医疗改革需重视五个转变

医疗问题作为人民群众最关心、最直接、最现实的利益问题,受到了党和国家的高度重视和关怀.不久前,中共中央作出的关于构建社会主义和谐社会若干重大问题的决定中,对加强医疗卫生服务,提高人民健康水平进行了专门论述,为医疗改革指明了前进方向,对医疗改革提出了具体要求.     

The quality of the quality indicator of pain derived from the minimum data set

OBJECTIVE: To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs). DATA SOURCE: Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000-2002. STUDY DESIGN: Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH-rated "severe pain." PRINCIPAL FINDINGS: Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility-level variation in the probability of FP and FN errors in facility-rated "severe pain." Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use. CONCLUSIONS: The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.     

Health-related quality of life measure based on the minimum data set

OBJECTIVES: To introduce a health-related quality of life measure for home care and institutional long-term care settings based on the Minimum Data Set (MDS) and the Health Utilities Index Mark 2 (HUI2). METHODS: Health attributes of Health Related Quality of Life (HRQOL) were identified, and suitable constructs were determined. Items from the MDS were mapped to the HUI2. Scores for the Minimum Data Set Health Status Index (MDS-HSI) were calculated using the HUI2 scoring function. Measurement properties are examined and reported. HRQOL scores were compared across study populations and to an external reference population. Random samples were drawn from long-term care clients in private households (n = 377), supportive housing apartments (n = 80), two residential care facilities (n = 166), and a chronic care hospital (n = 274) in Ontario, Canada. All sampled residents were assessed for health-related items using the MDS. RESULTS: The MDS-HSI results provide preliminary evidence of good validity. Institutional populations had lower overall HRQOL scores than community populations. Comparisons to existing Canadian national data support construct validity. CONCLUSIONS: The MDS-HSI provides a summary outcome measure and an indicator of health status in the six supporting attributes. Longitudinal research is required to assess the sensitivity of the measure to changes overtime. Further research is also required to establish the consistency between the preference weights used in this application of the HUI2 and those that would be derived from a frail elderly population.     

Ethical downsizing. Managers must focus on justice and human dignity

It is vital that leaders and managers focus on justice and human dignity in the workplace when faced with the possible need to downsize. First, administrators should clearly identify the goals of work force reduction, evaluate their importance, and consider whether they could be achieved through other means. Once they have made the decision to downsize, top managers must clearly communicate the reasons and the goals to those responsible for identifying the employees affected. Employees selected for layoff should be identified on the basis of the articulated goals for work force reduction, whenever possible. When this is not clear, the tough decisions can be based on a variety of factors: "across-the-board" reductions; employee abilities, qualifications, and performance; diversity goals; seniority; or multiple criteria. It is also important to respect human dignity in the layoff process. Affected employees should be informed in advance and given an honest explanation for the layoff. Ordinarily, they should be encouraged to work until the effective date. All employees need a clear and honest explanation of the reasons for and the expected effects of the layoff. There should be a stress on the free flow of information, without an effort to control it. How downsizing is handled says a lot about the nature of an organization and its leadership. Ethical downsizing is, first of all, a refusal to deny the complexity of the issues and evidence of the organization's commitment to justice and human dignity.     

The Seattle Alzheimer's disease data set

Forty families submitted to Genetic Analysis Workshop 8 are described. These are the families in the Seattle data set which have been typed for at least one genetic marker from the centromeric region of chromosome 21 or the q arm of chromosome 19. Thirteen of these families have average ages of onset below age 61 and are therefore considered to be early onset families. Seven of the families are of Volga German descent. Thirty-four of the families have autopsy documented Alzheimer's disease, including all 13 of the early onset pedigrees. The data set includes both the clinical and pedigree information available on the portions of the pedigrees used in the linkage analyses, genotype data on three loci on chromosome 19 and four loci on chromosome 21, and more extended family data on individuals who have not been included in the linkage analyses. © 1993 Wiley-Liss, Inc.     

重症监护的基本数据集探讨

本文分析了目前医院信息化建设的现状,重点分析了重症监护室基本数据的提取方法,并提出了重症监护的基本数据集。     

基于平行分析法的医疗工作质量小样本数据分析研究

目的 探讨分析四川省各地市州的医疗工作质量,分析总结各地市州医疗工作质量发展状况,制定相应政策提供科学依据,促进各地市州医疗工作质量的可持续发展.方法 通过文献分析法从工作强度指标、工作效率指标、医疗费用指标3个维度构成的评价指标体系,采用基于自助法(Bootstrap)抽样的平行分析法进行评价.结果 构造主成分综合评...     

The Kaiser-Permanente women twins study data set

The Kaiser-Permanente Women Twins Study began with the establishment of a large registry of twins at Kaiser-Permanente, a managed health care program in Oakland, California. In 1978–79, 434 pairs of women twins, 255 monozygotic and 179 dizygotic, with average age 41 years, were recruited from this registry for a study of coronary heart disease risk factors. Previous analyses of these data have shown moderate heritability for blood pressure and high heritability for lipids, even after adjustment for differential environmental covariance between twin types. For GAW8, the data provided included age, race, weight, height, blood pressure, lipids, smoking, alcohol consumption, exercise, degree of contact between co-twins, menstrual status, and medication for hypertension. Exam 2 of this cohort was completed in 1989–90 and has recently reported nearly complete heritability for lipoprotein(a). © 1993 Wiley-Liss, Inc.