我国评价医疗质量指标中存在的主要问题剖析

以国际医疗质量评价指标体系为基准，对国内目前所使用的医疗质量评价指标进行分析．发现国内目前评价医疗质量所使用的指标存在着如下主要问题：（1）现行指标与现代医疗服务质量概念和指标设计原则之间存在较大差距：（2）现行评价医疗质量的指标没有形成完整的体系；（3）现行指标在科学性、客观性和准确性方面存在较大问题：（4）过多使用“间接指标”。     

病例分型医疗质量评价指标体系的构建与应用

近年来，随着人们对医疗质量评价指标认识的进一步深化，探索医疗质量评价的有效性、科学性和适用性已成为医院管理界共同关心的问题。本文运用病例分型理论与方法，在专家咨询的基础上，按照“设立指标较少，包含信息较多”的原则，以病例分型评价指标为核心，构建病例分型医疗质量评价指标体系。     

病例分型应用研究概述

目的运用病例分型理论与方法分析评价临床科室、医师医疗质量。研究内容一是构建病例分型医疗质量评价指标体系；二是制订医疗质量评价指标标准值方法；三是量化考核临床医师医疗质量。方法收集我校三所附属医院2000年1月1日至2004年12月31日所有出院病例病案首页信息进行分型处理，构建病例分型组合，制订控制标准值。对临床科室、医师医疗质量进行描述性统计分析。结果为公正、客观和全面地评价临床科室、医师医疗质量提供了可借鉴的新模式，并有利于奖金分配、评功评奖、职称晋升和人才培养等方面激励措施的完善。     

护理专业医疗质量控制指标（2020年版）的构建

医疗质量评价与持续改进制度需不断完善。质量控制指标是一种以定量方式客观评估质量的元素,制定护理专业医疗质量控制指标,可促进护理质量管理水平提升。阐述了护理专业医疗质量控制指标（2020年版）构建原则、筛选标准、构建过程、指标内容、指标体系意义与特点,指出了指标体系的局限性,并从指标研发与应用两方面提出了建议,从而不断完善质量控制指标体系,提升医疗与护理质量。     

基层医院医疗质量评价问题及改进思路

目的分析基层医院医疗质量评价的不足,探讨相应的改进策略。方法首先对我国基层医院医疗质量评价意义、社会资本进入医疗行业对基层医院发展的影响以及医疗质量评价概念进行了论述,然后分析了基层医院目前在医疗质量评价过程中存在的问题,探讨相应的改进思路。结果医疗质量评价对于基层医院发展具有重要意义,目前我国基层医院医疗质量评价还存在许多问题,主要体现在尚未形成系统完善的医疗质量评价指标体系、医疗质量评价指标结构不合理以及医疗质量管理评价消极被动。结论为进一步提高我国基层医院的医疗质量评价水平,基层医院应该健全医疗质量评价指标体系、明确各评价指标的标准值以及提高对医疗质量管理评价的重视程度。     

三级肿瘤专科医院医疗质量综合评价指标体系构建

目的 构建三级肿瘤专科医院医疗质量综合评价指标体系，为肿瘤专科医院医疗质量监测和持续改进提供工具。方法 通过文献梳理初步确定医疗质量评价指标池，运用德尔菲法展开两轮专家函询，建立评价指标体系，采用层次分析法赋予各级指标权重。结果 两轮专家函询的专家积极系数分别为85.18%、100%;专家权威系数分别为0.82、0.85;总体指标协调系数分别为0.364、0.372,P均<0.05。构建的三级肿瘤专科医院医疗质量综合评价指标体系包括一级指标5项、二级指标55项。结论 构建的三级肿瘤专科医院医疗质量综合评价指标体系具有一定科学性，能够较好反映政策导向及医院发展需求，可为进一步丰富医疗质量评价内涵及助推医院高质量发展提供依据。     

基于定量指标的医疗质量评价体系对比分析

通过文献检索、政策查询等方法收集我国目前用于医疗质量评价的指标体系,并对比分析公立医院绩效考核、公立医院高质量发展、等级医院评审和DRG等涵盖的医疗质量评价指标。不同评价指标体系依其评价作用与意义在指标选取、权重、评价方法等均存在差异,提出加强信息支撑、做好数据质量控制、合理设置指标权重和评价方式、完善医疗质量管理与控制体系、加强各级质控中心建设与管理等对策,为将来定量质量指标评价工作的有效推进提供参考。     

二级以上医疗机构医疗质量管理评价指标初探

目的 :通过对上海市医疗机构医疗质量管理评价指标的研究,形成医疗质量管理评价指标,并利用指标探索对医疗机构质量管理状况进行评价。方法 :依据相关法律法规与规范性文件等进行指标筛选,并通过头脑风暴法初步形成具体指标。制作调查问卷下发全市各级卫生监督机构及部分二级以上医疗机构进行问卷调查。结果 :医疗机构与卫生监督机构对初步形成的医疗质量管理评价指标达成共识,可利用指标对上海市二级以上医疗机构的日常医疗质量管理进行评价,保障和提高医疗服务质量。结论 :上海市医疗质量管理评价指标的研究为进一步探索构建上海市医疗质量管理评价指标体系奠定了基础,不仅为医疗质量管理的监管信息化建设打好基础;同时也提高了卫生监督管理的内涵和质量。     

医院护理过程质量综合评价指标研究

目的 建立科学、实用、适应形势发展的医院护理过程质量评价指标体系，为医院护理管理部门合理评价、科学决策提供依据。方法 采用典型调查法，了解医院现行护理过程质量评价内容和方法；会议讨论确定评价指标体系的基本范畴；采用头脑风暴法、特尔斐法对指标进行筛选和论证，确立指标体系；用现场调查法对25个科室的护理过程质量进行评价和分析。结果 建立了医院护理过程质遣综合评价体系，涵盖护理服务、护理管理、护理技术和护理安全4个范畴并分解成不同层次的评价指标，整体结构由1个总目标、4项一级指标、12项二级指标、5项三级指标和290项子指标构成。结论 新指标体系强调护理服务理念、突出以病人为关注焦点的质量管理原则，层次清晰，操作性强，为科学合理评价护理过程质量提供了可靠保证。     

黑龙江省县级医院医疗质量评价指标体系构建研究

目的:建立一套科学合理、可操作性强的县级医院医疗质量评价指标体系。方法:通过文献研究比较国内外医院质量评价模型并筛选初始指标库,通过专题小组法确定质量评价框架,运用专家咨询法并结合直接评分法与变异系数法筛选指标及确定权重系数。结果:确定了以医疗结构质量、过程质量和结果质量为基本结构的县级医院质量评价框架和指标体系,它由3个一级维度、7个二级维度、31个三级维度指标及其相应的指标权重构成。结论:该评价指标体系将关键政策指标以及医院质量管理中的重点和难点环节评价指标有机结合,可操作性强,能够满足黑龙江省县级医院医疗质量管理的实际需要。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.