我国农村卫生服务存在的质量问题分析及解决对策

随着我国卫生服务水平的发展，农村卫生状况已经有了极大的改善，然而农村卫生服务质量还是存在相当多的问题。本文针对农村卫生的特点，指出农村卫生服务机构中存在的质量问题，并分析其原因，提出解决问题的对策。     

Patient, carer and staff experience of a hospital-based stroke service.

OBJECTIVE: Here, the aim is to study the experiences of patients, carers and staff throughout a hospital stroke care pathway. DESIGN: Focus groups of patients, carers and staff followed a semi-structured format to elucidate experiences. The groups were recorded, transcribed and subjected to thematic analysis. Analyses were verified by researchers and participants. RESULTS: Patients and carers produced four overlapping themes: 'information', 'staff attitudes', 'availability of care/treatment' and 'considering the whole person in context'. The carers' group produced two additional themes: 'accommodation of patients' individual needs' and 'burden of care'. Their experiences were complex and multi-faceted; positive views of the whole service co-existed with negative views of some aspects. The staff groups produced six themes: 'specialist service', 'split service', 'availability of care', 'consistency of care', 'staff morale' and 'wish for change'. Positive views of the specialist service were tempered by problems with physical and professional separation, staff shortages and 'hierarchical practice' that reduced collective decision-making. CONCLUSION: Some of the patients' and carers' perspectives have not been previously reported in the stroke literature, including a desire for individualized treatment, the consideration of wider, non-physical needs and the carers' sense of burden. In addition, the study revealed how staff, carers and patients viewed each other and the service and demonstrated the concordance of their perceptions. However, staff showed little insight into the users' need for information and negative experiences of care. In contrast with previous research, lack of emotional care, poor continuity of care and lack of staff knowledge and skills were not identified as problems.     

中国健康体检质量控制现状与展望

伴随着人们健康观念的转变,健康体检行业迅猛发展,保障和监管健康体检的质量成为研究的热点。本文就国内健康体检质控的现状、问题及对策进行综述。     

健康体检质量管理模式的建立与实施

随着社会的进步、人类知识的积累,健康管理行业和学科应运而生,而且近年来人们对健康体检需求量的增大和体检质量要求的提高,基于此,改革开放以来,南方医院充分发挥综合性大医院的优势,较早地开展了健康管理服务,探索出一套运用循证的理论、综合多学科的管理方法,对个人或团体健康信息采集的各环节进行全程质量监控的健康体检质量管理模式。     

离退休老年人睡眠和心理健康状况的评估

目的探讨离退休老年人的睡眠和心理健康状况。方法使用匹兹堡睡眠质量指数量表和症状自评量表对某干休所140例离退休老年人进行睡眠及心理测查。结果离退休老年人睡眠障碍的发生率为46．4％;离退休老年人的心理健康水平低于普通人;睡眠质量与心理健康水平存在明显正相关（P〈0．05）;影响睡眠质量的心理因素主要为焦虑、人际关系敏感和躯体化。结论离退休老年人的睡眠质量与心理健康水平较普通人差,且两者之间显著相关。     

A new method of evaluating selective school entrymedicals

There is an ongoing debate about the relative value of selective vs routine entrant medicals. This paper describes a districtwide study of entrant medicals using the tracer method to assess the prevalence and detection rates of problems at school entry. Overall 57% of school entrants were selected for a medical but there was a significant difference in selection rates in urban and rural schools. This selection rate is higher than that reported by other authors. There was a trend for tracer conditions to be more prevalent in urban areas although this was not statistically significant. Prevalence rates suggest that the method of selection successfully detected children with problems. The tracer methodology provided useful information for service planning without the collection of large amounts of data and has not, to our knowledge, been used before in community child health. We recommend this methodology to other districts as a simple and effective method of assessing selective entrant medicals.     

The compensating income variation of cardiovascular disease

This paper uses longitudinal data from the British Household Panel Survey to calculate the compensating income variation (CIV) of cardiovascular disease. It is found that the CIV decreases with age and is higher for men than for women. For women the estimated CIV is similar to those calculated by Groot et al. (2004). For men the estimates are somewhat higher than earlier reported.     

Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada.

OBJECTIVES: To develop a set of scientifically sound and managerially useful system-level cancer care performance indicators for public reporting in Ontario, Canada. IMPLEMENTATION: Using a modified Delphi panel method, comprising a systematic literature review and multiple rounds of structured feedback from 34 experts, the Cancer Quality Council of Ontario developed a set of quality indicators spanning cancer prevention through to end-of-life care. To be useful to decision-makers and providers, indicator selection criteria included a clear focus on the cancer system, relevance to a diversity of cancer providers, a strong link to the mission and strategic objectives of the cancer system, clear directionality of indicator results, presence of targets and/or benchmarks, feasibility of populating the indicator, and credibility of the measure as an indicator of quality. To ensure that the selected indicators would measure progress over time against specific and widely accepted goals, we created a strategy map based on the five strategic objectives of the Ontario cancer system: (i) to improve the measurement and reporting of cancer quality, (ii) to increase the use of evidence and innovation in decision-making, (iii) to improve access to cancer services and reduce waiting times, (iv) to increase efficiency across the system, (v) to reduce the burden of cancer. An analysis of the mean indicator ratings by experts, and the strategy mapping exercise resulted in the identification of 36 indicators deemed suitable for routine performance measurement of the Ontario cancer system. LESSONS LEARNED: The resulting instrument incorporates a credible evidence basis for performance measurement aligned to the five strategic goals for the Ontario cancer system. It represents the integrating of a management culture, focused on the implementation of a new strategic direction for the cancer system, with the underlying evidence-based culture of clinicians.     

The measurement of current perceived health among Chinese people in Guangzhou and Hong Kong,southern China

General percelved health might be considered as a trait measure of perceived health and has been shown to be a reliable predictor of mortality. Current perceived health might be thought of as a state measure and as such should be more sensitive to short-term changes in health status. This paper describes the development of an instrument, the CPH-42 which measures current perceived health among Chinese people. Over 1000 items associated with ill-health were collected after inter-viewing 90 subjects from out-patient and in-patient settings. To these were added 38 items from section 1 of the Nottingham Health Profile (NHP) and the Chinese Health Questionnaire (CHQ30), measures of functional status and mental health respectively. These items were administered to four groups of subjects and 42 items were extracted using discriminant analysis to create the CPH-42. Results show low levels of conceptual overlap between the CHQ30 and CPH-42, and slightly more overlap between the NHP and CPH-42. Subjects' health care utilization behaviour was linearly related to rated current perceived health. It is concluded that the instrument is both a valid and reliable tool (Guttman's split-half coefficient r=0.85) which measures a distinct area of subjective health and is shown to predict health services utilization behaviour significantly better than general perceived health.     

A comparison of approaches to health service quality in the UK, USA & Sweden and of the use of organizational audit frameworks

Health care reforms in the UK, USA and Sweden are leading healthproviders and purchasers to pay more attention to quality. Thispaper considers different approaches to proving and improvingquality before and after 1990 in these three countries. Thesecond part of the paper describes different frameworks forauditing health service quality, such as the ISO 9000 and USMalcum Baldridge award. It considers how purchasers can usethese frameworks in purchasing services, and how providers canuse the frameworks to assess and improve their own service quality.     

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England.

METHODS

Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates.

RESULTS

Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15).

CONCLUSION

Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.     

Quality indicators for health promotion programmes

Methods for systematically following up and auditing health promotion have been in demand for a considerable period of time. Quality assurance as an auditing method has opened up new opportunities in this area. On the basis of Donabedian's 'triad' of structure, process and outcome, the theoretical preconditions for and implementation of a number of successful health promotion programmes/ projects have been analysed with regard to their common characteristics. These characteristics have been generalized and then transformed into indicators of a successful health promotion programme/project. To ensure the practical applicability of the quality indicators, they were operationalized in what we call a 'question pro-forma'. Any negative response to a question on the pro-forma indicates quality defects in a programme, and any positive response the opposite. The 'template' can be employed for both the planning and auditing for quality assurance on health promotion programmes and projects. The question pro-forma has been tested successfully on a number of programmes and projects. The results from one study are shown in the article.     

"以人为本"医疗品质服务模式构建

医疗质量和服务品质是医院转型发展和内涵提升的根基.抓好品质管理,是医院建设发展的关键.针对新时期下,医院转型发展的客观需要,结合医院在品质管理工作中的一些做法和经验,从建强管理体系、突出重点环节、创新管理措施、浓厚品质文化等方面提出一些有效的举措,倡导医院注重医学伦理,为构建 "以人为本"的医疗服务新模式,推动医院持续健康发展提供有力的保障.     

The Relationships between Sleep and Mental and Physical Health of Chinese Elderly: Exploring the Mediating Roles of Diet and Physical Activity

Sleep quality, diet quality, and physical activity are significant factors influencing physical and mental health. However, few studies have explored their underlying mechanisms, especially among the elderly population in East Asia, where people have food culture and lifestyles distinct from those living in Western countries. Therefore, the current study aimed to explore the relationships among sleep quality, diet quality, physical activity, and physical and mental health in a Chinese elderly sample. Sleep quality, diet quality, physical activity, physical health, and mental health were investigated among 313 Chinese elderly (aged 51–92 years, M = 67.90, SD = 7.94). Mediation analysis was used to examine the empirical model based on previous theories and literature. Close positive relationships were observed between all factors investigated (r = 0.22~0.73, p < 0.001). The relationships between sleep quality and physical and mental health were partially mediated by diet quality and physical activity. In clinical interventions, sleep quality, diet quality, and physical activity can be targeted to improve physical and mental health among the older adult populations.     

以农村卫生为重点 提高全民族健康素质

中国曾经是国际初级卫生保健的典范，各国都把“人人享有初级卫生保健”作为人人享有健康权的底线。健全初级卫生保健，保障健康公平底线是政府的公共职能．农村卫生是提高全民健康素质构建和谐社会的基础。