基层卫生综合改革中医务人员收入满意度比较:基于付出——回报失衡视角

目的在付出——回报失衡视角下分析基层卫生综合改革前后基层医务人员的收入满意度情况。方法采取机构调查和员工调查相结合方式,随机抽取湖北省某区3个乡级医疗机构进行调查。以2014年为基线调查,2015年开展第二次调查。结果两年相比医务人员的基本医疗在增加,每医师日均担负门急诊人次增长0.45%;医师日均担负住院床日数增长8.83%。公共卫生工作量也呈现增长,家庭签约比例显著增加,高血压及糖尿病规范管理人数分别增长63.19%、53.49%,老年人健康管理人数增长14.18%。由于付出与回报失衡,员工收入不满意率高,2014年调查对象不满意率为77.19%,2015年为65.38%。结论基层医务人员付出——回报失衡问题突出,对收入不满意,技术劳务价值尚未在绩效分配制度中得到充分体现。建议:建立基于技术劳动价值的薪酬制度,动态监测工作量变化情况,完善绩效工资制度,实现付出——回报平衡。     

以加速康复外科临床路径体系提升医院内涵质量建设

目的推进基于加速康复外科病种临床路径体系建设,提升医院内涵质量建设。方法通过文献法、小组讨论法、专家咨询法等,制定8个重点病种的加速康复外科临床路径,以信息化整合形成临床路径束。结果此模式可 以降低患者住院日和住院费用,加快床位周转次数,年手术例数相应增加,尤其是三、四级手术量和占比明显增加。结论基于加速康复外科病种临床路径体系建设能够有效优化病种绩效,改善关键疗效指标,提升医院内涵质 量建设。     

内科医师临床技术等级评价探索

目的探索建立深圳市内科医师临床技术等级评价体系。方法通过分析2015年深圳市3家大型公立医院内分泌科、肾内科、心血管内科医师门急诊工作量、出院病历DRGs权重、手术操作RVUs值等,确定3个内科专科的医师临床技术分层分级标准,测算每位医师的技术级别,并与职称比对,探讨内科医师临床技术级别与职称的相关性。结果内科医师临床技术级别与职称相似度为38.02%,其中住院医师符合率86.36%,主治医师符合率29.85%,副主任医师符合率31.34%,主任医师符合率36.11%。结论通过临床技术评价体系反映临床医师的工作量及临床技术水平,更能真实反映内科医师的临床实际能力。     

内科医师临床技术等级评价探索

目的 探索建立深圳市内科医师临床技术等级评价体系。方法 通过分析2015年深圳市3家大型公立医院内分泌科、肾内科、心血管内科医师门急诊工作量、出院病历DRGs权重、手术操作RVUs值等?确定3个内科专科的医师临床技术分层分级标准，测算每位医师的技术级别，并与职称比对，探讨内科医师临床技术级别与职称的相关性。结果 内科医师临床技术级别与职称相似度为38.02%，其中住院医师符合率86.36%，主治医师符合率29.85%，副主任医师符合率31.34%，主任医师符合率36.11%。 结论 通过临床技术评价体系反映临床医师的工作量及临床技术水平，更能真实反映内科医师的临床实际能力。     

基于RBRVS和BSC的公立医院绩效考核与分配体系研究

为改变以收支为基础的传统绩效分配模式，南京市第一医院以RBRVS为核心，以工作量为基础，以BSC为补充，结合医院战略目标，建立了RBRVS-BSC绩效评价体系。经过实践，新的绩效评价模式提升了医院的运营能力，进一步调动了医务人员工作积极性，提高了医院成本控制能力，推动医院向科学化和精细化不断迈进。     

基于RBRVS和KPI的公立医院绩效考核与分配体系研究

基于持续改进理念,结合国家三级公立医院绩效考核指标和医院实际,优化内部绩效考核与分配体系。在坚持公益性基础上,建立以RBRVS为核心,以工作量为基础,以技术难度为标准,以质量考核为重点,以关键绩效指标（KPI）为补充的公立医院绩效考核与分配体系。经实践,新体系进一步调动了医务人员积极性,提升了医院运行效率,且病种结构不断优化,成本管控效果明显,体现了三级公立医院功能定位。     

临床路径实施中医务人员满意度调查及影响因素分析

目的分析医务人员对临床路径的接受程度及行为影响因素,为临床路径的持续开展提供参考。方甚通过查阅文献对医务人员的临床路径依从作定性讨论．结合问卷调查对临床路径实用性、工作模式改变及效果进行满意度测评。结果医务人员对于临床路径的接受程度尚可。且不同年龄、职称的医务人员对工作模式的影响存在显著性差异。结论临床路径的实施加大了医务人员的工作量,有必要建立相对完善的激励约束机制,并依托灵活的信息化手段,促进多学科协作．保障临床路径的顺畅实施。     

基于主诊医师负责制的住院绩效考核模式探讨

目的 建立主诊医师负责制下的住院绩效分配新模式,以适应医药分开改革的新要求.方法 探索基于医疗成果产出的岗位绩效管理考核和分配新制度,重点激励各主诊医师组医疗产出的工作量和工作难度,促使各主诊医师组增加服务量、提高技术水平和诊治疾病的难度.结果 以某科室各主诊医师组为例,从科室管理、团队建设、学科发展、工作效率等角度分析医改前后的转变.结论 重点激励分配制度,逐步被医务人员所接受,并取得较为明显的成效.     

基于病种管理的医师临床绩效评价指标体系构建

目的旨在变革传统的以经验为主的评价模式,建立一套基于病种管理的,具有客观性、可比性、可操作性的临床医师工作绩效评价指标体系。方法采用专家咨询、文献查阅等方法筛选评价指标,运用层次分析法确定指标权重。结果建立了包含3个维度(医疗效率、医疗质量与安全、病种难度与广度)、11个二级指标的医师临床绩效评价体系。结论以病种管理为基础的评价体系可量化比较临床绩效,具有一定创新性。     

基于病种劳务贡献分值的医师住院医疗服务绩效评价研究

目的：基于病种劳务贡献分值,建立医师住院医疗服务绩效评价模型,并进行实证应用。方法：构建病种住院医疗服务绩效评价指标体系,考量医疗服务项目中医师的劳务贡献,建立医师住院医疗服务绩效评价模型。结果：以样本医院为例,通过医师住院医疗服务绩效评价模型得出病种劳务贡献分值,能够科学客观反映医师在病种治疗过程中的劳务贡献。结论：相较于DRG及DIP,基于病种劳务贡献分值的绩效考核能客观、真实反映医师劳务贡献,体现不同病种住院医疗服务的差异性,适用于衡量单位劳务价值。     

How work context shapes physician approach to safety and error

A study was undertaken to examine how different hospital clinical settings compare in their capacity for physicians to attend to safety and employ a learning approach to error. Multiple qualitative methods were used to examine medical residency teams in the emergency department, surgery department, and the medical intensive care unit. The focus was on how physicians responded to errors that occurred and safety-related issues, and what features of the surrounding work context were associated with those responses. Observations of 3 separate medical residency team's everyday work were conducted over three 3-week spans, and follow-up interviews with select team members were conducted after each observational period. Evidence supported that physician capacity for attending to safety and error is shaped by structural features of the surrounding work context within hospitals, as well as the cultural dynamics inherent in physician groups working in a given clinical setting. Compared with the emergency department and surgery, the medical intensive care unit offered the greatest potential from a work setting perspective to have heightened physician attention to safety and error. This was due to its more collegial environment, the low permeability of its doctors and patients, more available physician downtime and group interactions, fewer disruptions, and greater work predictability. The emergency department had less capacity because of its intense workload, excessive disruptions, and high unpredictability of the clinical work found there. Surgery's capacity to deal with error and safety issues was adversely affected by the emphasis on hierarchy among surgeons, the high permeability of surgeons across hospital work settings, emphasis on individual blame when mistakes occurred, and workload. These findings highlight the necessity for health care organizations to conduct regular assessments of their clinical environments to help identify the workplace factors that shape clinician approach to safety and error. It also calls into question the singular, uniform approaches to enhancing quality and safety within health care organizations.     

构建门诊医疗质量管理体系

通过借鉴ISO 9001标准、PDCA循环和Donabedian质量测量模型等理论和方法，根据大型综合医院门诊的属性定位、服务内容及管理特点等，从质量目标、质量策划、质量保证、质量控制以及持续改进等5个维度构建了门诊医疗质量管理体系。该体系的构建促进了多院区门诊一体化管理。截至2018年，医院日均门急诊量较2016年上升11%；急危重症抢救成功率达99.79%；患者预约后平均等待时间较2016年缩短了近20分钟；每万人次投诉率下降至2.2%。门诊医疗质量管理体系有助于提升门诊管理质量，增强患者获得感，值得推广     

医院门急诊患者满意度调查分析

目的了解三级甲等医院门急诊就诊患者的满意度。方法选取某大学三所三级甲等医院,采用自行设计问卷对556名门急诊患者就其对医院服务满意度进行测评。结果患者对医院门急诊环境设施的满意率为91．16％;对就医等候或排队时间的满意率为87．59％;对工作人员服务效率和服务态度的满意率为95．60％;对医务人员医疗行为和技术水平的满意率为93．51％;对服务效果的满意率为95．77％。不同年龄组和文化程度组患者对门急诊的满意率总分比较有统计学意义（P〈0．05）,不同户籍所在地患者对是否愿意再到这所医院就医比较有统计学意义（P〈0．05）。结论总体而言,患者对医院门急诊服务的满意度较高,但仍有许多地方需要改进。①门急诊环境应更加舒适;②就诊环节应更加优化;③医疗费用应更加合理。     

Physician services in an academic neurology department: using the resource-based relative-value scale to examine physician activities.

The inability of physician managers and decision makers to critically analyze the resource utilization of physicians has hindered a more comprehensive understanding of the role of neurologists in the patterns and organization of medical practice. This article outlines an approach for using the physician work relative value units (RVUs) in the Medicare Fee Schedule (MFS) to address this problem and profile physician clinical activities in a comparative manner. These techniques are then used to profile the physician services associated with the neurology department at a large academic hospital. All 28,048 physician services associated with a neurology department in 1995 were studied. Using billing data, physician work RVUs were assigned to each service and the results analyzed by major services, type of service, and physician workload for physician work RVUs and physician charges. For the average service, mean physician charges were $187 per service while median physician charges were $120. Mean physician work RVUs per service averaged 1.3 RVUs, and the median was 0.94 per service. Of all the services provided in the neurology department, 65 percent are visits and consultations, while medicine services (e.g., nerve conduction studies, needle electromyography, neuropsychological testing, and electroencephalogram) make up 31 percent. All the other services combined represented less than five percent of the services in the department. The top five physicians in the department account for 33 percent of all physician work RVUs in the neurology department. Using the physician work relative values in the MFS provides a unique perspective for analyzing and understanding neurologists' work activities.     

2019年全国医疗机构医务人员诊疗过程手卫生监测报告

目的 建立医务人员诊疗过程手卫生监测数据的评价体系.方法 2019年9月1—30日采用手卫生观察员现场调查方法获取综合重症监护病房(ICU)、呼吸内科病区、骨科病区、感染科病区、儿科门急诊、血液透析室医生和护士手卫生执行情况,并统计同期调查科室工作量、手卫生用品消耗量以及医疗机构实际开放床位数,计算手卫生依从率和手卫生...     

Building Knowledge About Health Services Utilization by Refugees

The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.     

大型三甲医院与政府联合举办社区卫生服务中心运作模式分析

大型三级甲等医院与区政府联合举办社区卫生服务中心,缓解医院门诊压力,解决居民看病难问题,同时为出院患者提供延续治疗服务。此模式社区卫生服务中心业务用房和医疗设施设备的配置均由地方政府免费提供,交由医院独立经营管理,服从地方卫生主管部门的行业管理。该中心成立三年以来,随着知晓率不断提升,业务工作量逐年呈现大幅度上升,相当于成都相似规模其它社区卫生服务中心的3倍以上,病人满意度大于99%。三甲医院与区政府联合举办社区卫生服务中心,高水平的基本医疗技术赢得了社区居民的高度信任,极大的提高了中心的知名度,促进了公共卫生服务的开展;公共卫生服务的有序开展进一步提升了中心基本医疗业务的知晓率,促进居民选择就近就医,真正实现了分级诊疗。     

影响县级综合医院门诊量相关因素的分析

目的　了解影响县级医院门诊量的因素 ,为提高县级医院综合诊治水平提供依据。方法　采用随机抽样问卷调查法 ,问卷应答率 94 3%。结果　普通门诊量呈下降趋势 ,专家、急诊工作量呈上升趋势 ;患者择医对医疗水平保障程度、收费价格、知名专科、医院环境认同率提高。结论　加强医院内涵建设 ,发展重点专科、特色医疗 ,改善医疗服务 ,建立良好的医患关系 ,降低收费标准     

Toward an understanding of health services use in women with binge eating disorder

OBJECTIVE: This study examined health services use in community samples of 102 white and 60 black women with binge eating disorder (BED), 164 white and 85 black healthy comparison women, and 86 white and 21 black women with a noneating Axis I psychiatric disorder. RESEARCH METHODS AND PROCEDURES: Participants were matched on age, ethnicity, and education and were asked about their use of emergency room visits, outpatient physician visits for medical care, outpatient psychotherapy visits, and days spent in the hospital over the previous 12 months. Total health services use was computed. RESULTS: There were no between-group differences in outpatient physician visits or inpatient hospital days. Relative to healthy comparison women, women with BED and women with other Axis I disorders had increased total health services use, psychotherapy visits, and emergency department visits. Relative to women with noneating Axis I disorders, women with BED had less use of psychotherapy visits. Although obese white women were more likely to report emergency department visits than obese black women were, nonobese white women were less likely to report emergency department visits than nonobese black women were. DISCUSSION: That health services use by women with BED compared more with that of women with other Axis I disorders than with that of healthy women suggested that BED has clinical significance and is not benign in terms of its impact on the health care system. It appeared, however, that despite the availability of effective treatments, few women with BED received psychotherapy.