基于地理信息系统的区县老年护理床位配置方法研究

老年护理床位是养老护理资源中的核心部分,养老护理床位的设置规划对合理利用卫生资源,缓解老年护理床位一床难求的现状需求具有重大意义。老年护理床位配置问题可以分解为在哪里配置、配置多少和配置什么性质床位的问题。运用基于地理信息系统(GIS)的"引力法"模型,结合对老年人开展抽样调查,能够计算区县范围内的每个居委会的老年护理床位地理可及性,体现居民需求,并以地图的形式直观表达,从而较合理地解决上述问题。     

山东省床位配置标准测算方法研究

目的 为了向卫生行政部门制订区域卫生规划提供床位测算方法。 方法 采用普查方法对山东省所有市地进行相关调查，数据采取借用和自研公式进行测算。结果 到2005年，全省床位总量减少5．19％，市驻地减少4．97％，县驻地减少1．03％，乡地减少9．68％。结论 研究结果填补目前测算方法空白，有一定可操作性，但仍需在实践中推广和完善。     

医院床位配置标准的测算

在大中型医院热心于扩大规模的时候 ,本文的作者们能面对现实 ,冷静客观地分析某一医院的床位配置问题 ,这是十分难能可贵的。虽然所用的方法并不十分科学合理 ,但作者从“微观上也必须重视”资源配置的思路无疑是正确的。我们希望有更多的人士能关注这方面的研究 ,从医疗市场、疾病谱、医学模式、付费方式等诸多方面来研究医院资源配置的科学方法。     

上海市中心城区蝇类孳生情况调查

目的掌握蝇类孳生特点，为指导社区苍蝇控制工作提供依据。方法现场调查。结果苍蝇孳生阳性率为5．46％。结论建立一套管理制度，完善苍蝇防治工作。     

卫生床位配置标准测算方法及其应用

卫生物力资源包括卫生床位、卫生设备、卫生建筑等.卫生床位是最基本的和最重要的卫生物力资源,也是制定卫生资源配置标准的主要内容之一.该文论述卫生床位配置标准测算方法与数学模型,并用以测算出2001～2005年四川省卫生床位配置标准总量和省内21个市、地、州卫生床位配置标准量.     

上海市普陀区老年护理床位医疗保障情况调查

世界卫生组织把60岁以上的老年人口占人口总数的10%或者65岁以上人口占人口总数的7%称为人口老龄化。2010年底上海市户籍人口中,60岁及以上的老年人口占人口总数的23.4%,已经面临着人口老龄化的严峻挑战^[1]。     

上海市老年护理床位配置现状及问题

目的 :论证上海市老年护理床位的配置现状及存在问题。方法 :通过横断面调查获得床位数据,引用卫生统计年鉴、卫生财务年报等资料,通过纵向和横向比较,分析老年护理服务床位数量及构成的合理性。结果 :2012年上海市平均每千65岁及以上老年人口的护理床位数为49.3张,与发达国家齐平。老年护理医疗床位平均每千人口床位数仅6.4张,养老床位则为每千人口42.9张。老年医疗护理床位的使用率近90%,而养老床位入住率仅为70%左右。结论 :上海市老年护理床位总体上基本满足需求,但医疗护理床位相对匮乏与养老床位相对宽裕并存。增加政府重视和协调、明确老年护理机构功能定位和需方需求评估标准,合理引导分流成为当前解决问题之策。     

公立医院护理单元绩效点数测算模型的设计与应用

目的：以工作量考核为理论框架,构建三类护理绩效点数测算模型,分析不同模型应用于工作量考核的可行性。方法：通过专家咨询,确立护理单元绩效考评方案指标体系,以样本医院患者数据为基础,测算不同方案下护理单元绩效点数。结果：构建了单独使用DRG指标（方案1）、单独使用RBRVS指标（方案2）、DRG+RBRVS（方案3）三类绩效点数测算模型。结论：方案1侧重对诊疗结局的评价,不可用于评价设置虚拟床位的护理单元;方案2侧重资源消耗,体现多劳多得,适用于护理过程复杂的科室;方案3从护理全局出发,在兼顾公平的情况下,重塑了绩效管理的理念。     

上海市老年护理供需测算与长期护理制度建设研究

目的了解上海市老年人口的健康状况及老年护理供给和需求的影响因素,测算目前及2015年存在的床位缺口,提出构建与人口老龄化相适应的老年护理服务体系建设的政策建议。方珐通过理论研究、文献归纳、现场调研、焦点组访谈等定量和定性相结合的研究方法,对上海市老龄人口护理服务供给和需求现状进行评估。结果上海老年护理机构存在的主要问题：老年护理院亏损严重,运营不佳;老年护理院功能定位不清,服务项目有待完善;床位周转率极低,“压床”现象严重。结论多渠道筹资,合理配置卫生资源,推进多层次老年医疗护理服务体系：建立护理分类支付制度,引导良性就医：发展以家庭为基础的社区长期保健;多层次培养老年护理人才。     

上海市中心城区社区老年人群心理卫生服务需求探究

目的了解上海市中心城区社区老年人群心理卫生服务需求情况,以期探寻适合我国城市社区老年人群心理卫生服务的模式和方法。方法采用问卷形式对上海市某中心城区250位60岁以上老年人进行了整群随机抽样的入户调查。结果分别有17.3%、5.8%、5.6%的老年人认为自己"偶尔"、"经常"以及"需要定期"的心理卫生服务。其中,50.0%的自评健康状况很差,54.6%的对目前生活表示不太满意,40.9%的认为目前家庭压力比较大,40.0%的认为目前经济压力比较大的老年人对心理卫生服务有需求(即认为自己偶尔、经常或需要定期得到心理卫生服务)。只有8.2%的老年人接受过心理卫生方面的服务。老年人获得心理卫生知识的渠道主要是电视、广播、报纸、杂志等。结论应大力加强心理卫生服务的宣传,积极构建以社区为基础的社区老年心理卫生服务模式。     

Medical care in Australian residential aged care: Perspectives of residents,family, nurses and general practitioners

The importance of residential aged care facility (RACF)’s medical care is growing, driven by world-wide demographic trends in ageing populations. Despite this, there is a paucity of research into this care delivery from the perspective of those most involved. This study aimed to identify the enablers of and barriers to satisfactory RACF medical care by focusing on the general practitioner (GP) visit in the experience of residents, their family, registered nurses (RNs) and GPs. A multi-site case study was conducted at four purposively chosen RACFs in rural and regional New South Wales, Australia. Data derived from semi-structured interviews with 35 randomly selected aforementioned stakeholders and conducted in 2017 were evaluated using thematic, specifically framework analysis. The study's first key finding was related to the care team and to care recipients. It was evident that the quality of the RN–GP interprofessional collaboration was important for satisfactory care delivery. However, the care team was observed to additionally include RACF care staff and family members. Families were also in need of care. The study's second key finding was related to continuity of care. The interpersonal continuity of care provided by the existing GP continuing a new resident's care was beneficial. Informational continuity of care was found to be important but often disrupted by patient's information being initially unavailable, then fragmented and stored in different places. Medication management systems when accessed were poorly organised, time consuming and complex. This research suggests two useful new paradigms for residential aged care. The first is a re-envisaging of the resident care team to include the RN, GP, family and care staff, and those needing care to include residents and family. Secondly, care teams informed by interpersonal and informational continuity of care, and satisfactory resident care appears inextricably and positively linked.     

社区卫生服务改革的模式演进与版本升级研究——以上海市长宁区为例

任何改革在基层的实施都需要转换成一系列的制度安排或微观行为激励机制,不仅确保基层行动者之间的行为策略激励相容,还要确保基层行动者的行为模式与改革政策目标方向相一致。从上海市长宁区社区卫生服务改革的实践来看,其大致经过了四个阶段:标准化建设与组织确立、服务模式与机制改革、激励设计与内涵建设、平台打造与效能提升。长宁医改在不断深化政策试验与制度创新的过程中逐步化解新医改政策实施过程所产生的各类新问题及其与环境的相容性问题,以实现医改政策的制度化并为利益相关者的福利改进提供稳定的行为预期,从而不断降低基层行动者对政策实施的潜在抵制行为,逐步地将各类行动者的行为激励引导到与政策目标相一致的方向。     

An Australian study on the benefits of pastoral care to aged care residents in Christian affiliated homes

This study aimed to understand the experience of pastoral care (PC), that is, the provision of support, comfort and spiritual counselling, from the perspective of Australian aged care residents. A survey research design captured feedback on participants’ PC experience. Outcomes were reported by 575 residents (aged 53–102) across 41 sites. The majority perceived that they received a high quality of care (92%) and benefited from their meeting with the pastoral practitioner (80%), ‘often’ or ‘all of the time’. A few significant differences were found based on participants’ gender, spirituality (i.e. connection and meaning), religiosity (i.e. faith beliefs and religious practices) and well‐being. Females and participants who identified as both religious and spiritual were more likely to feel that their faiths/beliefs were valued. Those with greater psychological well‐being, as defined by the World Health Organisation (1998), were more likely to report receiving a high quality of care and greater benefits from receiving PC than those with poorer well‐being. Three overarching themes and eight subthemes were identified from the open‐ended responses: 1) personal qualities of the pastoral practitioner; caring, supportive, understanding and empathetic; 2) pastoral practitioner met specific needs; spiritual and religious, friendship and company and assistance, advice and help; and 3) positive impact on the participant; feeling listened to, peaceful and valued, accepted and respected. The qualitative findings resonate with Maslow's Hierarchy of Needs, to feel safe, belong and have self‐esteem. There was a synergy between what participants desire in the care they receive, as expressed in the open‐ended questions, and what the pastoral practitioners provide, as indicated in the quantitative findings. A study strength was its mixed‐method, multi‐site and cross‐organisational context, enabling PC to be explored across a diverse sample. Future research should consider a pre‐ and post‐test survey to more comprehensively capture the impact and benefits of PC.     

Health care of the aged in Korea

Korea's population is now aging very rapidly, but the country has not yet shifted its priorities nor instituted programs to meet the needs of an aging population. While the death rate has already achieved low modern levels, there are still traces of malnutrition and other debilitative conditions among the elderly and ill health is generally believed to be an inevitable accompaniment of old age. This leads to resignation and stoicism rather than active steps to deal with the growing problems. Furthermore, care of the aged is still viewed as a private matter to be handled by the person's family and the state plays a very minor role. Medical practice is largely private with physicians drawing their financial support chiefly from fees of their patients. Only one-fourth of the elderly population is presently served to any significant degree by modern medical practitioners. The basic reason for the general lack of skilled care is economic, although folk medicine still plays a role. Only civil servants are covered by any type of health insurance and only 9% of the elderly receive any health care as social welfare recipients. Ninety-five percent of the elderly live in families, three-fourths of them with children and financially dependent upon the children. Bedfast patients are cared for by spouses or daughters-in-law. But fundamental changes are under way in the structure of families which make home care of incapacitated members impractical and burdensome.(ABSTRACT TRUNCATED AT 250 WORDS)     

Costs and revenue of health care in a rural Zimbabwean district

The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no means exorbitant, albeit unfortunately not yet within reach of many sub-Saharan African countries today.     

At the interface of health and community care: developing linkages between aged care services in a rural context

This paper explores issues concerning the development of linkages across the interface between acute and community aged care services in a small regional Australian city. It addresses a participatory action research project that took place over a 2 year period involving an Aged Care Assessment Team (ACAT). Aged Care Assessment Teams are multidisciplinary teams whose members mediate between hospitals and the aged care system in the community and have a key role in developing networks and linkages between various service providers in the field. In an age of economic rationalist-inspired reform agendas in health and community care, rural infrastructures have been compromised to such a degree that the role of rural ACAT in developing linkages between sectors has never been more important. This paper takes up this issue and addresses the project findings, which highlight a field characterised by ineffective linkages within and between the various sectors, a lack of understanding of the operation of the rural aged care system among nurses working in regional hospitals, and the efficacy of ACAT working collaboratively with nurses to create new and more effective linkages in aged care.     

Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

The purpose of this retrospective, cross‐sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one‐quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2–6) vs. 6 days (2–10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.     

老年护理病房人力资源配置的思考

目的　从事老年护理工作的医护人员进行“人力资源现况调查”。方法　采用自制表格对从事老年护理工作的全部医务人员进行学历、职称、年龄等相关方面资料进行调查。结果　院内医生年龄梯度较狭窄、护理人员高学历骨干相对缺乏 ,人员配置有断层现象。结论　建议以高效、优化、合理的卫生人力资源配置 ,发挥我院现有从力资源的能量 ,提高医疗服务质量。