男科实验室质量保证和质量控制

质量保证(QA)和质量控制(QC)是所有实验室进行检测分析的基础。与其他医学学科相比,研究者最近才认识到男科实验室需要有QA和QC。此外,有证据表明,一些医生并不完全赞成尚需进行QA和QC的努力。然而,由于QA和QC是质量管理实施过程的中心环节,评审机构和监管部门越来越需要实验室制定有效的QA和QC措施。随着《世界卫生组织人类精液分析实验室技术手册》第5版的出版,该手册推荐的实验方法学已有相应的修改,现行的QA和QC体系也需作出一定程度的更新,以适应新的变化和要求。主要讨论该手册在3方面的变化,即:①建议根据精液质量推测体积。②精子活力等级由原来的4级改为3级。③将精子形态的参考值下限定为4%(95%CI为3%~4%)。还讨论了QC及QA在所有男科实验室检测中的重要性,包括即将开展的评估精子DNA完整性的实验。同时,阐述对从事男科学检验工作人员开展充分的初级培训与专业继续教育的必要性。     

病房重点病人管理系统与质量保证

总结回硕了北京积水潭医院十几年来建立病房重点病人管理糸统的做法及效果,实践证明,实施病 房重点病人管理不仅明显减少了医疗差错事故,在开展质量保证,提高医疗服务质量方面也起到了极为重要的作 用。提出病房重点病人管理系统是医院质量保证的重要管理系统。     

Quality of care assessment of public and private outpatient clinics in Metro Cebu,the Philippines

Despite large investments in primary health care in developing countries, evaluation of the quality of services has been neglected. Managers need information on service quality to identify specific ways to improve health-care delivery, and to determine how health programs can achieve their desired effects. We tested several quality-assessment methods in 48 public and private outpatient clinics in Metro Cebu, The Philippines. Structured observations of immunization sessions and clinic logistics highlighted functional problems at particular clinics that contributed to shortages of vaccines, sterilized needles and oral rehydration salts (ORS). Quality assessment of medical records for the treatment of diarrhea revealed a wide variation in the recorded quality of services. Clinical case histories were presented to public and private providers, who advised different approaches for case management, highlighting areas where improvement is needed. For example, public providers were more likely to use ORS to treat dehydration; private providers were more likely to enquire about symptoms of dysentery. Private providers were more likely to treat a mild respiratory infection with antibiotics, but few providers were likely to prescribe antibiotics for a child with signs suggestive of severe pneumonia. Advice to mothers was insufficient in most areas. These quality-assessment methods can be used by managers to develop training curricula and solve problems in the delivery of primary health-care services.     

承德市疾病预防控制机构实验室的质量保证

探讨疾病预防控制机构实验室质量保证措施,保障检测结果准确、可靠。建立完善的质量管理体系是质量保证的关键所在。对影响质量要素（人员、仪器设备和标准物质、样品、检测标准、检测环境、记录和检验报告等）及结果开展质量控制。才能使质量管理体系持续有效运行,检测能力和水平不断提高,检测数据准确、可靠。     

From Cottages to Condos

The home health care industry has under one a dramatic period of growth since the passage of Medicare (Title XVIII of the Social Security Act) in 1965. This growth has occurred in both the expansion of the total number of Medicare-certified agencies providing care, as well as the number of clients served and hours of care provided. It has been suggested that the single most important factor in this market expansion was the inclusion of a home care benefit in the original Medicare legislation, thus making it possible for nonprofit home care agencies to rely on a predictable source of government reimbursement. This paper explores the influence that amendments to the Medicare legislation slnce 1980 have had on market expansion, as well as other federal, state and private policy initiatives that have also influenced this growth. The authors sugest that overall growth does not equate with improved access or availability of needed services in the home for the frail and functionally-impaired elderly. Research findings from the first year of a three year study designed to document the impact of cost containment policies on community-based care for the elderly are reported in summary form to illustrate the authors position.     

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England.

METHODS

Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates.

RESULTS

Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15).

CONCLUSION

Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.     

X刀的物理参数测量及质量保证

介绍我院用现有直线加速器开展X刀的经验 ,叙述了相关物理参数的测量方法及结果 ,讨论了质量保证的有关问题。物理参数的测量值均达到X刀治疗的质量控制要求     

Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence

Background: Clinical Practice Guidelines (CPGs) are prominent tools in evidence‐based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. Methods: This narrative review examines the health‐related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? Results: Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. Conclusions: By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided.     

Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial

Objective. Depressive disorders are of great medical and political significance.Although evidence-based guidelines have been published and educationalinitiatives have been launched to implement them, they are rarelyactually used. The aim of the study was to implement clinicalpractice guidelines for outpatient care of depression usinga practice-oriented and interdisciplinary approach. Design. Controlled clinical trial with a naturalistic design (data collectionwithin routine practice) designed as a prospective pre-poststudy. Setting. Outpatient care. Participants. 29 general practitioners (intervention: 18; control: 11) and15 psychiatrists (intervention: 11; control: 4). Overall, thetreatment of 698 patients (two samples: pre: 361; post: 337)was documented. Intervention(s). Multifaceted intervention combining benchmarking, continuousmedical education and interdisciplinary quality circles forthe diagnosis and treatment of depressive disorders. Main outcome measures. Mixed-effects regression models for cluster-adjusted analysisof patients' symptom reduction. Results. Although physicians in the intervention group improved theirclinical effectiveness (proportion of patients with response/remission)to a greater extent than physicians in the control group (intervention:48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysisfailed to prove a statistically significant effect of the interventionon the treatment outcome. Conclusions. Although no statistically significant improvements were foundregarding the outcomes, the action programme provides importantwork, materials and results for an integrated treatment modelfor depression.     

The development of the Primary Care Clusters Multidimensional Assessment (PCCMA): A mixed-methods study

A strong primary care (PC) system is essential for an efficient and high-quality healthcare service. Many countries have adopted a model of PC that encourages different healthcare providers to work together, at scale, in multidisciplinary/multiagency teams (PC clusters). The aim of the present work was to develop a quantitative instrument for the systematic and comprehensive assessment of PC clusters. This was a non-experimental, mixed-methods study grouping four work packages (WP), and involving PC cluster leads and a wide range of key stakeholders from across Wales. Interviews with 22 PC cluster leads (34 %) investigated the clusters' functioning (WP1). A systematic review identified relevant PC assessment frameworks and instruments (WP2). An expert group reviewed the evidence and drafted the new assessment tool, further evaluated and amended in two stakeholder workshops (WP3).Thirty-eight cluster leads (62 %) completed the newly developed online assessment (WP4). The final instrument consisted of 53 indicators, across 11 systemic dimensions of PC and produced a comprehensive assessment of the functioning of PC clusters in Wales. This rigorous early development of an innovative instrument to evaluate PC at a scaled-up (cluster) level (particularly in the format of a 360-degree assessment) can inform healthcare policy decisions regarding the expansion and ongoing adjustment of the model in response to local needs and challenges.     

Clinical Quality Performance in U.S. Health Centers

Objective

To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.