医学信息交互集成（IHE）的现状和发展

简要介绍了IHE的概念和必要性，IHE的技术框架和重大作用，以及国内外发展的现状。     

医疗质量测量指标基础数据的标准化方法

目的尝试参考HL7 RIM方法规范化表达医疗质量指标的基础数据。方法以实验室检查为例,参照美国质量论坛提出的医疗质量数据模型(QDM),采用实体—属性—值的路线,用UML工具建立概念数据模型。属性的设置、描述及词汇遵照NQF定义,属性的数据类型参照HL7 Datatype。结果 QDM关注具有统计汇总意义的数据,类的属性包括HL7包含的状态、起始时间、截止时间、发送者、原因、结果以及RIM中没有定义的来源、记录、对象、设备地点、环境地点、偏侧性等。QDM数据在词汇方面也反映了其特有的应用语境。结论 QDM数据可参照RIM的表达方法描述,有利于质量指标标准化从基础数据元到文档结构的协调和统一,便于在CDA架构下实现相关信息的传输、交换和集成。     

Role of NCCN in Integrating Cancer Clinical Practice Guidelines into the Healthcare Debate

Many new drugs and drugs in the pipeline are referred to as targeted therapy. Targeted therapies have revolutionized the care of certain cancers, such as chronic myelogenous leukemia, but for other common malignancies, such as colon cancer, the impact on survival has been more modest. These seemingly incremental improvements coupled with the high cost of targeted therapy have focused the debate about the cost of healthcare squarely on oncology. Clinical practice guidelines are a common baseline starting point for this debate. Guidelines reflect clinical evidence and expert judgment, which is necessary to fill in the gaps when clinical evidence is not yet available or is evolving quickly. In addition, clinical guidelines inform other key aspects of oncology care, such as establishing a standard of care, which can then be translated into quality measures. Guidelines can also be reformatted to create an oncology drug compendium or rewritten to provide patient information.The data regarding healthcare costs are clear, persistent, troubling at the least, and truly frightening at worst. It is estimated that by 2014, nearly 20% of the nation''s economy will be consumed by healthcare, and the growth in healthcare spending will outpace economic growth through the next decade.1 The National Institutes of Health estimated that the overall cost of cancer in 2006 was $206.3 billion. Of this total figure, $78.5 billion represents direct medical costs, including inpatient and outpatient care, drugs, and devices.2     

Integrating the Use of Patient‐Reported Outcomes for Both Clinical Practice and Performance Measurement: Views of Experts from 3 Countries

Context

Patient-reported outcomes (PROs) can play an important role in patient-centered health care by focusing on the patient''s health goals guiding therapeutic decisions. When aggregated, PROs also can be used for other purposes, including comparative effectiveness research, practice improvement, assessment of the performance of clinicians and organizations, and as a metric for value-based payments. The feasibility of integrating the use of PROs for these various purposes on a wide scale has not yet been demonstrated. Our study was conducted to inform policymakers of prudent next steps for implementing PROs in clinical practice and performance measurement programs in order to maximize their impact on the quality of health care.

Methods

We conducted a qualitative study, interviewing 58 experts and leaders from 37 organizations (response rate: 88%) in the United States, England, and the Netherlands. Respondents included clinical practitioners (n = 30), measure developers (n = 11), and leaders of performance measurement programs (n = 17). We used a qualitative content analysis to assess current strategies for applying PROs in clinical practice and performance measurement and to identify barriers to and facilitators of further implementation.

Findings

The use of PROs in clinical practice and for performance measurement has developed both separately and in parallel. Experts across the stakeholder spectrum support the collection of PRO data in an integrated manner that would enable using the data for these distinct purposes. We identified 2 main concerns about the feasibility for integrated use of PRO data: the complexity of establishing routine data collection and the tension among stakeholders when using PRO data for different purposes. These contrasting stakeholder views suggested varying interests among clinicians, measure developers, and purchasers of care.

Conclusions

Data collection approaches that support the use of PROs in health care are underdeveloped, need better integration with clinical care, and must be tailored to the characteristics of the health care system. Enabling the sustainable use of PROs will require a shared vision of clinical professionals, purchasers, and patients, with a prudent selection of the steps in implementing PROs that will maximize their impact on the quality of health care.     

Bridging Policy and Service Performance of Hospital-Based Nutrition Support by Healthcare Information Technology

Although the healthcare policy was implemented to incentivize the multidisciplinary services of hospital-based nutrition support team (NST) in South Korea, timely completion of the services has been challenging in the hospitals. We enhanced NST healthcare information technology (NST−HIT) to bridge the gap between policy implementation and seamless execution of the policy in the hospital system. A 48 month pre-test−post-test study was performed, including a 12 month pre-intervention period, a six month intervention period, and a 30 month post-intervention period. The enhanced NST−HIT provided sufficient patient data and streamlined communication processes among end-users. A Student’s t-test showed that the timely completion rate of NST consultations, the reimbursement rate of NST consultations, average response times of NST physicians and nurses, and length of hospital stay significantly improved during the post-intervention period. A segmented regression analysis of interrupted time series showed that the average response times of NST physicians had sustained after the interventions. We believe that well-structured, multi-pronged initiatives with leadership support from the hospital improved service performance of hospital NST in response to national-level healthcare policy changes.     

The Benefits of Practice Standards and Other Practice-Defining Texts: And Why Healthcare Ethicists Ought to Explore Them

This article outlines one element of the work carried out by a group of Canadian ethicists [Practicing Healthcare Ethicists Exploring Professionalization (PHEEP)]-to begin the deliberative development of a set of practice standards for the Canadian context. To provide a backdrop, this article considers the nature and purpose of practice standards as they are used by regulated professions and how they relate to other practice-defining texts such as competencies, codes of ethics and statements of scope of practice. A comparative review of current practice-defining documents developed within the field of healthcare ethics practice suggests that practice standards are not yet among them. A review of the practice standards and related texts articulated by various other professions, both regulated and not yet regulated, indicates that while these groups of documents serve to define and clarify various dimensions of practice in individual disciplines, there is no clear standardized approach to the terminology, structure and content across these documents. It is suggested that this variability presents a degree of flexibility that ought to allay many of the anxieties that have been expressed about practice standards in healthcare ethics: practitioners, PHEs, are at liberty to define their practice as they see fit, albeit within reasonable parameters if regulation is sought. A proposal for a draft structure and potential content for Canadian healthcare ethics practice standards is offered.     

卫生与教育部门联合开展预防近视健康教育干预模式探讨

目的探索利用卫生和教育部门联手的形式开展预防近视健康教育干预的模式,提高健康教育效果。方法对广州市海珠区2所学校的879名中、小学生开展预防近视的健康教育干预活动,并对干预效果进行评估,包括问卷调查和教师访谈。结果干预实施后,试点学校中、小学生对近视核心健康知识的知晓程度有显著提高(P值均0.05),小学生对看电视、玩游戏、看书姿势等近视相关行为有明显转变(P值均0.05)。结论利用卫生和教育部门联手形式开展预防近视健康教育干预工作切实可行。近视健康教育工作要持之以恒,注重对学生预防近视技能的培养,且不能忽略对家长的教育。