肿瘤患者化疗中2种深静脉置管应用效果及专项护理成本比较

目的 对PICC及颈内静脉置管的实际护理成本与现行收费标准进行对比,证实实际护理成本与现行收费之间的偏差,在此基础上对比两者在肿瘤患者化疗中的利弊.方法 用项目成本阶梯分摊法,对接受PICC及颈内静脉置管患者实际投入的人力、财力、物力进行测量、归集、统计,核算出的实际护理成本并与其现行的收费标准进行对比；分析其成本及临床应用价值.结果 PICC实际成本(2259.99±30.99)元与现行收费标准1532.79元差价为-727.20元,颈内静脉置管实际成本(393.86±33.93)元与现行收费标准292.13元差价为-101.73元；PICC后并发症发生率为12％,颈内静脉置管为17％.HCC及颈内静脉置管实际专项护理成本大于现行收费价格,PICC的单次护理成本是颈内静脉置管的5.74倍,以一年4～6个化疗疗程计算,PICC护理成本与颈内静脉置管总成本(1年内)比较无显著差异,并发症发生率比较无显著差异.结论 临床应用PICC的优点多于颈内静脉置管,应优选PICC,次选颈内静脉置管.     

急诊ICU一级护理服务项目单项成本研究

目的:探讨急诊ICU一级护理病人10项基础护理单项成本核算,为合理调整医疗护理收费项目提供可靠依据,推进医院护理成本核算的科学化管理。方法:根据1998年《深圳市医疗收费标准》中的一级护理服务标准,应用项目阶梯成本分摊法对10项基础护理服务进行测算,对比现行的一级护理收费标准。结果:一级护理10项基础护理项目总成本为127.93元,其中人力成本53.55元,占总成本的41.85%;材料成本38.66元,占总成本的30.21%,现行的一级护理收费标准10元/天,仅是实际成本的7.8%。结论:医院护理服务价格严重偏离护理成本,建议相关部门重视护理项目合理收费,使护士劳动价值得到应有的补偿,体现护士的劳动价值。     

护理服务单项成本核算的研究

目的核算护理项目的成本,探讨成本核算的方法,提出成本管理的建议.方法按单项成本核算的方法,对护理项目的各成本构成及总成本,各成本要素在总成本中所占比例,护理项目成本与收费情况进行核算、比较.结果人力的投入与消耗在总成本中所占的比例最高,与护理工作相关的收费项目少,护理服务的收费与成本不相符.结论只有真正地描述护理过程中劳动耗费发生的实际情况,才能为制定护理收费标准提供依据,使护理成本得到合理的补偿,使护理价值为全社会所承认.     

慢性伤口专项护理服务成本的研究

目的 对慢性伤口专项护理实际成本进行核算,与现行收费标准进行对比,证实其偏差,为卫生行政部门及物价部门制定合理收费价格提供客观依据.方法 对慢性伤口护理服务各项成本构成进行测量、记录及归集,用项目成本阶梯分摊法进行核算.结果 单次慢性伤口护理的实际成本为(29.42±9.29)元,是现行收费(12元)的2.5倍.结论 慢性伤口专项护理收费标准严重偏离护理成本,不能体现护士进行专项护理的劳动价值.     

风险管理在急性白血病患者PICC护理中的应用

目的探讨风险管理在急性白血病患者PICC护理中的应用与效果。方法成立风险管理小组,回顾性分析PICC置管及维护中的风险因素,有针对性地制订并实施急性白血病患者PICC置管及维护的标准操作流程,对护士进行风险管理培训,提高护士风险识别和风险评价能力。结果降低了PICC置管期间静脉炎、导管堵塞、导管脱出、导管破损、导管感染的发生率(P0.01或P0.05)。结论实施PICC置管及维护风险管理,可以减少置管过程中的各类风险因素,为患者提供安全的护理服务。     

静脉输液实际消耗成本核算研究

目的:准确核算滨州市公立医疗机构静脉输液实际消耗成本,为制定合理的护理项目收费标准提供数据支持。方法:采用便利抽样方法,分别选取滨州市一、二、三级公立医疗机构各一家,收集其2010年的相关资料;运用项目成本核算法测算样本公立医疗机构不同途径静脉输液的实际消耗成本,分析成本构成并比较与政府定价的差异。结果:样本公立医疗机构静脉输液实际消耗成本为:三级普通钢针途径为25.46元、留置针途径为24.54元、PICC途径为36.87元、CVC途径为35.88元;二级普通钢针途径为19.80元、留置针途径为19.39元;一级普通钢针途径为15.55元。与政府定价之间的差距为12.60～30.87元,成本补偿率为11.78%～30.94%;分析其成本构成,占总成本比例最高的是护理人力成本,为39.05%～53.25%。结论:静脉输液实际消耗成本与现行收费标准差距悬殊,建议相关部门在项目成本科学核算的基础上,合理调整静脉输液收费标准。     

PICC规范化培训在临床护理中的应用

目的:评价PICC规范化培训在临床护理中的应用价值。方法:成立PICC护理学组,进行PICC置管及维护等相关知识的理论及操作培训和考核,比较培训前后PICC一次置管成功率、相关并发症发生情况及患者满意度等指标。结果:规范化培训后PICC一次置管成功率、患者满意度提高,发生导管堵塞、脱出及静脉炎、静脉血栓、导管感染的比例均降低(P<0.05,P<0.01)。结论:PICC规范化培训可有效提高PICC的护理质量,保证患者安全。     

延续护理对PICC带管出院患者的效果

目的探讨延续护理在出院PICC带管出院患者中的应用价值。方法选择2015年6月～2016年6月常规护理的80例PICC患者作为对照组,2016年7月～2017年6月90例延续护理患者作为观察组。对照组患者给予常规的PICC导管维护,观察组实施延伸护理服务,包括成立PICC置管延续性护理小组、建立PICC置管患者健康档案、制定PICC置管延伸护理内容、开展多形式延伸护理。干预后,评价2组患者PICC置管知识掌握情况、定时PICC导管维护率、PICC留置时间、护理满意度、PICC并发症等。结果观察组PICC置管知识评分为(22.34±3.38)分、定时PICC导管维护97.77%、PICC留置时间(142.35±18.45)d、护理满意度评分为(94.34±3.22)分,高于对照组的(16.37±4.46)分、85.00%、(98.35±17.48)d、(87.38±5.54)分,均P0.05),差异有统计学意义;PICC并发症2.22%低于对照组的11.25%(P0.05)。结论对PICC带管出院患者开展延续护理符合医学模式改进的要求,护理人员的服务地点从医院扩展至家庭与社会,有利于患者掌握PICC的相关知识,帮助患者正确维护PICC导管。     

ICU患者3种呼吸模式下口腔护理的项目成本研究

目的对ICU患者3种呼吸模式下的口腔护理进行项目成本核算,为制订合理收费标准提供参考。方法选择197例ICU患者,其中经鼻气管插管(A组)67例,经口气管插管(B组)65例,无气管插管(C组)65例,采用项目成本阶梯分摊法分别对3组患者口腔护理项目的成本费用进行核算。结果 3组患者的口腔护理实际成本均高于现行收费价格,3组患者口腔护理用时不同,其中人力成本费偏高,间接成本被忽视。结论口腔护理实际投入护理成本与现行收费价格严重偏离,有待按实际成本调整收费价格,以体现ICU护士的口腔护理服务价值。     

三级甲等医院分级护理成本核算与分析

目的：核算我院分级护理服务项目实际成本,分析不同护理级别之间成本的变化,对比不同科室之问等级护理收费实际成本与现行分级护理收费的差异,为制定合理的分级护理级别收费标准提供参考依据。方法：采用护士长问卷咨询法、现场调查法,选择有代表性的5个科室,应用项目阶梯成本分摊法对服务项目3个护理级别进行测算。结果：一级护理成本（57．08±12．21）元／d,二级护理成本（27．54±10．21）元／d,三级护理（16．64±7．21）7元／d;不同病区分级护理成本不同,均存在明显的差异。结论：现行的分级护理成本与实际成本存在明显差异,护士的劳动价值不能充分体现,等级收费标准有待改革。     

Cost assessment of headache in childhood and adolescence: preliminary data

Headache, and in particular migraine, is a common disturbance in childhood and adolescence. The disabling nature of headache, evident in the adult, together with its effects on family life and reduction in performance of scholastic activity, make it a disease with an elevated social economic impact. We present preliminary results of a prospective study conducted over 6 months on a population of headache sufferers in childhood and adolescence who referred to our Juvenile Neuropsychiatry Centre of the Hospital of Perugia. Our objective was to quantify the direct and indirect costs associated with juvenile headache.     

Outcome and costs of intensive care

A retrospective follow-up study was performed on 238 consecutive admissions in the surgical ICU. The patients were grouped into four categories according to the therapeutic intervention scoring system: 14 in class I, 13 in class II, 81 in class III and 130 in class IV. The mortality rate during their stay in the ICU (5.4%), after discharge from the ICU (2.1%) and 2 years after discharge from the hospital (7.6%) was estimated. The functional state after discharge from the hospital showed that 74% of the patients resumed their normal work, 10% were handicapped but self-reliant, and 1.3% were dependent on others in order to pursue their daily activities. Fifty-two percent of the total hospitalization costs were generated during the ICU stage which accounted for 17.5% of the hospitalization period. Sixty percent of the total financial investment was spent on the group of survivors who resumed normal work. The mean cost per was $ 7095 or $ 1 per survivor per day of active life over an average span of 15 years survival after discharge from the hospital.     

不同健康教育模式对糖尿病患者相关费用影响的效果分析

目的 评价短期集中强化糖尿病健康教育加后续的网络化随访对糖尿病患者费用水平的影响.方法 将83例糖尿病患者随机分为实验组41例和对照组42例分别采用短期集中强化糖尿病健康教育加后续网络化随访和传统的分次糖尿病健康教育的方式进行健康教育,在健康教育后3,6,12个月后分别评价2组患者的糖尿病相关费用水平.结果 干预后1～3个月实验组糖尿病患者的保健品费用显著低于对照组,干预后4～6个月实验组糖尿病患者的检查费用显著高于对照组.结论 短期集中强化的糖尿病健康教育短期内不改变糖尿病相关费用的月平均总额,改变费用构成比.     

Cost Analysis Related to Dose-Response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes From a Randomized Controlled Trial

Objective

The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

Methods

We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

Results

Lost productivity accounts for most societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P = .03), greater disability (P = .01), lower quality-adjusted life year scores (P = .01), and higher costs in the period preceding enrollment (P < .01). Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P = .03) and19.8 disability-free days (P = .04). No statistically significant group differences in quality-adjusted life years were noted.

Conclusions

A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.     

护理服务价值与价格背离的分析与思考

目的 研究护理服务价格与价值的关系以及对护理学科发展的影响.方法 按照中国行政区域划分随机抽取7个省市,对护理服务项目价格标准进行描述性分析,并将部分项目进行成本回收率的对比.结果 护理服务收费项目设置不够合理,成本回收率普遍偏低,定价缺乏核算依据.结论 提高对护理服务经济价值的认识,建立科学的护理成本核算体系,促进护理学科的可持续发展.     

Are web-based questionnaires accepted in patients attending rehabilitation?

Purpose: The aim of the present paper was to study preferences for web based self-administered questionnaires (web SAQs) vs. paper-based self-administered questionnaires (paper SAQs) and to evaluate the feasibility of using web SAQs in patients referred to cardiac, lung, occupational and cancer rehabilitation programs.

Methods: The patients were approached by mail and given the choice to answer the compulsory SAQs either on paper or on a web-based platform.

Results: Hundred and twenty seven out of 183 eligible patients (69.3%) were willing to participate and 126 completed the study. Web SAQs were preferred by 77.7%, and these patients were significantly younger, more often cohabiting and tended to have higher level of education than paper SAQ users. Mean number of data missing per patient was less among the web SAQ users than the paper SAQ users (0.55 vs. 2.15, p?Conclusions: Web SAQs were well accepted among the patients scheduled for rehabilitation, led to less missing data and considerable cost savings related to human resources. Patients referred to rehabilitation should be offered the choice to complete self-administered questionnaires on internet platforms when internet access is common and available.

• Implications for Rehabilitation

• The high acceptability of web-based self-administered questionnaires among rehabilitation patients suggests that internet platforms are suitable tools to collect patient information for rehabilitation units.

• Web-based modes of patient data collection demonstrate low number of missing data and can therefore improve the quality of data collection from rehabilitation patients.

• Use of web-based questionnaires considerably reduces administrative costs of data collection in rehabilitation settings compared to traditional pen and paper methods.

     

A blueprint for transforming stroke rehabilitation care in Canada: the case for change

Teasell RW, Foley NC, Salter KL, Jutai JW. A blueprint for transforming stroke rehabilitation care in Canada: the case for change.Stroke is a major source of disability in Canada and other developed countries, which carries with it a high toll in terms of personal suffering for the stroke survivor and their family in addition to the associated economic costs. Despite the impressive body of evidence describing effective and feasible stroke rehabilitation practices, stroke survivors, their families, and health professionals currently do not benefit from a rehabilitation system that is well organized and evidence based. Using the principles of best evidence, we make the case for needed changes to the current system based on 5 processes of care known to be important in the pursuit of optimal outcomes: (1) admission to specialized stroke rehabilitation units, (2) early admission to stroke rehabilitation units, (3) intensive stroke rehabilitation therapies, (4) task-specific rehabilitation therapies, and (5) well-resourced outpatient programs. Implementation of these strategies will be expected to result in improved functional gain, fewer complications, decreased mortality, and reduced need for institutionalization. In addition to providing improved care for both the stroke survivor and their family, evidence-based stroke rehabilitation care is more efficient and may reduce costs. Our experience in Canada suggests that instituting these 5 measures alone will result in significant improvements to the health care system.     

Comparative cost analysis of inpatient integrative medicine—Results of a pilot study

BackgroundCosts of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs.MethodsData from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests.ResultsIn total 1253 inpatients (81.4% female, 61.1 ± 14.4 years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly.ConclusionModern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment.