罗山县1999～2001年医疗卫生单位消毒质量监测结果分析

为进一步贯彻落实《消毒管理办法》和《消毒技术规范》,提高消毒工作质量,有效地控制院内感染,我站于1999～2001年对罗山县县、乡两级医疗卫生单位进行了消毒质量监测,结果报道如下。     

Medicare's national coverage decisions for technologies, 1999-2007

An analysis of Medicare national coverage decisions (NCDs) from 1999 through 2007 reveals that the Centers for Medicare and Medicaid Services (CMS) considers the available evidence as no better than fair for most of the technologies considered. Still, the CMS issues favorable decisions in 60 percent of the cases it takes on, although almost always with conditions placed on coverage. Since enactment of the 2003 Medicare Modernization Act, which legislated maximum review times for NCDs, the CMS has eliminated "long duration" decisions (more than one year) and has issued several "coverage with evidence development" decisions, which promise flexibility but also carry implementation challenges.     

河北省卢龙县1999～2001年婴幼儿杯状病毒腹泻流行病学研究

目的 研究河北省卢龙县5岁以下婴幼儿杯状病毒腹泻的流行特点。方法 应用酶联免疫吸附试验(ELISA)和逆转录—聚合酶链反应(RT—PCR)方法检测人类杯状病毒(HuCVs)。部分阳性标本的PCR产物经克隆测序，结合参考毒株相应的核苷酸序列进行进化分析。利用住院腹泻患者粪便样本中HuCVs的检出率，估计HuCVs腹泻住院率。结果 HuCVs检出率为31．6％，住院患者HuCVs阳性率为17．5％，主要分布在3～17月龄婴幼儿，发病主要集中在冬季。11株测序病毒之间的核苷酸序列同源性为55．1％～100％，均属于诺瓦克病毒(NLV)GⅡ遗传组。卢龙县2000年HuCVs流行株为NLVGⅡ-4和GⅡ-7，2001年为NLVGⅡ-3和GⅡ-7。初步估计HuCVs腹泻患者住院率为3．6‰。结论 河北省卢龙县婴幼儿中存在不同基因型杯状病毒感染，以NLVGⅡ组毒株为主，其疾病负担仅次于轮状病毒。     

以服务为基础的支付制度的国际研究现状及对我国的启示

以服务为基础的支付（ABP）是当前国际上关于医疗服务供方支付制度的理论研究热点。目前国内尚未有学者针对这一概念进行相关研究。本文从以服务为基础的支付制度的定义出发，介绍其基本概念、在国外的发展现状、主要实施模式和实证效果，并据此对我国当下的医保支付制度的理论研究和改革方案制定提供参考建议。     

Infants tested for hearing loss--United States, 1999-2001

Hearing loss (HL) occurs in one to three of 1,000 live births annually and, when left undetected, can result in developmental delays. To promote communication from birth, Early Hearing Detection and Intervention (EHDI) programs support early identification of infants with HL. Without EHDI programs, the average age of identification for HL is age 1.5-3.0 years, which is past the start of the critical period for optimal language acquisition. In 2001, a total of 48 states/areas with EHDI tracking and surveillance systems (30 funded by CDC) reported the percentage of newborns screened for HL. This report summarizes the results of an analysis of surveillance data for 1999-2001, which indicate that more infants were screened for HL, received diagnostic audiologic evaluations, and were enrolled in early intervention services in 2001 than in 1999 and 2000. Continued development of EHDI surveillance systems should assist states/areas in providing needed services to children with HL.     

Implementation of a severity-adjusted diagnosis-related groups payment system in a large health plan: implications for pay for performance

This article describes the implementation of the All Patient Refined Diagnosis Related Group (APR-DRG) inpatient payment system in a large regional commercial payer. The APR-DRG system replaced the Plan's current All-Payer DRG (AP-DRG) payment methodology on December 1, 2006, and is part of a strategic hospital payment redesign that will enable the Plan to control costs, increase pricing transparency for customers and providers, and reward hospital quality and efficiency. On the basis of modeled results using 2005 data, we found that the APR-DRG payment system using cost-based weights will do a better job of linking inpatient severity and use of resources to payments. The transition to the cost-based APR-DRG methodology with enhanced clinical specificity will also support measurement of hospital quality and efficiency in the Plan's performance improvement programs.     

Health behaviors of adults: United States, 1999-2001

This report presents prevalence estimates for key indicators of alcohol use, cigarette smoking, leisure-time physical activity, and body weight status among U.S. adults, using data from the 1999-2001 National Health Interview Surveys (NHIS). The NHIS is conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. Subgroups are compared in terms of prevalence of healthy and unhealthy behaviors. Methods Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). Questions on health behaviors were asked in the Sample Adult component of the basic core questionnaire. All data were self-reported. This report is based on a total of 96,501 completed interviews with sample adults aged 18 years and over, representing an overall sample adult response rate of 71.8% for the 3 years combined. Statistics were age adjusted to the 2000 U.S. standard population. Results Overall, 6 in 10 U.S. adults were current drinkers in 1999-2001; about 1 in 4 adults (23.1%) were lifetime abstainers. About 1 in 4 adults (23.1%) were current smokers and over one-half of adults (54.3%) had never smoked cigarettes. About 6 in 10 adults engaged in at least some leisure-time physical activity with about 3 in 10 regularly engaging in such activities. About 6 in 10 adults were overweight or obese (BMI > or = 25), with 4 in 10 adults having a healthy weight.     

Rehabilitation costs: implications for prospective payment.

OBJECTIVE: To obtain information relevant to development of prospective payment for Medicare rehabilitation facilities (RFs) and skilled nursing facilities (SNFs): compares service utilization, length of stay (LOS), case mix, and resource consumption for Medicare patients receiving postacute institutional rehabilitation care. DATA SOURCES/STUDY SETTING: Longitudinal patient-level and related facility-level data on Medicare hip fracture (n = 513) and stroke (n = 483) patients admitted in 1991-1994 to a sample of 27 RFs and 65 SNFs in urban areas in 17 states. STUDY DESIGN: For each condition, two-group RF-SNF comparisons were made. Regression analysis was used to adjust RF-SNF differences in resource consumption per stay for patient condition (case mix) and other factors, since random assignment was not possible. DATA COLLECTION/EXTRACTION METHODS: Providers at each facility were trained to collect patient case-mix and service utilization information. Secondary data also were obtained. PRINCIPAL FINDINGS: RF patients had shorter LOS, fewer total nursing hours (but more skilled nursing hours), and more ancillary hours than SNF patients. After adjustment, ancillary resource consumption per stay remained substantially higher for RF than SNF patients, particularly for stroke. The adjusted nursing resource consumption differences were smaller than the ancillary differences and not statistically significant for hip fracture. Supplemental outcome findings suggested minimal differences for hip fracture patients but better outcomes for RF than SNF stroke patients. CONCLUSIONS: Much can be gained from an integrated approach to developing prospective payment for RFs and SNFs. In that context, consideration of condition-specific per-stay payment methods applicable to both settings appears warranted.     

Ambulatory encounter systems: implications for payment and quality

Many key decision makers are looking to AESs solely for purposes of payment. This approach is unfortunate because many systems could be utilized for both payment and quality management purposes. It is important that the professional quality of care community be aggressive and document, through research and practical demonstration projects, how AESs can be used for both purposes. It is only in this manner that resource consumption can be both accurately analyzed and related to quality improvement.     

Health promotion competencies for Australia 2001-5: trends and their implications

This important research builds on past projects in Australia and internationally that have sought to define and clarify competencies required to work in health promotion. The paper briefly explains the process undertaken in 2005 to update the Australian health promotion competencies as a collaboration of several leading health promotion agencies. The article reports findings from research undertaken in 2001 and 2005 and compares trends in perceptions of health promotion competencies across time. This dialogue among researchers, health promotion academics and practitioners can help to further the impact of competencies research on professional practice in health promotion globally. This project placed a priority on methodology that engaged the health promotion workforce in Australia. A two-stage process was employed including expert consultation with 39 senior health promotion professionals, followed by a modified Delphi process to engage 400 practitioners. Space was allowed for comment on the competencies including suggested word changes, and respondents were also invited to add additional competencies. The research involved a modified Delphi study where participants were invited to rate each competency as "essential", "desirable" or "not relevant", and to suggest changes to wording, as well as additions to the list. Responses were received from 400 practitioners and the results were presented and compared with the 2001 survey results. Results indicate a substantial shift in perceptions about health promotion practice in Australia during the initial years of the 21(st) century.The overall significant changes in perceptions indicate that by 2005 the Australian health promotion workforce had substantially moved away from an individual behaviour-dominated perception of health promotion practice. Increasing recognition was given to competencies that reflect environmental, economic and policy influences on health, and increased recognition that these processes are legitimate and essential components of the health promotion process.     

Medicare's national coverage decisions, 1999-2003: quality of evidence and review times

In 1998 Medicare amended its procedures for making national coverage decisions for new technologies in an attempt to make the process more transparent and evidence based. We examined the quality of evidence for sixty-nine technologies reviewed by Medicare since then. Determinations by the Centers for Medicare and Medicaid Services (CMS) have generally been consistent with the strength of evidence. Good clinical evidence from rigorous studies is usually lacking for the technologies Medicare considers, although in most cases the CMS covers with conditions if there is at least fair evidence that benefits outweigh harms. Decisions referred to the external Medicare Coverage Advisory Committee (MCAC) have averaged eight months longer than non-MCAC decisions.     

HMO plan performance update: an analysis of the literature, 1997-2001

This paper synthesizes results from peer-reviewed literature published from 1997 to mid-2001, on various dimensions of health maintenance organization (HMO) plan performance. Results from seventy-nine studies suggest that both types of plans provide roughly comparable quality of care, while HMOs lower use of hospital and other expensive resources somewhat. At the same time, HMO enrollees report worse results on many measures of access to care and lower levels of satisfaction, compared with non-HMO enrollees. Quality-of-care results in particular are heterogeneous, which suggests that quality is not uniform--that it varies widely among providers, plans (HMO and non-HMO), and geographic areas.     

Medicare hospital outpatient services and costs: implications for prospective payment

Medicare expenditures of hospital outpatient department (HOPD) services are growing rapidly, prompting congressional interest in a prospective payment system. In this article, the authors identify frequently provided services and examine service volume and charges in the HOPD. Relatively few services drive Medicare HOPD spending, and volume is dominated by visits, imaging and laboratory tests, whereas surgery accounts for a large proportion of charges. Hospital-level variations in charges, costs, case mix, and outliers are also explored. There is substantial variation in charges and costs across hospital types. However, after case-mix adjustment, all hospital types have average costs within 6 percent of the national average.     

Racial segregation and county level intentional injury in Pennsylvania: analysis of hospital discharge data for 1997-1999

STUDY OBJECTIVE: This study examined whether high levels of racial segregation are associated with high county level intentional injury rates. DESIGN: Multiple linear regression was used to assess the association between county racial segregation (measured by the Gini coefficient) and intentional injury rates. Multicollinearity was assessed with Eigenvalues and condition indices. SETTING: State of Pennsylvania. PATIENTS: County level intentional injury rates for 1995 to 1997 were calculated from hospital discharge data. MAIN RESULTS: After controlling for other known county level risk factors, higher levels of racial segregation in a county were significantly related to higher intentional injury rates. Multicollinearity was not a problem. Population size and density, family stability and median income, together with the percentage male, unemployed, in poverty, divorced men, and high school graduates of the county were controlled. CONCLUSIONS: Racial segregation is an important factor in the rate of intentional injury in a community. These results may be important for municipal and state agencies when developing public policies to prevent violence and promote racial integration.