军队医院的医保培训现状及对策分析

医保培训考核管理是确保医务人员在规定时间范围内,完成医保政策学习所采取的主要办法。医院内医保培训管理研究,旨在培养医务人员重视医保管理,主动学习、深刻领会医保政策,在基本医疗保险框架内为参保患者合理用药、合理治疗和合理收费。文章针对医保培训管理现状,提出相应的对策,以确保医院医保培训考核管理工作的有效开展。     

落实医保政策 规范医保管理 提供优质服务

医保政策是否能够顺利地在医院落实，取决于医院对医疗保险工作的管理程度。因此医院必须重视对医保的管理。要适应医疗保险制度改革，转变观念，在医保管理工作中不断摸索经验．宣传政策、加强培训、强化管理、健全制度，努力为参保患者提供价廉质优的服务。     

某大型综合医院医保医师编码贯标实践与探索

目的：以国家医保贯标为契机推进院内医师库管理规范,建立院内医保医师管理机制,优化医师贯标赋码全流程,提高院内医师信息管理的准确度。方法：运用PDCA管理工具,在某大型综合医院2021年3月—2021年12月医保医师贯标期间,开展部门协调和持续改进工作,比较贯标过程中多阶段的医保医师赋码率,进而构建院内医保医师管理体系。结果：本文针对贯标过程中发现的医保医师分类管理以及部门间协调问题,通过PDCA循环,不断提出应对措施和建议,持续对医保医师管理方案进行优化,纠正以往粗放式、缺乏系统性管理的缺点,做到标椎化的全量赋码管理,赋码率从85.54%提升至100%。医院建立常态化管理机制,促进且保持日常赋码率超过97%。结论：通过医保医师贯标工作的顺利完成,案例医院提高了数据库的准确性,其成果具有鲜明的创新性和较强适用性,从而促进医院精细化管理水平的提高。医院将贯标与日常管理有机结合,促进贯标工作趋向常态化,提高贯标工作准确性。突出医师编码贯标在院内医保管理智能监控、DRG病案首页中的重要作用。     

专科医师培训工作的实践与认识

专科医师培训是医学生成长为能独立从事临床医疗工作医生的关键阶段．属于毕业后医学教育范畴．是医学教育连续统一体的重要组成部分．对提升临床医生的临床诊疗水平、提高医疗质量发挥着重要作用Ⅲ。而目前我国的专科医师培训工作尚处于试点阶段．在此阶段医院如何有效地做好专科医师培训工作．是医院管理者急需考虑的问题。本文以医院管理者的视角．简要介绍医院医师培训的概况．分析医院开展专科医师培训工作取得的经验．并结合工作实践提出做好专科医师培训工作的措施和建议。     

多种医保付费方式对军队医院的影响分析

本文阐述现阶段我国医院医保费用多种支付方式并存的现状以及对医院发展的影响,同时提出优化工作流程,重视临床路径,规范医疗行为,深化医院信息系统建设等措施是医院适应多种医保付费方式的可行性方法。     

建立专科医师流动层 促进医院整体医疗质量提高

2002年以来,采用“培训合约制”的方式向社会招收培训医师,在3年培训结束后实行二次就业,一部分医师流动到其它县市医院工作,从而在医院形成一个住院医师的流动层。至2008年12月,医院已先后接纳228名培训医师进行培训,这些培训医师成为承担临床一线医疗任务的主要力量。在现有医院医师编制无法改变的情况下,通过建立专科医师流动层的方式,扩大医院住院医师队伍,可以在一定程度上改变目前大型公立医院医师群体“倒金字塔”的畸形状况,充实扩大相对固定的住院医师群体,成为医院整体医疗质量提高的重要保证。经过这一严格培训过程的专科医师求职到其它不同级别医院工作,对基层医疗单位医疗质量的提高也发挥非常积极的作用。     

医学院校毕业生进行中医住院医师规范化培训的经验与体会

中医医院住院医师规范化培训,是对从事中医临床医疗工作的初级中医专业技术人员进行继续教育的一种规范化培训,是中医院中医临床队伍建设的基础环节,是培养高水平临床医学专业人才的重要手段和必经道路,关系到医院的可持续发展,因此越来越为医院管理和医务工作重视.但事实上目前在中医院从事临床工作的医师不一定全部来自中医院校.     

专科医师培训的实践与探索

专科医师规范化培训是完善我国毕业后教育的重要工作.介绍某大型三级甲等医院专科医师培训工作,详尽分析专科医师规范化培训的开展情况及存在问题,为进一步完善医院专科医师规范化培训提出建议.     

开展专科医师培训工作的实践探索

2010年2月卫生部等五部委发布了<关于公立医院改革试点的指导意见>,明确提出"建立住院医师规范化培训制度",并作为改革试点的九项主要任务之一,把住院医师培训作为全科医生、专科医生培养的必经环节[1].住院医师/专科医师培训是遵循医学人才成长规律的必然要求,对培养临床医师的临床工作能力至关重要[1-4].我国的专科医师培训工作目前尚处于试点阶段[2],在此阶段医院如何有效地做好专科医师培训工作,是目前医院管理者急需考虑的问题.我们从基地软件建设角度出发,简要分析医院开展专科医师培训工作的意义和面临的主要问题,并分别从医院可采取的措施和需政府部门协调的措施二个层面提出相应的对策和建议.     

医保相关投诉原因分析及对策

目的了解医保相关投诉的原因,针对性改进,防范于未然。方法对2011年~2013年的287例医保相关投诉登记资料进行分析,数据录入Excel表格进行归类。结果医保相关投诉原因有:患者理解医保政策有误,科室制度与医保政策不衔接,新政策更新快但医院宣传滞后,知情同意落实不到位,医保政策解读口径不一致等。结论医院应从做好医保政策准确对接、落实培训、重视患者知情权、医保政策解读口径一致、与医保中心保持良好沟通等方面着手,构建医、保、患三方和谐关系,快速适应我国"全民医保"新形势。     

部队卫生机构军医在职培训情况调查

本文通过访谈和调查问卷等方法,对某中心医院体系部队9所卫生机构的军医在职培训情况和诊疗技术需求情况进行调查研究,采用Epi Data及SPSS软件对所得数据进行统计分析,通过访谈和数据分析结果,总结部队卫生机构军医在职培训的现状和需求特点,并就完善部队卫生机构军医在职培训的机制进行探讨、提出意见建议,为军队区域一体化卫勤保障改革开展军医培训工作提供参考。     

论医院人力资源的管理

介绍了医院人事部门的主要职责、医院人事管理的重点及工作范围的改变,据此论述了医院人力规划的制定,包括医院人力规划的内容及制定医院人力规划应做的工作。     

Training for terrorism-related conditions in hospitals: United States, 2003-04

OBJECTIVE: This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff. METHODS: Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals. RESULTS: Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).     

基于SWOT模型分析下天津市医联体模式实施现状及对策研究

目的:结合我国医疗卫生现状及相关政策分析天津市开展医联体工作的实施现状,为医联体模式在天津市全面开展提供理论依据,对医疗卫生服务体系整体格局平衡具有现实的指导意义。方法:目的性选取天津市16个建立医联体的三级医院和基层医疗机构的20名人员进行半结构式访谈,采用Colaizzi内容分析法将资料整理分析,应用SWOT模型,归纳总结出天津市医联体模式在实施过程中的优势、劣势、机遇和挑战。结果:天津市开展医联体的优势包括提高基层医生医务能力,应用信息网络搭建沟通平台,提升社区整体水平;劣势包括基层医生工作繁多、压力大、积极性不高,药品管理制度限制患者基层就医,医保制度限制医联体运行;机遇包括医联体建设有国家政策支持,设立专人专岗从事医联体工作;挑战包括基层缺乏吸引人才的机制、区域发展不平衡、缺乏统一管理。结论:天津市医联体模式在实施过程中应加强用经济激励医务人员积极性、建立医联体统一管理制度、完善相关医保政策和药品管理制度,维持医疗卫生服务体系整体格局平衡,促进天津市医联体的全面开展。     

临床医生岗前培训中病历书写缺陷分析

目的加强住院医生及进修医生对病历书写的基本功训练。方法随机抽取我院近两年来由住院医生及进修医生书写的病历600份并进行分析。结果有书写缺陷的病历为312份,缺陷率为52%,其中现病史书写缺陷率最高,为34%。结论住院医生及进修医生应加强岗前培训,重点掌握现病史的采集及描述,以提高病历书写质量。     

The effect of physicians' training on prescribing beta-blockers for secondary prevention of myocardial infarction in the elderly

PURPOSE: The objective was to determine whether the year and medical school of graduation, the medical specialty and the sex of the treating physician was associated with prescribing beta-blockers after hospital discharge among survivors of myocardial infarction (MI), after adjusting for patient characteristics. METHODS: We carried out a dynamic retrospective cohort study using data from a longitudinal database that contained information on Quebec residents over the age of 65 years sent home from hospital after MI between 1990 and 1993. The outcome was a beta-blocker being dispensed after hospital discharge. Logistic regression was used to estimate the association between training characteristics and beta-blocker dispensation and clustering of patients within physicians was accounted for using Generalized Estimating Equations. RESULTS: The cohort consisted of 14,334 MI survivors who were treated by 3209 physicians, yielding a mean of about 4.5 patients per physician [standard deviation (SD) = 8.2]. Beta-blockers were prescribed to approximately one-third of subjects. After adjusting for patients' demographic characteristics, comorbid medical conditions, and markers of MI severity, physicians who were more likely to prescribe a beta-blocker included cardiologists and the most recent graduates (graduating after 1989). Systematic differences were also observed between graduates of different medical schools. CONCLUSIONS: After adjusting for differences between patients', the sex of the physician was largely unrelated to prescribing beta-blockers for secondary prevention of MI. However, prescribing differed by training characteristics such as medical specialty and year and medical school of graduation.     

Fixing family medicine residency training

The number of US medical students entering family medicine continues to decline. Despite the increased presence of family physicians on medical school faculty and increased exposure to family medicine during training, students still cite lack of respect and excessive knowledge base to master as reasons for not choosing our specialty. Specific changes must be made to family medicine residency training to make it more attractive to students and more compatible with the realities of practice today. These changes include eliminating maternity care as a requirement, lengthening training to 4 years, and reducing the number of residency slots available. These changes will ensure that graduating family physicians will be better prepared for practice, better qualified to obtain privileges in the hospital and clinic, and more respected by their colleagues and the public.     

Survey of hospital doctors'training goals in diagnosis and management of pulmonary diseases

Although subspecialty training goals for junior hospital doctors have not been evaluated, they are potentially useful for assessing clinical competence. A questionnaire was sent to medical residents, full-time pulmonary teaching staff, and community-based physicians who were asked to rate the importance of diagnosing and managing selected pulmonary diseases for the future practices of young hospital doctors. The latter also rated their perceived preparedness for the same training goals. Generally good intra- and intergroup agreement about the relevance of most of the training goals was observed, although the hospital doctors rated a greater number of items to be more important than did the two other groups. This finding may be attributed to institutional influences and to many clinical abilities expected of all physicians. Immunological or fibrotic and paediatric respiratory disorders were rated least important by most respondents. The hospital doctors disagreed on the basis of the distribution of their ratings about their preparedness for the same goals, which probably reflects varying training experiences and background. The process of developing general professional training goals in a subspecialty requires discussion, identification, and consensus to identify and potentially correct areas of weakness, with allowance for institutional training patterns. A survey such as described in this study can provide data that can help measure clinical competence and support or define curricular changes.     

The Public Hospital in American Medical Education

The importance of the public hospital system to medical education is often absent from the debate about its value. Best known as a core provider of services to the underserved, the safety net hospital system also plays a critical role in the education of future physicians. Particular strengths include its ability to imbue physicians in training with core professional values, to reveal through the enormous range of clinical experience provided many of the social forces shaping health, and to foster interest in and commitment to advancing population health. Faculty teaching in the public hospital system has unusual opportunities to reveal to learners the broader meanings of their diverse and rich experiences. Now, as an alarming array of pressures bearing down on the safety net system threaten its stability, the potential negative impact on medical education, were it to shrink or be forced to change its essential mission, must be considered. As advocates of the safety net system marshal forces to rationalize its funding and support, its tremendous contribution to the training of physicians and other health care professionals must be clearly set forth to ensure that support for the public hospital system's health is appropriately broad based.