邯郸市第一医院实施惠民措施剖析

邯郸市第一医院作为河北省邯郸市最大的3所三级甲等医院之一,覆盖邯郸市19个县、市、区的800多万人口,拥有600张病床和1700名职工(包括离退休人员),通过实施惠民措施,深化改革及强化管理,取得了显著效果。一、惠民措施的实践特点邯郸市第一医院的惠民措施包括:建立扶贫病房,对扶贫对象进行费用减免;实行单病种限价收费制度;派医疗队下乡以及免费培训乡村医生等支农措施。     

陕西省推行扶贫病房存在的问题及对策

为切实解决群众“看病难、看病贵”问题,陕西省决定从2005年12月1日开始,率先在卫生厅直属的7家医疗机构设立扶贫病房,享受对象主要是未享受医保的城市下岗职工、低保人群和农村五保户、特困户。目前,陕西省直医疗机构开设扶贫病床274张,减免金额115.07万元,人均减免医疗费用621.33元,在一定程度上缓解了贫困人群“看病难、看病贵”问题。但是工作中还存在不少困难和问题,有些方面还比较突出,亟待改进。一、存在的问题(一)扶贫病房工作进展不平衡。陕西省直7家医疗机构基本都能按照要求,拿出普通病床总数的10%作为扶贫病床,但在实际收治扶贫…     

"平价"质疑--关于组建济困或扶贫医院(病房)的拙见

阐述了使用“济困或扶贫医院(病房)”较之“平价医院(病房)”,其内涵外延较为准确且便于操作,利于适应医疗救济制度和基本医疗保险制度;论述了组建“济困或扶贫医院”,不宜采取另起炉灶方式;分析了武昌区政府举办的医疗济困模式、无主管部门的举办商业职工医院(企业医院)济困模式以及“四一三”济困医院等3种模式,比较了各自的特点;并对公立大医院开设“济困或扶贫病房”的费用支付方式,提出了建议。     

关于惠民中医院工作的四点建议

江宁区中医院于2004年12月18日正式挂牌成立南京市惠民中医院，为我区唯一的惠民中医院，也是全南京市唯一的惠民中医院，为全区内2万余名“低保、特困、困难”人员提供惠民医疗服务。成立惠民医院以来，共接诊惠民病人2789人次，其中住院239人次，门诊2550人次，发生总费用1215496元，优惠金额285407元，其中门诊减免93144元，住院减免192263元。其核心内容为实行医疗服务“五免五减半三优惠”。     

实施健康扶贫工程为老百姓多做好事

沙岭子医院是一家市属二级医院，我们认真落实党的卫生政策，关心群众疾苦，维护群众利益，努力减轻患者的经济负担。从20世纪80年代以来，就设有简易扶贫病房，对贫困患者优惠20％住院费。从2000年12月以来，又向所有出院患者发放了“住院优惠卡”，持卡再次住院者一律减免20％住院费。同时对持乡镇证明的特困患者，视情减免医药费。2004年9月正式成为“中国健康扶贫工程定点医院”。我院主要做了以下工作：     

“强化卫生事业的公平性、可及性、功效性和互动性”——推进卫生事业又好又快发展

卫生事业的发展如何才能又好又快？杭州市卫生局局长、党委书记陈卫强说：“关键是要强化卫生事业的公平性、可及性、功效性和互动性。”公平性：人人享有，机会均等 卫生服务的公平性是整个社会公平性的重要组成部分。目前，公平性的实践状况如何？陈卫强介绍说：就杭州市而言，近年来在卫生领域实施“四改联动”，关注弱势群体，建立医疗救助体系，推行新型农村合作医疗，建立惠民医院、惠民门诊、惠民病房，对特困人群实行医疗收费项目的减免等有效措施。然而，我们也应看到，卫生服务公平原则的实现需要相应的社会经济条件作为基础。由于社会经济发展的不平衡，如地域差别、城乡差别、公民收入差别，     

数据解读2007全省医院管理年

惠民医疗服务减免总人次402万人次。总金额达到2．51亿元 惠民医疗服务深入推进。各市各医院对未参加城镇职工基本医疗保险的城市下岗职工等弱势人群继续实行“六免两减”政策。济南市建立首家政府全额补助的惠民医院．探索惠民医疗服务的补偿机制。济宁市政府印发了《城乡困难居民大病医疗救助办法》，建立卫生、民政、财政、劳动保障等7部门联系会议制度,确定从捐赠款项和福利彩票公益金中提取8％～10％用于专项救助．     

省卫生厅确定在全省开展惠民医疗工作

为有效缓解社会特困群体看病难、看病贵问题，最近，省卫生厅确定在全省开展惠民医疗工作，逐步建立全省惠民医疗服务体系，建立特定救助人群医疗收费减免制度，为社会贫困群众提供公平可及的基本医疗卫生服务。惠民医疗服务对象，主要是城市居民最低生活保障对象中未参加城镇职工基本医疗保险人员、已参加城镇职工基本医疗保险但个人负担仍然较重的人员和其他特殊困难群众。其中，残疾军人、参合农民、老人和儿童优先作为特困服务对象。原则上，全部社区卫生服务机构首先作为惠民社区机构承担医疗救助任务；二级以上非营利综合医院作为社区卫生服务机构的上级转诊单位，均设立惠民门诊、惠民病房，其中惠民病床比例不得少于编制床位的10％。惠民医疗服务免收项目至少包括：惠民社区的门诊挂号费、普通门诊诊疗费、门诊出诊费；惠民门诊的专家挂号费、急诊挂号费、普通门诊诊疗费、急诊观察床位费；惠民病房的住院空调费、住院暖气费、血液常规检查费、尿液常规检查费、大便常规检查费。减免项目至少包括：心电图检查费、脑电图检查费、B超检查费等基本检查项目，减免比例不得低于10％，药品费用减免比例不得低于10％。     

关于扶贫医疗的思考

近年来,我国一些城市医院从服务社会,奉献社会,为政府排忧解难的思想出发,开展了多种形式的扶贫医疗。其主要做法是:开设扶贫门诊、病房;建立送温暖基金;对贫困病人不收挂号、护理等医疗技术服务费;不使用高价药和昂贵检查;减免部分检查费用;在不降低医疗护理水平的前提下,用最基础的诊疗方法使病人康复。实践表明,扶贫医疗有助于树立医院的良好形象,体现了党和政府对人民群众的关怀,有利于社会的稳定,受到了社会各界的好评。但笔者认为,扶贫医疗目前不宜提倡。     

对实施惠民医疗的思考

为构建和谐的医患关系，解决广大群众，特别是弱势群体的看病难、看病贵问题，济南市卫生局于2005年12月在全市卫生系统正式启动了“惠民医疗工程”。山东省卫生厅推广了济南市经验并要求，全省现有社区卫生服务机构均要开展惠民医疗服务，二级以上医院均要设立惠民门诊、惠民病房或病床，其中惠民病床数量一般不低于注册床位数的5％。     

Device-associated infection rates for non-intensive care unit patients.

BACKGROUND: Reference data from intensive care units (ICUs) are not applicable to non-ICU patients because of the differences in device use rates, length of stay, and severity of underlying diseases among the patient populations. In contrast to the huge amount of data available for ICU patients, appropriate surveillance data for non-ICU patients have been missing in Germany. OBJECTIVE: To establish a new module ("DEVICE-KISS") of the German Nosocomial Infection Surveillance System for generating stratified reference data for non-ICU wards. SETTING: Non-ICU patients from 42 German hospitals. METHODS: Monthly patient-days, device-days and nosocomial infections (NIs) (using Centers for Disease Control and Prevention definitions) were counted. Device use rates were calculated, and NI rates were stratified by different medical specialities. RESULTS: From July 2002 through June 2004, among the 77 wards, there were a total of 536,955 patient-days and 74,188 device-days (for CVC-associated primary bloodstream infections, there were 181,401 patient-days and 8,317 central vascular catheter [CVC]-days in 29 wards; for urinary catheter-associated urinary tract infections, there were 445,536 patient-days and 65,871 urinary catheter-days in 65 wards) and 483 NIs (36 bloodstream infections and 447 urinary tract infections). The mean device use rates were 4.6 device-days per 100 patient-days for CVCs (29 wards) and 14.8 device-days per 100 patient-days for urinary catheters (65 wards), respectively. Mean device-associated NI rates were 4.3 infections per 1,000 CVC-days for CVC-associated bloodstream infections and 6.8 infections per 1,000 urinary catheter-days for catheter-associated urinary tract infections. CONCLUSIONS: DEVICE-KISS allows non-ICUs to recognize an outlier position with regard to NIs by providing well-founded reference data for non-ICU patients.     

Impact of a latex policy on an acute NHS hospital: an audit

BACKGROUND: A latex policy was introduced in 1999 in a large, acute UK hospital. AIM: To audit the impact of the policy. METHOD: Semi-structured interview of the managers of 40 wards between April 2001 and July 2002. RESULTS: A policy was available on only 26 (65%) of the wards. Compliance with the policy was limited to 20 (50%) wards. CONCLUSIONS: Compliance with the policy was low in the hospital. Staff and patients are being unnecessarily exposed to the hazard of latex.     

Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households.

OBJECTIVE: To assess the prevalence and duration of methicillin-resistant Staphylococcus aureus (MRSA) carriage among hospital employees and transmission to their households. DESIGN: A point-prevalence survey of MRSA carriage (nasal swabbing) of staff and patients throughout the hospital; a prevalence survey of MRSA carriage in 2 medical wards, with carriers observed to estimate carriage duration; and evaluation of transmission to MRSA-positive workers' families. All MRSA isolates were analyzed by pulsed-field gel electrophoresis. During the study, no MRSA outbreak was detected among hospitalized patients. SETTING: A 600-bed, public tertiary-care teaching hospital near Paris. RESULTS: Sixty MRSA carriers were identified among 965 healthcare providers (prevalence, 6.2%; CI95, 4.7%-7.7%). Prevalence was higher in staff from clinical wards than from elsewhere (9.0% vs 2.1%; P < .0001). Identity of isolates from employees and patients varied from 25% in medical wards to 100% in the long-term-care facility. MRSA carriage was identified in 14 employees from 2 medical wards (prevalence, 19.4%; CI95, 10.3%-28.5%). Prevalence depended on the length of service in these wards. Transmission to households was investigated in 10 MRSA-positive workers' families and was found in 4. All isolates from each family were identical. CONCLUSIONS: Few data are available concerning the prevalence of MRSA carriers among hospital employees in the absence of an outbreak among patients. MRSA transmission between patients and employees likely depends on the frequency and duration of exposure to MRSA-positive patients and infection control measures employed. Frequent transmission of MRSA from colonized healthcare workers to their households was documented.     

Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards

The aim of this study was to compare the distribution of Candida species in patients hospitalized in an intensive care unit (ICU) and in conventional wards. A retrospective analysis was performed covering an 18-year period in a 700-bed teaching hospital. Various body sites were investigated in all patients admitted during the study and isolates were identified by microscopic and macroscopic morphology, and by commercially available kits. The susceptibility of strains to amphotericin B and flucytosine was assessed by the ATB-fungus system, itraconazole and fluconazole by Etest. No difference was observed between the distribution of Candida species in ICU and in conventional wards. Candida albicans represented about 70% of isolates and Candida glabrata was the second most common species involved in infection or colonization. The small number of C. glabrata resistant to fluconazole suggested this antifungal agent as suitable empirical treatment for non-immunocompromized patients in whom a fungal infection was suspected.     

军队干休所设立家庭病房的思考与建议

军队离休干部普遍进入＂两高期＂,在干休所设立家庭病房可以缓解体系医院床位紧张,可以提高离退休干部的生活质量和生命质量。本文就在干休所设立家庭病房存在的问题分析,对建设家庭病房进行思考和探讨,并提出对策与建议。     

应急情况下新型冠状病毒肺炎患者隔离与收治病房的改造

 

自2019年12月以来,新型冠状病毒肺炎疫情来势迅猛,部分地区医疗机构现有隔离留观病房和隔离病房数量远远满足不了患者应收尽收、应治尽治的要求。依照原有建筑布局,因地制宜将普通病区应急改造成隔离病房,是快速缓解供需矛盾的必然之举。该文就将普通病区应急改造成隔离病房时的选址、方案设计及需要注意的关键问题进行探讨,以便为类似的改造提供参考。

     

Medical problems of elderly patients admitted to a mental illness hospital--incidence, nature and importance for service provision.

The study deals with 147 elderly patients admitted to acute psychiatric beds in a Health District where access to medical rather than to psychiatric beds for elderly people was easier. Fifteen of these patients were transferred from medical wards and 53 had 56 problems which needed treatment from a physician. Collaboration between physicians and psychiatrists in the management of elderly psychiatric patients requires more extensive facilities than those available in joint assessment units.     

Spatial and temporal analysis of Clostridium difficile infection in patients at a pediatric hospital in California.

OBJECTIVE: To examine the usefulness of temporal and spatial analysis in identifying nosocomial transmission of Clostridium difficile among pediatric patients hospitalized on four wards at The Children's Hospital of Central California from September 8, 1998, to January 16, 1999. DESIGN: Stool specimens obtained from the clinical microbiology laboratory during the study period were tested by culture and latex agglutination for C. difficile. Polymerase chain reaction was used to identify toxin genes. Isolates obtained were mapped to a grid for each ward and were analyzed using the Knox test. Results were compared with DNA fingerprints generated by arbitrarily primed polymerase chain reaction. RESULTS: Total occupancy of these 4 wards was 438 during the study period. Stool specimens were available for 256 (58%) of these patients, yielding 67 C. difficile isolates and generating 2,211 case pairs for analysis by the Knox test. After stratification by toxin status, 5 clustered pairs of toxigenic isolates were identified on 1 of the wards by this method. Fingerprint analysis identified 4 clusters with indistinguishable banding patterns on 2 of the 4 wards. Two of the identified clusters were toxigenic and 2 were nontoxigenic. None of these clusters corresponded to clusters identified by the Knox test. CONCLUSIONS: The Knox test is an ineffective method for identifying cases resulting from nosocomial transmission of C. difficile in a pediatric setting due to the persistence of C. difficile spores and the unique environment of a pediatric hospital. Molecular analysis remains the most effective method.     

日间病房管理模式的新探索

日间病房是世界医学发展的新趋势和新的诊疗模式,将一些需要短期住院手术、观察、治疗的收治对象列入其中,这是探索和解决病人介于门诊与住院之间诊疗问题的有效尝试,本文对日间病房管理模式进行了新的探讨。     

Inequalities in health in the city of Bristol: a preliminary review of statistical evidence

This article compares statistical indicators of health with those of material and social deprivation for 28 wards of the city of Bristol, England. Four general indicators of health were examined-a combined rate per 1,000 live births of stillbirths and infant deaths; deaths of persons aged 15 to 64 per 1,000 of that age; deaths of persons aged 65 and over per 10,000 of that age, and numbers of babies born after 40 weeks gestation weighing less than 2,800 (and 2,500) grams per 1,000 births having that period of gestation. Measures of average and cumulative rank were used to augment tests of the significance of correlations between different indicators. The degree of rank consistency was high, and several wards at the top and the bottom of the rankings were clearly distinct on all indicators. Five indicators of deprivation were also examined-the percentages of: 1) households with fewer rooms than persons; 2) households lacking a car; 3) economically active persons seeking work; 4) children aged 5 to 15 who receive school meals free; and 5) households experiencing disconnection of electricity in the previous 12 months. Again the consistency of ranking according to the five indicators was high, with marked differences on all five indicators between the highest and lowest ranking wards. Between 1971 and 1981 some forms of deprivation increased in nearly all wards. According to some criteria, deprivation increased more in wards already most deprived in 1971 than in those least deprived. Finally, a strong association between the two sets of indicators was found. On the data available to health and planning authorities poor health is significantly correlated with deprivation. There are therefore implications for new forms of joint policy-making on the part of different departments of local and central government.