医院门诊患者向社区卫生服务机构分流的经济效益

通过对不同医疗机构的医生和病人的调查,了解目前病人的分布、就诊次均费用和可分流情况,测算出实现病人合理分流后病人的分布及可节省的医疗费用。结果表明:病人的最佳流向有19.50%、23.28%和57.22%的病人分别在三级医院、二级医院和社区卫生服务机构就诊,如果能使目前病人的就诊分布实现合理分流,可分别节省100.70亿元、505.53亿元的间接医疗费用和直接医疗费用,占2004年个人卫生支出的14.89%。病人的合理分流不仅能解决部分看病贵问题,而且能缓解看病难的问题,提高资源的利用效率,实现社区卫生服务机构和医院之间合理分工、密切协作的互动关系。     

综合医院远程医疗服务对促进社区医疗服务改革的实践与思考

分享综合医院开展远程医疗服务的实践经验,阐述综合医院面向社区卫生医疗服务机构开展远程医疗的意义及存在的问题,以提升社区卫生医疗服务机构的医疗服务质量。     

加强社区卫生服务 改善孕产妇保健管理模式

抓好孕产妇保健管理工作对促进经济发展,提高人民群众的健康水平至关重要。目前北京市孕产妇保健管理涉及不同的医疗机构(或非医疗机构)或同一医疗机构的不同部门,这种管理模式存在的弊端主要有:孕前保健不到位;孕产妇保健信息不准确;不利于基层妇产科门诊的发展,影响基层开展孕产妇保健的积极性;背离了医疗机构倡导的“以人为本”的宗旨;对产科医院也有不利影响。因此必须借助社区卫生服务的不断完善,建立“以社区卫生服务机构为依托,以综合医院、专科医院妇产科为后盾,将孕产妇保健和信息搜集溶为一体,将社区卫生服务组织和综合医院、专科医院妇产科溶为一体”的孕产妇管理模式。要实现城市孕产妇管理新模式,还必须做如下工作:争取政府部门的支持;制定政策引导孕妇合理分流;加强社区卫生服务机构与综合医院、专科医院妇产科联系;对开展孕产妇保健工作的社区卫生服务机构和医务人员实行准入管理。     

卫生资源配置转向社区卫生服务的预测模型

根据目前我国各地社区卫生服务发展状况,以及对我国未来经济和人口发展趋势的预测,建立一个按照目前各地经济水平对社区卫生服务投入的预测模型。结果显示,如果各地根据这个预测模型计算的比例对社区卫生服务进行补助,能够合理分流14.00%病人到社区卫生服务机构,节约医疗费用700余亿元。     

城市医疗服务中双向转诊影响因素的探讨

双向转诊是社区卫生服务机构与城市综合医院双方面的互动，但目前却以社区卫生机构自发、无序地向综合医院单向转诊为主，并未实现真正意义上的双向转诊。究其原因，影响双向转诊制度运作的因素很多。我们以利益相关者为分析框架，从国家和卫生行政部门、城市综合医院、社区卫生服务机构及患者等4个层面，就其影响因素进行探讨。     

双向转诊制度的SWOT分析

<正>双向转诊制度是社区卫生服务机构与区域大中型综合医院、专科医院签订协议,让一般常见病、多发病在社区卫生服务机构治疗,大病则转向二级以上的大医院,而在大医院确诊后的慢性病治疗和手术后的康复则可转至社区卫生服务机构,从而实现"小病在社区,大病进医院,康复回社区"。双向转诊制度是解决居民"看病贵"、"看病难"的重要途径,是发展和完善社区卫生服务的重要环节之一。     

区域卫生信息平台在社区卫生中的应用

本文通过联合技术验证项目中对社区卫生服务信息管理系统和社区接入端系统的改造,探索通过社区卫生服务机构及其信息系统与区域医疗卫生信息平台之间的标准化、规范化的对接模式及其技术实现方式。研究内容可为进一步开发完善社区卫生服务机构基于健康档案的信息化应用,特别是对社区与综合医院进行双向转诊业务的信息系统设计开发提供规范性、可操作性的实现方法。     

城市二级医疗机构间患者流管理的仿真建模研究

随着我国城市社区卫生服务网络的建设已初具规模,如何促使患者更多地选择社区卫生服务机构就诊成为至关重要的问题.通过仿真软件Arena建立城市二级医疗机构间患者就诊的流动模型,结合北京市海淀区综合医院和社区卫生服务机构的就诊数据,分析在给予社区转诊到综合医院病人就诊优先权的情况下,患者就医的等待时间、城市二级医疗机构间各类医疗机构利用率的变化.同时,以最大化治疗病人数为目标,结合考虑各类医疗机构利用率平衡的情况下,计算出社区卫生服务机构分流患者的最优比例,以期为政府进行患者流控制与管理提供参考.仿真结果从患者角度证明了转诊优先的激励政策能缩短其就诊的等待时间,从系统的角度验证了社区首诊制能给城市医疗系统带来的效率提升.     

综合医院举办社区卫生服务机构的SWOT分析

目的：运用战略管理学领域的SWOT分析方法,了解北京大学第三医院第二门诊部医务人员、医院管理决策层人员及周边社区居民对大型综合医院举办社区卫生服务机构的看法,了解第二门诊部的相关情况及有关的政策法规和其它外部环境。提出大型综合医院举办社区卫生服务机构的可行性与发展策略。 方法：文献研究、小组座谈和个人深入访谈等定性资料收集方法。 结果：通过对内部资源和外部环境的SWOT分析,确定了自身的优势与不足以及发展中面临的机会与威胁。结论：大型综合医院举办社区卫生服务机构是提高社区卫生服务水平、满足社区居民卫生服务需求的有效途径之一,政府应在其公共卫生服务和人事制度方面予以支持。     

三级教学医院办社区卫生服务的思考

三级教学医院多数为医疗教学科研为一体的特大型综合医院，关于三级教学医院为什么要办社区卫生服务?怎样办社区卫生服务?对三级教学医院兴办的社区卫生服务如何定位?与基层办的社区卫生服务机构的关系……等问题，笔者认为，这其中有政策的理解和认识问题，也有实践中的运作问题。为此，提出以下几点讨论意见。     

A framework of children's hand skills for assessment and intervention

Background Hand skill development or mastery has a huge influence on children's early development and participation in everyday activities. Assessment of difficulties with children's hand skills typically involves a systematic process considering all potential factors that may impact on hand skills. This helps identify key hand skill difficulties and select specific interventions that are relevant to the individual child. This paper describes the development of the Children's Hand Skills Framework (CHSF) that can be used as a conceptual guide to analyse and describe children's hand skills in the assessment and intervention process. Methods A comprehensive literature review of the existing hand skill models and instruments was conducted to develop the CHSF content, and experts' reviews via an evaluation feedback questionnaire were used as a means to validate the CHSF. Results The literature review revealed that the functional repertoire of children's hand skills can be divided into six distinct categories. Manual gesture and body contact hand skills are two categories, in which the hands do not make contact with any object. Arm–hand use, adaptive skilled hand use and bimanual use are object‐related hand skill categories where the hands do contact objects. The final category is related to the general quality of children's hand skills. Each of the six hand skill categories can be further broken down into three to seven subcategories. The feedback from the experts further demonstrated high levels of agreement for the inclusion of the CHSF subcategories. Conclusions The CHSF offers a helpful guide to comprehensively describe the complexity of children's hand skills in the assessment process and has the potential to enhance and promote communication about functional use of children's hand skills among professionals. The CHSF is also conceptually compatible with the International Classification of Functioning, Disability, and Health, providing a holistic consideration of both children's hand skills and relevant International Classification of Functioning, Disability, and Health factors for further assessment and intervention planning.     

不同医疗保障制度下政府对医院补偿的比较研究

目的：研究不同医疗保障制度下政府对医院的补偿情况,对我国进行医院补偿机制的改革提供参考。方法：文献回顾法。结果：发现国家卫生服务保障模式对医院投入最大,社会医疗保险模式投入最少,市场医疗保障模式和储蓄医疗保障模式投入居中。结论：改变医院趋利行为的关键在于政府在医院补偿系统中的地位,我国不论采取何种医疗保障制度都必须提高政府对医院的投入。     

论军队医院军事效益对社会和经济效益的作用

本文分析论述了当前军队医院必须面对的军事效益、社会效益和经济效益之间的关系,提出军队医院在搞好卫勤保障的同时,要积极参与建设和谐社会,服务社会大众。通过实现军事效益,带动社会效益、经济效益的提升,完成好我军卫勤新时期新阶段的使命任务。     

HIV-screening among pregnant women in the region of Amsterdam in 2002

In 2001, the Municipal Health Service started offering HIV tests to all pregnant women in and around Amsterdam. All midwives and all hospitals but one participated in this HIV screening. In 2002, of the 10,752 pregnant women offered HIV testing 13.6% refused. HIV antibodies were detected in 24 women (0.26%). The HIV prevalence was doubled compared to the prevalence in 1990-1991, but the number of newly HIV-infected pregnant women remained stable (0.1%). The high number of refusals, as a result of which many HIV-infected women might be missed, is alarming. For this reason, in January 2003, the Municipal Health Service started HIV testing by the opting-out approach. Under the opting-out approach, women are notified that an HIV test will be included in the standard test battery, together with tests for hepatitis B and syphilis, unless she explicitly refuses. It is expected that the opting-out approach for HIV screening of pregnant women will be implemented nationwide in 2003.     

Family planning in the reorganized N.H.S. (b) Future of the clinic service

The National Health Service (N.H.S.) of the United Kingdom will be resturctured in April 1974 and that will be the start of a new era, the author asserts. Family planning services are ready for an integration and that is what the reorganization will aim for. Access to family planning services at present is achieved through the general practitioner, free access clinics and hospitals, and there is no coordination of these 3 contraceptive services. The family planning Association (FPA) has been responsible for the establishment of clinic services and for the rise in contraceptive services. The reorganization of N.H.S. will also aim for decentralization so that the main reponsibility for the integration of family planning services will be done at the district level. A Co-ordinator of Family Planning Services should be appointed for each district. In the integrated Health Service, each clinic is to have a local backup of health visitor and social workers, and consultant obstetricians and gynecologists.     

Using operational information and information systems to improve in-patient flow in hospitals

PURPOSE: To consider how information and information systems can be used to support improving patient flow in acute hospitals (a key target for the National Health Service in England), and the potential role of the National Programme for Information Technology currently being developed. DESIGN/METHODOLOGY/APPROACH: The literature plus past and present research, teaching and consulting experience with all levels of the National Health Service is drawn on to consider information provision and requirements. FINDINGS: The National Programme for Information Technology specifies many features designed to support improving patient flows, though timescales for implementation are longer than those for the pledged flow improvements, and operational use of this type of information system has been problematic in the National Health Service. RESEARCH LIMITATIONS/IMPLICATIONS: The work is limited to the National Health Service and information systems in use and planned for it. The National Health Service access targets, flow improvement initiatives and the National Programme for Information Technology apply primarily to England. PRACTICAL IMPLICATIONS: Some bed/flow management information systems currently in use incorporate tools and capabilities in advance of what is outlined in the National Programme for Information Technology, and some rare cases of culture changes in information system use have been achieved. One should learn from these to inform development and implementation of National Programme systems. These existing information systems and approaches may also be useful to hospitals considering systems prior to implementation of the National Programme for Information Technology. ORIGINALITY/VALUE: There has been very little consideration of the use of operational information and information systems for bed/flow management in the literature. Development and implementation of National Programme for Information Technology systems should build from an understanding of the practice and context of bed/flow management.     

某军医大学卫生事业管理专业本科毕业生岗位任职胜任度调查

目的了解卫生事业管理专业本科毕业生岗位任职胜任度,为更新完善人才培养方案提供意见参考。方法利用自制问卷,采取配额抽样的方式,对某军医大学1993—2008级卫生事业管理专业共9届本科毕业学员进行问卷调查。结果①院校或研究所、医院或疗养院更倾向于认为所在单位需要卫生事业管理专业人才;②不同学年制调查对象对本科教育胜任度的评价结果存在统计学差异;③基层部队调查对象中认为本科教育对岗位任职帮助很少的比例较高。结论卫生事业管理专业对任职岗位的针对性培养有待进一步增强。该专业人才培养方案中教学知识体系、教学内容上可向院校或研究所、医院或疗养院倾斜,多开设相关的课程。     

社区居民就医意向与卫生服务利用研究

目的：了解广州市海珠区社区居民就医意向与卫生服务利用状况。结果：患病后未就医的占36．73％；选择到诊所的占6．86％；选择到社区卫生服务机构的占5．38％；选择到街道、区级医院就医的占16.88％；选择到市、省、部级医院就医的占34．14％不同年龄、婚姻状况、文化程度、职业、医疗费用支付方式的居民在就医意向上存在差别。居民不满意社区卫生服务的主要原因是服务项目少、费用高及技术欠佳结论：只有完善医疗收费价格体系和社区卫生服务职能，才能更好地引导居民建立合理的就医行为，使社区卫生服务真正被社区居民所接受。     

Rethinking patient satisfaction: patient experiences of an open access flexible sigmoidoscopy service

The high morbidity and mortality rates for colo-rectal cancer in Teesside, UK, have led to the initiation of an open access service in two local National Health Service Trust hospitals. This paper reports the results of a pilot patient satisfaction study of the service using a combination of participant-observation, in-depth interviews and questionnaire methods. Although offering a standardised service, ethnographic study revealed interesting differences in practice and follow-up procedures between the two hospitals. Patients, both verbally and on paper, expressed high levels of satisfaction with the services offered at both hospitals, yet in-depth, qualitative research revealed a more complex picture. The evidence from this research will be used to argue that standard consumer satisfaction questionnaires of health provision are inadequate indicators of patients' experience of health care delivery.     

A bed too far. The implementation of freedom of choice policy in the NHS

Freedom of hospital choice has become a popular policy among the European public health services to ensure better patient rights, reduce waiting times and improve efficiency and quality in public hospitals. The English National Health Service has recently adopted this policy. This organisation needs to introduce important reforms in order to implement this policy, in particular in the information that it provides to patients. This paper presents the Andalusian Health Service (SAS) initiative in the disclosure of information, based on patient surveys, so it can be understood by patients. Andalusia implemented a freedom of choice policy 10 years ago. This paper also studies how SAS hospitals are scored by patients and how the quality of hospitals may affect their choice. Regression analyses indicate that two hospital dimensions, a 'human dimension' and a 'facilities dimension', significantly explain how patients assess the quality of the Andalusian hospitals. Nonetheless, these two dimensions do not explain the reputation of the hospitals, a main aspect when choosing a hospital, to the same extent. The lessons provided by looking at the SAS experience may give an insightful knowledge on whether patients in England will finally opt for the best hospitals.