门诊信息系统研究

传统的门诊信息系统一般只较好地解决了门诊收费问题,新一代比较完整的系统将以医生诊间系统为核心,从病人预约和挂号开始,将门诊就诊全过程信息化,文章分析了其必要性和可行性,并就门诊病人就诊ID标识,反馈式管理模型的设计和实施,门诊医生诊间系统,门诊病历的录入,门诊系统建设的投入／产出比分析,。门诊系统实施难点等有关问题进行了讨论。     

Structure of an automated management system for the medical technology activities of the polyclinic

Block diagrams of building an automated control system for management of operational processes in an outpatient clinic are analysed.     

System for automating primary examinations of the public in a polyclinic

Presented in the paper is an automated system for original examinations of population in a typical outpatient clinic. Main functional parameters and specifications are given. The system is capable of managing the data basis for the region with population of 50 000 inhabitants.     

优化门诊输液流程 提高患者用药安全

静脉输液疗程短、起效快,是一种治疗疾病重要且有效的手段,在临床治疗中占有重要地位。本文针对北医三院现有门诊输液流程中的安全隐患问题,从方便患者、保障患者安全的角度出发,利用医院信息系统平台在优化门诊输液流程、提高服务质量方面做了一些探索,并简要分析优化后门诊输液流程的特点。     

Improving outpatient clinic efficiency using computer simulation

To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The stimulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.     

Characteristics of veterans using Veterans Affairs community-based outpatient clinics

In the late 1990s, the Department of Veterans Affairs (VA) initiated a system of community-based outpatient clinics to enhance access to care. The purpose of this study was to explore factors that may be related to veterans' desire to transfer care from VA-based to community clinics. Among 1,452 veterans who were currently receiving VA clinic care and were eligible for care in two community-based clinics in rural Minnesota, 85 percent responded to a survey. Fifty-four percent of respondents requested community-based outpatient clinic care. Multivariate analysis revealed that veterans less satisfied with VA care were more likely to request a transfer to a community clinic, whereas Veterans SF-36 scale scores were not strongly associated with request for community-based outpatient clinic care. Veterans who had more VA clinic visits were less likely to request community-based outpatient clinic care. The likelihood of requesting also varied across the VA facilities and by VA eligibility level.     

The Impact of Hospital Acquisition of Physician Practices on Referral Patterns

Multiple parties influence the choice of facility for hospital‐based inpatient and outpatient services. The patient is the central figure, but their choice of facility is guided by their physician and influenced by hospital characteristics. This study estimated changes in referral patterns for inpatient admissions and outpatient diagnostic imaging associated with changes in ownership of three multispecialty clinic systems headquartered in Minneapolis‐St. Paul, MN. These clinic systems were acquired by two hospital‐owned integrated delivery systems (IDSs) in 2007, increasing the probability that hospital preferences influenced physician guidance on facility choice. We used a longitudinal dataset that allowed us to predict changes in referral patterns, controlling for health plan enrollee, coverage, and clinic system characteristics. The results are an important empirical contribution to the literature examining the impact of hospital ownership on location of service. When this change in ownership forged new relationships, there was a significant reduction in the use of facilities historically selected for inpatient admissions and outpatient imaging and an increase in the use of the acquiring IDS's facilities. These changes were weaker in the IDS acquiring two clinic systems, suggesting that management of multiple acquisitions simultaneously may impact the ability of the IDS to build strong referral relationships. Copyright © 2015 John Wiley & Sons, Ltd.     

排队叫号系统在门诊的应用

本文阐述了排队叫号系统在我院门诊各专家诊室、门诊药房、门急诊儿科输液室、放射、超声、内镜等医技科室的广泛应用,及在门诊流程改造中发挥的作用。实施此系统后,我院门诊服务水平得以改善,患者满意度明显提高。     

门诊分诊叫号相关辅助系统的开发与应用

分析了当前门诊分诊叫号系统存在的问题,并给出切实可行的解决方案,成功开发了多款独立的辅助系统,很好地解决了现实中的问题,提高了分诊叫号系统的实用性和健壮性,降低了门诊一线工作人员的压力,改善了患者的就医感受.     

The impact of an outpatient heart failure clinic on hospital costs and admissions

This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south-central Ontario was undertaken to determine whether the patients managed in an outpatient heart failure clinic used fewer hospital resources (as expressed in number of admissions, complexity of admission, and length of stay (LOS)) than a matched cohort who were not managed in an outpatient clinic. Statistical significance of LOS opportunities could not be demonstrated (owing to sample size), however, the heart failure clinic is making a positive impact on all types of admissions (CHF and non-CHF) in terms of LOS and suggests that management in an outpatient setting for chronic disease states is important for acute care hospitals to consider.     

User satisfaction is influenced by the interval between a health care service and the assessment of the service

In order to improve the quality of patient care, questionnaires are often used to identify user’s experiences and evaluations, but only a few studies have examined whether measuring user satisfaction at different time points influences the assessment of health care. Several studies have shown equivalency between paper and electronic patient reported outcomes; however, none of these studies have considered the fact that electronic questionnaires are usually completed at the hospital, while paper questionnaires are typically completed at home weeks after the visit. In order to ensure that the comparison of results collected by the two different methods are not biased, the aim of this study was to determine if the interval between an outpatient visit and the assessment of the quality of care influences user satisfaction and to compare response rates between questionnaires completed at different times. In a follow-up study, parents from a paediatric outpatient clinic in Denmark were quasi-randomised to 1 of 3 groups: group 1 completed an electronic questionnaire on a touch screen computer in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; group 2 completed a paper questionnaire in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; and group 3 completed a paper questionnaire 3–6 weeks after the visit. A total of 1148 parents completed at least 1 questionnaire. User satisfaction was significantly lower when the assessment was made after a visit to the outpatient clinic compared to an assessment made at the clinic. The response rates of questionnaires completed at the clinic were significantly higher than the response rates of questionnaires completed after the visit. Both the timing of surveys and response rates need to be taken into consideration when planning user surveys. Outcomes from surveys conducted at different times are not readily comparable.     

海洛因成瘾者社区美沙酮维持治疗工作门诊运营效率分析

目的:分析社区美沙酮维持治疗工作门诊(简称"门诊")的运营效率及影响因素。方法:通过问卷调查和定性访谈,运用边际成本方法进行分析。结果:日均门诊量287人是美沙酮门诊运营的最佳工作效率点,目前多数门诊未达到此状态;日均治疗例数、每工作人员和每平米面积分摊的治疗人数,以及例均成本和构成比较分析显示,美沙酮门诊运营的投资效率和成本控制均存在一定问题。建议:加强门诊服务的社会基础建设、激励机制建设和后续干预,提高治疗效果和门诊运行效率;中央转移支付应改变目前的支付方式和一刀切的支付标准,逐步建立一套考核指标及相应的效率补偿机制,以提高资金的运作效率和工作效率。     

门诊患者复诊流程再造

在门诊就医过程中,存在着较高比例当日再次返回诊室就诊的现象,复诊患者与正在就诊患者存在就医秩序的冲突,医师看诊常常被打断,影响诊疗思路,延长看诊时间,同时,患者的隐私得不到有效保护.随着门诊患者复诊现象的不断增加,原有的就诊秩序和流程较难保障.以问卷形式对军队某三级甲等医院的门诊患者进行满意度调查,以了解复诊患者在全门诊就医流程中存在的问题[1],为完善门诊管理制度,实现流程再造提供科学的决策依据.     

Patient referral by telemedicine: effectiveness and cost analysis of an Intranet system

The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared--Peijas Hospital (PH) with telemedicine and Hyvink?? Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an e-mail consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were not declined. Productivity in the hospital increased over threefold by using e-mail consultations instead of traditional outpatient visits. The wide interactive use of the intranet referral system between secondary and primary care improved clinical effectiveness, lowered direct costs, increased productivity and was cost-effective.     

双向查对制度在门诊输液护理中的效果观察

目的探讨双向查对制度在门诊输液护理中的应用效果。方法将256例门诊输液患者随机分为实验组和对照组各128例。对照组患者采用常规查对制度的方法,实验组患者采用医务室自制的双向查对制度方法和流程。结果实施双向查对制度和科学的流程后,使本院医务室门诊输液过程中发生护理差错及纠纷的比例降为零。结论通过规范实施双向查对制度的内容和流程,有效的杜绝了门诊输液过程中差错和纠纷的发生,实现患者的安全管理质量的持续改进,也让患者感到真正的满意和放心。     

医院门诊收费票据微机化监控管理探讨

目的：针对当前医院门诊收费票据管理存在的问题,探讨行之有效的管理方法。方法：从制度及措施等方面入手,结合实际工作情况,加强票据管理。结果：根据提出的办法及微机化管理手段,完善对门诊收费票据的规范管理。结论：医院应将门诊收费票据管理视为医院管理的重要组成部分,并通过微机化监控手段来提高票据管理水平。     

我院通过整合资源优化预约诊疗的实践

通过改善内部管理制度与流程、充分利用现代管理理念和科技手段整合多方资源等举措,有效提高了门诊预约诊疗的服务质量和水平,使得预约挂号率逐年上升,取得了较好的社会效益.在此基础上结合实际情况,对目前预约诊疗存在的问题进行分析并提出应对建议.     

建立门诊医患互动诊疗新模式的探讨

为进一步提高医疗技术资源的应用效能,提高门诊诊疗效率和患者就诊效率,有效缓解门诊“三长一短”的现状．在门诊传统诊治模式的基础上,建立门诊医患互动诊疗新模式,实现科学分诊和交替诊治,开辟患者就诊新流程。就医患者因此避免了相互间的影响,缩短了滞留门诊的时间：医生因此减少了大量的“非技术性”工作,诊疗科室改变了工作中时闲、时忙效率低下的状况。有限的医疗资源得到更加有效的运用。     

2007～2011年门诊量季节变动调查分析

目的分析门诊量季节变化规律,为医院今后门诊工作及制度决策、计划提供科学依据。方法用季节指数法,分析门诊月份、季度波动特点及规律。结果医院门诊量的季节变动以一年为一个周期,随季节变化而引起周期性的变动,变动幅度大致相同。结论根据门诊季节变化规律合理配置人员,可提高门诊服务质量。     

东莞市社会基本医疗保险制度社区首诊SWOT分析

2008年东莞市建立了社会基本医疗保险制度,并实行门诊统筹和社区首诊.社区首诊制是巩固东莞市新建的社会基本医疗保险制度和社区医疗服务体系的重要措施.利用SWOT分析方法来考察东莞市社区首诊制政策,进而提出完善社区首诊制的一些思考.