服务为本建立"农民家庭合同保健"制度

近年来 ,我们在县委、政府和上级主管部门的领导、支持下 ,在全县积极推行了农民家庭合同保健工作 ,为探索和建立新时期的农民健康保障办法做了一些尝试 ,收到了较为满意的效果。1　主要做法我们开展的农民家庭合同保健是在乡村卫生服务管理一体化和农村社区卫生服务的基础上 ,以农村基层卫生机构为依托 ,以乡村卫生人员为骨干 ,以辖区内农户和重点人群为对象 ,以预防保健为重点 ,以“人人享有卫生保健”为目标 ;采取合同形式 ,为农村居民提供基本医疗预防保健服务的一种新型健康保障办法。开展这一工作应坚持“政府引导、互助共济、自愿有…     

农民家庭合同保健制度的实践与思考

河南省武陟县地处黄河北岸 ,全县共有人口 62万 ,其中农业人口 5 1.5万 ,占 83.3%。全县辖 15个乡镇 ,366个行政村。有乡镇卫生院 15所 ,农村社区卫生服务站 5 7个 ,一体化管理村卫生所 2 93个 ,一体化管理防疫点 4 3个 ,乡村医生 984人。1999年以来 ,该县在全面开展乡村卫生组织管理一体化和农村社区卫生服务的基础上 ,积极进行农民家庭合同保健试点探索 ,在建立新时期农民健康保障制度方面进行了有益的尝试 ,并取得较好成效。截止2 0 0 0年底 ,全县共有 11767户农户同社区卫生服务站或卫生所签订了家庭保健合同 ,占全县总农户的9.87%。参…     

河南省淅川县建立农村居民慢性非传染性疾病保健合同效果评价

目的评价河南省浙川县建立农村居民慢性非传染性疾病(以下简称慢性病)保健合同的实施效果．探讨我国农村社区慢性病管理的工作模式。方法对352例签订合同的慢性病病人采取问卷调查。结果352例慢性病病人(高血压306例、糖尿病46例)，高盐饮食的危害知晓率由干预前的21．4％提高到干预后的99．2％，低盐饮食者由干预前的42人(11．9％)提高到干预后的175人(49．7％)。规范服药人数由干预前的125人(35．5％)提高到干预后的275人(78．1％)。结论通过对镇、村两级卫生人员的慢性病防治知识培训．转变了服务模式，采取主动上门服务、利用多种形式在社区内广泛宣传慢性病防治知识；教育重点人群改变其不良生活习惯：与所掌握的慢性病病人签订健康保健合同，进行体检、建档、规范化管理、预防指导和健康促进．探索了农村居民慢性病防治管理办法。     

新型合作医疗制度下慢性病管理的效果评价

目的分析湖北省黄冈市实施新型农村合作医疗以来,农村居民的慢性病相关情况,评价新型农村合作医疗制度下慢性病的管理效果.方法入户调查收集资料,Epidata 3.0 录入数据,SPSS 12.0进行统计分析,计算慢性病患病率和疾病的经济风险度.结果黄冈市农村居民的慢性病患病率高于全国农村,它对居民造成了很大的经济负担.结论从长远来看,实施家庭合同保健对于降低慢性病的患病率和死亡率是一种有效的方法.     

影响农村"家庭合同保健"入保率因素的探讨

目的：探讨影响农村家庭合同保健人保率的因素；方法：通过分层抽样调查，获取河南省武陟县在开展家庭合同保健制度两年多的相关资料，利用SPSS10．0对资料进行了相应处理；结果：家庭经济收入，性别，年龄都是影响家庭合同保健人保率的重要因素，尚不能认为文化程度对家庭合同保健人保率有影响。     

影响农村“家庭合同保健”入保率因素的探讨

目的 :探讨影响农村家庭合同保健入保率的因素 ;方法 :通过分层抽样调查 ,获取河南省武陟县在开展家庭合同保健制度两年多的相关资料 ,利用 SPSS10 .0对资料进行了相应处理 ;结果 :家庭经济收入 ,性别 ,年龄都是影响家庭合同保健入保率的重要因素 ,尚不能认为文化程度对家庭合同保健入保率有影响。     

保健干部慢性病患病情况分析及管理对策

干部保健范围主要包括副县处级以上在职干部、退休干部、离休干部及高级知识分子、专业技术人才。随着社会经济的发展,人们生活水平的提高,生活方式的改变,高血压、高血脂、糖尿病、冠心病等慢性疾病已成为严重危害人民群     

慢性病患者家庭韧性干预策略效果的系统评价

目的 系统评价慢性病患者家庭韧性干预策略,为未来构建慢性病患者家庭韧性干预方案提供循证依据。方法 计算机检索PubMed、Embase、Web of Science、Cochrane Library、CINAHL、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库（WangFang Data）、维普信息资源系统（VIP）、中国临床试验注册中心（Chinese Clinical Trial Registry）、美国临床试验注册中心（ClinicalTrials）,主题词结合自由词检索,检索时限为从建库至2022年5月17日,纳入所有慢性病患者家庭韧性干预策略相关研究,筛选文献并进行质量评价,最终对纳入的研究结果进行定性描述分析。结果 最终纳入10篇文献,其中8篇结果显示采取适当干预能提升慢性病患者的家庭韧性水平,多家庭小组会议、单家庭会议、面对面结合线上家庭会议三种干预方式对提升研究对象的家庭韧性水平均有一定的作用。结论 多家庭小组会议、单家庭会议、面对面结合线上家庭会议等干预方式可提高慢性病患者家庭韧性水平,各种家庭韧性干预措施的效果还存在差异和不确定性。     

因地制宜服务为本探索农村家庭合同保健制度

渐川县位于豫、鄂、陕3省结合部，是全国移民大县和国家重点扶持县。全县辖16个乡镇，516个行政村，4181个自然村，总人口72万，其中农业人口65万，占90％。乡镇卫生院“个，村卫生所417个，村医900名。     

慢性阻塞性肺疾病慢性病管理家庭路径的构建

目的 构建慢性阻塞性肺疾病(COPD)慢性病管理家庭路径,为COPD的慢性病管理提供理论依据。方法 以PDCA为理论框架,查阅国内外文献,采用德尔菲法对来自全国的15名专家进行2 轮的问卷函询。结果 2轮专家咨询的问卷有效回收率均为100％,权威系数为0.85,判断系数为0.93,熟悉系数为0.76,最终确定COPD慢性病管理家庭路径,包括一级指标6项(评估、计划、实施、评价、变异、反馈),二级指标21项,三级指标53项;指标协调系数分别为0.14、0.08、0.09,三级指标专家意见协调性有统计学意义(P<0.05)。结论 COPD慢性病管理家庭路径经检验,专家意见集中,结果科学可靠,可为COPD患者的慢性病管理提供理论依据。     

A regional health care system partnership with local communities to impact chronic disease

Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project. In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases. The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.     

The impact of chronic disease management in primary care on inequality in asthma severity

Chronic disease management (CDM) is now widely available in primary care, but methods of delivery are highly variable. The focus of this study was to examine whether CDM provided in asthma clinics was more effective in reducing the severity of asthma symptoms, particularly for deprived populations. There was no evidence of 'inverse care' in the provision of CDM in clinics and good evidence that it was associated with a reduction in the severity of asthma symptoms for both deprived and affluent populations.     

某社区慢性病自我管理健康教育对自我效能的影响

[目的 ]　评价社区慢性病自我管理健康教育项目对改变患者自我效能的效果。　 [方法 ]　按照社区随机对照试验研究设计 ,将 2 97名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD )等疾病并自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩检验 ,比较有基线和 6个月后两次问卷调查数据的 12 8名干预组病人和 12 7名对照组病人于项目实施 6个月之后在自我效能方面的变化。　 [结果 ]　干预组病人的症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 1.0 8分和 1.0 7分 (P值均 <0 .0 1)。　 [结论 ]　慢性病自我管理项目实施 6个月后改善了参加者对疾病管理的自我效能     

Depression care management: impact of implementation on health system costs

This study examined the mental health care costs associated with implementation of a collaborative care management (CCM) of treatment for depression in primary care. A retrospective review of all costs was performed over a 2-year period associated with providing care to adult patients at clinical sites with CCM versus those with usual care, comparing total and mental health per member per month (PMPM) costs for 2008 and 2009 (patient population = 103,000). The mental health-PMPM costs as a percentage of total health care costs at the clinic without CCM were 4.65% in 2008 and 4.5% in 2009 (p = .085). In the clinics with CCM, there was a significant difference between the 2 years with a decrease noted in 2009 of 4.91% compared with 4.36% in 2008 (p < .0001). This study demonstrated that, on a population basis with the implementation of CCM, the metric of mental health-PMPM (using the actual costs of delivering care) suggested that an increased short-term cost of care is not always realized. Collaborative care management treatment for depression may be a more cost-efficient method of care for the population as a whole, even in the short term.     

医保签约管理模式下的家庭医生制度绩效评价指标研制与结构过程评价

目的:设计医保签约管理模式下的家庭医生制度绩效评价模型,依托模型从结构和过程维度评估改革实施的情况,并提出完善建议。方法:对上海市长宁区通过考核认证并开展签约服务的154名家庭医生进行问卷调查,从改革的制度体系结构和过程行为转变维度对家庭医生签约服务与医保支付方式改革予以评估。结果:通过专家咨询法构建医保签约管理模式下的家庭医生制度绩效评估模型,评价模型遵循"结构—过程—结果"的逻辑,主要包括制度体系结构、行为转变过程、产出结果价值3个一级维度,下涵9个二级维度、25个三级维度。调查显示改革在供给模式、队伍建设、激励机制、服务模式、家庭医生的行为转变等评价维度均取得了较好的成效。结论:在结构与过程方面,改革取得了一定的成效,仍需加强人才建设、协同服务、激励机制等方面的建设。     

The integration of primary care and case management in chronic disease

Case management historically has been facility based and has focused on discharge planning and utilization review. Integrated case management needs to include risk screening, disability prevention programs, linked information processes, and interdisciplinary teams that manage care over time and across settings. This article describes one such model that can change primary care into a process that involves the entire team, including the patient.     

The equity lens in the health care performance evaluation system

The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the ‘equity process’ by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.     

The impact of a proactive chronic care management program on hospital admission rates in a German health insurance society

Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n = 17,319) and Comparison (n = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P < 0.001). The overall decrease in admissions for the Intervention group was driven by risk stratification levels 2 and 1, for which admissions decreased by 8.2% and 14.2% compared to Comparison group increases of 12.1% and 7.9%, respectively. Additionally, Intervention group admissions decreased as the number of calls increased (P = 0.004), indicating a dose-response relationship. These findings indicate that proactive chronic care management care calls can help reduce hospital admissions among German health insurance members with chronic disease.