美国营养教育和注册营养师培养制度

详细介绍了美国最具权威性的营养师资质"注册营养师"的培训、资格认定和获得注册资格后的继续教育项目.并以美国康奈尔大学营养科学系本科营养师课程项目和营养师实习项目为例,介绍了美国注册营养师培养单位的资质认定和培养营养师过程,特别是康奈尔大学营养实习地点、实习内容和方式.还介绍了美国注册营养师的就业单位等方面内容.     

美国营养教育和注册营养师培养制度

详细介绍了美国最具权威性的营养师资质"注册营养师"的培训、资格认定和获得注册资格后的继续教育项目.并以美国康奈尔大学营养科学系本科营养师课程项目和营养师实习项目为例,介绍了美国注册营养师培养单位的资质认定和培养营养师过程,特别是康奈尔大学营养实习地点、实习内容和方式.还介绍了美国注册营养师的就业单位等方面内容.     

JCI标准特点解析及其对中国医院评审的影响

《美国医疗机构评审国际联合委员会医院评审标准》（简称《JCI标准》）是国际上公认的先进医疗服务标准。本文系统的介绍了“美国医疗机构评审国际联合委员会”JCI及《JCI标准》的历史、理念、特点及内容,并对《JCI标准》的特点进行了解析,同时将其与《三级综合医院评审标准实施细则》（2011年版）的理念、方法及内容进行了比较分析。强调我国医疗机构借鉴和使用《JCI标准》有利于提高医疗服务水平,促进医疗安全。     

U.S. Army-Baylor University Health Care Administration Program: evidenced-based outcomes in the military health system

The purpose of this research is to assess the impact of an educational program on the Military Health System on some of the evidence-based educational outcomes for the Individual (student) and the Society (all Army Medical Treatment Facilities). The U.S. Army-Baylor University HCA program provides a unique opportunity to assess the impact of an educational program on the Military Health System (MHS). Since the majority of the graduate students are military officers who serve in military medical treatment facilities (MTFs), tracking their career progression allows assessing the value added of the U.S. Army-Baylor University HCA experience from 1951 to 2001 (n = 2234). The context of Society outcomes includes all the Army MTFs where U.S. Army-Baylor University HCA graduates execute their leadership skills. During the time from 1994 to 2001, all of the Army MTFs in the MHS (n = 38) were examined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In a similar but shorter time frame (1997-2001), DoD patient satisfaction assessments were conducted. The Individual outcomes (career advancement, increase in status, higher professional association membership) demonstrate that the selection criteria used for program admission appear to be successful. The Society outcomes showed higher JCAHO scores and satisfied consumers in Army facilities with Baylor graduates as the Deputy Commander for Administration (DCA). Continued internal program assessments (curriculum reviews) and external reviews (Accrediting Commission on Education for Health Services Administration accreditations of 5 years in 1987, 8 years in 1993 and 7 years in 2001, and 7 ACHE student chapter awards) attest to the strengths of the U.S. Army-Baylor University HCA program. Educating the MHS shareholders (patients, beneficiaries, professional and support staff, senior leaders) and leveraging technology to. share best practices for all administrators (including non-Baylor graduates) will help improve the quality patient care of the Military Health System and other healthcare systems.     

Certification for Disease-Specific Care Programs

There is a growing interest in the US among payors, purchasers of healthcare benefits, providers, policy-makers and the public in the promise of disease management or disease-specific care. While there have been early efforts to standardize the application and measurement of disease-specific care programs, no national standards or uniform performance measurement specifications existed prior to 2002. The Joint Commission on Accreditation of Healthcare Organizations (Illinois, USA) published its national standards and conducted its first certification evaluation for disease-specific care in February 2002. The Disease-Specific Care (DSC) Certification Program is fundamentally based on an evaluation of a disease-specific care program’s compliance with the Joint Commission’s standards, implementation of adherence to clinical practice guidelines and its outcomes of care. Organizations that have achieved Joint Commission DSC Certification have reported impressive results from their performance measurement and improvement activities.     

Meeting the Joint Commission's information management planning standard: a primer and example

The 1994 edition of the Accreditation Manual for Hospitals contains the first release of the Joint Commission on Accreditation of Healthcare Organizations' new standards for information management. These standards reflect the Joint Commission's vision of how hospitals should be managing one of their key corporate assets: information. The article focuses on the information management planning section of the standards. A sample information management plan is provided along with practical advice and experience in conducting a strategic planning project.     

Continuous improvement in dietetics education with a regional advisory board: a model that works

Continuous improvement has been a focus of business and health care for years. The Commission on Accreditation for Dietetics Education has also identified the need for continuous improvement in dietetics education programs and requires them to seek outside counsel to help accomplish it. Most dietetics education programs develop advisory boards to provide this outside counsel, but finding individuals to commit to an ongoing advisory board can be challenging. Dietetics internship directors from dietetics practicum programs throughout Arizona created the Arizona Dietetic Practicum Advisory Committee (AzDPAC), which uses suggestions from preceptors, interns, and committee members to generate ideas for improvement. Since the conception of AzDPAC both tangible and intangible outcomes have occurred. Tangible outcomes include better coordination among programs, development of a combined annual affiliate meeting, standardization of forms, creation of a combined "Clinical Bootcamp," development of a Web page describing all programs, and better networking among interns from different programs. In addition, AzDPAC improved cooperation and sharing of expertise and created an available group of peers for new directors. An advisory committee of regional program directors is a model that works in providing dietetics education programs with ongoing outside counsel and ideas for continuous improvement.     

基于JCI标准的医院人力资源管理

国际医疗卫生机构认证委员会(Joint Commission International Accreditation,JCI)开展JCI评审的最终目的是通过评审促进医疗质量的不断提高,为患者提供更安全的就医环境,减少患者与员工的风险。SQE是JCI医疗机构管理标准中"人员资格与教育"评价标准,目的是要制定一种有效的机制,对医疗活动执行情况进行考核,以保证医院人力资源管理的规范化发展。     

美国卫生管理专业硕士认证制度的发展及启示

随着医疗改革的深入,我国卫生管理硕士教育的质量改进面临更多的机会和挑战。卫生管理专业的认证不仅能促进卫生管理教育质量持续改进,还可以为卫生相关机构提供交流平台,为其提供高质量人才,从而促进卫生系统的整体改善。美国卫生管理专业硕士(MHA或MSHA)认证机构从"大学卫生管理专业协会"(AUPHA)发展到"卫生管理教育认证委员会"(CAHME),其目标、任务、标准和认证重点也在灵活地随着时代的变化而逐步发展。其中,CAHME基于"胜任力"模型的认证标准是值得我国卫生管理专业教育发展借鉴的。     

Academy of Nutrition and Dietetics: Revised 2018 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners

Registered dietitian nutritionists (RDNs) engaged in education of nutrition and dietetics practitioners facilitate meaningful learning of required knowledge and supervised practice competencies in nutrition and dietetics curricula and proactively support all facets of the learning environment. Addressing the unique needs of each educational situation and applying standards appropriately is essential to providing evidenced-based, learner-centered, up-to-date education for future nutrition and dietetics practitioners. The Academy of Nutrition and Dietetics (Academy) leads the profession by developing standards that can be used by RDNs for self-evaluation to assess quality of practice and performance. The Standards of Professional Performance consist of six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The Academy's Revised 2018 Standards of Professional Performance for RDNs in Education of Nutrition and Dietetics Practitioners provide standards and indicators for three levels of practice—competent, proficient, and expert—which are used to gauge and guide an RDN’s performance in nutrition and dietetics practice in educational settings.     

American Dietetic Association: standards of practice in nutrition care and updated standards of professional performance

The Standards of Practice in Nutrition Care, the Standards of Professional Performance, and Specialty and Advanced Standards, along with the Code of Ethics, compose one of the three key blocks of the new Scope of Dietetics Practice Framework. Referred to as the Evaluation Resources block, they are used collectively to gauge and guide a competent level of dietetics practice and professional performance.These resources will continue to evolve as new trends in dietetics practice emerge. All dietetics professionals should have in their personal libraries the most recent copies of the resources that compose the Scope of Dietetics Practice Framework. To ensure that practitioners always have access to the most updated resources, the latest copies will be available on the ADA Web site at www.eatright.org. Also available on the Web site will be presentation materials, case scenarios, and other application tools to support practitioners in communication about and implementation of the standards.     

Disclosure and documentation of reported unanticipated medical events or outcomes: Need for healthcare provider education

In 2001 the Joint Commission on Accreditation of Healthcare Organizations added "requirement to disclose unanticipated outcomes" to accreditation standards. Full disclosure increases patient satisfaction and trust in physicians. Though studies suggest elements of complete disclosure, there are no national standards.     

The role of accreditation in transforming health services management education

The core function of the Accrediting Commission on Education for Health Services Administration (ACEHSA) is to improve quality in health services management education. All specialized accrediting agencies provide quality assurance by developing standards of quality, assessing programs and reporting to stakeholders, as part of their public accountability function (Council for Higher Education Accreditation). Standards of quality derive from the level of competency considered essential within the domain of practice of health services managers. Accreditation review by ACEHSA is oriented to quality improvement and quality assurance, which have different purposes and are difficult to accomplish in the same process. The purpose of this paper is to discuss ACEHSA's role in evaluating the quality of health services management education programs in North America. The first objective is to describe the process of defining quality and to identify the skills, knowledge and abilities derived from it. The second objective is to discuss the measurement of quality, including using standardized measures, and determining whether the purpose is quality improvement or quality assurance. The third objective is to examine how quality measures are reported, and how reporting impacts the quality assessment process. Finally, the future role of ACEHSA is discussed, with regard to benchmarking measures of quality and publicly reporting relative levels of academic program quality.     

Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Nutrition and Dietetics Technicians,Registered

Nutrition and dietetics technicians, registered (NDTRs) face complex situations every day. Competently addressing the unique needs of each situation and applying standards appropriately are essential to providing safe, timely patient-/client-/customer-centered quality nutrition and dietetics care and services. The Academy of Nutrition and Dietetics (Academy) leads the profession by developing standards that can be used by NDTRs (who are credentialed by the Commission on Dietetic Registration) for self-evaluation to assess quality of practice and performance. The Standards of Practice reflect the NDTR’s role under the supervision of registered dietitian nutritionists in nutrition screening and the Nutrition Care Process and workflow elements, which includes nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention/plan of care, nutrition monitoring and evaluation, and discharge planning and transitions of care. The Standards of Professional Performance consist of six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, indicators provide measurable action statements that illustrate how the standard can be applied to practice. The Academy’s Revised 2017 Standards of Practice and Standards of Professional Performance for NDTRs along with the Academy/Commission on Dietetic Registration Code of Ethics, and the Scope of Practice for the NDTR provide minimum standards and tools for demonstrating competence and safe practice, and are used collectively to gauge and guide an NDTR’s performance in nutrition and dietetics practice.     

Rural Health Professions Education at East Tennessee State University: Survey of Graduates From the First Decade of the Community Partnership Program

CONTEXT: To help meet rural Appalachian needs, and with initial support from the W.K. Kellogg Foundation, East Tennessee State University partnered with 2 counties to implement a health curriculum for nursing, public health, and medical students in a rural setting. The Community Partnerships Program 3-year longitudinal curriculum included theoretical, conceptual, and practice elements of the 3 disciplines incorporated into an experiential, inquiry-based, service-learning program. Interdisciplinary learning, problem solving, and reinforcement of career choices in medically underserved rural communities were emphasized. PURPOSE: To compare career choices, attitudes, and practice locations of Community Partnerships Program graduates with traditional graduates. METHODS: Surveys were mailed to Community Partnerships Program and traditional program graduates matriculating from 1992 to 2002 (response rates 58/84 and 72/168, respectively). FINDINGS: Community Partnerships Program graduates indicated a significantly greater interest in rural primary care, care for the underserved and interdisciplinary group collaboration, and were more likely to practice in rural locations than did their traditionally educated peers. Family, personal factors, and the availability of employment were major influences in determining the decision to choose a career in a rural location. Community Partnerships Program graduates indicated they were better prepared to work in interdisciplinary teams and were more likely to work in community-based programs and activities than did the traditional graduates. CONCLUSION: A program that enrolls students interested in rural health care and provides training in rural communities produces graduates who will practice in rural areas.     

The development and evaluation of Student Training, Education and Practice for Dietetics CD-ROM: a computer-assisted instruction programme for dietetic students

The Student Training, Education and Practice for Dietetics (STEP‐DIET) CD‐ROM was developed at the University of Surrey to prepare dietetic students for the practical dietetic training component of their Nutrition/Dietetics degree. This study aimed to evaluate student response to the programme and its effectiveness as a teaching tool, based on the evaluation framework of D.L. Kirkpatrick (Evaluating a Course, 2nd edn. London, Kogan Page). Quantitative and qualitative methodologies were employed, with 41 dietetic students, separated by year group, completing questionnaires and taking part in six focus groups, at the University of Surrey. Student attitudes towards the instruction method and the STEP‐DIET programme itself were investigated, in conjunction with their perceived learning achievements. Students rated the programme highly in terms of design and content, however, there was a reluctance to accept computer‐assisted instruction (CAI) as a sole teaching method. A number of learning achievements relevant to dietetic practice were reported including a perceived increase in ability to conduct a dietetic interview and an increased understanding of the management of Type 2 diabetes. In general students reacted positively to the STEP‐DIET programme and it was perceived by students to be effective in preparing them for the practical component of their dietetic training.     

Toward the Implementation of Mental Health Consumer Provider Services

Encouraged by the New Freedom Commission, mental health systems such as the Veteran Administration (VA) are now becoming more recovery-oriented. Consumer providers (CPs)—those with serious mental illness who are further along in recovery who provide services to others with similar mental health problems—are viewed as a key part of this change. However, organizational change theories suggest that careful consideration of implementation issues is critical when disseminating new and sometimes controversial services into existing organizations. Therefore, to guide the dissemination of CP services, the literature on the effectiveness of CPs was reviewed, and interviews, focus groups, and a brief survey of 110 administrators, providers, and patients were conducted at three large VA clinics in Southern California. Questions focused on their perceptions of feasibility and acceptability of CP services. Using literature and study findings, an organizational change framework and other strategies to overcome potential implementation challenges of CP services are suggested.Alexander S. Young, MD, MSHS, Director, Health Services Unit, VISN 22 MIRECC, West LA VA Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.Joseph Hassell, MA, Program Coordinator, Health Services Unit, VISN 22 MIRECC, West LA VA Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.Larry Davidson, PhD, Associate Professor and Director, Yale Program for Recovery and Community Health, Yale University School of Medicine, Department of Psychiatry, Erector Square 6W, Suite IC, 319, Peck Street, New Haven, CT 06511, USA.     

Highlighting 2004 award-winning initiatives

This issue takes a closer look at how five award-winning healthcare organizations are finding--and continually refining--innovative ways to provide high-quality healthcare. One of those organizations is Robert Wood Johnson University Hospital Hamilton, which recently was named the fourth healthcare winner of the annual Malcolm Baldrige National Quality Award. The Joint Commission on Accreditation of Healthcare Organizations recently selected two facilities in the hospital category--Stamford Hospital and Staten Island University Hospital--as recipients of the eighth annual Codman Award for their work in using outcomes measurement to promote quality care. The Reading Hospital and Medical Center received a Cheers Award from the Institute for Safe Medication Practices for its toolkit promoting patient safety. Sentara Healthcare System, top winner of the American Hospital Association's Quest for Quality Award, has been cited for its efforts to align its quality and safety goals with its organizational goals.     

The Kentucky plan revisited: lessons learned from an innovative doctoral education program

In the first doctoral education special issue of the Journal of Health Administration Education, the authors presented the University of Kentucky College of Public Health's plans for an innovative new Doctor of Public Health (Dr. P.H.) degree. The degree as designed, prepares graduates for professional practice, and included extensive supervised field experience as part of the academic training linking theory with practice. Based upon the interest that the Kentucky Dr.P.H. degree program received, the authors will share the experience of the degree's initial years of operation through a "lessons learned" paper. As the program evolved there have been many lessons related to trends, curriculum design, admissions, prerequisite requirements, curriculum innovations, scheduling, the comprehensive examination, and attrition. In addition, there are many questions for the future. "In theory, theory and practice are the same. In practice, they are not."-- Lawrence Peter "Yogi" Berra.