基于电子病历的医院信息平台设计及构建

目的:构建以电子病历为基础的医院信息平台,提高医疗服务质量和效率.方法:分析医院现有信息管理系统,结合卫生信息化建设需求,分数据源层、通信交换层、数据整合层、应用服务层4个层次来实现医院信息平台的建设.结果:该医院信息平台可满足三级综合医院对病历书写、质控的需要;可满足卫生部对三级医院电子病历复审方面的需要;可满足相关规范对于互联互通的需要.结论:该平台将提升医院医疗决策、管理和诊疗水平.     

电子病历——医院信息化建设的核心

随着医学诊断技术的飞速发展和电子信息技术在医疗领域的广泛应用,医院信息系统已从最早的以收费管理为中心的管理信息系统,到以病人医疗为中心的业务支持系统,即用电子设备书写、保存、管理、传输、重现的数字化的病人诊疗记录.谨就电子病历的概念、发展现状、电子病历应涵盖的内容、电子病历结构、存在问题及电子病历相关法律技术等问题,简述如下.     

A profile of Department of Veterans Affairs hospital based home care programs

This paper describes the Department of Veterans Affairs (VA) home care program and compares it to community-based programs. Structure and process data were collected on hospital based home care programs in VA facilities nationwide (n=75). Supplemental data were obtained on staffing and patient attributes. Although the VA provides program guidelines, some variability was noted. The characteristics of VA programs and patients were then compared to National Center for Health Statistics survey data. This comparison revealed that VA programs provide a more comprehensive array of services to patients including physician home visits than most community-based programs.     

A profile of hospital acquisitions

The number of hospitals acquired by hospital systems has declined from 99 facilities in 1996 to less than 63 facilities between 1999 and 2000. We evaluated the market, operating and organizational factors, and their relationship to these hospital acquisitions that occurred during this period of decline. We found that acquired hospitals, on average, operated at a loss, incurred higher debt levels, and were more likely to be located in markets with a large number of health maintenance organizations. Older, for-profit hospitals with fewer occupied beds were also likely targets for hospital acquisitions.     

电子病历促进医院信息化建设

本文介绍电子病历的应用现状，分析电子病历需要解决的问题和当前主要的研究发展方向，并归纳出电子病历系统的体系结构，说明实施电子病历对医院信息化建设与发展的至关重要性。     

Risk adjusting cesarean delivery rates: a comparison of hospital profiles based on medical record and birth certificate data

OBJECTIVES: Compare the discrimination of risk-adjustment models for primary cesarean delivery derived from medical record data and birth certificate data and determine if the two types of models yield similar hospital profiles of risk-adjusted cesarean delivery rates. DATA SOURCES/STUDY SETTING: The study involved 29,234 women without prior cesarean delivery admitted for labor and delivery in 1993-95 to 20 hospitals in northeast Ohio for whom data abstracted from patient medical records and data from birth certificates could be linked. STUDY DESIGN: Three pairs of multivariate models of the risk of cesarean delivery were developed using (1) the full complement of variables in medical records or birth certificates; (2) variables that were common to the two sources; and (3) variables for which agreement between the two data sources was high. Using each of the six models, predicted rates of cesarean delivery were determined for each hospital. Hospitals were classified as outliers if observed and predicted rates of cesarean delivery differed (p < .05). PRINCIPAL FINDINGS: Discrimination of the full medical record and birth certificate models was higher (p < .001) than the discrimination of the more limited common and reliable variable models. Based on the full medical record model, six hospitals were classified as statistical (p < .01) outliers (three high and three low). In contrast, the full birth certificate model identified five low and four high outliers, and classifications differed for seven of the 20 hospitals. Even so, the correlation between adjusted hospital rates was substantial (r = .71). Interestingly, correlations between the full medical record model and the more limited common (r = .84) and reliable (r = .88) variable birth certificate models were higher, and differences in classification of hospital outlier status were fewer. CONCLUSION: Birth certificates can be used to develop cesarean delivery risk-adjustment models that have excellent discrimination. However, using the full complement of birth certificate variables may lead to biased hospital comparisons. In contrast, limiting models to data elements with known reliability may yield rankings that are more similar to rankings based on medical record data.     

医院门急诊手写电子病历的应用

手写电子病历可将患者病历原样完整保留在医院数据库中,可作为患者就诊过程中院方医疗行为的记录,也是医疗质量好坏的评价、医疗纠纷举证及医师诊疗过程监督的凭证。通过后台操作,可进行病历质量考核,工作质量管理,医疗数质量分析,系统解决了门急诊病历及时采集、保留、管理以及统计分析等问题。     

Exercise and eating disorders: a 3-year inpatient hospital record analysis

The purpose of this study was to describe the exercise behavior across the DSM-IV eating disorder diagnosis (anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS)) and determine if differences exist among exercise category (high level and low level), type of exercise (aerobic, strength, and total), Eating Attitudes Test (EAT), Eating Disorders Inventory (EDI-2), and the length of inpatient hospitalization. This study was a retrospective analysis of 199 inpatient hospital records of female patients (age M=20.6, S.D.=7.03) in the following diagnostic categories: AN (n=115, 58%), BN (n=38, 19%), and EDNOS (n=46, 23%). Patients were also grouped by a median split into low- and high-level exercise categories based on their total amount of weekly exercise. No significant relationship was found between diagnosis and exercise category (high and low) or diagnosis and exercise type (total, aerobic, and strength exercise). This is valuable because exercise specialist may be a worthwhile addition to treatment teams working with all eating disorder diagnostic groups. The high-level exercisers showed significantly greater scores on the EAT [F(2,1,110)=5.117, P<.05] and weight preoccupation [F(1,1010)=4.861, P<.05] than the low-level exercise groups. There were significant relationships between total exercise and EAT (r=.354, P<.01), drive for thinness (r=.262, P<.01), and body dissatisfaction (r=.312, P<.001). Total aerobic exercise was significantly related to EAT (r=.352, P<.001), drive for thinness (r=.272, P<.01), and body dissatisfaction (r=.268, P<.01). Finally, total strength exercise was related to body dissatisfaction (r=.249, P<.05). A significant difference was found among exercise group and length of hospitalization [F(1,155)=14.384, P<.000]. The high-level exercisers were in treatment for 3 weeks longer than their low-level exercisers. A forced stepwise multiple linear regression was calculated to predict the length of hospitalization. At Step 1, diagnosis and Body Mass Index (BMI) on admission explained 27% of the variance in length of inpatient hospitalization [F(4,154)=18.08, P<.004, r(2)=.273]. When two exercise variables were included, aerobic activity explained an additional 5% of variance, whereas strength activity explained an additional 0.3% of the variance. Three-fourths of the predictors explained significant components of the total 32% variance. The present study demonstrates that patients with greater total exercise and a greater total aerobic exercise show a significantly greater drive for thinness and require a longer length of hospitalization. This association was not present with total strength exercise levels. Effective clinical methods to modify total aerobic exercise levels need to be determined with inpatient populations.     

Inpatient hospital use in the first year after release from prison: a Western Australian population-based record linkage study

Objective: To describe three aspects of inpatient use for ex‐prisoners within the first 12 months of release from prison: the proportion of released prisoners who were hospitalised; the amount of resources used (bed days, separations and cost); and the most common reasons for hospitalisation. Methods: Secondary analysis of whole‐population linked prison and inpatient data from the Western Australian Data Linkage System. The main outcome measure was first inpatient admission within 12 months of release from prison between 2000 and 2002 and related resource use. Results: One in five adults released from Western Australian prisons between 2000 and 2002 were hospitalised in the 12 months that followed, which translated into 12,074 inpatient bed days, 3,426 separations and costs of $10.4 million. Aboriginals, females and those released to freedom were most at risk of hospitalisation. Mental health disorders such as schizophrenia and depression, and injuries involving the head or face and/or fractures, accounted for 58.9% of all bed days. Ex‐prisoners were 1.7 times more likely to be hospitalised during a year than Western Australia's general adult population of roughly the same age. Conclusions: Using whole‐population administrative linked health and justice data, our findings show that prisoners are vulnerable to hospitalisation in the 12‐month period following their release from prison, particularly Aboriginals, females and those with known mental health problems. Implications: Further research is needed to assess whether contemporary services to support community re‐entry following incarceration have led to a measurable reduction in hospital contacts, especially for the subgroups identified in this study.     

Relationship between travel time to the nearest hospital and survival from ruptured abdominal aortic aneurysms: record linkage study

BACKGROUND: There is currently a trend in Britain to concentrate specialist services in a smaller number of hospitals in order to improve outcomes. However, for rapidly life-threatening conditions such as ruptured abdominal aortic aneurysms (RAAAs), the resulting increased travel time to hospital might adversely affect survival. This study aimed to evaluate the relationship between travel time to the nearest hospital and survival from RAAAs in West Sussex. METHODS: Information was collected regarding outcome, postcode, age, sex and diagnoses for all West Sussex residents who had a RAAA between January 1996 and September 1999, including admissions and deaths, wherever they occurred. Deprivation scores were calculated based on postcode. Potential travel time to the nearest hospital was calculated using "Microsoft AutoRoute Express" and its effect on outcome was analysed using multiple logistic regression. RESULTS: After adjusting for age, sex, Townsend deprivation score and nearest hospital, the odds ratio for survival associated with a 10 min increase in potential travel time to the nearest hospital was 0.97 (0.88 unadjusted) (95 percent confidence interval for adjusted odds ratio: 0.70 to 1.34; p = 0.86). CONCLUSION: Several previous studies suggested better survival with longer distances travelled. They are likely to be biased by omission of community deaths. This methodologically better study found no such relationship between RAAA survival and travelling time to hospital in West Sussex, although confidence intervals were wide. This is particularly pertinent while there is a push to centralize vascular and other services in the United Kingdom.     

Occupational risk factors of lung cancer: a hospital based case-control study

OBJECTIVES: To investigate the relation between lung cancer and exposure to occupational carcinogens in a highly industrialised region in western Europe. METHODS: In a case-control study 478 cases and 536 controls, recruited from 10 hospitals in the Antwerp region, were interviewed. Cases were male patients with histologically confirmed lung cancer; controls were male patients without cancer or primary lung diseases. Data were collected by questionnaires to obtain information on occupations, exposures, and smoking history. Job titles were coded with the Office of Populations, Censuses and Surveys industrial classification. Exposure was assessed by self report and by job-task exposure matrix. Exposure odds ratios were calculated with logistic regression analysis adjusted for age, smoking history, and marital and socio-economic status. RESULTS: A job history in the categories manufacturing of transport equipment other than automobiles (for example, shipyard workers), transport support services (for example, dockers), and manufacturing of metal goods (for example, welders) was significantly associated with lung cancer (odds ratios (ORs) 2.3, 1.6, and 1.6 respectively). These associations were independent of smoking, education, civil, and economic status. Self reported exposure to potential carcinogens did not show significant associations with lung cancer, probably due to nondifferential misclassification. When assessed by job-task exposure matrix, exposure to molybdenum, mineral oils, and chromium were significantly associated with lung cancer. A strong association existed between smoking and lung cancer: OR of ex- smokers 4.2, OR of current smokers 14.5 v non-smokers. However, smoking did not confound the relation between occupational exposure and lung cancer. CONCLUSIONS: The study has shown a significant excess risk of lung cancer among workers in manufacturing of metal goods, manufacturing of transport equipment (other than automobiles), and transport support services. Assessment of exposure to specific carcinogens resulted in significant associations of chromium, mineral oils, and molybdenum with lung cancer. This study is, to our knowledge, the first study reporting a significant association between occupational exposure to molybdenum and lung cancer.       

Determinants of maternal mortality: a hospital based study from south India

During 1981-1986, 86 maternal deaths transpired at the obstetrics department of the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India. The maternal mortality rate stood at 5.8/1000 births. 31.4% were primigravidae. The percentage of maternal deaths characterized as gravidae 2-4, 5, and multigravidae was 42.9%, 9.3%, and 16.4%, respectively. The leading causes of death were sepsis (41.9%), especially septic abortion (30.2%); eclampsia-severe preeclampsia (10.5%); ruptured uterus (9.3%); and hemorrhage and prolonged labor (8.1% each). Direct obstetric causes of death accounted for 81.4% of all maternal deaths. Indirect obstetric causes of death were hepatitis (5.8%), heart disease (4.7%), and severe anemia (2.3%). Most of the women who died were illiterate (97.6%), poor (98.8%), and had received no prenatal care (94.2%). 47.7% traveled more than 60 km to the hospital. Quacks or untrained traditional birth attendants had excessively interfered with about 33% before they reached the hospital, especially the septic induced abortion, obstructed labor, and ruptured uterus cases. Among the 48 women who delivered before dying, there were 24 live births (5 of whom died during the early neonatal period) and 24 still births. These findings indicate a need for a cooperative effort to improve and expand maternal and child health care in the community.     

Poliomyelitis, measles and neonatal tetanus: a hospital based epidemiological study

Vaccine-preventable diseases constitute a major health problem contributing to the morbidity and mortality in many developing countries including Egypt. WHO adopted resolutions to eradicate poliomyelitis by the year 2000, eliminate neonatal tetanus by the year 1995, and reduce measles mortality by 95% and morbidity by 90%, compared to the pre-immunization levels by 1995. Evaluation of preventive programs for these diseases necessitates availability of up to date information on their occurrence. The present study was undertaken to determine the current epidemiological features of poliomyelitis, neonatal tetanus and measles, to identify the trends of these diseases as well as to determine their outcomes and hospital loads. Data about the admitted cases of poliomyelitis, neonatal tetanus and measles were collected from the hospital register of Alexandria fever hospital for five successive years (1992-96). Available information on age, sex, residence, diagnosis, outcome of treatment, dates of admission and discharge were collected. The total number of cases of the three diseases admitted to the hospital during the period 1992-96 were 1406, measles represented 85.4%, neonatal tetanus 13.9% and poliomyelitis 0.7%. The results revealed that in the year 1994 only one case of poliomyelitis was admitted and since then no other cases were reported. The number of measles cases increased gradually in the latter years and about 78% of them were older than five years of age. A significant increase in the age of measles occurrence was observed. A gradual decline in the number of neonatal tetanus cases was observed. These cases were more apt to occur among early neonates but still clustered in certain geographical areas. The results of the study pinpoint the long term impact of the well run program aiming at eradicating poliomyelitis in Alexandria. However, for elimination of neonatal tetanus and controlling measles morbidity, further activities are required including strengthening the surveillance activities for detection of the high risk geographical areas and the high risk factors.     

病案信息为医院管理服务

目的:通过病案信息资源的分析,为医院管理提供依据.方法:从六个方面阐述病案信息在医院管理中的作用.结果:病案信息对医院的内部管理及公安、司法、商业保险等外部单位提供帮助.结论:对病案信息的充分利用,提高了医院的现代化管理水平.     

Correlations of siblings' and mothers' utilisation of primary and hospital health care: a record linkage study in Western Australia

A relationship between maternal and child use of general practitioners (GPs) has been shown to exist for some time, however, the reasons for this relationship are not clear and the extent to which this relationship extends to tertiary care is unknown. The aim of this study was to examine the relationships between the utilisation of health care by siblings and mothers over a 14 year period. A retrospective cohort study of 756 mothers and their 1494 children up to age 14 years was conducted in three general practices in Western Australia. Medicare claims and hospital morbidity records for 1984-1997 were linked using deterministic and probabilistic matching. Generalised Estimating Equations and correlations were used to examine the relationships between the utilisation of primary and hospital health care by family members. Significant correlations were found between hospital admissions of all participants and their GP visits, specialist visits, pathology and diagnostic imaging combined and hospital length of stay. There was a strong association between siblings' use of GPs. A child's rate of GP attendance increased with that of its mother. There was a weak but significant relationship between siblings' use of hospitals, and a child's hospital admission rate increased with that of its mother. It is concluded that there is a strong relationship between siblings' use of GPs and a weaker but still significant association between the hospital admissions of siblings. As expected, there were strong associations between mother and child visits to GPs. There was also an association between a mother's use of hospital and that of her children. This finding reduces the plausibility that the relationships found between utilisation of health care by siblings and mothers can be explained entirely by behavioural factors, and suggests the presence of intergenerational correlation of morbidity.