不同日常生活自理能力分级护理成本核算的研究

目的 构建合适的护理成本核算体系,切实体现护理工作劳动价值,为管理者制定护理收费标准、评价效益、降低医疗成本提供理论依据.方法 同期随机抽取9个病区360例患者,分别运用按等级护理收费与按日常生活自理能力(ADL)分级结合护理项目成本核算两种计费方法,计算护理人员完成各项护理所产生的费用情况,比较两者的差距.结果 ①不同ADL分级患者的单项直接护理时间呈递进关系;②不同ADL分级患者的多数单项直接护理服务成本差异有统计学意义,计算的成本与现行的等级护理收费标准相比,后者项目不全且价格普遍偏低;③患者出院时统计两种计费方法产生的总护理服务费差异有统计学意义.结论 按ADL分级进行护理项目成本核算,以此为据制定护理服务价格,能很好地体现护理人员地劳动价值,也能让患者明明白白消费.     

成本核算中发挥护士长的管理作用探讨

成本核算是加强医院经济管理的一种趋势,也成为护理管理中的一项重要内容。它关系到科室社会效益和经济效益的提高。科室护士长日常工作中直接负责着大量卫生资源的使用和管理,合理利用资源,努力降低成本,是护士长在科室管理中的重要任务。我院把成本核算与以患者为中心的护理管理有机地结合起来,严格计划、控制,从而使医疗护理服务达到优质、高效、低耗,得到了主管部门的肯定和赞扬。     

家庭护理成本核算的方法及其意义

为了促进我国家庭护理成本研究体系的发展,为相关政策的制定提供依据,分析界定了家庭护理成本核算的相关概念,探讨了成本核算的意义及国内外家庭护理成本核算的方法。     

护理服务成本核算研究体系的思路与模型

对护理成本核算的现况与背景、护理成本核算的内容及意义、护理成本核算的思路进行了阐述。     

三级甲等医院单项护理服务标准成本和实际成本研究

目的测算三级甲等医院单项护理服务的标准成本和实际成本,寻找控制成本和提高护理质量的有效途径。方法现场测量法测得实际操作时间和标准操作时间,在此基础上,用成本核算法测算单项护理服务的实际成本和标准成本,分析、比较各成本要素所占比重。结果各护理项目的标准成本均高于实际成本。人力成本和耗材成本的比重在实际成本和标准成本中变异较大,而设备折旧及维修费、管理费、业务费、教育科研费基本相同。结论成本控制的同时应重视护理质量,应该加强规范化操作的培训。     

护理服务成本核算研究体系的思路与模型

对护理成本核算的现况与背景、护理成本核算的内容及意义、护理成本核算的思路进行了阐述。     

20项护理技术服务成本核算对护理价值的体现

目的探讨20项护理技术服务成本核算对护理价值的体现。方法对20项护理技术服务项目的人力成本、护理材料、消耗时间进行护理成本核算。结果20项护理服务技术项目的3项成本249.62元与规定价格113.00元比较差价-136.62元,显示护理技术项目收费价格低,甚至无收费价格,护理价值得不到社会的承认。结论20项护理服务技术项目的3项成本核算为医政和物价部门制定符合成本规律的护理技术服务收费价格提供一定的客观依据,提高护理质量,体现护理价值。     

护理服务成本核算研究进展

随着医院改革不断深化和医疗市场竞争日益激烈，成本核算已成为医院及卫生事业机构管理的一种重要手段和组成部分。护理成本是医院重要的成本因素，医院通过实行护理成本核算，可合理地配置人力资源、制订合理的护理服务价格，并有助于改善护理管理和运营模式，进而降低医院整体成本，提高医院经济效益和社会效益，现报道如下。     

我国护理成本核算研究的现状及思考

随着市场经济和医疗卫生体制改革的不断深化和完善,成本核算越来越成为医院经营管理的重要内容之一。护理虽然与医疗同处于一个经营实体中,但由于两者服务方式的差异,两者的成本核算必然也存在差异,因此护理成本应独立于医疗成本进行核算。     

分级护理成本核算研究现状

分级护理是根据对病人病情的轻、重、缓、急及其自理能力评估,按照护理程序的工作方法所制定的不同护理措施及遵嘱给予不同级别的护理。我国的分级护理始于1956年,一直沿用至今[1]。目前,是我国医院护理工作的组织模式,是护理工作制度和规范的重要组成部分,指导着临床护理人员有效地实施针对不同病情     

Outcome and costs of intensive care

A retrospective follow-up study was performed on 238 consecutive admissions in the surgical ICU. The patients were grouped into four categories according to the therapeutic intervention scoring system: 14 in class I, 13 in class II, 81 in class III and 130 in class IV. The mortality rate during their stay in the ICU (5.4%), after discharge from the ICU (2.1%) and 2 years after discharge from the hospital (7.6%) was estimated. The functional state after discharge from the hospital showed that 74% of the patients resumed their normal work, 10% were handicapped but self-reliant, and 1.3% were dependent on others in order to pursue their daily activities. Fifty-two percent of the total hospitalization costs were generated during the ICU stage which accounted for 17.5% of the hospitalization period. Sixty percent of the total financial investment was spent on the group of survivors who resumed normal work. The mean cost per was $ 7095 or $ 1 per survivor per day of active life over an average span of 15 years survival after discharge from the hospital.     

Primary-care-based episodes of care and their costs in a three-month follow-up in Finland

Objective To explore patient characteristics, resource use, and costs related to different episodes of care (EOC) in Finnish health care.

Design Data were collected during a three-month prospective, non-randomized follow-up study (Effective Health Centre) using questionnaires and an electronic health record.

Setting Three primary health care practices in Pirkanmaa, Finland.

Subjects Altogether 622 patients were recruited during a one-week period. Inclusion criteria: the patient had a doctor’s or nurse’s appointment on the recruiting day and agreed to participate. Exclusion criteria: patients visiting a specialized health guidance clinic for pregnant women, children, and mothers.

Main outcome measures Patient characteristics, resource use, and costs based on the ICPC-2 EOC classification.

Results On average, the patients had 1.22 EOCs during the three months. Patient characteristics and resource use differed between the EOC chapters. Chapter L, “Musculoskeletal”, had the most episodes (17%). The most common (8%) single EOC was “upper respiratory infection”. The mean cost of an episode (COE) was €389.56 (standard error 61.11) and the median COE was €165.00 (interquartile range €118.46–288.56) during the three-month follow-up. The most expensive chapter was K, “Circulatory”, with a mean COE of €909.85. The most expensive single COE was in chapter K, €32 545.56. The most expensive 1% of the COEs summed up covered 36% of the total COEs.

Conclusion Patient characteristics, resource use, and costs differed between the ICPC-2 chapters, which could be taken into account in service planning and pricing. Future studies should incorporate more specific diagnoses, larger data sets, and longer follow-up times.

• Key points

• The most common episodes were under the ICPC-2 “Musculoskeletal” chapter, but the highest mean and single-episode costs were related to the “Circulatory” chapter.

• The mean (median) cost of episodes that started in primary care was €390 (€165) during the three-month follow-up.

• Patient characteristics, resource use, and costs differed significantly between the ICPC-2 chapters. The most expensive 1% of the episodes covered 36% of the total costs of all the episodes.

     

急诊科人文关怀护理研究进展

急诊科作为医院的窗口,人文关怀的实施在推进医院优质护理服务中起着重要作用。本文从人文关怀护理的内涵、急诊科人文关怀护理实施的现状、急诊科护士关怀能力及培养等方面进行综述,为更好地推进急诊科人文关怀护理的实施提供参考。     

专病专护研究促进了护理管理质量的提高

介绍专病专护的实践方法 ,如何应用专病专护理论指导疾病的观察及护理 ,怎样在工作中鼓励病人及家属参与护理工作 ,在专病专护宣教中做到“五个明白”。促进了护理管理质量的提高。通过开展专病专护提高了护士的钻研与思考能力 ,体现了护理工作的知识价值 ,培养了一批专病专护骨干     

Service use and costs for people with headache: a UK primary care study

This paper aims to estimate the service and social costs of headache presenting in primary care and to identify predictors of headache costs. Patients were recruited from GP practices in England and service use and lost employment recorded. Predictors of cost were identified using regression models. Service and social costs were available on 288 and 282 patients, respectively. Average service costs over 3 months were ￡117 whilst total costs (including lost production) were ￡582. Patients referred to neurologists had service costs that were ￡82 higher than those not referred (90% CI ￡36–￡128). Costs including lost employment were higher by ￡150, but this was not significant (90% CI -￡139–￡439). The annual mean service and social costs, weighted to represent population rates of referral, were ￡468 and ￡2328, respectively. Higher costs were significantly related to pain. Age was linked to higher service costs and lower social costs. The figures extrapolated to the whole of the UK suggest ￡956 million due to service use and ￡4.8 billion including lost employment. These are likely to be underestimates because many people experiencing headaches do not consult their GP.     

The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study

Objective We examined the relationship between major ICU characteristics and labour cost per patient.Design Four-week prospective data collection, in which the hours spent by each physician and nurse on both in-ICU and extra-ICU activities were collected.Setting Eighty Italian adult ICUs.Measurements and results The cost of the time actually spent by ICU staff on ICU patients (labour cost) was computed for each participating unit, by applying to the average annual salaries the proportions of in-ICU activity working time for physicians and nurses. Multiple regression analysis was used to identify ICU characteristics that predict labour costs per patient. Labour cost per patient was positively correlated with ICU mortality and patients average length of stay (slopes =0.67, p =0.048 and 0.09, p <0.0001, respectively). Labour cost per patient decreases almost linearly as the number of beds increases up to about eight, and it remains nearly constant above about twelve beds. The number of patients admitted per physician (not per nurse) increases with the number of beds (Spearman correlation coefficient =0.567, p <0.0001).Conclusions Our findings suggest that ICUs with less than about 12 beds are not cost-effective.The authors appear on behalf of the GiViTI group [Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (Italian Group for the Evaluation of Interventions in Intensive Care Medicine)]. A complete list of study participants appears in the Appendix     

重症监护室护理成本研究进展

介绍了护理成本的定义,研究护理成本的目的和意义,国内外护理成本的核算方法及其现存的问题。综述了近年来国内外监护室护理成本的研究进展。     

PICC置管及维护专项护理成本研究

目的证实PICC置管及维护项目所投入的实际护理成本与现行收费之间的偏差,为护理劳动价值得到合理补偿提供客观依据。方法 用项目成本阶梯分摊法,对PICC置管106例次及置管后维护145例次实际投入的人力、财力、物力进行测量、归集、统计,对实际投入护理成本进行核算,与现行PICC置管及维护的收费标准进行对比分析。结果单项次PICC置管成本(2259.99±30.99)元,比现行收费标准1532.79元高727.20元(33%),单项次维护成本(61.96±5.23)元,比现行收费标准38.71元高23.52元(38%)。结论现行PICC置管及维护专项护理技术收费价格严重偏离实际投入护理成本,护理服务价值未能得到应有的补偿和体现。     

重症监护室护理成本研究进展

介绍了护理成本的定义．研究护理成本的目的和意义．国内外护理成本的核算方法及其现存的问题。综述了近年来国内外监护室护理成本的研究进展。     

A blueprint for transforming stroke rehabilitation care in Canada: the case for change

Teasell RW, Foley NC, Salter KL, Jutai JW. A blueprint for transforming stroke rehabilitation care in Canada: the case for change.Stroke is a major source of disability in Canada and other developed countries, which carries with it a high toll in terms of personal suffering for the stroke survivor and their family in addition to the associated economic costs. Despite the impressive body of evidence describing effective and feasible stroke rehabilitation practices, stroke survivors, their families, and health professionals currently do not benefit from a rehabilitation system that is well organized and evidence based. Using the principles of best evidence, we make the case for needed changes to the current system based on 5 processes of care known to be important in the pursuit of optimal outcomes: (1) admission to specialized stroke rehabilitation units, (2) early admission to stroke rehabilitation units, (3) intensive stroke rehabilitation therapies, (4) task-specific rehabilitation therapies, and (5) well-resourced outpatient programs. Implementation of these strategies will be expected to result in improved functional gain, fewer complications, decreased mortality, and reduced need for institutionalization. In addition to providing improved care for both the stroke survivor and their family, evidence-based stroke rehabilitation care is more efficient and may reduce costs. Our experience in Canada suggests that instituting these 5 measures alone will result in significant improvements to the health care system.