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1.
目的通过介绍典型国家及地区经验,阐述医保如何通过经济手段促进医疗服务质量提升,供我国大陆地区参考。方法采用文献分析法。采取主题词与分类号组合的检索方式,收集美国、英国及我国台湾地区有关医保与医疗服务质量的文献。结果美国实行基于价值支付的奖惩机制,包括医院服务价值购买计划、再入院扣费计划、医院获得性疾病扣费计划;英国实行提升基层医疗服务质量的激励机制;我国台湾地区实行结合医院评价体系的总额预付制。结论为促使我国大陆地区通过医保支付进一步推进医疗质量管理,建议建设卫生主管部门与医保部门有机融合的医疗质量考核系统,采用质量指标的多元计分方式,设计与质量联动的奖惩机制等。  相似文献   
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目的构建眼科日间手术室护理质量评价指标体系,为客观评价眼科日间手术室的护理质量提供科学依据。方法于2020年1—8月基于"结构-过程-结果"三维质量模型,通过文献检索、半结构访谈、德尔菲专家函询法和层次分析法构建眼科日间手术室护理质量评价指标体系。结果2轮专家函询的问卷有效回收率均为100.0%,专家权威系数分别为0.851和0.858,专家协调系数为0.098~0.264。最终构建的眼科日间手术室护理质量评价指标体系包含一级指标3项、二级指标11项、三级指标57项。结论本研究构建的眼科日间手术室护理质量评价体系具有较高的科学性和可靠性,可全面、客观地评价眼科日间手术室护理质量,促进眼科日间手术室护理质量持续改进。  相似文献   
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背景 2020年3月,上海市卫生健康委提出在基层医疗卫生机构设置发热哨点诊室,以局部应急处置与常态化疫情防控相结合的原则,应对疫情零星散发。 目的 探索并构建一套普适、规范的发热哨点诊室运行评价指标体系。 方法 2021年1—4月,采用目的性抽样法,分别从上海市中心城区、郊区、城郊结合地区选取1家发热哨点诊室,通过实地考察、对来自3家发热哨点诊室的10名工作人员进行两轮半结构化深度访谈,获得原始资料,借助ROST CM6软件整理访谈资料,采用Charmaz建构主义扎根理论的范式分析资料。采用目的抽样法,邀请熟悉发热哨点诊室运行特征的专家(发热哨点诊室管理者、高校研究人员、相关协会学者、卫生发展研究机构人员等)12名作为函询对象,于2021年5—6月采用专家函询法对其进行两轮函询,并运用层次分析法确定各级指标权重、检验各级指标逻辑一致性,最终形成发热哨点诊室运行评价指标体系。 结果 基于扎根理论构建而成的发热哨点诊室运行评价指标体系由5个一级指标、13个二级指标、29个三级指标组成。两轮专家函询问卷的有效回收率均为100.0%,专家权威系数均为0.81,Kendall's W系数分别为0.265(χ2=163.768,P<0.001)、0.320(χ2=130.323,P<0.001)。最终形成的发热哨点诊室运行评价指标体系由5个一级指标(功能和职责、诊室设置要求、人员配备、工作流程和工作规范)、13个二级指标和25个三级指标构成,5个一级指标的权重分别为0.033 7、0.056 4、0.392 6、0.377 8、0.139 5。各层级指标的一致性比率(CR值)为0.056 5、0.032 5、0.042 4(<0.100 0)。 结论 将扎根理论运用于发热哨点诊室运行评价指标体系的构建具有较强的操作性,构建的评价指标体系具有一定的科学性和应用价值。后续随着政策的迭代,可借助扎根理论对评价指标体系进行进一步补充和完善。  相似文献   
4.
目的评价蒲地蓝联合布地奈德治疗小儿急性咽喉炎的疗效。方法选取2018年1月-2019年12月间曾于我院就诊的102例小儿急性咽喉炎患者并根据其用药,将其分为对照组55例与观察组47例,除常规治疗外,对照组予布地奈德治疗,观察组予地蓝联合布地奈德治疗,观察对比两组疗效。结果观察组治疗总有效率为97.87%(46/47),显著高于对照组的83.63%(46/55),差异具有统计学意义(P<0.05);两组治疗中均无严重不良反应发生。结论蒲地蓝联合布地奈德治疗小儿急性咽喉炎的疗效显著,安全可靠,具有推广应用价值。  相似文献   
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PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and 18F-Fluorodeoxyglucose (18F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.  相似文献   
9.
ObjectiveThe Japan Society of Gynecologic Oncology published the first guidelines for the treatment of cervical cancer in 2007. The aim of this research was to evaluate the influence of the introduction of the first guideline on clinical trends and outcomes of patients with early-stage cervical cancer who underwent surgery.MethodsThis analysis included 9,756 patients who were diagnosed based on the pathological Tumor-Node-Metastasis (pTNM) classification (i.e., pT1b1, pT1b2, pT2b and pN0, pN1, pNX) and received surgery as a primary treatment between 2004 and 2009. Data of these patients were retrospectively reviewed, and clinicopathological trends were assessed. The influence of the introduction of the guideline on survival was determined by using a competing risk model.ResultsFor surgery cases, the estimated subdistribution hazard ratio (HR) by the competing risk model for the influence of the guideline adjusted for age, year of registration, pT classification, pN classification, histological type, and treatment methods was 1.024 (p=0.864). Following the introduction of the first guideline in 2007, for patients with lymph node metastasis, the use of chemotherapy (CT) as a postsurgical therapy increased, whereas that of concurrent chemoradiotherapy (CCRT)/radiotherapy (RT) decreased (p<0.010). For pN1 cases, the estimated subdistribution HR by the competing risk model for the influence of the guideline was 1.094 (p=0.634). There was no significance in the postsurgical therapy between CT and CCRT/RT (p=0.078).ConclusionsSurvival of surgical cases was not improved by the introduction of the guidelines. It is necessary to consider more effective postsurgical therapy for high-risk early-stage cervical cancer.  相似文献   
10.
BackgroundA woman's negative perception of her subjective childbirth experience can have consequences on the mother's psychological state and on early mother–baby relationships. To date, there is no validated tool in France allowing to evaluate childbirth experience in a multidimensional way. The aim of this study is to validate the Questionnaire Assessing the Childbirth Experience (QEVA) in a French sample of mothers. This tool was developed in a previous study where the authors combined 25 items into 6 dimensions: representations and expectations, sensory perceptions, feeling of control, perceived social support (medical staff and partner), emotions (positive and negative) and first moments with the baby.MethodsThe sample included 256 women recruited in a maternity ward. Sociodemographic and obstetric characteristics of our sample were compared to those of the French national perinatal survey. The structure of the QEVA with 17 items was explored by an exploratory structural equation modeling (ESEM). An analysis of the internal consistency was conducted on the sub-scores of the identified factors, and the concurrent validity was assessed with the Peri-traumatic Distress Inventory (PDI) through a correlation and its associated t-test.ResultsThe characteristics of our sample and those of the national perinatal survey do not differ on age, marital status, parity, cannabis use, infertility treatment, epidural and baby weight, in favour of the good representativeness of our sample. The study of the QEVA structure revealed a 4-dimensional structure. Analysis of the psychometric qualities showed a good internal consistency, with an observed alpha value ranging from 0.69 to 0.86. The QEVA also shows a good concurrent validity with the peri-traumatic distress scores (r = 0.51).ConclusionTo date, the QEVA is the first standardized tool allowing a multidimensional evaluation of the subjective experience of childbirth. It has been validated on a French population using an exploratory structural equation modeling. This tool, which is simple to use and well accepted by mothers, enables health professionals not only to screen mothers experiencing difficult childbirth and in need of support, but also to adapt health care according to the dimensions of the birth experience and its associated difficulties (emotions during the birth, interactions with health professionals, first moments with the baby, or post-partum emotions).  相似文献   
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