Functional capacity and five-year mortality in a sample of urban community elderly

To assess the validity of a functional status measure in communityelderly, 1317 residents of Barcelona, Spain, aged 65 years orover were interviewed at home in 1986 and their vital statuswas assessed five years later from census data. Functional capacitywas measured by self-reported ability to perform nine basicactivities (ADL) and four instrumental activities (IADL) ofdaily living. Significantly lower survival rates were foundfor males, older age groups, functionally dependent subjectsand for those reporting poor health. Relative risks of death,estimated by Cox's regression controlling for health statusand sociodemographic variables were 3.17 (95% CI=1.98–5.08)for ADL-dependent elderly, and 2.14 (95% CI=1.32–3.46)for IADL-dependent elderly, compared with elderly reportingbeing fully independent. Functional capacity based on ADL stronglypredicts subsequent mortality and provides relevant informationon health status of community elderly. Nevertheless, cross-culturalvalidity of functional capacity based on IADL measures deservesfurther research.     

Causes of death in an urban public hospital

For the study reported here, we examined the charts and autopsy reports of every death in the Department of Medicine at Cook County Hospital for the year 1983. In that period, there were 11,677 admissions to the Department and 476 deaths, yielding a mortality of 4.1 percent. There were 50 percent more deaths in the intensive care unit than on the general wards. Malignancies accounted for greater than one-third of all deaths. Lung cancer, which occurred in one of every six deaths in the department, was the single most-common diagnosis. The other leading causes of death were cirrhosis, gastrointestinal malignancies and cerebrovascular accidents. Cardiovascular mortality was somewhat less than expected. These figures reflect some of the serious diseases of the urban indigent population, which are, in turn, associated with cigarette smoking, alcoholism and hypertension. Decreases in morbidity and mortality are likely to be influenced by preventive medical measures and early detection campaigns. Department of medicine curricula and outpatient clinic programs should devote attention and resources to these areas.     

某地市级公立医院高质量发展的实践探索

新形势下,地市级公立医院需要紧跟时代步伐,积极探索建立现代医院管理制度,从规模扩张转向提质增效,由粗放式管理转向精细化管理,资源配置从注重物资要素转向人力资源管理,从而推动公立医院高质量发展。以南京医科大学附属淮安第一医院为例,介绍医院探索高质量发展的主要举措,包括打造学科品牌、全面提升精细化管理水平、创新人力资源管理方法等,提出了以学科建设作为各项工作第一要务、以精细化运营管理作为可持续发展的后盾、以提升人力资源价值作为高质量发展的基石等,为地市级公立医院高质量发展提供参考。     

国外公立医院改革的现状与启示

公立医院在西方各国的医疗保健和卫生服务体系的建立和发展中曾经发挥了巨大的作用,但依然存在一些严重的问题。该文简要介绍了国外五种医疗卫生体制中具有重要代表性的国家公立医院改革的主要措施,探讨了国外公立医院改革对中国公立医院改革的启示。     

Healthcare reform perspectives of rural and urban hospital leaders--issues and attitudes

What are the perspectives of rural and urban hospital leaders--administrators, physicians, and board members--regarding healthcare reform? Both groups support substantial reform in healthcare delivery. They agree that changing malpractice and tort laws is one of the leading strategies for reforming healthcare and that reform should be financed by income tax credits or a combination of employer premiums and government taxes.     

我国公立医院改革研究综述

我国公立医院改革试点3年来,在各改革领域都有所探索并形成初步思路。但改革中仍存在不少困惑,体制机制改革未形成统一趋势。文章通过文献分析与研究,评论了现有公立医院改革文献的研究情况,并从医疗资源配置、制度机制设计等方面提出公立医院改革的发展方向。     

Smokers hospitalized in an urban, public hospital: addiction, stages of change, and self-efficacy.

BACKGROUND: This study characterizes adult smokers on the medicine service of an urban, public hospital, including stage of change, self-efficacy to quit, and nicotine dependence, and explores relationships between perceived and actual smoking-related illness and these three predictive variables. METHODS: Adult patients (n = 154) admitted to the Medicine service of Denver Health Medical Center in October and November 1996 were surveyed using a written questionnaire. RESULTS: The proportion of smokers in this population was 45.7% (95% CI = 42.0%, 49.4%). Adjusted for age and sex, the proportion of smokers in this population was significantly greater than in Colorado (28.8% vs 21.8%, P < 0.001). About half (54.2%) were willing to try free nicotine patches during hospitalization. Among smokers with diseases recognized as smoking-related, 30.4% believed their reason for admission was related to smoking, compared to 20.4% among those with no smoking-related diseases (P = 0.18). Patients who believed their hospitalization was due to smoking had greater intentions (P = 0.001) and self-efficacy (P < 0.001) to quit. CONCLUSIONS: Targeting smokers who perceive that their illness is smoking-related may optimize inpatient smoking interventions.     

Regional perinatal care in crisis: a case study of an urban public hospital

Regionalized perinatal care is intended to guarantee pregnant women and neonates access to appropriate care regardless of ability to pay. Its effectiveness depends on the willingness of hospitals to transfer high-risk patients according to established protocols and affiliations. This study examines maternal transfers (n = 896) to Cook County Hospital (CCH), a public facility and a designated perinatal center in Chicago. In 1987 and 1988, the majority (68%) of maternal transfers to CCH came from out-of-network hospitals, and 52% of these came directly from another perinatal center. The data indicate that 62% of the out-of-network transfers who delivered were medically high-risk. The study also documents the transfer of women in active labor, a violation of federal law. The term "perinatal dumping" is introduced to mean the transfer of high-risk pregnant women between hospitals for economic rather than medical reasons. Strategies for safeguarding the integrity of regionalized perinatal care are discussed.     

Effect of the hospital nursing environment on patient mortality: a systematic review

OBJECTIVE: Research has examined the effect of the structure of health systems on health outcomes, but not how outcomes are affected by the nursing environments in hospitals. Our objective was to gather, critically appraise and synthesize all relevant primary research on the effect of the nursing environment on patient mortality. METHODS: Five electronic bibliographic databases were searched from their beginning through to May/June 2001, and Medline and CINAHL were updated to March 2004, using pre-determined search strategies and inclusion criteria. Studies were included if they met pre-determined criteria, reporting primary data both on a hospital environment and patient mortality. Methodological rigour was appraised using accepted criteria for the evaluation of research protocols, including case-mix adjustment. RESULTS: This paper focuses on 27 identified studies that investigated the impact of one or more attributes of the nursing environment on patient mortality. Nineteen studies found an association between one or more unfavourable attributes and higher mortality. There was considerable variability in attribute and outcome measures, settings and research quality across studies. This precluded statistical pooling of results. CONCLUSIONS: On balance, current evidence indicates that social and environmental attributes of hospital nursing practice have an effect on the outcomes of care. Before optimal practice settings can be designed, further research of greater rigour is needed to provide a better understanding of the mechanisms that link the nursing environment to patient outcomes.     

Socio-spatial perspectives on the utilization of emergency hospital services in two urban territories in Quebec

Hospital emergency services located in urban areas have been severely congested for several years in the province of Quebec. This problem is not caused by ambulatory patients who are using emergency services as a regular source of care, but by patients in need of emergency services. To study the factors affecting the utilization rates of emergency services in two urban areas, the city of Laval and the Quebec metropolitan area, two samples of more than 30,000 patients each were drawn from the 1981 file of the Régie de l'assurance-maladie du Quebec. The utilization rates of emergency services for emergent and urgent causes in these two samples were computed on the basis of the census tract location of these patients. The socio-economic characteristics of these census tracts were taken from the 1981 Canadian census, the distance travelled from each census tract to the location of hospital emergency services was computed and included as a predictor of the utilization rates. Also, the prevalence of chronic and psychiatric diagnoses were obtained for each census tract. The result of the analysis showed that distance affected the utilization rates only in the Quebec metropolitan area where the hospitals are mostly located in the downtown area near deprived and working class neighbourhoods, while the socio-economic characteristics affected the utilization rates in both Quebec and Laval.     

Control of vancomycin-resistant enterococci in a hospital: a five-year experience in a Taiwanese teaching hospital

In order to prevent transmission of hospital-acquired vancomycin-resistant enterococci (VRE), the infection control team (ICT) of the National Taiwan University Hospital (NTUH) introduced practical guidelines from January 1997 to June 2000. All patients at NTUH found to be infected or colonized with VRE were placed in strict contact and cohort isolation. Surveillance cultures were obtained from other patients in close proximity in order to determine any spread of VRE. If identified, these patients were also placed in contact and cohort isolation, and their isolates were subjected to antimicrobial susceptibility testing and molecular typing by pulsed-field gel electrophoresis. During this period, 20 patients were found to have VRE. Based on typing results, there were three occasions where the same VRE strain had spread between index patients and roommates or patients staying in neighbouring rooms. No further spread occurred after applying strict contact isolation for these patients. The hospital-acquired VRE infection rate was around 0.03 to 0.09 per 1000 discharges during the intervention period. After July 2000, however, members of the ICT did not actively monitor or implement any interventions to control VRE. The rate then increased to 0.20 per 1000 discharges in 2001. This study suggests that interventions for the control of VRE, based on the guidelines from the Hospital Infection Control Practice Advisory Committee, are effective for control of VRE spread. Failure to adhere to these guidelines may result in an increase in hospital-acquired VRE.     

Rural vs urban hospital performance in a ‘competitive’ public health service

In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann–Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals.     

我国公立医院管理与考核的现状、问题及政策建议

在国家增加医疗卫生投入、医疗保障覆盖面逐步扩大的情况下,加强对公立医院的考核监督,就成为保障医改效果最终实现的关键措施。目前,我国在医改中对公立医院的定位和作用认识还不够清楚、法律和政策框架不健全,尤其是对非营利性机构监管措施严重缺失;公立医院管理体制不完善,行业管理力度薄弱;公立医院治理结构不明晰,政府和公立医院之间的委托代理授权关系虚化;对公立医院考核监督体系不健全,考核结果没有充分起到激励公立医院改进绩效的作用。我们提出了强化对公立医院的监督管理的政策建议,一是明确公立医院定位,完善公立医院法制;二是理顺公立医院管理体制,提高管理能力;三是建立公立医院产权和财务管理制度;四是建立公立医院绩效考核和信息公开制度;五是加强对公立医院的立法监督和群众监督,建立公立医院审计制度和巡视制度;六是建立和完善公立医院数据收集和发布机制。     

Delayed effects of A-bomb radiation: a review of recent mortality rates and risk estimates for five-year survivors.

A review of published data relating to A-bomb survivors has led to the conclusion that since they were based on the mortality experiences of five year survivors estimates of radiation effects should have been controlled for two opposing forces-namely, selective survival of exceptionally fit individuals during the period of heavy acute mortality and residual disabilities. Both effects were dose-related and beyond question, and the disabilities probably included the effects of incomplete repair of bone marrow damage. Therefore, in addition to differences between high and low dose being largely obliterated, there was probably distortion of cancer effects. The two opposing forces are clearly the reason why the change from the high mortality rates of 1945-6 to the low rates of the 1950s was not accompanied by a change from a position to a negative association with dose, and imperviousness to the residual disabilities is probably the reason why sudden deaths of previously healthy individuals (exemplified by suicides) were an exception to this rule. Finally, impairment of bone marrow function probably accounts for the early epidemic of myeloid leukaemia; the apparent absence of other cancers at this time, and the relatively high dose-related death rates for blood diseases other than leukaemia.     

基于丹尼森模型的公立医院文化建设研究

基于党委领导下的公立医院文化建设背景,并引入企业文化建设常用的Denison组织文化模型,从参与性、一致性、适应性和使命四个维度分析党委领导下公立医院文化建设的特点,并据此提出相应的发展建议,以期为新时期公立医院文化建设发展提供新的思路。