRSR与Probit的回归方程为[AKY^5]=0.250Probit-0.745（F=362.461,P<0.05,R=0.980）;将不同地市公共卫生资源配置分为四档,肇庆市、广州市、佛山市、深圳市四市公共卫生资源配置处于较高水平,则汕尾市、潮州市则较为落后。结论 广东省公共卫生资源整体上逐年提升,但每万人口公共卫生人数与目标相比还具有差距;不同地区间公共卫生资源配置差异大,人均获得资源不均衡。     

临沂市放射诊疗资源配置现况调查

目的 了解临沂市放射诊疗资源配置现状,为卫生行政部门进一步优化资源配置提供数据支撑。方法 对全市所有开展放射诊疗的医院进行普查,用SPSS软件对数据进行统计分析。结果 临沂市共有放射诊疗机构305家,放射诊疗设备943台,市民平均每万人拥有放射诊疗设备0.89台,每家机构拥有放射诊疗设备平均数市区是县区的1.48倍。全市共有放射诊疗工作人员2208人,每家医院拥有放射诊疗工作人员7.24人,其中三级、二级、一级和未评级医院拥有放射诊疗工作人员数量分别为89.63、17.64、3.37和2.77名。结论 临沂市放射诊疗设备配置比例失衡,大型放射诊疗设备配置较少且分布集中,每万人拥有放射诊疗工作人员数量不足且分布不均。需科学配置放射诊疗资源,促进地区间的平衡发展,实现资源的优化配置。     

凤阳山-百山祖保护区药用蕨类植物资源

凤阳山-百山祖自然保护区自然环境优越，植被保存良好，植物资源丰富，其中具有药用价值的蕨类植物共有79种，按其药效可分为解表类药、清热类药、祛风湿药、利尿类药、驱虫药、止血类药、活血祛疯药、补虚类药、平肝息风药等16类。