我国老年家庭护理成本核算的现状与分析

随着人口老龄化,我国老年医疗护理需求急剧增加.为进一步合理配置老年卫生资源,在相关政策支持下,我国社区卫生服务近年来得到较快发展.家庭护理,作为社区卫生服务的重要形式,既可以满足老年人日益增长的长期照顾需要,又通过减少住院日和住院率降低了卫生资源耗费,其作用越来越受到重视和肯定.     

慢性伤口管理卫生经济学评价的研究现状及思考

卫生经济学评价不断应用在临床领域中,近年来慢性伤口管理的卫生经济学评价逐渐发展起来.从慢性伤口的投入及产出指标,卫生经济学评价在不同种类慢性伤口管理中的应用现状,护士在慢性伤口管理卫生经济学评价中发挥的作用方面进行综述,以期为临床决策提供相应的依据.     

我国城市家庭护理服务模式的现状与分析

随着人口老龄化,我国卫生供给压力不断增大。为进一步合理配置老年卫生资源,政府将社区卫生服务置于重要的战略地位。而家庭护理作为社区卫生服务的重要形式,在满足日益增长的老年卫生服务需求中起着至关重要的作用。合理的家庭护理模式将提高卫生服务的社会效益和经济效益,促进整个卫生服务的供需平衡。本文旨在从服务对象、组织管理等方面,探讨我国城市家庭护理服务模式现状,为我国进一步开展家庭护理研究,优化家庭护理模式提供参考。     

我国城市家庭护理服务模式的现状与分析

随着人口老龄化,我国卫生供给压力不断增大.为进一步合理配置老年卫生资源,政府将社区卫生服务置于重要的战略地位.而家庭护理作为社区卫生服务的重要形式,在满足日益增长的老年卫生服务需求中起着至关重要的作用.     

我国城市家庭护理服务模式的现状与分析

随着人口老龄化，我国卫生供给压力不断增大。为进一步合理配置老年卫生资源，政府将社区卫生服务置于重要的战略地位。而家庭护理作为社区卫生服务的重要形式，在满足日益增长的老年卫生服务需求中起着至关重要的作用。合理的家庭护理模式将提高卫生服务的社会效益和经济效益，促进整个卫生服务的供需平衡。本文旨在从服务对象、组织管理等方面，探讨我国城市家庭护理服务模式现状，为我国进一步开展家庭护理研究，优化家庭护理模式提供参考。[第一段]     

上市后药物经济学评价方法(Ⅰ)--建立经济学评价框架,评价经济学证据

药品是中国重要的卫生资源.尽管上市前药品研究已受到相当重视,但对上市后药品的实际问题关注较少.合理使用和分配上市后药品资源是中国的决策者面临的主要问题之一.经济学评价作为优化分配和使用药品的有效工具现已得到公认.本文介绍了上市后药物的经济学评价方法与原则.上市后药物的经济学评价根据证据的有效性和数量分为三种情况,并相应地采取不同的研究方法.但上市后药物经济学评价方法应采取标准路径.此外,本文还介绍了建立经济学评价框架和评价经济学证据的方法,特别是针对同类药物的评价方法.     

我国老年家庭护理成本核算的现状与分析

随着人口老龄化，我国老年医疗护理需求急剧增加。为进一步合理配置老年卫生资源，在相关政策支持下，我国社区卫生服务近年来得到较快发展。家庭护理，作为社区卫生服务的重要形式，既可以满足老年人日益增长的长期照顾需要，又通过减少住院日和住院率降低了卫生资源耗费，其作用越来越受到重视和肯定。[第一段]     

国外家庭护理流程化管理模式的概况及启示

随着人口老龄化卫生压力日益增加,家庭护理由于具有良好的成本效益,已成为许多发达国家缓解老年卫生资源供需矛盾的基本卫生政策[1].家庭护理的发展平台是社区卫生服务.从经营方式上划分,目前国际上存在3种社区卫生服务发展模式[2],代表国家分别是美国、英国和日本.     

卫生经济学评价在护理不良事件管理中的应用进展

对卫生经济学评价常用方法及其在护理不良事件管理中的应用现状进行综述,为临床护理管理者改善病人结局,选择最优方案节约医疗资源并分析其特点,以及进一步研究提供参考.     

国外家庭护理流程化管理模式的概况及启示

随着人口老龄化卫生压力日益增加,家庭护理由于具有良好的成本效益,已成为许多发达国家缓解老年卫生资源供需矛盾的基本卫生政策。家庭护理的发展平台是社区卫生服务。从经营方式上划分,目前国际上存在3种社区卫生服务发展模式,代表国家分别是美国、英国和日本。这3个代表国家,以流程化管理理念为基础,在不同的社区卫生服务模式下发展了相应的家庭护理服务模式。现介绍美国、英国和日本家庭护理流程化管理模式,为促进我国家庭护理科学化管理,提高家庭护理服务效率提供借鉴和参考。     

New challenges in ageing: Home care

Most nations are undergoing two fundamental demographic changes: concentration of their population in cities and accelerated pace of population ageing. The fastest-growing population is that 85 years and over. Morbidity increases with advancing age, functional capacities decrease; this results in decreased performance of activities of daily liver and need for services. The challenge is particularly strong in urban areas. Modern societies seek solutions in maintaining the elderly in their homes through home care programmes for those who are functionally impaired, homebound, and need support in home-making and home nursing. Home care is firmly established in programmes for the elderly. In order to become a scientific discipline home care has to define its boundaries, identify clients by careful multidisciplinary assessment, provide answers regarding its cost-effectiveness, evaluate outcomes of home caring, develop indicators of high-quality care and advise appropriate home care technology, which is affordable and accessible. Home care for the elderly population living in remote rural areas is one of the future challenges.     

Delivery of rehabilitation services to people aging with a disability

The disabled elderly population continues to grow. Systems of care for the disabled elderly are vast, ranging from inpatient facilities to outpatient programs and home programs. Recent advances in technology allow us to reach patients in their homes through telemedicine. Support services within the community are growing, and case managers are becoming more necessary as it becomes more difficult to navigate the health care system. As providers of rehabilitative services, we must help our patients find the most appropriate setting to receive care. As the focus continues to shift from inpatient to outpatient care and to home services, we must approach health care in a dynamic fashion and with flexibility. We must be advocates for our patients and their caretakers. Significant research questions remain, and health care policy requires development. As the population ages and the disabled elderly population become a focus of fiscal experts, we must look to provide the most cost-effective yet functionally productive health care. We may shift from focusing on functional performance in a therapy gym or inpatient rehabilitation unit to functional performance at home. We must focus on IADL and QOL indicators and must strive to find ways to provide efficient, cost-effective care. Medicaid, Medicare, and third-party insurers offer various options.The VHA offers additional benefit to those who are eligible. Advocacy groups such as the American Association of Retired Persons struggle to meet its members' needs and concerns while generating income to provide education and other resources. We must work to promote the strengths of the elderly population by addressing preventive strategies while maintaining functional independence.     

医养结合背景下居家养老护理服务需求调查

目的了解社区居家养老老人对护理服务的需求情况,为开展针对性护理提供依据。方法采用自行编制的调查问卷于2018年8月对上海市徐汇区康健街道的750名居家老人进行现场问卷调查。调查内容包括:老人一般资料以及对医养结合相关政策知晓程度、对健康及护理服务的需求和满意度情况。结果被调查的750名社区老人的平均年龄为(72.62±8.17)岁,87.5%具有初中及以上文化程度,59.1%的老人缺乏照护人员,74.1%的老人患有一种及以上慢性病,79.4%的老人不知晓医养结合,92.1%的老人对提供居家护理服务项目所知甚少。护理需求中排序前3位的是输液(52.5%)、抽血检验(42.2%)和疼痛护理(9.9%),83.0%的接受过相关服务的老人对目前居家养老护理服务感到满意。结论目前居家养老的老人年龄偏大、合并的慢性疾病多,且缺乏照护人员,对居家养老护理服务需求高。今后需针对居家老年人的需求,建立健全的居家养老护理服务模式,以满足其医疗健康服务需求。     

Introduction

Due to advances in medicine and economic development, the percentage of Korean elderly is increasing markedly. If preparation is not made for the coming aged society, there is a possibility that the development of the Korean nation will be hindered. The increase in the number of the elderly is increasing the social/national burden of providing medical care for the elderly. Meanwhile, with the trend toward the nuclear family, the increase of female participation in social activities, and the increase of elderly who live alone, it is difficult for nursing homes alone to solve the problem of providing support for the elderly. Long‐term medical treatment and care of the elderly has become the responsibility of both the government and society. Under these conditions, the Korean policy for elderly patients can be classified broadly into home care, community care, and institutional care. In order to prepare for the aged society, deficient facilities need to be supplemented and home care and community care need to be expanded so as to increase the communities’ ability to support the elderly . Homes, communities, government and the private sector should work together to provide integrated welfare and health care to the elderly.     

Home health care and the elderly in the 1980s

Because the cost of institutional care for long-term patients has risen, home health has become a more visible and viable alternative to the growing elderly population. This article discusses problems found in the rapid expansion of home health services and presents two alternative health care delivery systems that address these problems: the Medicaid Waiver and the Social/Health Maintenance Organization.     

Needs of the elderly and the politics of health care. The social context of changes in the delivery system

The emergence of the elderly as a substantial subgroup within the population has been identified as signaling a crisis for the health care system. This article places recent changes in health care financing for the elderly in the context of biomedical, demographic, and social factors. These factors, in turn, are related to the larger economic and political structures that have shaped our national health care policies and programs. Current policies and programs are inadequate in meeting the needs of the elderly because they provide a limited array of services. This article also examines how the needs of the elderly have been portrayed to support age-based entitlements to limited health care coverage, irrespective of need across age strata. Physical therapists can use their understanding of the genesis of particular public policies to assist in developing a health care system that is responsive to the needs of all members of society.     

The Effectiveness of the Around‐ the‐Clock In‐Home Care System: Did It Prevent the Institutionalization of Frail Elderly?

This study compares two communities in Japan from the perspective of community health care resources and their use by the elderly during 1992-98. In one community, programs of home care services for the elderly were reorganized to provide around-the-clock in-home nursing and home help services seven days a week (ACC). Official records were the major sources of data. Evidence from the analysis indicated that ACC might contribute to less use of institutionalization as an alternative to home care, even though, in some instances, institutionalization is the only appropriate alternative.     

Capturing activity,costs, and outcomes: The challenges to be overcome for successful economic evaluation in palliative care

Abstract

Palliative care, as with other health care services, is faced with the difficulty of competing for limited health care resources. Health care decision makers seek to maximize ‘value for money’ when selecting services to fund. The challenges for the palliative care community are to (a) demonstrate the cost effectiveness of its interventions in comparison to other health services and (b) provide evidence that the resources currently allocated are being used efficiently. Health economic evaluation can be conducted to support this. In this paper different economic approaches to evaluating health care services are introduced. Providing examples from (home based) palliative care we consider the opportunities to progress this work. We also describe the related challenges of capturing activity, costs, and outcomes. Although the very nature of this area of care presents unique methodological challenges that will need to be overcome, appropriate analyses will allow comparisons across the wider health sector and strengthen the argument for palliative care services.     

基于老年视角的社区护士主导居家养老影响因素的质性研究

目的：通过老年人的视角来探讨社区护士主导居家养老服务的影响因素,为构建以社区护士为主导的居家养老服务体系提供参考。方法应用质性研究的现象学方法,对15名社区老年人进行面对面半结构化访谈,采用Colaizzi主题分析法对获得的资料进行分析。结果从老年人的视角提炼出5个主要影响因素：人力资源配比不均衡,老人经济条件不足,社区护士待遇低,社区护士养老知识技能和综合素质欠缺,社区护士的社会价值降低。结论大部分老年人对以社区护士为主导的居家养老接受度不高,社区护士主导居家养老的发展需要国家政策和资金支持;社区护士应加强各项养老知识技能的培训和提高自身的综合素质,同时政府和社区应加强对社区护理的宣传,以提高居民的信任。     

老年人子女对老年人家庭护理服务支付意愿的研究

目的了解老年人子女对老年人家庭护理服务的支付意愿,并探索其影响因素。方法采用条件价值评估法调查北京市三个街区320名老年人子女,调查问卷主要包括4个部分:对家庭护理服务及调查情况的描述;老年人子女的人口统计学资料;家庭护理服务的支付意愿;对问卷的理解程度。结果绝大多数的被调查者(有227例,占70.0%)愿意支付老年人家庭护理服务的相关费用;影响老年人子女对老年人家庭护理服务的需求和支付意愿的因素有:经济状况、健康意识、照顾老人经历(P0.05)。结论老年人子女对老年人家庭护理服务持肯定态度,但支付意愿受到多种因素影响,应采取国家和个人共同付费的收费方式。