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医疗服务质量和费用是卫生保健系统经常面临的两个互相竞争的关键要素。医疗费用的不断上涨是否带来质量的提升是不同卫生保健系统共同关注的问题,解决该问题的核心在于了解医疗服务质量和费用之间的关系。本文通过对国外有关质量和费用关系的理论与实践研究进行综述,基于Donabedian结构—过程—结果三维度质量框架进行归纳分析,尝试对目前该主题的研究进展进行系统梳理和展示。研究结果显示,现有研究的分析单位一般基于地区、服务提供者、病人等水平;不同研究所用到的质量指标差异较大;较多研究关注结果质量和费用的关系,而对于结构质量和过程质量与费用关系的研究尚不足;多数研究基于住院环境下,较少研究关注门诊环境,缺乏二者对比的研究。基于现有证据,尚无法对医疗服务质量和费用的关系得出一致的结论,但不同研究所用到的质量指标、数据与方法或局限性等仍值得未来的研究借鉴,以便于更客观合理的对质量和费用关系进行探讨。 相似文献
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陈练魏瑗赵扬玉 《中国卫生质量管理》2022,(5):006-9
通过文献回顾,对世界卫生组织产科质量指标体系、英国产科质量指标体系、美国产科质量指标体系、欧洲围产期保健计划、丹麦产科质量指标体系及我国的产科质量指标体系现状进行总结。认为我国产科质量指标体系缺乏最佳的指标变化趋势及期望达到的目标值,缺少基于产科质量指标进行质量改进的研究和证据,尚无基于产科质量指标体系的信息化质控平台。对此,建议探索产科质量控制指标的适宜标准值,建立质量指标和医疗质量评价的关联性,拓展指标体系内涵,加快信息化建设。 相似文献
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通过分析英国国家质量平台,提出从有效性、满意度和安全性3个纬度出发建立质量指标体系。认为质量指标的选取与临床指南提供的质量标准以及对应的临床证据和经济证据直接相关,并进一步探讨了质量指标转化为数据结果的合理方式,为构建医疗机构质量指标体系提供了新的方法和思路。 相似文献
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目的:构建适用于公共卫生决策领域的证据质量分级方法。方法:基于德尔菲调查法对24名专家进行2轮函询,形成证据评价的条目内容、评分细则及综合评价方法的共识。结果:2轮函询后专家意见基本一致,问卷回收率均高于80%,专家积极系数较好;权威系数均高于0.85;Kendall协调系数分别为0.227和0.494,显示具有统计学意义(P<0.05)。整合专家意见,最终构建15个一级条目、55个二级条目,综合各部分条目评价结果(最高计15分),最终转化为高(>11)、中((8-11])、低((4-8])、极低(≤4)4个级别的证据强度。结论:基于德尔菲调查法初步建立了公共卫生决策证据质量分级系统,具有较好的适用性和可行性,但其系统性能和可推广性有待进一步验证。 相似文献
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金宝相 《国外医学:卫生经济分册》1994,11(1):19-22
美国正处于重新认识初级卫生保健的过程。很多建立已久的英国卫生保健组织与支会方法已被引入美国的医疗保险中,如严格控制的专科转诊制,按人收费和按服务补偿相结合,对社区一定人口的医疗负责制。本对美英的初级卫生保健进行比较,着重在两国整个卫生保健体制及组织、方法和结果的异同点。 相似文献
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目的 将数据包络分析方法(Data Envelopment Analysis,DEA)应用于医院的技术效率和质量的评价,来比较纳入质量指标作为产出变量后医院绩效的变化.方法 利用2003年弗吉尼亚州53家非联邦急诊医院的相关信息及肺炎治疗质量数据,以技术指标为产出指标和以技术指标结合质量指标为产出指标建立2个DEA模型.结果 在模型1中,DEA有效的医院数为16所;在模型1的基础上加上质量指标作为产出变量(模型2)进行分析后,DEA有效的医院数为21所,模型2有效性高于模型1(P<0.05).结论 医院要注重同时提高技术效率和医疗质量,以优化资源的利用,提高医疗机构绩效. 相似文献
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《中国卫生检验杂志》2015,(8)
<正>为保证检验质量,临床实验室通常需开展内部质量控制、外部质量评价及方法性能的确认与验证等活动。执行这些活动,分析质量指标必不可少。尽管已有的众多分析质量指标可通过斯德哥尔摩会议所确定的等级层次去指导,临床实验室设定分析质量指标~([1]),但目前尚无统一的设定标准或哪个等级的分析质量指标完全适用临床实验室。如:美国建议采用临床实验室改进修正案(CLIA)的指标,欧洲指标则来源于外部质量评价(EQAS)活动~([2]),而根据生物学变 相似文献
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[目的]提高管理水平和服务质量,促进旅行卫生保健事业的健康发展。[方法]在旅行卫生保健中心导入ISO9000族标准质量管理体系,建立规范化、科学化和标准化的质量管理体系。[结果]在旅行卫生保健中心有效地贯彻和运行ISO9000族标准质量管理体系,优化管理,为旅行者提供全方位和优质的服务,提高社会和市场竞争能力。[结论]面对入世后的新形势,旅行卫生保健中心要生存和发展,必须与国际接轨,导入ISO9000族标准,建立并有效地运行与旅行卫生保健具体专业技术特点和实际相适应的质量管理体系,从根本上提高旅行保健中心的管理水平、工作效率、服务质量和服务水平。 相似文献
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Trends in meningococcal disease in Italy in 1988 总被引:1,自引:0,他引:1
Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years. 相似文献
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C L Rümke 《Nederlands tijdschrift voor geneeskunde》1985,129(51):2469-2471
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Leon Braier Ashley Levy Klaus Dror Asher Pardo 《American journal of industrial medicine》1981,2(2):119-123
Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood. 相似文献
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Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors. 相似文献
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This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965. 相似文献
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恶性肿瘤已成为中国居民的主要死因之一。近些年来,中国政府积极推进肿瘤预防和控制领域的研究工作,取得了很大的进步。本文简要汇总中国在肿瘤流行病学领域的研究进展,具体包括2019年的肿瘤负担、癌症危险因素及其干预、筛查和早期发现、癌症防治专项行动(2019-2022年)方案等方面,以期为我国肿瘤防治工作的有效开展提供技术支撑和理论依据。 相似文献
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目的 了解绵阳市2012年市售蔬菜中农药残留情况,为食用蔬菜监管提供依据.方法 全部样品均按照GB/T 5009-2003的方法进行农药的残留检测.依据GB 2763-2005《食品中农药最大残留限量》进行判定.结果 2012年共检测蔬菜165份,农药检出率和超标率分别为72.12%和23.64%.豆类、根茎类、叶菜类、瓜果菜类和食用菌类蔬菜检测农药残留超标率分别为8.00%、23.53%、36.00%、5.26%和27.03%,差异有统计学意义(x2=11.41,P<0.01).不同种类农药超标率差异有统计学意义(x2 =62.42,P<0.01).夏季和冬季蔬菜农药超标率差异无统计学意义(x2=3.44,P>0.05).结论 绵阳市叶菜类蔬菜中农药残留情况较为严重,应采取有效措施,加强蔬菜的监督管理,从源头禁止高毒农药的使用,加大蔬菜种植、销售环节的监测,确保市民食用蔬菜的安全. 相似文献