公立医院临床服务类科室交叉成本的分摊方式探索

随着医疗业务内容的不断发展和变化,公立医院已设置的四大类核算单元和三级医疗成本分摊体系,但仍无法解决临床服务类科室交叉成本分摊的问题,因此造成了临床科室收支不配比的情况。通过分析公立医院临床服务类科室交叉成本的特点及其产生原因,进而采用按收入占比的方法进行临床服务类科室交叉成本分摊。其中,核算单元的准确划分、提高成本核算数据的准确性,对完善医院全成本核算体系、加强医院成本费用分析、开展医疗项目成本核算和医院未来发展具有重要意义。     

医工科是现代化医院的重要组成部分

1医工科在医院中的地位医工科是医学工程科的简称。各级综合性医院的科室设置,基本上分职能科室、临床科室和医技科室三大块,医工科是两大职能科室之一。目前,医工科已成为医院临床医疗工作的重要环节和支柱,为临床和附诊科室提供强有力的技术支持。医工科又称为器材科、设备科,大医院的医工科有的又称为生物工程中心,象301医院、成都军区昆明总院。在三甲医院的验收达标中明确表明医工科为必设科室从系统观点看,医工科是指医院运行系统中的技术支持系统,它在医院起着越来越重要的作用。因此,卫生部《医院分级管理办法(试行草案)》按医院功…     

县级医院手术科室绩效考核指标体系效果评价

目的验证县级医院手术类临床科室绩效考核指标体系的应用效果,为该指标体系的推广应用提供依据。方法选取成都市某县医院作为应用的典型案例,运用县级医院手术类临床科室绩效考核指标体系,对其6个手术类临床科室进行为期1年的绩效考核,将绩效考核结果和科室运营数据作为实证检验资料,并进行科室运营情况前后比较和自身前后配对t检验。结果全部高优指标或高优达标指标都呈增长态势,大部分低优指标或低优达标指标都呈下降趋势。15个考核指标中有12个指标差异有统计学意义。结论县级医院手术类临床科室绩效考核指标体系,对于手术类临床科室的绩效考核更加具有针对性、实用性、有效性,促进了手术类临床科室提高工作效率、提升运营水平、减轻患者经济负担,具有较好的应用价值,适合在县级医院中推广。     

ABC分类法在医院感染管理绩效考核中的应用

目的 探讨ABC分类法在医院感染管理绩效考核中的作用.方法 根据管理特点和工作性质将科室分为A、B、C3类,分别制定绩效考核方案进行考核.结果 除重症监护室（ICU）外,A类科室中其他科室以及B、C类科室主要考核指标均有所改善.结论 分类管理绩效考核方法提高了管理效率,实现了医院感染管理质量的持续改进.     

系统聚类法与综合指数法在临床科室评先中的应用

目的找到一种使医院不同业务性质临床科室能够进行评比的标准尺度。方法采用系统聚类法与综合指数法相结合的评价方法,用系统聚类法将临床科室依据工作指标进行分类,再用综合指数法在每一类临床科室中选出最优科室。结果实现了依据多数量指标聚类选最优临床科室。结论通过系统聚类法与综合指数法的结合,实现医院不同性质临床科室之间的评比,克服了主观人为因素的影响,为医院激励优秀科室提供了参考方法。     

南京市妇幼保健院信息系统科室代码设计方案与实践

目的建立符合妇幼专科特色的科室代码,作为统计工作的基础用于医院信息系统。方法构建组织框架,以卫生健康委员会《监测网络科室编码及科室名称规则》《江苏省三级妇幼保健院评审标准与细则》《南京市妇幼保健院科室设置》为基本制定原则,通过召开启动会,广泛征询各科室意见,发布《南京市妇幼保健院信息系统科室名称及编码的管理规定》文件,制定科室代码修订系列流程,保证可持续发展。结果建立医院信息系统科室代码字典并在全院实施,医院统计工作效率大幅提高。结论科室代码是医院信息系统的灵魂,建立规范的科室代码字典方法和步骤可为同类型医院提供参考。     

论医院成本核算

一、确定成本核算的对象所谓成本核算对象,是指费用的归集和分配的对象。根据目前医院的业务情况和管理水平,医院试行成本核算的对象可以分三大类:一是医疗服务成本,包括门诊部和住院部各临床医技科室;二是药品消     

基于KPI的医院临床科室绩效考核等级的测算

医院实施绩效考核是为调动员工积极性、提升科室管理水平、促进医院发展而采用的一种有效管理方法。结合医院近期在医院管理中开展绩效考核的工作规划,我们率先以24个临床科室为考核对象,运用KPI的量化评价方法[1],根据临床科室工作性质的不同,将不同专业、不同层次的临床科室划分成3个考核区域,按科室完成的基本工作量以＂好、较好、一般＂来测评出3个等级,即一、二、三等,为医院按工作绩效取酬的分配机制提供考核依据。     

临床科室奖金预留金的核算和管理

目前,绝大多数医院仍然实行工资加奖金的分配制度。奖金部分基本是实行两次分配的办法：第一次是由医院按临床科室绩效考核结果,将奖金分配给临床科室;第二次是临床科室按医护人员贡献大小,再分配给本科室人员。在第二次奖金分配过程中,医院从人性化角度出发,允许临床科室保留一部分预留金,作为科室集体活动费用,一般控制在科室奖金总额的5％～6％。     

基于系统聚类与密切值法的临床科室综合效益评价

目的应用系统聚类和密切值法评价临床科室效益,为医院管理临床科室综合评价问题提供方法。方法用系统聚类法将各临床科室分类、密切值法对各临床科室综合效益进行评价并排序。结果系统聚类为4类,结合密切值排序依次为:1类儿科;2类妇产科、消化内科、呼吸内科、神经内科、普外科、肾病内科、心血管内科、眼科、耳鼻咽喉科;3类骨科、感染疾病科、神经外科、肝胆外科、胸外科、ICU;4类康复科。结论系统聚类法和密切值法的结合运用可以准确对医院临床科室综合效益进行分类和评价,结果直观、可靠。     

Ambulatory medical care utilization estimates for 2005

OBJECTIVE: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2005. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. METHODS: Data from the 2005 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 4.0 visits per person annually. Between 1995 and 2005, population visit rates increased by about 20% in primary care offices, surgical care offices, and OPDs; 37% in medical specialty offices; and 7% in EDs. The aging of the population has contributed to increased volume of visits because older patients have higher visit rates. Visits by patients 40-59 years of age represented about 28.5 percent in 2005, compared with 23.9 percent in 1995. Black persons had higher visit rates than white persons to hospital OPDs and EDs, but lower visit rates to office-based primary care and to surgical and medical specialists. In the ED, the visit rate for patients with no insurance was about twice that of those with private insurance; whereas for all types of office-based care, the visit rates were higher for privately insured persons than for uninsured persons. About 29.4 percent of all ambulatory care visits were for chronic diseases and 25.2 percent were for preventive care, including checkups, prenatal care, and postsurgical care. The leading treatment provided at ambulatory care visits was medicinal with 71.3 percent of all visits having one or more medications prescribed, up by 10% since 1995 when encounters with drug therapy represented 64.9 percent of all visits. In 2005, 2.4 billion medications were prescribed or administered at these visits.     

A public health model of Medicaid emergency room use

This study builds a public health model of Medicaid emergency room use for 57 upstate counties in New York from 1985 to 1987. The principle explanatory variables are primary care use (based in physicians' offices, freestanding clinics, and hospital outpatient departments), the concentration of poverty, and geographic and hospital availability. These factors influence the emergency room use of all Medicaid aid categories apart from the Supplemental Security Income recipients. Inherent in these findings are a number of policy implications that are explored in this article.     

US primary care delivery after the Health Center Growth Initiative: comparison of health centers, hospital outpatient departments, and physicians' offices

We compared patient management during primary care visits in 3 settings (health centers, hospital outpatient departments, and physicians' offices) and investigated racial/ethnic and insurance-based disparities in the wake of the recent health center program expansion. Within health centers, there were few differences in patient management across racial/ethnic or insurance groups. In contrast, the other settings displayed more racial/ethnic and insurance disparities in patient management during visits. Health centers performed processes of care with comparable or higher occurrence, relative to physicians' offices. Health care disparities were also attenuated in health centers, compared with other primary care settings.     

坚持分级管理 促进各项工作上台阶

江津市妇幼保健院在市场经济体制下，改变传统的办院模式，走医院分级管理的道路，建立健全各项分级管理的规章制度，充分利用有限的卫生资源，坚持以病人为中心、以质量为核心的宗旨，充分发挥各职能科室和临床科室的管理作用，使分级管理制度化、经常化、规范化、科学化，调动了职工的积极性，促进了医院的发展。     

Variation in the ecology of medical care

BACKGROUND: We wanted to quantify how the location in which medical care is delivered in the United States varies with the sociodemographic characteristics and health care arrangements of the individual person. METHODS: Data from the 1996 Medical Expenditures Panel Survey (MEPS) were used to estimate the number of persons per 1,000 per month in 1996 who had at least 1 contact with physicians' offices, hospital outpatient departments, or emergency departments, hospitals, or home care. These data were stratified by age, sex, race, ethnicity, household income, education of head of household, residence in or out of metropolitan statistical areas, having health insurance, and having a usual source of care. RESULTS: Physicians' offices were overwhelmingly the most common site of health care for all subgroups studied. Lacking a usual source of care was the only variable independently associated with a decreased likelihood of care in all 5 settings, and lack of insurance was associated with lower rates of care in all settings but emergency departments. Generally, more complicated patterns emerged for most sociodemographic characteristics. The combination of having a usual source of care and health insurance was especially related to higher rates of care in all settings except the emergency department. CONCLUSION: Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care.     

情商在医院感染管理中的作用

目的为提高医院感染管理专职人员的管理效能,创造和谐的管理环境。方法分析情商在医院感染管理中所起的作用并重视情商培养。结果医院各部门、各科室对医院感染管理工作由被动变为主动,感染管理工作不断深化,做到和谐管理,人人参与。结论发挥情商因素在医院感染管理中的重要作用,使医院感染管理工作达到事半功倍的效果。     

Emergency room encounters of pediatric patients with asthma: cost comparisons with other treatment settings

More than 67,000 claims from a national database were analyzed to determine the relative costs of treating pediatric patients with asthma in physicians' offices, hospital outpatient departments, or emergency rooms. Billed charges and paid claims for these cases in emergency rooms average more than 5 times higher than in physician offices. Emergency treatment generally results from a failure of proper management and education in the primary care setting. Educational programs for pediatric patients with asthma and their families could save resources as well as reduce the trauma often associated with visits to the emergency room.     

A fix at the University of Texas Medical Branch

Problem: A well established teaching hospital geographically isolated is having difficulty getting physicians to refer patients to its island location. Solution: 1) Purchase an electronic network connecting the hospital with physicians within about a 100-mile radius of the hospital; 2) choose a network that offers physicians insurance and demographic information, test results from various hospital departments. The network also will offer physicians the ability to complete pre-admission paperwork for a patient on the system, as well as obtain discharge summaries. Physicians also will be able to use the teaching hospital's medical library in their offices or in their homes.     

The Medicare Critical Access Hospital Program: The First Year

The Medicare Critical Access Hospital (CAH) program, part of the Balanced Budget Act of 1997, is a nationwide limited service hospital program. Structured interviews were conducted in August and September 1998 with key people in state offices of rural health, state hospital associations, departments of health or departments of facility licensing in all 50 states to assess their progress in the development of the CAH program. The majority of states expressed interest in the CAH program. Twenty-one states were moving formally toward involvement in the program. States that had developed or were in the process of developing a state plan estimated that between 183 to 227 hospitals would convert to CAHs in the next one to two years. States that were the most successful with plan development appeared to be states that participated in the Essential Access Community Hospital/Rural Primary Care Hospital program, states where there was dialogue about the possibility of a limited service hospital program and states with widespread support in the state. A pressing need for most states is for reliable fiscal consulting or analysis that could be applied to individual hospitals that are considering conversion to CAHs. The CAH program shows promise for successful implementation based on its early results.