医院质量体系认主下与跨世纪医院质量工程的设想

跨世纪医院质量工程是指一个规范化的医院质量管理方案，四方面质量管理同步进行的全方位质管理管理、五个层微控与宏观管理相结合的良好性管理机制，一项保证质量工程切实实施的质量体系认证制度。医院质量体系认证是实施跨世纪质量工程的重要保证和基本内容之一。     

科室综合护理质量排名的管理效能

为探讨护理质量的管理效能，全面提高护理质量，本介绍了该院在实施科室综合护理质量排名的方案和实施科室综合护理质量排名的体会，为全面提高综合护理质量管理提供参考。     

医疗质量督查对医疗质量的影响

我校组织３所附属医院认真按照上海市卫生局关于《上海市医院医疗、护理、医技和输血科质量管理考核方案》，加强了医疗质量的检控管理，重点抓了三级医师查房及手术前后等质量管理。在抓落实中，高标准、严要求，切实把医疗质量管理的内容落实到科室日常工作和医务人员的运行中；同时，抓了深层次管理，理顺了护理体制管理，较好地促进了质量的提高，参与上海市各医院间的医疗质量督查检查评比，取得了显著的提高。     

关于实行全方位多层次质量考核的实践

众所周知,医院管理的核心内容是医疗质量,它是医院生存和发展的生命线,而质量管理方案又是保证质量的前提条件。几年来我院根据不同阶段出现的不同问题多次调整考核方案,最后形成了一套全方位,多层次,全员参与的质量管理体系,使每位工作人员都同时处在考核与被考核之中,提高了医务人员工作的主观能动性,增加了考核的力度,收到了良好的效果。     

医院质量体系认证与跨世纪医院质量工程的设想

跨世纪医院质量工程是指一个规范化的医院质量管理方案、四方面质量管理同步进行的全方位质量管理、五个层次的微观质控与宏观管理相结合的良性管理机制、一项保证质量工程切实实施的质量体系认证制度。医院质量体系认证是实施跨世纪质量工程的重要保证和基本内容之一。     

我院医疗质量管理的做法与体会

以“病人为中心、质量为核心”是我们的办院宗旨。我院始终把医疗质量管理作为医院的中心工作来抓 ,建立了有效的质量管理组织 ,健全了一系列医疗规章制度 ,完善了医疗质量监督、检查运行机制 ,促进了医疗质量的全面提高。1　建立完善管理组织及制度 ,增强质量管理意识我院成立了院级、职能部门及科室三级质量管理组织及其它相关的院级管理委员会 8个 ,共同参与医疗质量形成各环节的计划、组织、协调、控制和服务保障工作。各个组织均订立相应工作制度、职责、考核方案 ,质量管理委员会对基础质量、环节质量、终末质量进行全程有效的监控。…     

医院门诊质量管理探讨

医院门诊质量是医院医疗质量的重要组成部分，是医院整体水平的直接反映。加强门诊质量管理是提高医院管理的重要工作，是医院建设的重要课题。本论述了医院门诊质量管理的发展趋势、医院门诊质量管理的要点，并提出了加强医院门诊质量管理的措施。     

医院传染病报告管理工作质量的监测

为了更好地贯彻执行《中华人民共和国传染病防治法》有关疫情报告条款 ,合肥市第三人民医院院开展了对法定传染病报告管理的监测工作 ,并将此项工作纳入了《医院综合目标管理责任制方案》,取得了显著的效果。现将 1996～ 1999年的监测情况报告如下 :1　监测范围及内容1.1　监测范围　我院是综合性医院 ,未设传染科门诊。按照《全国医院法定传染病报告管理检查方案》的要求 ,制定了我院传染病报告管理制度 ,对内科门诊、肠道门诊、儿科门诊、性病门诊 (皮肤科、泌尿科、妇科 ,以下称性病门诊 )的传染病报告工作质量实施监测。1.2　监测内容　…     

浅谈医院病案管理

案不仅是病人就医的医疗记录档案,而且是临床进行正确诊断、抉择治疗方案和护理的科学依据,是处理医疗纠纷时必不可少的医疗证据,是卫生统计机关的重要资料来源,是医院全面医疗质量管理的基础.在医院的现代化管理中,强化病案管理,充分发挥病案管理的职能作用,是不断提高医院管理水平的重要途径之一.     

医院感染持续质量管理模式研究

医院感染持续性质得管理是在全面质量管理基础上,对医疗工作进行医院感染过程管理和要素管理,保持不间断地医院感染监控,以提高医院感染控制述了地续质量管理的实质及意义、主要方法及管理模式,对医院感染持续质量的关键问题,即要素提取、采集、医院感染危险因素分析、医院感染预测、报警教学模型以及医院感染管理信息系统软件设计与编程进行了讨论。     

Integrated care programmes for chronically ill patients: a review of systematic reviews.

OBJECTIVE: To investigate effectiveness, definitions, and components of integrated care programmes for chronically ill patients on the basis of systematic reviews. DESIGN: Literature review from January 1996 to May 2004. MAIN MEASURES: Definitions and components of integrated care programmes and all effects reported on the quality of care. RESULTS: Searches in the Medline and Cochrane databases identified 13 systematic reviews of integrated care programmes for chronically ill patients. Despite considerable heterogeneity in interventions, patient populations, and processes and outcomes of care, integrated care programmes seemed to have positive effects on the quality of patient care. No consistent definitions were present for the management of patients with chronic illnesses. In all the reviews the aims of integrated care programmes were very similar, namely reducing fragmentation and improving continuity and coordination of care, but the focus and content of the programmes differed widely. The most common components of integrated care programmes were self-management support and patient education, often combined with structured clinical follow-up and case management; a multidisciplinary patient care team; multidisciplinary clinical pathways and feedback, reminders, and education for professionals. CONCLUSION: Integrated care programmes seemed to have positive effects on the quality of care. However, integrated care programmes have widely varying definitions and components and failure to recognize these variations leads to inappropriate conclusions about the effectiveness of these programmes and to inappropriate application of research results. To compare programmes and better understand the (cost) effectiveness of the programmes, consistent definitions must be used and component interventions must be well described.     

Disease Management as a Part of Total Health and Productivity Management

When adults become ill they typically use more than just medical care services. They often miss time from work or incur periods of short term disability. In some cases, they also use workers’ compensation, occupational health or long term disability programme services and, in some situations, sick employees may attend work but be substantially less productive. Disease management programme vendors can enhance their services by managing the full spectrum of health and productivity programme services that people use, not just medical care services.Health and productivity management (HPM) refers to the coordination of the many types of services that employees use. These services include medical care, disability programmes, workers compensation programmes, employee assistance programmes, absenteeism and occupational safety programmes. HPM also refers to activities meant to enhance on-the-job productivity. HPM requires that disease management programme managers take a broader view of health and disease management than is typical. These programme activities may include deciding which disease(s) to address as priorities; developing treatment guidelines that focus on more than just clinical care; choosing appropriate and relevant outcome measures to address; implementing interventions that enhance productivity, improve health, and limit unnecessary medical care use; and supporting continuous quality improvement efforts.Considering these activities under an HPM umbrella requires a focus on productivity and quality of life that will add substantial value to the services offered by disease management programmes. The HPM approach will be more costly initially, but should prove more cost effective in the long term, since it considers a much wider array of potential benefits from health and disease management.     

Parenting for the promotion of adolescent mental health: a scoping review of programmes targeting ethnoculturally diverse families

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent–adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist.     

Roles of laboratories and laboratory systems in effective tuberculosis programmes

Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB.     

Outsourcing

Health plans have generally elected to build their own disease management programmes using their own resources. In addition to the widespread belief among health plans that their mission includes active management of chronically ill members despite their lack of background in that area, the ‘build’ trend has been fuelled by a lack of high quality vendor-supplied (‘outsource’) programmes and by a failure to understand or believe the inherent value proposition of the better vendors. The better vendors guarantee improvements in cost, quality and member satisfaction — all at no budgeted expense to the health plan.This article explores outsource alternatives to the conventional ‘build’ approach and identifies that a variety of factors make outsource programmes much more compelling choices for most health plans than internal programmes, particularly in the rarer and more serious disease categories. However, the clear lesson of Accordant Health Services (based in Greensboro, North Carolina, USA) and others is that for the more expensive, complex diseases requiring multiple interventions at the provider and patient level, the expertise available through outsourcing provides the better solution, as measured by cost savings, quality improvement and especially ease of implementation.     

Treatment Expectations in Congestive Heart Failure

Heart failure (HF) is a major public health problem which is increasing in prevalence due to the aging of the population. Despite recent advances in the pharmacotherapy of HF, morbidity and mortality rates both remain high, owing in part to the presence of multiple medical, psychosocial, behavioural and economic factors which confound HF management.Multidisciplinary HF disease management programmes are ideally structured to deal with the myriad issues which confront the physician in managing complex HF patients, and several studies have now documented that such programmes are effective in reducing hospital admissions, improving quality of life, and decreasing the overall cost of medical care. In addition, disease management programmes offer a multitude of advantages to the HF patient, including reductions in both morbidity and mortality, and these benefits translate into improved patient satisfaction.     

The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review

The effectiveness of current approaches to workplace stress management for nurses was assessed through a systematic review. Seven randomised controlled trials and three prospective cohort studies assessing the effectiveness of a stress management programmes were identified and reviewed. The quality of research identified was weak. There is more evidence for the effectiveness of programmes based on providing personal support than environmental management to reduce stressors. However, since the number and quality of studies is low, the question as to which, if any, approach is more effective cannot be answered definitively. Further research is required before clear recommendations for the use of particular interventions for nursing work related stress can be made.     

Selecting a Vendor for Disease Management Programmes

Many health maintenance organisations (HMOs) and provider organisations are developing disease management programmes to improve quality of care and lower costs for patients with chronic diseases. Many of these organisations ultimately decide to outsource these programmes to vendors rather than ‘build’ the programmes themselves. Once the decision is made to outsource a disease management initiative, HMOs and provider organisations face the difficult and important task of selecting a vendor from over 100 companies offering disease management programmes.This article describes an effective vendor selection process. This process enables organisations to identify all potential vendors, efficiently narrow the search to a smaller set of companies likely to offer effective programmes and, ultimately, select a preferred vendor. The article emphasises the importance of achieving and maintaining physician support for the disease management strategy. It outlines how to use a provider advisory committee to enable physicians to provide input into the selection process and to enhance the likelihood of achieving physician support for disease management initiatives.Another critical element within the vendor selection process is evaluating the ability of vendors to deliver financial benefits to the client organisation. For many chronic diseases, competent vendors should be able to ‘guarantee net financial savings’ — savings that are larger than the cost of the disease management programme. Finally, the vendor selection process can be complex and time consuming. Use of a structured procedure to identify vendors, conduct a ‘request for proposal’ process, obtain provider ‘buy-in’, select a vendor, and negotiate a contract can greatly accelerate efforts to outsource disease management programmes. In addition, this approach will increase the likelihood that the selected vendor will help an HMO or provider group achieve its goals with respect to patients with chronic disease.     

Building round the ward

This month's special feature is devoted to computers and nursing. We look at the possibilities and pitfalls in selecting a nursing management system, ask whether senior nurses are making the most of resource management and quality assurance programmes, and find promising results from an experiment with handheld computers by community nurses.     

A Population-Based Approach to Asthma Disease Management

Asthma disease management (DM) programmes often focus on patients who are considered to be high resource users, such as those with recent emergency department visits and/or hospitalisations, or patients who have been diagnosed with severe persistent asthma. These programmes often focus on a few patients who have acute needs, but may not identify the populations with the highest future resource use. A population-based approach to disease management focuses on identifying deficiencies in asthma management across the population diagnosed with the disease and establishes a partnership between the patient, provider and healthcare plan to improve the overall quality of asthma care. The disease management approach described in this article is population-based, and is intended to raise the standard of medical care across a spectrum of patients with asthma.