城市医院盲目扩张为何屡禁不止

国家卫生部为合理配置卫生资源．缓解群众看病贵．曾多次提出严格要求，禁止城市大医院盲目扩大规模，特别是限制低效率重复的建设项目。然而，有相当多的城市医院仍然置国家卫生部指令于不顾，有禁不止，继续大兴土木，楼房越盖越高．室内装修越来越豪华．导致卫生资源的新一轮浪费。     

院长专家热议--理性看待医院规模扩张

扩张动作——北京大学第一医院兼并交通医院2003年1月,北京大学第一医院与交通部北京交通医院签订协议,交通医院合并到北大医院。交通医院是二级综合医院,人员技术水平较为薄弱,床位110张,床位使用率不足50％,年收入不足1000万元,交通部从2003年为该院“断奶”。     

论公立大医院规模扩张与建立新型医疗服务体系的冲突

新医改方案提出要进一步完善医疗服务体系,其重要任务之一是完善以社区卫生服务为基础的新型城市医疗卫生服务体系,明确各级各类医院的功能和职责。而当前各公立大医院纷纷在进行不同程度不同形式的规模扩张。文章认为公立大医院无限规模扩张的方向与建立并完善新型医疗服务体系的目标是相悖的,公立大医院的规模扩张既抢占了政府资源与市场资源,又不利于自身的经营,一定程度上阻碍了新型医疗服务体系的建立与完善。     

在规模扩张中加强医院管理的实践与体会

上海市南汇区中心医院在近几年高速规模扩张中,在医院管理的实践中,注重打造高素质的科室主任队伍,培养临床能力强的初中级医师队伍,重视地方疾病谱的研究,并抓好重点学科建设,基本满足了医院规模快速扩张的需求。     

医院的规模建设与风险防范

对250家不同层次的公立综合性医院近3年的规模建设等数据进行分析,从医院负债经营和收益的低下等方面,探讨医院规模扩张及重复建设的原因和潜在风险。提出加强对医疗机构的规划和监管、合理控制医院发展规模和投资行为,把握内涵建设与外延发展的关系,充分利用现有医疗资源产生最大绩效,积极抵御经营风险和债务风险等建议。     

内生性卫生资源在医院集团化扩张中的作用

医院集团化作为医院重组[1] 的一种形式 ,是实现医院低成本扩张、优化卫生资源配置的一种有效手段 ,通过集团化的扩张 ,可以达到扩大规模效应、降低医疗成本、提高医院竞争力的目的。我院是青岛市市属规模最大的综合性三级甲等医院 ,在医院重组过程中 ,通过兼并、联合的方式 ,形成了以市立医院为核心 ,由青岛市皮肤病院、北九水疗养院、东部医院、建工医院、建材医院、北海医院、交通医院组成的青岛市立医疗集团[2 ] ,集医疗、科研、教学、预防、保健功能于一体。为保证重组后医院集团综合竞争力的有效提高 ,在医疗管理中 ,我们将内生性卫生…     

控制医院扩张规模缓解“看病难、看病贵”

近年来,我国医疗卫生事业发展迅速,其中一个突出表现就是医院规模日益扩大。合理确定医院的适宜规模,已经成为当前各级卫生主管部门和医院决策层关注的一个十分重要而紧迫的课题。在社会主义市场经济下,分析当前我国医院发展规模的现状,医疗服务需求、结构、变化规律以及存在的问题,探讨在改进过程中政府、医院应承担的责任。     

叫停医院扩张软着陆还是休克疗法？---规模扩张，机遇大于风险

我国人口众多和医疗需求大,是医院扩张的最大背景。值得关注的是,部分政策助推了医院的规模扩张。无论是不同等级医院的评比、国家或省重点学科的申报,都有一个最基本的要求,这就是床位数。因而,具备相应的规模成了政策认定医院级别的基本条件。拿我们医院来说,无论是身为教学医院,对规模有要求,     

公立医院盲目扩张“病”在何处？

卫生部部长陈竺上月在卫生部召开的加快公立医院改革工作座谈会上指出,在新一轮改革中,公立医院尤其是大型公立医院,不能采取不符合功能定位的、单纯规模扩张的简单外延式模式发展。这种盲目发展会导致资源进一步向城市大医院集中,加剧看病难、看病贵问题,同时造成运营成本大幅增加,给医疗质量和安全带来隐患,并削弱基层医疗卫生服务体系。     

'Trusting blindly can be the biggest risk of all': organised resistance to childhood vaccination in the UK

Sociological interest in vaccination has recently increased, largely in response to media coverage of concerns over the safety of the MMR (measles, mumps and rubella) vaccine. The resulting body of research highlights the importance of risk and trust in understanding parental and professional engagement with vaccination. To date, only limited attention has been paid to organised parental groups that campaign against aspects of vaccination policy. This paper reports findings from a qualitative study of contemporary groups in the UK, and develops three main lines of argument. First, these actors are best analysed as 'Vaccine Critical groups' and include Radical and Reformist types. Second, Vaccine Critical groups discursively resist vaccination through a reframing that constructs risk as unknown and non-random. Third, trust as faith is negatively contrasted with the empowerment that is promised to result from taking personal responsibility for health and decision-making. Whilst representing a challenge to aspects of vaccination policy, this study confirms that the groups are involved in the articulation and promotion of other dominant discourses. These findings have implications for wider sociological debates about risk and trust in relation to health.     

Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale

To derive a brief bedside pressure ulcer prediction tool for patients admitted to acute care hospitals, we conducted a prospective study of first pressure ulcer incidence among 1,190 consecutive patients hospitalized in selected wards of a Swiss teaching hospital. Baseline predictors included patient age and items from the Norton and Braden ulcer prediction scales. During follow-up, 170 patients developed new pressure ulcers. The predictive ability of baseline assessments decayed over time. Occurrence of first pressure ulcer in the 5 days after admission (129 events) was best predicted by patient age (5 levels), mobility (3 levels), mental status (3 levels), and friction/shear (3 levels). The Fragmment score (sum of friction, age, mobility, mental status) was linearly related to pressure ulcer risk, and its area under the receiver operating characteristic curve (0.80) was higher than for the Norton (0.74; P = 0.006) and Braden (0.74; P = 0.004) scores. This brief pressure ulcer prediction scale performed well in an acute care setting. Use of this scale may facilitate the implementation of pressure ulcer prevention interventions.     

High nutrition risk is associated with higher risk of dysphagia in advanced age adults newly admitted to hospital

Aim

To establish the prevalence of nutrition risk and associated risk factors among adults of advanced age newly admitted to hospital.

Methods

A cross‐sectional study was undertaken in adults aged over 85 years admitted to one of two hospital wards in Auckland within the previous 5 days. An interviewer‐administered questionnaire was used to establish participant's socio‐demographic and health characteristics. Markers of body composition and muscle strength were collected. Nutrition risk was assessed using the Mini Nutritional Assessment‐Short Form (MNA‐SF), dysphagia risk using the 10‐Item Eating Assessment Tool (EAT‐10) and level of cognition using the Montreal Cognitive Assessment.

Results

A total of 88 participants with a mean age of 90.0 ± 3.7 years completed the assessments. A third (28.4%) of the participants were categorised by the MNA‐SF as malnourished and 43.2% were classified at risk of malnutrition. A third (29.5%) were at risk of dysphagia as assessed by EAT‐10. Malnourished participants were more likely to be at risk of dysphagia (P = 0.015). The MNA‐SF score was positively correlated with body mass index (r = 0.484, P < 0.001) and grip strength (r = 0.250, P = 0.026) and negatively correlated with risk of dysphagia (r = ?0.383, P < 0.001).

Conclusions

Among newly hospitalised adults of advanced age, over two thirds were malnourished or at risk of malnutrition, and a third were at risk of dysphagia. Nutrition risk was positively correlated with low BMI and grip strength and negatively correlated with dysphagia risk. Findings highlight the importance of screening for dysphagia risk, especially in those identified to be malnourished or at nutrition risk.     

医院风险管理中风险的范畴

医院风险概念的界定和分析是医院风险管理工作的前提。医院风险种类多样,具有一些独特的特征。医院风险管理工作应根据医院风险的特征进行。     

医院规模经济研究述评

随着我国公立医院纵向整合热潮的出现和医院规模的不断扩大,医院多大规模合适的问题引起了政策制定者和学术界的关注.我们对国内外医院规模经济的研究现状、存在的问题进行梳理,以期对我国医院规模经济的研究提供理论和方法上的指导.     

Developing a Japanese hospital physician satisfaction scale

PURPOSE: Hospital physician shortages are widely recognized as a national problem in Japan. Although physician job satisfaction has a relationship with service quality and physician turnover, there is no measure to assess Japanese hospital physician satisfaction. This paper aims to establish a measure of job satisfaction for Japanese hospital physicians and evaluated its psychometric performance. DESIGN/METHODOLOGY/APPROACH: Two cross-sectional physician surveys were used--a pilot survey, conducted as a self-administered questionnaire; and a validation survey conducted on-line. FINDINGS: A total of 82 hospital physicians completed the pilot questionnaire. Factor and reliability analyses produced a 28-item, 6-subscale and 2-global satisfaction scale measure, the Japan hospital physicians satisfaction scale (HPSS). Results supported the measure's reliability and validity. For the validation survey, 146 hospital physicians completed the online questionnaire. One question item was substituted following factor analysis. Results also displayed the measure's adequate psychometric properties. RESEARCH LIMITATIONS/IMPLICATIONS: Participating physicians were convenience samples, which may not fully represent Japanese hospital physicians. ORIGINALITY/VALUE: The JHPSS, a brief questionnaire measuring Japanese hospital physician job satisfaction, should be useful for providing better quality care and improving our understanding of and ability to deal with Japanese hospital workforce issues.     

医院财务风险与预防

财务部门是医院中的一个重要的职能部门,如今人们已经越来越认识到财务信息的准确性直接影响医院的决策和未来的发展.医院要引入相关的财务管理,防范财务风险,使医院能够在未来的改革中能持续健康的经营发展下去.