河北省卫生资源配置标准编制的理论与方法

卫生资源配置标准编制的关键是针对卫生资源配置现状、存在问题，确定科学的编制理论与方法。只有在科学的理论与方法指导下，进行测算与编制，卫生资源配置标准才能符合实际，具有可行性，便于操作。     

公共卫生决策数据元概念框架的研究

目的建立公共卫生决策数据元（指标）概念框架,确定框架的维度、子维度及其关联关系。方法应用文献分析法和概念分析法确定概念框架的结构、维度和子维度。概念框架是建立在健康影响因素模型的基础上,总体框架遵循科学性、实用性、关联性、系统性和可扩展性的5个原则。维度和子维度的确定依照概念化、目标化、独立性和数目不宜过多的4个原则。维度间的关系则根据公共卫生的特点和公共卫生理论确定。结果提出了健康结果、非医学健康因素、公共卫生系统绩效、公共卫生系统资源、社区特征和保障体系5个维度和20个子维度组成的概念模型,并说明了维度间的相互关系。健康结果维度包括健康状态、人体功能和死亡3个子维度;非医学健康因素的4个子维度是健康行为、生活和工作条件、个人资源和环境因素;公共卫生系统的绩效包括有效性、可及性、效率、安全性和反应性;公共卫生资源包括机构资源、人力资源、财政资源、设施资源和信息资源;社区特征和保障体系维度由社区特征、公共卫生政策法规和保障体系组成。结论作为对公共卫生系统的抽象,概念框架全面地反映了公共卫生系统的组成和复杂的公共卫生过程。可指导公共卫生系统指标体系、乃至公共卫生信息系统的建立。概念框架与以结构、过程、条件和结果所组成的卫生服务质量评价模型相吻合。     

The California Clinical Data Project: a case study in the adoption of clinical data standards for quality improvement

The California Clinical Data Project is a statewide initiative to remove barriers to the widespread and effective use of information technology to improve chronic disease care. The project is a case study in the development and widespread adoption of clinical data standards by varied and often competing stakeholders. As an initial step, the project defined precise data standards for the batch reporting of pharmacy claims data and laboratory results data. These uniform standards facilitate the flow of existing electronic clinical information into disease registries and electronic health record systems. Pharmacy and lab results data now are being exchanged electronically with this standard among the largest health plans, medical groups, and clinical laboratories participating in California's pay-for-performance programs. Lessons from this project may apply to the development and adoption of data standards for other states and locales and for the emerging national health information infrastructure.     

From benefits evaluation to clinical adoption: making sense of health information system success in Canada

This article proposes a Clinical Adoption Framework for making sense of health information system (HIS) success in Canada. It extends Canada Health Infoway's Benefits Evaluation Framework with contextual factors that influence HIS adoption by clinicians, which include people, organization, implementation, and the macro environment. Our hypothesis is that successful clinical adoption of an HIS requires explicit recognition, strategies and actions that address the factors described in the framework. Validation of this framework by stakeholders and literature has thus far been favourable. Its potential application with selected evaluation approaches in specific settings, the implications and work ahead are discussed.     

The adoption of complementary and alternative medicine by hospitals: a framework for decision making

As a result of increased consumer awareness, personal preference, and limitations of conventional medicine, many individuals are turning to complementary and alternative medicine (CAM). In response to this movement, many community hospitals are striving to be innovative providers. Society is leaning toward a more comprehensive style of healing that incorporates all aspects of wellness. During the last three decades, the public has increasingly used CAM. Arnold (1999) cited a study published in the Journal of the American Medical Association that reported that 39 million people sought either advice or treatment from a CAM provider and 42 percent of Americans used some form of alternative therapy. With the population becoming increasingly educated, aware, and proactive about wellness, many Americans see CAM as an effective alternative to traditional medicine. Healthcare organizations have responded, although slowly, to this trend, as new alternative medicine clinics, hospital departments, and research centers emerge throughout the United States. Although alternative medical practices are being used by an increasing number of people, there is still limited understanding of what CAM includes and how it influences health services organizations. Understanding this new market and its implementation in the healthcare setting is of interest to healthcare administrators. This article defines CAM, discusses its rising popularity, identifies its adoption in today's hospitals, and depicts barriers to its implementation. Finally, an analytical framework developed by the author is used to suggest factors for administrators to consider in CAM implementation in their organizations.     

Public health, data standards, and vocabulary: crucial infrastructure for reliable public health surveillance.

The present, rapid adoption of electronic records in clinical care is likely to shift public health surveillance from passive, human-mediated abstraction to active, computer-generated reports. However, the accuracy and efficiency of this process depends upon the adoption of consistent information standards from beside to population and the relevance of these data to public health. This article outlines the current status of data standards of relevance to public health and expands upon the ideal goal state in which health information would be collected once and then reused for multiple health-related purposes, including public health surveillance.     

High-level adoption of electronic health records

The adoption of electronic health records (EHRs) is now a national priority, but evidence shows that the level of typical adoption is low. We describe the goal of "high-level adoption" of an EHR system defined as a community of clinicians using an EHR system to share patient information, and create a summary of a patient's health, through the timely documentation of care, as well as through effective communication among caregivers, with a focus on patient safety and efficient use of resources. There are 10 key principles to achieving high level-adoption. These are: (1) shared medication lists; (2) shared patient problem lists; (3) established guidelines for communication about patient information among clinicians; (4) use of standard terminology; (5) preventive services; (6) integration of external data; (7) computerized provider order entry; (8) regional health information exchange; (9) adoption of clinical decision support; and (10) reuse of data for public health and research.     

The use of volume standards in health services

The ways in which volume standards are implemented by health services organizations are not clear. Therefore, the authors sought to evaluate the extent of use of volume standards, the purposes for which such standards were developed, and the sources of the standards in a sample of health services organizations. The authors found that volume standards were used widely by accrediting organizations, professional societies, and hospitals in their sample, but almost never by health maintenance organizations. Volume standards were used for ensuring adequate experience among residents, providing guidelines to residency programs, and privileging and credentialing physicians. Expert consensus appeared to be the usual source of volume standards.     

The hospital community benefit standards program and health reform

This article suggests that the community hospital can be an important key to health reform at the local level; that community benefit guidelines are acceptable to hospitals and community leaders in a 49-site national demonstration program; and that these guidelines can prove useful for communities in moving toward health reform. Types of community involvement by hospitals are categorized, and examples of each type are developed. Community benefit programs can be a promising approach to effectively respond at the local level to the problems of poor health status, lack of access to care, and increasing health care costs. Addressing financing of care without attention to changes in the delivery system will not lead to effective health reform.     

The relationship between the stages of exercise adoption and other health behaviors

PURPOSE: To examine the relationship between stage of exercise adoption and the practice of other health behaviors. DESIGN: Demographic, socioeconomic, and health behavior data were collected using a cross-sectional mail survey. Data were collected as part of a larger employee benefits research study. SETTING: Montana State University-Bozeman, Bozeman, Montana. SUBJECTS: University employees (n = 1269) comprised of 46% men with a mean age of 44 years. MEASURES: Demographic and socioeconomic data included age, sex, marital status, level of income and education, dependent status, and job classification. Stage of exercise adoption classifications were based on self-reported responses to four exercise statements. The health behaviors included in this study were cigarette and smokeless tobacco use, seat belt use, alcohol use, and use of stress management practices. Logistic regression analysis was used to determine if stage of exercise predicted the presence of each of the health behaviors while controlling for demographic, socioeconomic, and other health behavior variables. RESULTS: The survey response rate was 68%. Respondents in action exercise stage (p = .0367) were less likely to smoke cigarettes than respondents in precontemplation stage of exercise. Respondents in contemplation (p = .0419), preparation (p = .0060), action (p = .0432), and maintenance (p = .0006) were more likely to use seat belts than respondents in precontemplation. Respondents in maintenance (p = .0059) were more likely to use regular stress reduction techniques than respondents in precontemplation. CONCLUSIONS: Although longitudinal research is needed to determine any causal relationships, this research suggests that encouraging individuals to become more involved in exercise could indirectly influence other health behaviors. Hence, exercise could be a possible "gateway" behavior toward healthier lifestyle practices.