以阻抗法实现胃运动功能的测量

介绍一种非侵入性胃运动功能检测系统。该系统胃部体表阻抗的测量,可以同时提取由胃蠕动和胃排空引起的阻抗变化信号,系统以普通个人计算机为基础实现了FIR数字滤波器,能够有效地滤除由呼吸等因素造成的干扰。人体实验表明,胃部体表阻抗的测量能够表征胃的蠕动和排空。另外,前后设置的同心圆电极对胃阻的测量更为有效。     

Variation in 30-Day Readmission Rates from Inpatient Rehabilitation Facilities to Acute Care Hospitals

ObjectivesTo quantify the rate of readmission from inpatient rehabilitation facilities (IRFs) to acute care hospitals (ACHs) during the first 30 days of rehabilitation stay. To measure variation in 30-day readmission rate across IRFs, and the extent that patient and facility characteristics contribute to this variation.DesignRetrospective analysis of an administrative database.Setting and ParticipantsAdult IRF discharges from 944 US IRFs captured in the Uniform Data System for Medical Rehabilitation database between October 1, 2015 and December 31, 2017.MethodsMultilevel logistic regression was used to calculate adjusted rates of readmission within 30 days of IRF admission and examine variation in IRF readmission rates, using patient and facility-level variables as predictors.ResultsThere were a total of 104,303 ACH readmissions out of a total of 1,102,785 IRFs discharges. The range of 30-day readmission rates to ACHs was 0.0%‒28.9% (mean = 8.7%, standard deviation = 4.4%). The adjusted readmission rate variation narrowed to 2.8%‒17.5% (mean = 8.7%, standard deviation = 1.8%). Twelve patient-level and 3 facility-level factors were significantly associated with 30-day readmission from IRF to ACH. A total of 82.4% of the variance in 30-day readmission rate was attributable to the model predictors.Conclusions and ImplicationsFifteen patient and facility factors were significantly associated with 30-day readmission from IRF to ACH and explained the majority of readmission variance. Most of these factors are nonmodifiable from the IRF perspective. These findings highlight that adjusting for these factors is important when comparing readmission rates between IRFs.     

医院计量管理模式的探讨

随着医学科学向前发展,医学计量在医疗工作中的地位和作用明显提高,做好医院计量管理工作尤为重要。本文从医院计量管理的特性、内容和方法,医院计量机构设置模式,计量人员组合,检定工作等几个方面进行了论述。旨在为医院计量管理工作奠定基础。     

外来务工患者住院护理需求调查与对策

目的调查外来务工患者住院需求,以便有针对性地提供相应的护理服务,满足这一特定人群的需求。方法抽取2007年1—12月本院住院患者600例,将外来务工患者300例列为实验组,本地住院患者300例列为对照组,比较2组住院需求方面的差异。结果外来务工患者组发生疾病大部分项目比本地患者偏高,有统计学意义(P0.05);在住院期间需求依次为心理需求、社交需求、获得信息的需求、技术需求、安全需求、态度需求和生理需求等方面。结论外来务工人员住院患者应加强心理和社会的支持,满足患者的信息需求,重视住院安全,提高护理质量,以减低或消除影响健康的危险因素,促进健康和提高生活质量。     

某二级甲等医院剖宫产率调查与分析

目的评估剖宫产率的趋势,发现剖宫产率居高不下原因及解决措施。方法根据某院2009年1月—2013年12月助产技术年度服务报表,按照自然分娩数、剖宫产数等进行统计分析。对该院2014年1-3月入院在没有临床指征前提条件下选择剖宫产分娩的49名产妇,采用自行设计的调查问卷进行问卷调查。结果该院5年的剖宫产率均超过全国平均水平,平均值达到71.40%,且无指征剖宫产比例逐年增高。产妇中因为＂害怕分娩疼痛＂而选择剖宫产的占89.80%,＂选好日期＂这一社会因素也不容忽视。结论作为二级医院,医院应在尽可能的条件下提高医护人员业务水平,解决因技术原因造成的剖宫产率增高,但降低剖宫产率不单单是一个医疗问题,还是一个社会性问题,需要全社会的共同努力。     

医院危机预警体系模型的测算

目的：使用医院危机历史数据测算获得医院危机预警体系模型。方法采用SPSS 16．0统计软件对8家医院的危机数据指标进行分析,使用逻辑回归法进行试算,获取方程。结果模型具有统计学意义,发生危机前30天医院高层管理者行为不当并被媒体曝光（X1）,医院中最高级领导层到与一线工作者之间的管理层级数（X3）,发生危机前30天患者投诉次数（X12）和发生危机前30天媒体负面宣传数（X18）是该模型的基本参数,模型公式为Y＝－5．533＋2．296*X1＋0．811*X3＋0．671*X12＋1．208*X18。结论医院危机管理应注重高层管理者的德行、信息畅通程度、患者满意度和社会公共关系四个方面,也是预测医院危机爆发的重要参考指标。     

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

Objective. To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model.
Data Sources. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002.
Study Design. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors.
Principal Findings. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs.
Conclusions. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.     

医院顾客满意度测评体系研究

本研究从某大型综合性医院的实践出发,对测评体系进行了构建并进行了实证研究。确定了包括感知医疗质量、感知服务质量、便利程度、环境质量和约束条件共5个结构变量的模型,对测量指标进行了界定。     

基于管理改进视角的医院患者满意度测评研究

患者满意度测评对于提升医疗服务质量、减少医患纠纷、构建和谐医患关系具有重要意义,因此,患者满意度测评在医院管理当中得到了广泛的应用.满意度测评具有宏观与微观两个不同的层面,从医院管理的角度来讲,微观层面的患者满意度测评具有重要意义.文章基于医院管理改进的视角,从测评体系的构建、测评方法的选择、测评结果的应用等方面对患者满意度测评进行了探讨,研究结果有助于医疗机构患者满意度测评的开展与实施.     

医院医学计量工作的特点与难点分析研究

通过对军队中心医院医学计量工作开展情况的分析,阐明了军队中心医院医学计量工作的特点与难点,结合实际工作经验及方法．提出了相应的对策,并提出医学计量工作日常化的理念,将医学计量工作纳入到医学工程部门对医学装备全寿命管理的环节当中。     

医院社会责任测量：研究思路和指标体系

在新医改的大背景下,医院社会责任的定量评估对患者、政府和医院自身都有着深远的意义。结合国内外医院社会责任测量方面的研究,明确研究思路之后,对医院社会责任活动的14项内容提出了相应的测量指标。     

军队中心医院医学计量工作流程研究

目的：研究军队中心医院医学计量工作流程。方法：针对军队中心医院医学计量_Y-作的特点与难点,结合实际工作经验．以现有计量法律法规为依据,精简并规范军队中心医院医学计量工作流程。结果：提出了军队中心医院医学计量工作年度工作流程、医学装备质量安全管理流程、医学计量检定工作流程。结论：完善和规范了军队中心医院医学计量工作流程．进一步确立了医学计量工作在医学装备全寿命质量安全管理体系中的地位和作用,提高了工作效率,促进了医学计量工作的执行力度与实际效能。     

Measurement and Validation of Kinetic Parameter Values for Prediction of Biodegradation Rates in Sewage Treatment

Analysis of about 140 oxygen uptake curves from standard biodegradation tests with the electrolytic respirometer yielded growth kinetic parameter values. The maximum observed growth rate, μ_max, on the 52 different substances varied between 1 and 6/day. The measurement of the half-saturation constantK_sat the depletion phase of the oxygen uptake curves appeared problematic. For 24 substances the values were below 1 mg ThOD/liter. Apparently highK_svalues of several tenth mg ThOD/liter for the other 28 substances are explained by retarded mineralization of intermediates due to the relatively high initial test concentrations of up to 300 mg ThOD/liter. At lower test concentrations (down to 15 mg ThOD/liter) the measuredK_svalues for these substances were also typically below or around 1 mg ThOD/liter. Based on the above-mentioned maximum growth rates and the low values forK_s, the predicted steady-state residual concentration of these substances in the effluent of completely mixed sewage treatment plants is between 10 and 100 μg/liter. This level is in accordance with the range of measured values taken from literature. Based on this research and additional data from literature, the separation between readily and inherently degradable can be made at the critical values of μ_max≈ 1.5/day andK_s≈ 1 mg ThOD/liter.     

新疆地区综合型医院门诊医疗服务品质评价指标体系的构建和应用

综合型医院门诊医疗服务品质是新医改时期医疗机构建设与发展的全新课题,而科学、合理地评价医疗机构的服务品质对推进医院自身建设和发展均具有重要意义。研究采用理论研究与实证分析相结合的方法,试图构建一套符合新疆地区民情,体现病人需要与期望的、可信而有效的综合型医院门诊服务品质测评指标体系,为医院医疗服务质量的评价与改善提供客观的测量工具,以便于掌握和分析不同类型患者对医疗机构的服务需求。     

Effects of Cocooning on Coronavirus Disease Rates after Relaxing Social Distancing

As coronavirus disease spreads throughout the United States, policymakers are contemplating reinstatement and relaxation of shelter-in-place orders. By using a model capturing high-risk populations and transmission rates estimated from hospitalization data, we found that postponing relaxation will only delay future disease waves. Cocooning vulnerable populations can prevent overwhelming medical surges.     

公立医院综合绩效奖金计量模型研究——基于RBRVS的本土化应用

以资源消耗为基础的相对价值评价体系(RBRVS)在我国公立医院有三种主要应用模式(点值模式、绩效费率模式、本土化绩效指标模式).随着RBRVS应用的拓展,在本土化应用过程中出现了一些问题,最终体现在RBRVS的具体计量模型上,影响绩效奖金的核算.本文基于RBRVS本土化应用的一般计量模型,结合其它绩效考评工具和辅助措施...