加拿大医疗体制的特色及其对我国的借鉴意义

虽然中国与加拿大在历史、文化、政治、经济等领域存在着较大的差异,且对于卫生服务的需求、医疗卫生的效果也有显著差异,但对这样一个连续6年联合国发展指标评比中名列第一的国家的医疗卫     

国际卫生改革经验对我国卫生体制改革的借鉴

通过对国际卫生改革经验的研究,作者建议,我国的基本卫生保健制度改革要立法先行;体现"公平优先、兼顾效率"的原则,确保人人享有公共卫生服务和基本医疗服务;基本卫生保健内容要与具体国情和财力相适应;正确认识政府和市场的作用,实现政府主导与市场机制的有效结合;做好卫生发展规划,发展社区卫生服务,建立健康"守门人"制度;建立社会化的老人照顾体系;拓宽卫生筹资渠道等。     

社区医疗服务公司化管理是卫生体制改革的突破口

我院自施行卫生体制改革以来，始终把“社区医疗服务公司化管理”作为突破口，现将我院卫生体制改革的具体情况总结如下。     

航空安全管理经验对我国医疗安全管理的借鉴意义

商业航空业与医疗行业同属于高风险行业,商业航空业30余年的航空安全管理取得了巨大的成功.该文分析和探讨了商业航空业的高风险因素及其采取的积极应对策略,包括健全航空安全报告系统、航空风险分析系统、灾害预警指标体系、航空安全文化以及中国民航"四不放过"等措施.航空安全管理的许多策略和经验教训与医疗安全管理中遇到的相类似,值得医院管理者学习和借鉴.     

从医疗费用的增长看卫生体制改革

近年来，医疗费用增长过快，致使医院成为人们议论的话题和新闻媒体关注的焦点。导致医疗费用增长的原因是多方面的，包括卫生管理体制、国家的改革政策、市场经济的冲击、法律、保险、传统风俗等等。控制医疗费用的增长要靠国家和社会的力量，其中卫生管理体制是一个重要方面。我们重点讨论中国医疗费用增长的原     

新加坡对医疗保险的管理及其借鉴意义

一、新加坡对医疗保险的管理 (一)对医疗保健服务的干预 1.基本医疗服务的界定 基本医疗服务的界定倾向于那些临床证明疗效确定且成本一效果比良好的项目,用药范围是按照WTO推荐药品制定标准用药目录。基本医疗服务中也列入一些昂贵的检查、用药及治疗项目,但要由主     

我国社区老年卫生服务的规范化健康管理

随着我国人口和健康发展战略的前移和下移以及医学模式的转变,社区卫生服务在医疗卫生领域的作用越来越显得重要和突出。世界卫生组织早在20世纪80年代就提出“社区承担卫生保健责任”的构想．充分表明社区卫生服务在全球卫生工作中的战略地位。社区卫生服务的目的是要把80％以上居民的健康问题解决在社区,为居民提供全程优质的健康管理的卫生服务。提高居民的整体健康水平和生活质量。其内容包括：健康教育、健康促进、老年保健、妇幼保健、卫生防疫、疾病的预防、诊治和康复、社区心理卫生和精神保健等。     

日本的卫生管理对我国农村卫生发展的借鉴

1基本概况根据中日合作在安徽省建立的初级卫生保健技术与管理培训中心项目工作的需要,为了使该项目覆盖的技术与管理中心及辐射的分中心的管理者更好地了解日本的卫生事业发展及地域医疗保健情况,以便更好地推动项目工作的开展,受日本JICA财力事业团的邀请,2001年11月5日至16日,中国安徽卫生管理研修考察团一行9人,对日本的卫生工作进行了多地域、多部门、多层面的考察学习.     

我国社区老年卫生服务的规范化健康管理

随着我国人口和健康发展战略的前移和下移以及医学模式的转变.社区卫生服务在医疗卫生领域的作用越来越显得重要和突出.世界卫生组织早在20世纪80年代就提出"社区承担卫生保健责任"的构想,充分表明社区卫生服务在全球卫生工作中的战略地位.社区卫生服务的目的是要把80%以上居民的健康问题解决在社区.为居民提供全程优质的健康管理的卫生服务.提高居民的整体健康水平和生活质量.其内容包括:健康教育、健康促进、老年保健、妇幼保健、卫生防疫、疾病的预防、诊治和康复、社区心理卫生和精神保健等.     

美国卫生体系整合模式探索及其对我国的启示

我国正在大力探索建设优质高效的以人为本的整合型医疗卫生服务体系。面对卫生体系严重的碎片化问题,美国近年来在卫生服务的整合方面做了不少尝试。其中,在建设责任型保健组织（Accountable Care Organization,ACO）和以患者为中心的医疗之家（Patient-Centered Medical Home,PCMH）方面取得了一些有益的经验。本文在文献综述基础上探讨了这两类实践的主要做法、成果、问题,及其对我国支付方式改革、医疗卫生机构整合、基层医疗卫生服务团队建设、卫生信息体系整合及如何因地制宜推进整合改革的相关启示。     

The Patient‐Centered Medical Home and Patient Experience

Objective

To examine the relationship between practices'' reported use of patient-centered medical home (PCMH) processes and patients'' perceptions of their care experience.

Data Source

Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices.

Study Design

This is an observational, cross-sectional study. Using standard ordinary least-squares and a sample selection model, we estimated the association between patients'' care experience and the use of PCMH processes in the practices where they receive care.

Data Collection

We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices.

Principal Findings

We found that practices'' use of PCMH processes was not associated with patient experience after controlling for sample selection as well as practice and patient characteristics.

Conclusions

In our study, which was large, but somewhat limited in its measures of the PCMH and of patient experience, we found no association between PCMH processes and patient experience. The continued accumulation of evidence related to the possibilities of the PCMH, how PCMH is measured, and how the impact of PCMH is gauged provides important information for health care decision makers.     

我部医疗保健工作的管理

为了以一流的标准做好重点对象医疗保健工作，本介绍了该部开展医疗保健工作的体会。一是强化组织领导，强化保健意识，强化措施到位，强化激励机制，强化硬件建设；二是强化管理，从健全完善制度，加强能级管理，周密科学安排，严格质量把关等方面入手，按万无一失地要求落实保健工作。三是优质服务，通过加强窗口建设，狠抓学习提高，鼓励技术创新，重视保健教育等手段，以一流的标准完成保健工作。     

Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff

Objectives

To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff.

Lessons Learned: Medical and Health Care Management for Emergency Workers at the TEPCO Fukushima Daiichi APP Accident

During the emergency work at the Fukushima Daiichi Atomic Power Plant (APP), the Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in medical and health care management issues, including special medical examinations, on-site triage and initial treatment, patient transportation, lodging and food, and long-term health care for emergency workers. To resolve these problems, the Ministry of Health, Labor and Welfare (MHLW) issued a series of compulsory directives and provided administrative guidance to TEPCO. Based on the experiences and lessons learned, the MHLW recognized that the proper management and implementation of medical and health care management in response to a similar accident would require sufficient measures and systematic preparation, including the following:

1. In case of large-scale nuclear accidents, the government needs to assist in dispatching medical staff to the affected plants.

2. Nuclear facility operators, medical facilities and fire departments should make an agreement to clarify the division of the roles played prior to the accident and should conduct emergency drills periodically with the full attendance of related personnel to identify and resolve the problems.

3. Operators need to develop a support base at a safe distance from the plant and to prepare to develop makeshift lodgings in case of emergency.

4. Operators need to come to an agreement to share food stocks among closely located nuclear plants and prepare cooking equipment that can be used in case of blackout to provide warm foods and drinks to as many workers as possible.

5. It is necessary to conduct long-term follow-up for emergency workers, including health care system, medical examinations and mental health consultations.     

One-Year Medical Utilization and Mortality in Home Health and Nursing Home Care Recipients from Northern Taiwan

ObjectivesHome health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan.DesignThis study employed a prospective cohort design.Setting and ParticipantsWe enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December 2017.MethodsMultivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality.ResultsCompared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality.Conclusions and ImplicationsCompared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients.     

Human Resources Management Practices and Patient Satisfaction in Home Health Care

Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores.     

新时期军队高级干部医疗保健管理的做法与成效

为确实做好新时期军队军职以上干部医疗保健工作,进一步提高服务质量,本文介绍该院保健工作的改革经验和具体管理方法,包括:上下级管理(系统化管理)、制度化管理和人性化管理.具体讲述组建“院、办、科”三级管理体系、建立、完善各项规章制度、加强宣教实现自我管理,及开展以人为本的文化管理的具体措施.     

High-Tech Home Health Care

This study examines staff perspectives and personnel issues related to the delivery of high-tech home health care services to older adults. Data were collected from a national sample of 154 agency directors and 92 local agency staff. Agency staff and directors consistently report an increase in high-tech service delivery over the past five years. Both agency directors and local staff agree that a variety of staff may be involved in the delivery of high-tech services, including both professional and paraprofessional staff. Although agency directors report providing training to at least one or more type of direct care staff, agency staff are less likely to report being required to participate in training programs. The provision of high-tech services impacts the agency, the staff, and the patient in various ways. Most staff feel that high-tech care enhances the quality of life of older patients, although high-tech care may be somewhat difficult to define and even more difficult to deliver. Challenges related to the provision of high-tech care, including providing adequate staff training, and developing appropriate quality assurance measures, are discussed.     

基层医疗保健机构孕产妇保健服务利用现状与相关因素分析

目的 探究影响孕产妇利用保健服务的相关因素,并结合地区实际,提出了相关建议和措施.方法 对在我院进行保健服务的1558名孕产妇进行调查分析,结合实际情况用SPSS 18.0统计学软件进行系统分析.结果 文化程度、家庭年收入水平、居住地距离、职业和医保等因素对孕产妇保健服务利用影响较大;同时,在1 558名受访者中,接受孕前保健指导的比率相对较低,早孕检查、5次以上产检率和住院分娩率结果相对较高,说明近几年来孕产妇对保健服务利用的意识有所提高,但产后访视比例仅为21.76％,比例较低.结论 针对当前现状,研究认为,个人、基层医疗保健机构及卫生管理部门等各方应当分别在提高认识水平、提高服务水平及加强基层系统建设等方面进行改善,以提高孕产妇保健服务的利用,提高优生优育水平.