基于数据包络分析的重庆市卫生资源配置效率研究

目的 分析2015—2020年重庆市各区县卫生资源配置效率,为重庆市提升资源配置效率提供参考。方法 采用数据包络分析的BCC模型和Malmquist指数对2015—2020年重庆市各区县卫生资源配置效率进行分析。结果 在2020年,重庆市卫生资源配置的综合效率不高,38个区县中有7个区县处于DEA有效状态,8个区县处于DEA弱有效状态;2015—2020年,重庆市全要素生产率指数均值为0.945,3个区县的全要素生产率指数大于1。结论 重庆市各区县卫生资源配置效率有待提高,重点在于提升技术进步水平;重庆市四大区域内部和四大区域之间卫生资源配置效率差异较大,需整合医疗卫生资源,重视医学科技创新和成果转化,达到提升卫生资源配置效率的目标。     

基于秩和比法评价粤港澳大湾区卫生资源配置现状

目的 评价粤港澳大湾区卫生资源配置情况。方法 基于每千人口床位数、每千人口执业（助理）医师数、每千人口注册护士数和医护比四项指标,利用秩和比法综合评价2018年粤港澳大湾区11个区域的卫生资源配置现状,并比较综合评价结果。结果 2018年粤港澳大湾区各区域在四项指标上存在一定差异,变异系数范围为0.2Symbol~A@0.6;RSR回归方程为[AKY^5]=0.182x-0.405,相关系数r=0.993;卫生资源配置情况按Probit值分为三级,Probit<5（相对较少）:东莞、肇庆、深圳、佛山和惠州;5<6（中等）:江门、澳门、中山和珠海;probit>6（相对较多）:香港和广州。结论 粤港澳大湾区整体卫生资源配置较好,区域内部卫生资源配置差异性较大。undefined/html>     

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。     

广东省专业公共卫生机构卫生资源配置公平性分析

目的 分析广东省专业公共卫生机构卫生资源配置现状及其公平性,为后续研究和公共卫生服务资源的优化配置提供数据支撑。方法 对广东省专业公共卫生机构卫生资源配置情况进行描述性分析;通过卫生资源集聚度（HRAD）分析其配置的可及性和公平性。 结果 广东省专业公共卫生机构数呈负增长,为- 10.13%,而公共卫生人力资源总量逐年递增,年均增速在3.0%以上。2019年各地市公共卫生资源配置的公平性差异显著。2013—2019年东翼地区公共卫生人力资源基于人口分布的公平性较差,而西翼和山区公共卫生资源基于地理分布的可及性较差。结论 广东省专业公共卫生机构卫生人力资源配置总量逐年增长,但增速尚需提高。区域间、区域内卫生资源配置的可及性、公平性差异显著,公共卫生资源分布不均衡的状况仍然存在,人才短缺的情况仍是短板。应持续推动优质公共卫生资源扩容和区域均衡布局,稳定和发展公共卫生人才队伍,提高现有公共卫生资源的配置效率和利用效率。     

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。     

陕西省血液调配机制建立与运行

建立血液调配机制,可缓解医疗资源相对丰富的中心城市临床血液供需矛盾,逐渐实现采供血服务均衡化。建立了陕西省血液调配机制,实现了省域中心城市与周边城市血液资源的均衡化。认为不断优化血液调配机制,加强中心城市与周边城市采供血机构间的沟通合作,是实现省域内血液资源均衡、缓解中心城市季节性供血紧张的有效方法之一。     

Development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities: Our experience with the University Placement Allocation Committee

The present paper outlines the development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities. Although based on our experience in South Australia with the University Placement Allocation Committee (UPAC), the primary goal is to outline the steps that would be useful if placement coordinators at other universities in Australia decided to establish and maintain an allocation committee. A survey of field supervisors was also conducted and field supervisors endorsed UPAC as a constructive mechanism for allocating community placements.     

Pediatric Transplantation in the United States, 1996–2005

Solid organ transplantation is accepted as a standard lifesaving therapy for end-stage organ failure in children. This article reviews trends in pediatric transplantation from 1996 to 2005 using OPTN data analyzed by the Scientific Registry of Transplant Recipients. Over this period, children have contributed significantly to the donor pool, and although the number of pediatric donors has fallen from 1062 to 900, this still accounts for 12% of all deceased donors. In 2005, 2% of 89 884 candidates listed for transplantation were less than 18 years old; in 2005, 1955 children, or 7% of 28 105 recipients, received a transplant. Improvement in waiting list mortality is documented for most organs, but pretransplant mortality, especially among the youngest children, remains a concern. Posttransplant survival for both patients and allografts similarly has shown improvement throughout the period; in most cases, survival is as good as or better than that seen in adults. Examination of immunosuppressive practices shows an increasing tendency across organs toward tacrolimus-based regimens. In addition, use of induction immunotherapy in the form of anti-lymphocyte antibody preparations, especially the interleukin-2 receptor antagonists, has increased steadily. Despite documented advances in care and outcomes for children undergoing transplantation, several considerations remain that require attention as we attempt to optimize transplant management.     

Regional Variations in Peer Reviewed Liver Allocation Under the MELD System

The Model for End-Stage Liver Disease (MELD) is used to assign priority for liver transplantation candidates. The Organ Procurement and Transplantation Network (OPTN) approved recognized exceptional diagnoses (RED's) for which MELD fails to accurately measure priority. Centers can request increased MELD points in cases not recognized by this policy (non-RED's). Our aim was to compare regional practices to justify non-RED requests for MELD adjustments. The UNOS/OPTN database was queried to extract all adult cases for which a non-RED MELD adjustment was requested from 2/27/02 until 8/27/03. The data were stratified by region and justification. Data for 29,510 listings were available. 26,947 had complete diagnosis information. There were 827 non-RED requests of which 477 (57.7%) petitions were approved by the regional review boards (RRBs). The approval rate varied significantly among regions (range: 28-75%, p<0.0001). The most common non-RED's were complications of portal hypertension (48%). The percentage of patients listed with non-RED's varied significantly among regions (0.7-8.3 %, p<0.0001), as did the proportion of patients transplanted with non-RED's (2.1-31.9%, p<0.0001). Demographics did not differ among regions requesting non-REDs.Widespread regional variations exist in the handling of requests for non-REDs. These variations point to the need for reform to standard exception criteria.     

Adult Liver Transplant Candidate Attitudes Toward Graft Sharing Are Not Obstacles to Split Liver Transplantation

Split liver transplantation (SLT) benefits society by increasing the total number of transplants that can be performed, but it is yet unknown if a decreased post-transplant survival (in comparison to whole liver transplantation) would make participation in SLT less appealing to adult liver transplant candidates. A 20-item questionnaire was administered to 50 adult candidates to assess attitudes toward SLT and organ sharing. The overall attitudes of 60% of participants were classified as utilitarian (maximizing benefit to greatest number of candidates), while 26% were classified as self-preserving (maximizing individual benefit) and 14% were undecided. Ninety percent of participants would be willing to share even if expected survival was less than that of whole liver transplantation, and 69% felt that pediatric candidates should have priority over adult candidates. In conclusion, attitudes toward graft sharing and the possibility of compromised survival benefit are not barriers to SLT for most adult liver transplant candidates.