Supply of inpatient geriatric medical services in Australia

This study summarizes the findings of a national survey of inpatient geriatric services in Australia conducted in 2001. These data are unique as there are no uniform administrative data systems available to provide this information. Eight hundred and eighty-eight hospitals were surveyed and full responses were received from 690, representing 78% of hospitals and 85% of all hospital beds. The results illustrated wide variation in the style and level of provision of services among hospitals and across regional and state jurisdictions.     

Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France

OBJECTIVES: To identify risk factors for deep vein thrombosis (DVT) in older patients with restricted mobility or functional disability.
DESIGN: Cross-sectional.
SETTING: Forty-two postacute care departments in France.
PARTICIPANTS: Eight hundred twelve patients aged 65 and older.
MEASUREMENTS: Twenty-two predefined characteristics were investigated, including medical and surgical risk factors, dependence in six basic activities of daily living (ADLs) rated using the Katz index, mobility, the reported value of the Timed Up and Go Test, and pressure ulcers. All patients underwent lower limb ultrasonography on the day of the cross-sectional study.
RESULTS: DVT was found in 113 patients (14%, 33 proximal DVTs (4%) and 80 isolated distal DVTs (10%)). A positive trend was found in the odds of DVT for higher values on the Timed Up and Go Test for patients who were not bedridden or confined to a chair ( P =.007). In two-level multivariable analysis adjusting for prophylaxis against venous thromboembolism, independent risk factors for DVT were aged 80 and older (adjusted odds ratio (aOR)=1.71, 95% confidence interval (CI)=1.05–2.79), previous history of venous thromboembolism (aOR=2.03, 95% CI=1.06–3.87), regional or metastatic-stage cancer (aOR=2.71, 95% CI=1.27–5.78), dependence in more than three ADLs (aOR=2.18, 95% CI=1.38–3.45), and pressure ulcers (aOR=1.85, 95% CI=1.05–3.24).
CONCLUSION: Severe dependence in basic ADLs and higher Timed Up and Go Test score are associated with greater odds of DVT in older patients in postacute care facilities in France.     

Ambulatory health care use by patients in a public hospital emergency department

OBJECTIVE: To describe primary care clinic use and emergency department (ED) use for a cohort of public hospital patients seen in the ED, identify predictors of frequent ED use, and ascertain the clinical diagnoses of those with high rates of ED use. DESIGN: Cohort observational study. SETTING: A public hospital in Atlanta, Georgia. PATIENTS: Random sample of 351 adults initially surveyed in the ED in May 1992 and followed for 2 years. MEASUREMENTS AND MAIN RESULTS: Of the 351 patients from the initial survey, 319 (91%) had at least one ambulatory visit in the public hospital system during the following 2 years and one third of the cohort was hospitalized. The median number of subsequent ED visits was 2 (mean 6.4), while the median number of visits to a primary care appointment clinic was 0 (mean 1.1) with only 90 (26%) of the patients having any primary care clinic visits. The 58 patients (16.6%) who had more than 10 subsequent ED visits accounted for 65.6% of all subsequent ED visits. Overall, patients received 55% of their subsequent ambulatory care in the ED, with only 7.5% in a primary care clinic. In multivariate regression, only access to a telephone (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.39, 0.60), hospital admission (OR 5.90; 95% CI 4.01, 8.76), and primary care visits (OR 1.68; 95% CI 1.34, 2.12) were associated with higher ED visit rates. Regular source of care, insurance coverage, and health status were not associated with ED use. From clinical record review, 74.1% of those with high rates of use had multiple chronic medical conditions, or a chronic medical condition complicated by a psychiatric diagnosis, or substance abuse. CONCLUSIONS: All subgroups of patients in this study relied heavily on the ED for ambulatory care, and high ED use was positively correlated with appointment clinic visits and inpatient hospitalization rates, suggesting that high resource utilization was related to a higher burden of illness among those patients. The prevalence of chronic medical conditions and substance abuse among these most frequent emergency department users points to a need for comprehensive primary care. Multidisciplinary case management strategies to identify frequent ED users and facilitate their use of alternative care sites will be particularly important as managed care strategies are applied to indigent populations who have traditionally received care in public hospital EDs. This study was supported by a grant from the Emory Medical Care Foundation.     

某军队医院护士工作压力及应对方式

目的在军队编制体制改革期,探讨某军队医院护士的工作压力、应对方式的现状及其关系。方法采用一般资料调查表、护士工作压力源量表、简易应对方式问卷,对266名某军队医院护士进行调查。结果①某军队医院护士工作压力源总均分为(2.08±0.14),工作量及时间分配得分为(2.55±0.33),位于首位;②应对方式与常模比较,消极应对方式低于常模(t=-36.093,P0.01);③工作压力与消极应对方式呈显著负相关(r=-0.280,P0.01)。结论军队医院护士采用消极应对方式较少,采取积极应对方式越多,工作压力越小。     

大型综合医院开展健康管理服务的SWOT分析

健康管理不仅是一个概念,也是一种方法,更是一套完善、周密的服务体系。目前,国内开展该项服务的机构主要集中在大型综合性医院和商业化的健康管理服务机构。笔者运用SWOT分析方法,对大型综合医院开展健康管理服务存在的主要优势、劣势、机会和威胁进行分析,并综合运用SO策略、ST策略、WO策略、WT策略提出了7条发展策略。     

四川省县级公立医院药事服务费收取标准初探

[目的]基于取消药品加成的假设,测算不同经济地区县级公立医院药事服务费的收取标准,为新一轮公立医院改革方案提供参考依据。[方法]文献分析法、问卷调查法、访谈法和损失平移法。[结果与结论]以药养医现象仍突出。实施药事服务费能改变医院财务收支结构,更能体现医生的劳动价值。不同经济地区药事服务费收取标准存在差异,测算结果与国内研究结果基本一致,具有一定的合理性。     

SWOT分析法在公立医院战略管理中的应用

随着医药卫生体制改革的不断深入,公立医院在面临大力发展机遇的同时也面临着严峻挑战。将SWOT分析法运用到公立医院战略管理中,通过系统地分析公立医院所面临的内部优势、劣势、外部存在的机会和威胁,从而使公立医院在部署战略规划中,能够找准医院发展的目标和方向,最大限度地利用内部的优势和外部的机遇,规避威胁,降低风险,以便在激烈的医疗市场中获得生存和发展。     

新形势下对我国公立医院市场化改革的分析

在深化医药卫生体制改革中,公立医院的改革是重中之重,事关医改的成败。笔者在总结我国公立医院发展现状的基础上,对公立医院市场化改革进行分析,并提出以产业化与企业化促进公立医院的发展;以社会化与多元化促进公立医院改革及政府加大购买服务以促进公立医院市场化改革的建议。     

三甲医院提升患者感知价值策略研究

随机抽取了广州地区10家三甲医院进行问卷调查。结果显示,患者感知价值与预期价值有一定落差。对此,医院应切实采取重视医患有效沟通、改善医护人员态度、提供及时服务、形成良性互动的意见反馈机制、缩短患者就诊等候时间等措施来提升患者感知价值。