Role of the medical institution in comprehensive medical care

The diagnosis procedure combination (DPC) of Japan started in April 2003. It is a unique "per day" payment system that evolved from diagnosis-related group and prospective payment system, which was a "per case" system. After a trial of two years, various undesirable problems of DPC have been revealed. A review of those problems in major diagnostic classifications (16) is in progress. The main problems are: 1) the medical institution-specific coefficient; 2) up-coding; and 3) consideration for expensive medical equipment such as during cardiac catheterization. The inclusive payment system is described and the problems of DPC are discussed.     

First-line medical care for the injured

The development of a joint hospital and general practitioner organization in East Cumberland to provide medical aid for the seriously injured before they reach hospital is described. The advantages of such a joint organization are presented.     

Emerging trends in the outsourcing of medical and surgical care

As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.     

三医联动下PICC维护网的构建与实践

目的在三医联动、分级诊疗背景下,探讨区医疗中心对基层医院PICC护理管理的影响。方法将PICC维护网建立前后各70例PICC置管化疗患者分别作为对照组和研究组。对照组按各医院常规护理;研究组由区中心医院作为区医疗中心,组建PICC管理团队,负责周边社区卫生服务中心的PICC的护理管理、人员培训和质量监控,行规范的PICC维护。结果研究组PICC相关并发症相对少于对照组,但差异无统计学意义(均P 0. 05),护理满意率显著优于对照组(P 0. 01),护士满意率优于PICC维护网建立前。结论在三医联动改革下,区中心医院在全区范围内建立PICC维护网,对基层医院开展业务帮扶,提升其服务能力,为社区肿瘤患者提供更方便、安全、优质的PICC维护服务,有利于促进三医联动的进一步深化。     

Early medical care and mortality in polytrauma

This study attempts to objectively estimate the efficiency of early medical care. It is based on the comparison of two series of multiple injured patients. Ten years separated the two groups and during this period, an Emergency Medical Aid Service (SAMU 94) was created. The positive effect of early medical care was established through the variations of injury severity indices currently used in polytrauma: after the institution of Mobile Intensive Care Medical Units on the site of accidents cardiac arrests were ten times less numerous although lesions were more serious in the second series. Without taking into account the mortality rate of lower-limb trauma, where crush syndromes were very numerous, mortality rate decreased as far as spinal, chest, abdominal, and pelvic traumas were concerned. An estimation of the cost of such a system raised the problem of maximizing the efficiency of improved early medical care.