The changing private practice environment: how to analyze opportunities

The search by physicians for opportunities to improve the short-term performance and long-term value of their practices has resulted in the creation of a range of affiliation and group practice structures and changed the traditional private practice profile. The resulting ability to structure an environment that is optimal for each practitioner or group of practitioners can enhance the delivery of medical care and serve to attract an array of individuals to private practice. In order for this evolution to be successful, however, the entities must be developed with thoughtful and detailed analysis and should be flexible enough to adapt to the continually changing environment.     

The teaching of health statistics: meeting the needs of a changing practice

The findings of the study did support the faculty's hypotheses. First, only 50% of the hospitals retain responsibility for the statistical function. This finding was, however, affected by the size of the hospital, with 100% of the hospitals of 400 beds or less retaining such responsibility. Second, the findings showed that only 12.5% of the hospitals had entirely manual statistical systems. However, 50% of the hospitals did compile some statistics manually, including the daily hospital census and discharge service statistics. Finally, in looking at the UT Memphis statistics curriculum and those of 14 other medical record administration programs in the Southeast, the hypothesis that curricula did not mirror this changing practice was confirmed. Although 100% of the programs surveyed had students memorize statistical formulas, only 36% had students working with computers in the statistics course. Of the 14 programs, only 6 specifically covered QA of statistical data in the statistics course, and 9 did not deal at all with how to assess the adequacy of policies and procedures for gathering statistical information. As a result of these findings, UT Memphis has modified its statistical course to increase the emphasis on computerization, QA, and assessment of statistical policies and procedures. These changes will better prepare the UT Memphis graduate for the statistical responsibilities that they will face in the workplace.     

我国公立医院治理改革的挑战与解决思路

公立医院治理是关于政府作为所有者和监管者与公立医院管理者之间的职责、权利和义务的制度化安排。我国公立医院治理改革面临的主要挑战是:对改革方向的认识不统一和操作路径不清晰;改革的动力不足;存在公共治理与公司治理的认识误区;公共治理的社会参与发展薄弱;管办分开和政事分开的操作思路尚未厘清;公立医院治理改革的外部环境不配套。推进改革需要明确公立医院组织变革的最终目标;下一步应大力推进相关配套改革;推进公立医院公益事业法人治理改革试点;启动事业单位组织变革的立法程序。     

Health 2.0: how interactive Web sites are changing the healthcare industry

Having a Web site is no longer a luxury or perk for your practice and your patients. A Web site is a basic necessity that patients are expecting firom their physicians and their practices. But patients want more than a mere Internet presence. They are expecting an interactive Web site, and they want to be able to communicate with the practice and the physicians. This article will discuss the creation of an interactive Web site and why it is necessary for doctors to enhance their Web site so that patients can interact with the practice.     

Quality assurance for clinical research: challenges in implementing research governance in UK hospitals

The oversight of clinical research in the UK is currently in a state of flux. Discusses the quality assurance problems that have arisen in the management of research and the protection of the rights of human participants. Contrasts clinical governance and regulatory approaches to research quality assurance and performs a critical analysis of the Department of Health (England) Research Governance Framework (RGF) to see where it falls within the continuum. Highlights the implications for UK hospitals engaged in clinical research through the presentation of a case study in implementing the RGF. Concludes by suggesting the priority areas that need to be addressed and invites further debate regarding the merits of a clinical governance or regulatory approach to research quality assurance.     

临床营养如何面对未来

本文是Wilmore教授为纪念Rhoads教授,在美国第十三届肠内肠外营养学会议上的发言.作者简单回顾了22年来临床营养的发展史,阐述了新科技成果对临床营养学三个方面所产生的影响(调整机体对疾病或治疗的反应性、提供组织特殊需要的营养基质、应用生长因子);并鼓励我们勇于面对新技术的挑战,共同探讨一些尚未解决的问题.显示了营养支持已成为医学领域中一个不可缺少的组成部分.     

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care.

Design: Qualitative case studies using semi-structured interviews and documentation review.

Setting: Twelve purposively sampled PCG/Ts in England.

Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members.

Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts.

Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment).

Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

     

Chronic pain: treatment barriers and strategies for clinical practice

BACKGROUND: Chronic pain is a clinical challenge for the practicing physician. Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief. Patient-related barriers, such as lack of communication and unwarranted fears of addiction, further complicate pain assessment and treatment. The health care system itself can hinder pain relief through practical constraints in the community and fear of regulatory scrutiny by the physician. METHODS: Information was gathered by doing a literature search, collating clinical information from practice and additional research findings from national meetings, and reviewing the Bulletin of the American Pain Society. Key search terms included "pain," "chronic pain," "pain management," "pain assessment," "pain treatment," and "barriers to pain management." RESULTS AND CONCLUSIONS: Concrete steps for the clinician engaged in the treatment of chronic pain include selection and administration of an effective opioid, dose titration, short- vs long-acting opioids, opioid rotation, ongoing assessment, and consideration of patient preferences. In addition, communication, coping behaviors, and pain education play important roles in the pain equation.     

Improving clinical practice guidelines for the 21st century. Attitudinal barriers and not technology are the main challenges

Through the use of three scenarios, this paper presents the challenges for clinical practice guidelines in the 21st century. Such challenges relate to technological developments to improve the efficiency and pace of the development process, to ensure that clinical practice guidelines are kept up to date, and to facilitate implementation of guidelines in the clinical setting. To improve and ensure the validity of the content of clinical practice guidelines, we need to address the important problem of publication bias, for which researchers, granting agencies, industry, and journal editors share responsibility. This means insisting on registration of trials at their inception, and incentives backed up by rules for funding and peer review publication that would promote behaviors to avoid publication bias. The more difficult challenges for clinical practice guidelines relate to what are referred to as attitudinal factors. To achieve optimal efficiencies in development and maintenance of clinical practice guidelines, we need to promote cooperation among various information resource providers internationally and to stress partnership over leadership. Finally, there need to be reconciliation of the different stakeholder perspectives of the value and purpose of clinical practice guidelines so that they are used appropriately as aids to decision making and are not abused as tools for controlling clinical practice.     

Securing busy hospital garages and lots in urban centers: how four hospitals and a medical school are meeting today's and tomorrow's challenges

Parking lots and garages, besides being by definition targets for auto theft and break-ins, like emergency rooms record a proportionately higher number of incidents of a serious nature compared to other hospital areas. These include burglaries, robberies, and assaults. Whether the parking facilities are located in high-traffic urban centers or are providing services that attract victims of serious crimes, the need to maintain and upgrade parking security is a high priority for the hospital security executives interviewed for this report. Here, they give details on the steps they are currently taking or plan to take to provide round-the-clock protection for a wide range of parking patrons--patients and visitors as well as doctors, nurses, other employees, and students.     

Integrating security in multiple, remote, and diverse facilities: how major health systems are meeting today's and tomorrow's technological and organizational challenges

As the trend to mergers and diversification of healthcare facilities grows, so too does the challenge to security directors to effectively and efficiently protect not only acute care, emergency, and outpatient facilities, but physician office buildings, parking garages, long-term-care units, medical schools, technical service units, and even health clubs. Besides the different security and communications problems posed by each type of facility, the problem of distance between facilities and their geographic location must also be met. In this report, we'll update you on the approaches being taken by security and planning executives at three leading health systems and how they are dealing with current and future problems.     

Using patient-reported outcomes in clinical practice: challenges and opportunities

Purpose

Introduce and explore issues at an international conference about the use of patient-reported outcomes (PROs) in clinical practice.

Methods

Review of salient literature, clinical and personal experiences, conference presentations and discussions, and post-conference comments from outside experts.

Results

PROs (information from patients about a health condition and its management) have been assessed through self-reports for at least four decades. Traditional applications are in clinical and health services research. Uses in clinical practice, although increasing, are less common and more challenging. PROs can enhance the understanding of patients’ experiences and responses to therapy and inform clinical practice.

Conclusions

We pose and discuss four main questions: (1) Will clinicians accept PRO measures? (2) Will clinicians use PRO measures? (3) Will measuring PROs actually improve those outcomes? (4) Will PROs be perceived as having other, less salutary purposes? A patient-centered perspective on PRO measurement presents issues about the extent to which PROs can accurately capture patient experiences and assess psychosocial and environmental factors that influence communication with clinicians and eventual outcomes. We end with comments about the intersection of PROs and bioethics, noting contributions that PROs may make to beneficence, patient autonomy, and distributive justice.