医院绩效管理体系框架的构建与思考

随着医院内部管理模式和运行机制的转变,绩效管理逐渐得到管理者的高度重视。结合所在医院开展绩效管理的实践,探讨了进行绩效管理的框架体系建设,包括绩效管理目标体系、组织过程体系、制度体系和组织保证体系,并讨论了实施绩效管理应注意的几个问题。     

Failure to utilize functions of an electronic prescribing system and the subsequent generation of ‘technically preventable’ computerized alerts

Objectives

To determine the frequency with which computerized alerts occur and the proportion triggered as a result of prescribers not utilizing e-prescribing system functions.

Methods

An audit of electronic inpatient medication charts at a teaching hospital in Sydney, Australia, was conducted to identify alerts fired, to categorize the system functions used by prescribers, and to assess if use of short-cut system functions could have prevented the alerts.

Results

Of the 2209 active orders reviewed, 600 (27.2%) triggered at least one alert. Therapeutic duplication alerts were the most frequent (n=572). One third of these (20.2% of all alerts) was ‘technically preventable’ and would not have fired if prescribers had used a short-cut system function to prescribe. Under-utilized system functions included the option to ‘MODIFY’ existing orders and use of the ‘AND’ function for concurrent orders. Pregnancy alerts, set for women aged between 12 and 55 years, were triggered for 43% of drugs ordered for this group.

Conclusion

Developers of decision support systems should test the extent to which technically preventable alerts may arise when prescribers fail to use system functions as designed. Designs which aim to improve the efficiency of the prescribing process but which do not align with the cognitive processes of users may fail to achieve this desired outcome and produce unexpected consequences such as triggering unnecessary alerts and user frustration. Ongoing user training to support effective use of e-prescribing system functions and modifications to the mechanisms underlying alert generation are needed to ensure that prescribers are presented with fewer but more meaningful alerts.     

A systematic review to evaluate the accuracy of electronic adverse drug event detection

Objective

Adverse drug events (ADEs), defined as adverse patient outcomes caused by medications, are common and difficult to detect. Electronic detection of ADEs is a promising method to identify ADEs. We performed this systematic review to characterize established electronic detection systems and their accuracy.

Methods

We identified studies evaluating electronic ADE detection from the MEDLINE and EMBASE databases. We included studies if they contained original data and involved detection of electronic triggers using information systems. We abstracted data regarding rule characteristics including type, accuracy, and rationale.

Results

Forty-eight studies met our inclusion criteria. Twenty-four (50%) studies reported rule accuracy but only 9 (18.8%) utilized a proper gold standard (chart review in all patients). Rule accuracy was variable and often poor (range of sensitivity: 40%–94%; specificity: 1.4%–89.8%; positive predictive value: 0.9%–64%). 5 (10.4%) studies derived or used detection rules that were defined by clinical need or the underlying ADE prevalence. Detection rules in 8 (16.7%) studies detected specific types of ADEs.

Conclusion

Several factors led to inaccurate ADE detection algorithms, including immature underlying information systems, non-standard event definitions, and variable methods for detection rule validation. Few ADE detection algorithms considered clinical priorities. To enhance the utility of electronic detection systems, there is a need to systematically address these factors.     

在实践中探索公立医院管理体制改革的新思路

回顾与借鉴国有企业改革的经验,探讨了公立医院产权制度改革的形式、管理体制改革的动因;探索医院特制改革中的问题解决途径.从无锡市医疗卫生体制改革中获得启示:要找准改革的突破口;实施创名院、建明科、出名医发展战略.盘活资源,加强院前急救;创文明行业,树良好形象;整合资源、优化配制,打造医疗服务品牌.     

现代医院人力资源管理体制研究

剖析了当前我国医院人力资源管理的弊端,对比先进国家的人力资源管理模式和理念,确立了我国现代医院人力资源管理的目标,并提供了应达到目标的对策分析.     

新《医院财务制度》下的成本管理

以新《医院财务制度》的颁布实施为背景,阐述了在新形势下加强医院成本管理工作的必要性,同时解析了新制度中关于医院成本管理的相关内容和具体要求,针对具体形势和新制度的相关要求对医院如何开展成本管理提出了建议。     

基于军卫一号工程的医院图书管理系统设计与实现

目的: 将医院的图书进行计算机管理,实现医院图书室图书管理工作的数字化和信息化. 方法: 以PB(PowerBuilder)和ASP 作为系统开发的主要工具和技术路线,图书管理端使用C/S(Client/ Server) 架构,用户使用的检索查询窗口使用B/S(Browser/Server)架构. 结果: "军队医院图书管理系统"的成功开发方便了管理人员的图书管理,也有益于医院工作人员的学习. 结论:"军队医院图书管理系统"运行稳定,工作可靠,功能较完善,满足了使用要求.     

我国公立医院“管办分开”管理体制改革现状分析与探讨

我国公立医院改革试点指导意见颁布以来,全国各地陆续开始实施了公立医院改革的试点工作,本研究通过文献检索及评阅,汇总了12个城市公立医院＂管办分开＂管理体制改革方案,并进行比较分析与探讨,旨在为我国制定科学合理的公立医院管理体制提供参考。     

论医院质量管理体系中院长的职责

在医院质量管理体系中,最高管理者是院长或院领导班子。作为最高管理者,应该制定并保持组织的质量方针和质量目标,决定有关质量方针和质量目标的措施;加强医院内部沟通,在医院内促进质量方针和质量目标的实现;确保整个医院关注顾客要求;确保实施适宜的过程以满足患者和其他相关方要求;确保获得必要资源;定期评审医院质量管理体系并持续改进。只有这样,才能真正提高医院工作质量,满足患者需要,提高卫生健康水平。     

医院数字化管理系统“金字塔”型功能架构的探讨

提出以医院管理决策支持信息核心为塔顶的,包括患者（或顾客）就诊信息核心、医院运营信息核心、医院外部信息核心、医院管理决策支持信息核心等四个方面的医院数字化管理系统“金字塔”型功能划分架构,并详细介绍了每个核心的子模块。通过金字塔形功能的划分,以期为医院管理者及软件开发商提供一个新的角度或方式实施医院数字化管理系统的建设。     

基于医疗质量管理的医院核心指标直报系统的构建与应用

介绍了浙江省医疗质量管理核心指标直报系统的建设背景、构建过程和具体做法,总结了成效和体会,针对存在的问题提出下一步完善措施。直报系统提高了数据收集的及时性和准确性,也提高了数据资料的共享性和利用度,为改善医疗质量提供了数据支撑,为卫生行政部门制定政策提供了客观依据,为医院评审评价建立了基础数据库。     

现代医院管理制度下公立医院章程建设问题与对策探析

在现代医院管理制度建设中,医院章程是不可或缺的重要内容,是医院管理的主要依据.公立医院需考虑国情、院情,以法律法规为基础,创建合理、有效、权威的医院章程,促进医院全方位发展,保障医院公益性.阐述了公立医院章程创建的重要意义,分析了其现状和现存问题,并针对性提出对策建议.     

公立医院建立健全现代医院管理制度的实践与思考

建立健全现代医院管理制度是深化公立医院改革、推进医院治理体系和治理能力现代化的客观要求。本文阐述了某公立医院按照现代医院管理制度建设的要求,以完善治理体系、加强精准管控、再造服务流程及增强品牌实力为重点,提升医院经济运营效率及品牌影响力,以期对其他医院完善现代医院管理制度提供有益借鉴。     

新医院财务制度下的全面预算管理的探讨

根据新医院财务制度和新医改意见的实施方案,寻求既符合社会公益准则,又顺应市场的管理方式。全面预算管理作为医院财务管理的重要组成部分,应引起医院决策者的高度重视。笔者分析了目前医院预算管理环节存在的主要问题及编制方法,并对医院在新医院财务制度下如何加强全面预算管理提出了几点建议。     

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.     

新《医院财务制度》下如何加强公立医疗机构的资产管理

资产是机构运行和发展的物质基础,由于资产管理制度的缺失以及管理行为的不科学导致的资产损失,是当前阻碍公立医疗机构运行与发展的主要问题之一。该文针对当前我国医院资产管理存在的常见问题,结合新颁布的《医院财务制度》的实施,就如何深入加强公立医疗机构的资产管理进行初步探讨。     

浅谈当前医院财务管理机制中的难点及对策

伴随着我国经济体制改革的不断深入,医疗市场竞争的不断加剧,使得财务管理在医院管理中的地位和作用也越来越重要.但是,现行的医院财务管理机制已明显不能适应医院管理的需要.本文拟从预算管理、筹资管理、成本管理、资产管理等方面对医院财务管理机制中的难点提出一些对策.     

试论现行医院成本管理体系局限性及其改进

随着社会经济环境的变迁,现行医院成本管理体系的局限性日益显现,并影响着医疗服务的市场化进程.现代市场经济条件下的医院要随着经营环境的变化,不断改进成本管理体系,提高社会经济效益.