The influence of rural physicians' perception on referral patterns to a university hospital.

The patient referral process is based on a complex set of social rewards and costs for the referring physician. For the physician or institution potentially receiving referrals, a key question is, why is one institution selected over other available choices? Factor analysis of a survey of rural physicians revealed five factors of reward and cost associated with the choice of where to refer patients. Further analysis of these factors suggested that the ability to have patients admitted and treated when necessary is central to the satisfaction of the referring physician and their willingness to continue the consultant relationship. Adequate information about the consultants was also important to satisfaction. Other factors have less influence. Further, “admissions when necessary” was the only reward/cost factor which predicted physicians who referred more to the university hospital than to other hospitals. If a university hospital wants to develop strategies to encourage referrals from rural physicians, it must be cognizant of these social reward-cost factors.     

面向科研创新的中医药图书馆建设与发展策略探索——以广州中医药大学为例

高校图书馆与高校科研相辅相成,不可分割。在当今高校科研蓬勃发展、信息化建设飞速前进的背景下,对高校图书馆的建设提出了新的更高的要求,该文以广州中医药大学为例,从该校的图书馆建设与科研情况出发,从资源、环境、服务和管理4个方面,探索中医药图书馆的发展策略。     

Delayed discharge. Home truths

The Department of Health wants to turn home improvement agencies into key players in provision of services to older people discharged from hospital. 104 clients have been referred to the project: 55 related to hospital discharge and 49 to admission prevention. Having a single point of contact for a range of home improvement services has made referrals easier.     

Chest pain, weakness, and elevated cardiac enzymes: how would you treat?

You are making rounds in the hospital one Saturday morning when you receive a call from the emergency department saying a 68-year-old man is having chest pain, weakness, and "positive cardiac enzymes." His electrocardiogram (ECG) reading is reported as unremarkable. Because it is the weekend and no cardiology consultation is available at your hospital, the family medicine resident wants to know if you would like to admit the patient to your service or transfer him to a larger hospital. You decide that you can best make this decision by going to the emergency department and personally evaluating the patient.     

Hospitals are loath to cite satisfactory level of profit

The healthcare industry likes to talk about the need to earn a reasonable profit, but no one wants to nail down what constitutes a reasonable profit margin for a hospital, says Michael Millenson.     

广州市医院公共关系状况调查分析

目的 了解广州市医院管理中的公共关系状况。方法 对广州市不同级别的医院进行问卷调查。结果 一个医院的等级和级别越高．公共关系意识越强，服务理念也越好，但各级医院的危机公关工作水平有待提高。建议 医院要树立塑造形象及全员公关的意识，并建立医院公共关系危机管理部门。     

Zum Verhältnis zwischen Medizinischer Fakultät und Universität

University medicine is presented as a relationship of three partners: the university hospital, the medical school, and the university as a whole. The university gains from the interdisciplinary potential of the medical school in teaching and research, and vice versa. Vis-à-vis the university hospital, the medical school is strengthened by the university’s independent political standing and its expertise in legal and budget issues. Just as the financial separation between the university hospital and the medical school provided more clarity, a clear financial accounting between the medical school and university is possible, based on the parameters by which money is allocated to the university and the central services provided to the medical school. To make full use of the opportunities that university medicine can provide, the university has to act strategically as a whole.     

Contribution retribution. Health system, CEO must pay excise taxes after pressuring workers to help fund state association's PAC through payroll deductions

The IRS wants not-for-profit health systems to remember to keep their distance from politics--it's taxing the payroll contributions at one system that went to a state hospital association's PAC. Kenneth Robbins, left, says hospitals should always be conscious of activities that could jeopardize their tax-exempt status. "It's an issue we've been concerned with as long as I can remember," he says.     

A cost-savings analysis of the use of a predictive instrument for coronary-care-unit admission decisions.

The predictive instrument for acute ischemic heart disease is one of several clinical decision aids developed to reduce unnecessary coronary-care-unit (CCU) admissions. Previous cost analyses of such decision aids have been based on hospital charges; however, estimates based on hospital charges significantly overstate true cost savings to hospitals. The actual savings for a hospital that wants to implement the predictive instrument depend on the hospital's cost structure, the competitiveness of its medical care, and its payor mix.     

高校医院常识思考

高校医院作为高等院校的重要组成部分,在立德树人的人才培养过程中承担着重要的使命。在健康中国战略和高校回归常识的背景下,探讨高校医院的常识。用质性研究的方法,从人才诠释的视角,讨论高校医院在培养“健全人”中的担当与使命;从大众健康意识的认知与变迁的视角,论述高校医院的运作职能。建立治疗、预防、保健、自然生活“四位一体”的全方位健康生活管理服务模式应当成为高校医院的常识。     

Branding time at Columbia

This week Columbia/HCA Healthcare Corp. introduces a national advertising blitz believed to be the largest ever by a healthcare provider. The hospital giant wants to instill its brand name in the American lexicon, and it's willing to spend millions to do so.     

Making a low cost IPSec router on Linux and the assessment for practical use

We installed Linux and FreeS/WAN on a PC/AT compatible machine to make an IPSec router. We measured the time of ping/ftp, only in the university, between the university and the external network. Between the university and the external network (the Internet), there were no differences. Therefore, we concluded that CPU load was not remarkable at low speed networks, because packets exchanged via the Internet are small, or compressions of VPN are more effective than encoding and decoding. On the other hand, in the university, the IPSec router performed down about 20-30% compared with normal IP communication, but this is not a serious problem for practical use. Recently, VPN machines are becoming cheaper, but they do not function sufficiently to create a fundamental VPN environment. Therefore, if one wants a fundamental VPN environment at a low cost, we believe you should select a VPN router on Linux.     

走进市场创造辉煌

医院走进市场是医疗体制改革和社会发展的必然结果 ,是医院生存和发展的必然选择。医院走进市场 ,应确定在市场中的角色 ,制定经营管理策略 ,加强形象建设和宣传 ,提高医疗质量 ,扩大医疗容量 ,找准经济增长点 ,增加有效投入 ,并根据医疗市场变化 ,实行弹性经营管理。医院只有走进市场 ,才能取得良好的经营业绩 ,创造辉煌。     

浅析医疗费用虚高难下的症结

当前人民群众看病贵的问题十分突出，已成为社会关注的热点和难点，要解决这一问题，找准其中的原因是关键，本文从医院的角度对造成医疗费用虚高难下的症结做一分析，认为医疗费用虚高难下的症结是药价高、检查多。     

Mortality in a public and a private hospital compared: the severity of antecedent disorders in Medicare patients.

OBJECTIVES. The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. METHODS. Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. RESULTS. Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. CONCLUSIONS. The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations.     

Viewpoint: National Healthcare Spending and Fiscal Control: Comparisons among 15 Countries

The human factor is central to healthcare, yet its proper management has remained beyond the reach of health-care organizations. This qualitative study examines strategic human resource management (HRM) issues in a university and a community hospital. The findings indicate that the two hospitals lacked a clear understanding of their strategic intent and objectives; as a result, their human resource (HR) practices lacked coherence and direction. Whereas the community hospital understood the interrelationship between culture and HRM, the university hospital did not. Moreover, the university hospital showed only a modest understanding of competencies needed in managing HR function, which hampered its ability to identify competent HR managers and employees. The community hospital made significant gains in the past few years in managing its culture and people by recruiting a competent HR manager. The relationship between HR practices and clinical outcomes was much less clear in the university hospital than it was in the community hospital.     

Hospital privileges for family physicians at university hospitals

Of the more than 350 family practice residency programs in the United States, 72 are affiliated with a medical school. Seventy-eight percent of these university programs hospitalize all or some of their patients at a university hospital. These hospitals grant various privileges to family physicians with the following frequencies: general medicine (94 percent), adult intensive care (50 percent), coronary care (65 percent), general pediatrics (81 percent), pediatric intensive care (29 percent), normal newborn nursery (79 percent), intensive care nursery (12 percent), routine obstetrics (77 percent), and high-risk obstetrics (31 percent). Sixteen (22 percent) of the university-based programs do not use a university hospital at all, either because the university hospital is too far away or because there is no university hospital. Only one program does not use the university hospital because of difficulty in obtaining privileges. Family physicians are unable to obtain various hospital privileges because of political reasons at the following percentages of university hospitals: general medicine (2 percent), adult intensive care (33 percent), coronary care (40 percent), general pediatrics (8 percent), pediatric intensive care (31 percent), newborn nursery (8 percent), intensive care nursery (29 percent), routine obstetrics (13 percent), and high-risk obstetrics (17 percent).     

高校医院的社区化改革探讨

目的:探讨高校医院社区化改革中存在的问题。方法:通过调查访谈进行研究探讨。结果:高校医院的社区化改革中存在的问题包括经费、人才、定位和患者信任度等方面,这里主要有改革方向不够明确、体制因素以及缺乏改革动力等方面的原因。结论:高校医院要真正发挥其作为社区卫生服务中心的功能,需要相对独立于学校,纳入地方政府的社区卫生服务体系;当前需要地方政府、高校和校医院同心协力,在完善医疗保障制度、落实双向转诊制度和提高服务水平等方面进行努力,逐步建立完善的社区卫生服务体系。     

Strategic human resource management issues in hospitals: a study of a university and a community hospital

The human factor is central to healthcare, yet its proper management has remained beyond the reach of healthcare organizations. This qualitative study examines strategic human resource management (HRM) issues in a university and a community hospital. The findings indicate that the two hospitals lacked a clear understanding of their strategic intent and objectives; as a result, their human resource (HR) practices lacked coherence and direction. Whereas the community hospital understood the interrelationship between culture and HRM, the university hospital did not. Moreover, the university hospital showed only a modest understanding of competencies needed in managing HR function, which hampered its ability to identify competent HR managers and employees. The community hospital made significant gains in the past few years in managing its culture and people by recruiting a competent HR manager. The relationship between HR practices and clinical outcomes was much less clear in the university hospital than it was in the community hospital.     

Community orientation, strategic flexibility, and financial performance in hospitals

The objective of this study was to examine how community orientation and strategic flexibility affect accounting measures of financial performance in acute care hospitals. This cross-sectional study used organizational data from the American Hospital Association, environmental data from the Area Resource File, and financial data from the Healthcare Cost Report Information System. We tested our hypotheses on 1,779 hospitals using OLS regression models that controlled for organizational and environmental factors that might affect financial performance. The community orientation of a hospital had a negative impact on its short-term financial performance. However, the strategic flexibility of a hospital with regard to structure and resources was significantly and positively associated with hospital performance. Our findings are important to healthcare managers. Specifically, although a community orientation is thought to be essential for improving the health of populations, the healthcare market may lack clarity concerning the wants and needs of patients and payers to such a degree that this orientation does not result in improved short-term financial performance. In contrast, when a hospital maintains flexibility in its resource allocations and organizational structure, it can meet changing needs and uncertainties and thereby enhance financial performance.