Implementation of best practice in advance care planning in an 'ageing in place' aged care facility

Background For many older people, a residential aged care facility is home, a place where they should have the choice to die comfortably with a sense of control of care and treatment. An advance care plan describes the process of planning end-of-life care while a person is still able to make decisions with the aim of using this information should a person become unable to communicate their wishes. In the residential aged care setting, an advance care plan should be based on discussions involving the resident, family members and caregivers regarding the beliefs, values and goals of the resident and their family. It is not limited to the final days and weeks before dying, it can encompass a positive and open attitude towards death and dying. Aim The aim of this project was to examine the process of how residents' end-of-life care wishes is recorded and to ensure that the implementation of an advance care plan is performed according to the best available evidence. Method There were four stages to the project. The first stage involved interpretation of the five audit criteria. The criteria related to involving residents and their families in an advance care plan, providing them with appropriate information about end-of-life issues, and ensuring that staff are appropriately trained about an advance care plan. Next, the records of staff and resident were audited using JBI-PACES, the Joanna Briggs Institute's Practical Application of Clinical Evidence System. The next stage (Getting Research into Practice, GRIP) involved a process of situational analysis, action planning and action taking to improve compliance with best practice, followed by a post-implementation audit. Results Initially, compliance with an advance care plan best practice was fairly poor - less than 50% for each audit criterion. The GRIP phase highlighted seven barriers which were addressed during the implementation part of the project. These barriers included deficits related to the knowledge and education of residents, families and staff members, and issues related to administration and documentation, and concerns that any implementation process would not be sustainable. The post-implementation compliance was greater than 75% for each criterion. Conclusion The project highlights the ongoing challenges of educating residents and families, as well as staff on the importance of discussing/completing an advance care plan. Several improvements were made to the facility's documentation and records keeping processes, including the identification of resident's wishes regarding end-of-life treatment. Residents and their families expressed a high level of satisfaction with these changes. Indeed, an increase in completed advance care plans at the facility had a clear benefit in improving care for residents towards the end of their life.     

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

Background Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.     

Rapid assessment methods used for health-equity audit: diabetes mellitus among frail British care-home residents

BACKGROUND: To perform a health-equity audit of diabetes care among elderly care-home residents. STUDY DESIGN: Health-need assessment using rapid-evaluation methods. SETTING: Residents of care homes in Newcastle upon Tyne, UK. PARTICIPANTS: All care-home residents in the city. OUTCOME MEASURES FOR DIABETES: To carry out health-need assessment, agree partners and issues, assess equity profile, and to agree high-impact local action to narrow the gap, according to the guidance on health-equity audit provided by the Department of Health. RESULTS: A combination of qualitative and quantitative methods were used to develop a methodology to complete the health-need assessment component of the health-equity audit. A number of criteria for an appropriate standard of care, and how the current service met these standards, were reported in a timely fashion to the primary care trust. The domains comprised national standards for care, diabetes prevalence, adequacy of coverage and standard of care delivered, and environment, including availability of equipment and knowledge and attitudes of care staff. The output was structured to identify a number of key issues: the diabetes register under-represents the number of cases of known diabetes mellitus (3.5% vs. 11.5%); weights and blood-pressure measurements were incorporated into the care-home environment; this population had inappropriately high rates of glucose monitoring, secondary care involvement and little evidence of co-ordinated eye screening; and staff needed training for diabetes care, which they recognized. Finally, recommendations were agreed for the immediate response and a local action plan agreed to narrow the health gap. CONCLUSIONS: It is feasible to use rapid-evaluation methodologies to initiate a health-equity audit of current diabetes services for care-home residents in a large health district, informing the primary care trust about health equity for this vulnerable group of patients. The tools developed can be used again to inform the iterative process of health-equity audit in the future. We would recommend the use of these methods and similar combined qualitative/quantitative techniques as valuable alternatives for a health-equity audit in the absence of extensive databases on which to assess health equity.     

The development of an infection control link-nurse programme in a district general hospital

Management of hospital-acquired infection is costly, and a vital part of risk management. It is also closely linked with the quality of patient care. Information regarding hospital-acquired infection is increasingly being sought by both purchasers and providers. This paper describes the setting up and development of an infection control link-nurse system over a fouryear period in a district general hospital. It gives practical details of methodology and problems encountered. Emphasis is given to the incorporation of infection control principles into ward and departmental standard setting. Having set up the system, subsequent monitoring of the process by a clinical audit programme is described. The importance of the responsibility of staff, at ward and departmental level, in high-level infection control practice is discussed.     

Designing and implementing E-health Applications in the UK's National Health Service

Telemedicine/e-health applications have the potential to play an important role in Britain's National Health Service (NHS), including the NHS in Scotland. The Scottish Telemedicine Action Forum (STAF) was established by the Scottish Executive Department of Health in 1999 to take a range of applications, targeted on national priorities, into routine service. In the process it has provided insights into how advanced information and communication technologies (ICTs) can be moved from the research stage into routine service. In this article four of the projects are described and analysed focusing on the key issues that have emerged as critical for carrying projects successfully through to implementation in service as follows: 1. A multisite videoconferencing network linking 15 minor injury units to the main accident and emergency (A&E) centre. 2. A single-site neonatal intensive care "cotside" laptop system to assist communication between parents and clinical staff. 3. A single-site outpatient chronic disease management system. 4. A multisite software audit tool to support the care of cleft lip and palate patients from birth onward.     

Discussion of quality and audit in health

Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated.     

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care.

Design: Qualitative case studies using semi-structured interviews and documentation review.

Setting: Twelve purposively sampled PCG/Ts in England.

Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members.

Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts.

Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment).

Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

     

A costed profile audit of the surgical management of female stress incontinence

BACKGROUND AND AIMS: To conduct a profile audit of three surgical treatments for urinary stress incontinence through the application of an episode costing process. METHODS: Four stage methodology: (1) construction or a profile of care for each of the surgical approaches (setting the standard); 2) calculation of a theoretical profile cost; (3) calculation of the observed costs from real patient episodes; (4) comparison of observed costs with profile costs, (comparing present practice with established standard). RESULTS: Profiles of care were constructed and compared with 39 actual in-patient episodes. Tension free vaginal tape (TVT Gynecare) is the cheapest modality of treatment in terms of both the expected profile cost and also observed (real patient) cost. Colposuspension is the most expensive form of treatment with real costs significantly greater than the expected profile. Clinical issues such as length of stay, duration of surgery, patient selection and complication rates were revealed through the exception reporting process. Length of stay is the main determinant of overall cost. CONCLUSION: It is possible to construct a costed and auditable standard of care for a surgical procedure. This standard can be compared with real patient costs calculated using the same methodology. Exception reporting based on differences between expected and real costs can be used to facilitate the audit of clinical practice. The technique is limited, however, by the need to collect accurate and detailed activity data.     

A comparative analysis of six audit systems for mental health nursing.

PURPOSE: To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health. DATA SOURCES: Published material relating to the following six systems: the Central Nottinghamshire Psychiatric Nursing Audit; Psychiatric Nursing Monitor; Standards of Care and Practice; Achievable Standards of Care; Quartz; and Quest. DATA EXTRACTION: Comparison of the six systems according to an analytical framework derived from detailed empirical study (structures, processes and outcomes) of one of them in use and the educational evaluation literature. Examination of the extent to which guidance is provided for operating the systems and for wider process-related aspects of audit. RESULTS OF DATA SYNTHESIS: Five of the systems failed to specify some important elements of the audit process. Conceptually, the six systems can be divided into two main types: 'instrument-like' systems designed along psychometric lines and which emphasize the distance between the subjects of audit and the operators of the systems, and 'tool-like' systems which exploit opportunities for care setting staff to engage in the audit process. A third type of system is the locally-developed system which is offered to a wider audience but which does not make the same level of claim to universal applicability. CONCLUSION: The analytical framework allows different approaches to audit to be compared and contrasted not only according to the techniques used, but also according to process issues. The analysis of six systems revealed a variety of different techniques and procedures which can facilitate, in a methodologically rigorous manner, practitioner and other stakeholder involvement in audit processes.     

Learning together: clinical skills teaching for medical and nursing students

OBJECTIVE: To evaluate the feasibility and effectiveness of shared learning of clinical skills for medical and nursing students at the University of Manchester. DESIGN: Medical and nursing students learned clinical skills in either uniprofessional or multiprofessional groups. These groups rotated through skills stations taught by multiprofessional facilitators. The groups stayed together for a series of 3 sessions held at weekly intervals (an induction meeting followed by 2 3-hour teaching sessions). Both quantitative and qualitative methods were used to evaluate the project. CONTEXT: A total of 113 Year 3 students registered on the Medical (n = 41), Bachelor of Nursing (Honours) (n = 43) or the Diploma for Professional Studies in Nursing (n = 29) courses participated in the project which was set in the clinical skills unit of a teaching hospital. RESULTS: Pre- and post self-evaluation of confidence levels for the taught skills revealed a statistically significant increase for all skills. The primary reason students gave for participation in the project was to learn or consolidate skills. An additional inducement for participation was the opportunity to share knowledge and observations between professional groups. Tutors also evaluated the experience favourably, particularly with regard to small group discussions. They indicated that the programme provided an opportunity to standardise clinical skills teaching. CONCLUSION: Collaborative learning opportunities for nursing and medical students are feasible and add value to the learning experience. Data indicate positive outcomes of learning in multiprofessional groups, comprising increased confidence levels, increased understanding of others' professional roles and personal development.     

异地就诊医保核算监督机制的完善对于医保体系高效化管理的意义

目的 探讨异地医保稽核制度的完善对于提高医保体系效率的意义.方法 通过对我国现行异地医保的稽核方式存在的漏洞和弊端进行分析,同时提出加强监督的相关建议.结果 目前异地医保稽核方式存在着实施困难、网络不健全、各地区之间合作性差,合作标准不统一等弊端,需要不断加强网络建设、建立全国性的医疗记录登记、实施全国统一的医保政策、甚至建立统一的医保体系等是进一步加强医保监督机制的有效措施.结论 健全的监督机制对于提高异地就医结算的的审核效率、审核意义重大.     

Report of a nutritional screening audit

Background: Malnutrition in hospitals has been widely documented and nutritional screening forms part of the National Professional Standards for Dietitians. As a result of this concern, a nutrition screening tool has been incorporated into the nursing care plan documentation. Aims: To audit the use of the screening tool in nursing care plans for elderly patients and examine the communication methods concerning the need for individual nutritional care. Methods: A standard chart was used to audit patient notes. In addition, a short informal interview was conducted with nursing staff. Results: Use of the screening tool was variable and fewer than half of those identified by this tool as in need of nutritional care were referred to the dietitian. Conclusion: Ward staff are prioritizing patients referred for dietetic care, even when they have been identified by the screening tool, but this is not always done systematically. Improvements could be made in the relevant documentation. Further training of ward staff and a follow-up audit should be undertaken.     

A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program.

The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.     

Increased frequency and accuracy of MUST screening after use of a nutrition screening round

Background: Surveys indicate that malnutrition remains common among hospital patients (Russell & Elia, 2010). It is recommended that all patients be screened on admission and weekly (NICE, 2006). The Malnutrition Universal Screening tool (MUST) is a sensitive and specific screening measure (Kyle et al., 2006). In Homerton Hospital, the nutrition screening round (NSR) ran alongside transition of paper‐based screening onto an electronic patient record system (EPR). This study aimed to assess the effectiveness of a dietitian‐led NSR as a method of training staff to use MUST. Methods: Malnutrition screening was audited on an elderly care ward and an adult rehabilitation unit. The number of MUST scores undertaken within 24 h of admission and the frequency of weekly screening were assessed. Data gathered included the numbers of patients with accurately measured height, weight, body mass index, weight loss and acute disease effect scores. A weekly NSR was then conducted on these two wards alongside consultant ward rounds, with the dietitian carrying out nutritional care and all staff gaining practical experience of MUST by assisting with screening of each patient. After 20 weeks, screening levels were re‐audited and, at 24 weeks nursing staff took back full responsibility for MUST screening. A final audit of screening levels took place 1 month after staff on the two designated wards had taken back responsibility for screening. Results: The initial audit indicated that, of 53 patients, 26 had a paper MUST proforma present. Of 23 patients who were on the wards for >7 days who had a MUST proforma, only one was screened each week as per NICE guidelines. The 20‐week mid‐intervention audit showed that the number of patients on the wards for ≥1 week with an accurate MUST screen recorded on EPR had increased to 100%. Increased detection of malnutrition led to prompt, effective nutrition support. The final audit at 28 weeks showed sustained screening levels, with all patients on the ward for ≥1 week being accurately screened for malnutrition by ward staff alone. Discussion: The NSR appeared to target factors identified as being behind low levels of screening, including a low awareness of screening policy and poor screening skills (Porter, et al., 2009).Confidence in carrying out MUST was increased by ‘hands‐on’ training in the immediate patient environment. Perceived barriers to screening cited in other research include pressures of workload (Hodge, 2008). The NSR demonstrated that screening was not as time consuming as assumed and that it could be fitted alongside other tasks. Previous studies have suggested training might be targeted toward all clinical staff (Wong & Gandy, 2008). The NSR project supports this finding, demonstrating that the involvement of all members of the multiprofessional team is strongly conducive to embedding MUST within clinical care and as part of weekly ward routine. Conclusions: A NSR is an effective way of providing practical training in nutritional screening. A NSR raises the ward level profile of screening, encourages it to become routine practice and is a feasible method of increasing frequency of screening in line with policy to enhance patient care. References: Hodge, A. (2008) An exploratory case study of cancer nurses’ understanding and use of nutritional screening in patients diagnosed with cancer. J. Hum. Nutr. Diet. 21 , 388–389. Kyle, U.G., Kossovsky, M.P., Karsegard, V.L. & Pichard, C. (2006) Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin. Nutr. 25 , 409–417. NICE (2006) Nutrition Support in Adults. Clinical Guideline 32. London: NICE. Porter, J., Raja, R., Cant, R. & Aroni, R. (2009) Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals. J. Hum. Nutr. Diet. 22 , 203–299. Russell, C. & Elia, M. (2010) Nutrition Screening Survey in the UK and Republic of Ireland in 2010. Redditch: British Association for Parenteral and Enteral Nutrition. Wong, S. & Gandy, J. (2008) An audit to evaluate the effect of staff training on the use of the Malnutrition Universal Screening Tool. J. Hum. Nutr. Diet. 21 , 405–406.     

Strengthening patient involvement in rehabilitation

Stronger involvement from the patient in health care is advocated because of the changed role perception, due to the increasing therapeutic possibilities in the course of medical progress, thoughts concerning ethical considerations and medical legislation, and also on the basis of scientific findings. Different levels of personal involvement can be identified: participation in decision-making processes, participation in the management of diseases, as well as participation on the system level. The implementation of these in health care is still insufficient due to various barriers at different levels. Besides barriers on the physicians' side, limited health literacy and low patient activation are discussed as obstacles for stronger patient involvement. Furthermore, specific adjustments are necessary for implementation in rehabilitative health care, especially due to the treatment in a multiprofessional team. In a current funding initiative with an emphasis on rehabilitation, research projects with a focus on participative healthcare are being performed.     

Compliance with best practice: implementing the best available evidence in the use of physical restraint in residential aged care

The Aged Care Clinical Fellowship, funded by the Commonwealth Department of Health and Ageing and conducted through the Joanna Briggs Institute is an initiative designed to improve the care of older Australians through clinical leadership and promotion of best practice. This paper outlines one of the projects undertaken at Carinya of Bicton, a residential aged high care facility, using an audit and feedback process to implement best practice standards in the use of physical restraint. Aims Between 12% and 47% of residents in residential care facilities are restrained; however, initial observation of residents restrained in the project facility showed that restraint devices were utilised in up to 40% of residents. Within the aged care sector there has been a shift in attitude to reducing or eliminating restraint in aged care facilities. Restraint is seen as a negative experience for the resident, being associated with physical discomfort, embarrassment and restriction of freedom and of movement. The purpose of the project was to improve practice in the area of physical restraint through the process of auditing current practice against evidence-based, best practice criteria and ultimately to reduce the level of restraint in the facility. Methods This practice improvement project utilised an audit and implementation cycle. The Joanna Briggs Institute Practical Application of Clinical Evidence System and best practice criteria developed from a systematic review were used to determine compliance with best practice. The Getting Research into Practice module was then employed to develop strategies to improve practice. Results The follow-up audit indicated there has been a reduction in the number of residents restrained, increased use of alternatives to restraint and an awareness on the part of all care staff of the policies and procedures, which govern the use of restraint in the facility. Conclusions It is recognised that the success of this project is in part due to the focus of all staff in the area and the support and assistance given to staff by management and the project team. This support will need to continue because while practice has improved in the short term, there are still barriers to change in this area. Also of benefit has been a shift in emphasis of the continuous quality improvement program at the facility to a more clinical focus. Management and staff, especially members of the project team have agreed that this process be utilised to improve practice in a number of other areas such as falls, constipation and behaviour management.     

A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings

BACKGROUND: Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention. METHOD: The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention. RESULTS: The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting. CONCLUSIONS: Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.     

Completing the audit cycle: the outcomes of audits in mental health services.

AIMS: To assess how far those UK National Health Service mental health settings that tested, and prior to publication, used the Newcastle Clinical Audit Toolkit for Mental Health (NCAT) completed the audit cycle. DATA SOURCES: Twelve clinical audit project reports, each focused on one of the five modules in the NCAT, from four rounds of activity over a 2-year period; clinical and managerial staff in the settings where audit projects had taken place. DATA EXTRACTION: Interviews with audit project team members about the recommendations of the 12 audit project reports and about contextual issues; all projects had reported at least 2 years previously. RESULTS OF DATA SYNTHESIS: In analysing the audit project outcomes, five categories of inaction were discernible and five further categories were needed to describe varying states of progress. It was necessary to discriminate between actions attributed to the NCAT audit projects and actions attributed mainly to other initiatives. In total, 26.4% of audit recommendations were still under discussion or in progress. A relatively low proportion of recommendations from audit report findings (34.7%) had been implemented, and these were divided almost equally between recommendations attributed to the NCAT projects (38) and those attributed to other initiatives in the organization (37). CONCLUSION: Investigation of the medium-term outcomes of clinical audit projects has provided an insight into what might usefully be termed the process of completing the audit cycle. The time-scales required to reach the point at which action is deemed to have been implemented or not may be as long as 3 years. Conceptualizing the action stage of the cycle as a single discrete event fails to do justice to the complexity of the process, and attributing the implementation of change in clinical settings to single causes such as individual audit projects is problematic.     

医务人员视角下国家医学中心和国家区域医疗中心的功能任务落实情况评估

目的:从医务人员的角度评价国家医学中心和国家区域医疗中心(以下简称两个中心)的功能任务落实情况。方法:对截至2020年10月完成批复设置的6个国家医学中心和5个国家区域医疗中心共15家主体医院的613名医务人员进行问卷调查,采用描述性分析及秩和检验进行定量数据分析。结果:医务人员认为两个中心在医疗、预防等方面的功能任务落实情况较好,科研与教学方面还有差距,其对于两个中心建设的需求聚焦于人才队伍建设。结论:两个中心要加快高层次医学人才的引进和培养;建立并完善满足临床需求的医教研应用协同机制;强化自身功能定位对于医务人员的导向作用,引导调动医务人员参与两个中心建设的积极性。