异地医保快速直接结算系统的构建

目的 构建完善医院异地医保快速直接结算服务系统,最大限度提高异地患者当日结算率。方法 分析影响医院异地医保当日结算率的主要原因,在信息化和组织管理两个层面构建全方位多维度的异地医保直接结算服务系统。结果 组织管理和信息化管理两个层面的有机结合,形成了完整的闭合管理链条,使当日结算率大幅提高。结论 两个层面相互补充,缺一不可,共同构成完善高效的结算管理系统,最大程度满足了异地医保患者的快速直接结算需求,减少当日结算差错率。     

门诊患者投诉原因分析及对策

医疗投诉是指患者及家属在医院接受医疗保健服务的过程中,对医院或医院工作人员所提供的服务不满意而到有关部门反映问题的一种行为[1]。以患者为中心,实施高效、快捷、优质门诊服务,力争做到＂零＂投诉是医院适应社会市场经济体制改革而形成的全新服务模式和思维方式。     

医院医保办发生医疗纠纷的原因分析及措施探讨

随着国家经济发展和医改的不断深入,尤其是新型农村合作医疗保险政策的实施,现在几乎人人享有医保,越来越多的老百姓看得起病,甚至也敢到大医院去看病,医疗市场异常繁荣。同时医疗纠纷逐年增加,一方面病人及其家属依法维护自己权益的意识明显增强;另一方面病人及其家属对医疗服务质量期望值不断提高。致使医疗纠纷成为社会热点问题。     

医保患者肿瘤化疗单病种超支原因分析及改进措施

通过对2011年医保单病种超支数据统计分析,结果显示我院收治的医保单病种共45个,其中恶性肿瘤化疗单病种患者人数最多,为4 591例,占医保患者的30％,超支总额也最高,达到近200万元.分析肿瘤化疗单病种超支的原因包括:患者人数多是造成超支总额高的主要原因;多学科开展恶性肿瘤化疗,超支程度有所不同;病种分布和诊疗水平存在差异造成超支;免疫和中药制剂等辅助药物使用不当.医院应开展肿瘤规范化培训,成立肿瘤协作中心,坚持“低水平广覆盖”医保基本原则,限制使用非治疗所必须的辅助药物等综合措施.     

军队医院医保基金运行风险及对策

2013年,社会医疗保险基金付费制度改革在全国推开,从＂照单全收＂到＂总额控制＂,医疗保险基金运行面临严峻形势。军队医院任务繁重,既承担着平战时部队官兵和老干部的卫勤保障任务,又服务于地方广大群众,为更好满足部队官兵医疗需求及各项军事任务的完成,医院收入的一部分必须依赖于医保基金。在当前医保基金＂总额控制＂以及医疗费用上涨等矛盾的影响下,如何规避风险,合理控制费用,防止医疗行为导致的医保基金收入不平衡,     

浅析医保窗口服务存在的问题及对策

我国的基本医疗保险制度和医保工作是新时期国家公共政策的重要组成部分,与国计民生息息相关[1]。而医保窗口服务工作与民生联系最紧密,直接关系到参保患者就医问题。本文通过分析影响医保窗口服务质量的因素,进一步规范医保窗口管理及服务流程,提高服务质量,更好地为参保     

军队医院加入地方医保工作的实践与体会

国务院《关于建立城镇职工基本医疗保险制度的决定》出台以后,我院根据中国人民解放军总后勤部“关于军队医院要积极参与地方社会医疗制度改革”的要求,主动适应形势,积极参与此项工作,成为贵阳市首批医保定点医院,两年的医保工作体会如下。     

做好医保工作促进军队中小医院全面发展

随着国家医疗保险制度改革的迅速发展和全面实施,医保覆盖面不断扩大,医保对象由原来单一的城镇职工扩展到个人就业人员、居民、学生等.目前,大部分军队医院均被列入当地基本医疗保险定点医院.作为医保定点医院,承担着为广大参保患者提供优质的医疗服务和保证医疗保险基金安全有效使用的双重责任.     

Magnetic resonance imaging in real time: Advances using radial FLASH

Purpose

To develop technical advances for real‐time magnetic resonance imaging (MRI) that allow for improved image quality and high frame rates.

Materials and Methods

The approach is based on a combination of fast low‐angle shot (FLASH) MRI sequences with radial data sampling and view sharing of successive acquisitions. Gridding reconstructions provide images free from streaking or motion artifacts and with a flexible trade‐off between spatial and temporal resolution. Immediate image reconstruction and online display is accomplished with the use of an unmodified 3 T MRI system. For receive coils with a large number of elements this process is supported by a user‐selectable channel compression that is based on a principal component analysis and performed during initial preparation scans.

Results

In preliminary applications to healthy volunteers, real‐time radial FLASH MRI visualized continuous movements of the temporomandibular joint during voluntary opening and closing of the mouth at high spatial resolution (0.75 mm in‐plane) and monitored cardiac functions at high temporal resolution (20 images per second) during free breathing and without synchronization to the electrocardiogram.

Conclusion

Real‐time radial FLASH MRI emerges as a simple and versatile tool for a large range of clinical applications. J. Magn. Reson. Imaging 2010. © 2009 Wiley‐Liss, Inc     

医学院校本科生自我和谐和自信心对时间管理倾向的影响

目的探讨某医学院校本科生自我和谐和自信心对时间管理倾向的影响。方法采用自我和谐、自信心和时间管理倾向问卷的形式对某医学院在校208名本科生进行调查。结果①医学院校本科生的时间管理倾向与其自信心和自我灵活性呈显著正相关,同自我和谐总分和自我经验与不和谐分数呈显著负相关。②医学院校大学生的自信心和自我灵活性能够预测时间管理倾向29.5%的变异量。结论医学院校大学生的自我和谐和自信心对医学院校大学生的时间管理倾向具有预测作用。     

急性ST段抬高型心肌梗死首次医疗接触至球囊扩张再灌注时间延迟分析

目的本研究分析不同的转运方式的STEMI患者以首次医疗接触至再灌注时间(FMC-to-B)为基础的各救治时间段,探讨与指南的差距。方法选取2012年1月至2015年10月解放军第三〇六医院急诊就诊的315例STEMI患者,按不同转运方式分为急救体系(EMS)转运组及非EMS转运组,分析各急救时间,包括发病至FMC时间(SO-to-FMC)、转运时间、FMC-to-B、导管室启动延迟时间、介入操作延迟时间、急诊至球囊扩张血管再通时间(D-to-B)。结果两组患者SO-to-FMC、转运时间及FMC-to-B比较,EMS组明显低于非EMS组,差异有统计学意义(P<0.05);院前急救时间,EMS组为91 min,明显低于非EMS组的148 min,差异有统计学意义(P<0.05)。两组D-to-B时间及院内急救时间比较,差异无统计学意义(P>0.05)。结论利用EMS系统转运方式可以有效的缩短院前急救时间,从而缩短总缺血时间。我院院前急救时间与指南标准比较,还有很大差距,有必要建立有效的急救体系来缩短缺血时间并提高预后。     

High spatial and temporal resolution cardiac cine MRI from retrospective reconstruction of data acquired in real time using motion correction and resorting

Cine MRI is used for assessing cardiac function and flow and is typically based on a breath‐held, segmented data acquisition. Breath holding is particularly difficult for patients with congestive heart failure or in pediatric cases. Real‐time imaging may be used without breath holding or ECG triggering. However, despite the use of rapid imaging sequences and accelerated parallel imaging, real‐time imaging typically has compromised spatial and temporal resolution compared with gated, segmented breath‐held studies. A new method is proposed that produces a cardiac cine across the full cycle, with both high spatial and temporal resolution from a retrospective reconstruction of data acquired over multiple heartbeats during free breathing. The proposed method was compared with conventional cine images in 10 subjects. The resultant image quality for the proposed method (4.2 ± 0.4) without breath holding or gating was comparable to the conventional cine (4.4 ± 0.5) on a five‐point scale (P = n.s.). Motion‐corrected averaging of real‐time acquired cardiac images provides a means of attaining high‐quality cine images with many of the benefits of real‐time imaging, such as free‐breathing acquisition and tolerance to arrhythmias. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study

Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupational health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compared with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 1996 and 1997 by occupational health or medical insurance physicians. The most common reasons for referral were the exclusion of occult fractures of hands and feet, whiplash injuries, reflex sympathetic dystrophy or avascular necrosis, or the differentiation between an old and a recent vertebral fracture. X-rays were only available for comparative review of 53 patients, so only those were analysed. The results of bone scintigraphy were compared with X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the number and location of abnormalities. For 19 of the 53 patients, bone scintigraphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among these 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplementary radiological investigations revealed no abnormalities, and in five patients no further investigations were undertaken. Finally, in three of the 53 patients, X-rays revealed bone damage (burst fractures) whilst the corresponding bone scintigraphy was negative, thus excluding recent injury. In conclusion, in 22 patients, representing 42% of the cases analysed, bone scintigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding active bone damage after a traffic or industrial accident. This makes bone scintigraphy a useful investigation in situations where a full or partial disablement claim has to be confirmed, extended or terminated. Received 17 December 1998 and in revised form 19 April 1999     

Incidence and body location of reported acute sport injuries in seven sports using a national insurance database

Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84 754 registered injuries during the study period (year 2006‐2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention.     

Flexible retrospective selection of temporal resolution in real‐time speech MRI using a golden‐ratio spiral view order

In speech production research using real‐time magnetic resonance imaging (MRI), the analysis of articulatory dynamics is performed retrospectively. A flexible selection of temporal resolution is highly desirable because of natural variations in speech rate and variations in the speed of different articulators. The purpose of the study is to demonstrate a first application of golden‐ratio spiral temporal view order to real‐time speech MRI and investigate its performance by comparison with conventional bit‐reversed temporal view order. Golden‐ratio view order proved to be more effective at capturing the dynamics of rapid tongue tip motion. A method for automated blockwise selection of temporal resolution is presented that enables the synthesis of a single video from multiple temporal resolution videos and potentially facilitates subsequent vocal tract shape analysis. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.