基于XML WEB SERVICES技术改进医保结算接口模块

本文介绍了一个现有的基于微软COM 技术实现的分布式医疗保险实时结算系统,并分析了现有系统存在的缺陷。为了改进这些缺陷,采用XML WEB SERVICES技术重新改写接口部分代码,并分析了改进后新系统相对老系统所具有的优点。     

CULTURALLY COMPETENT SERVICES WITHIN A STATEWIDE BEHAVIORAL HEALTHCARE TRANSFORMATION: A MIXED‐METHOD ASSESSMENT

In 2005, New Mexico created a single health plan to administer all publicly funded behavioral health services. Our mixed‐method study combined surveys, document review, and ethnography to examine this reform's influence on culturally competent services (CCS). Participants were executives, providers, and support staff of behavioral healthcare agencies. Key variables included language access services and organizational supports, i.e., training, self‐assessments of CCS, and maintenance of client‐level data. Survey and document review suggested minimal effects on statewide capacity for CCS during the first three years of the reform. Ethnographic research helped explain these findings: (a) state government, the managed behavioral health plan and agencies failed to champion CCS and (b) increased administrative requirements minimized time and financial resources for CCS. There was also insufficient appreciation among providers for CCS. Although agencies made progress in addressing language assistance services, availability and quality remained limited.     

IAPT,ANXIETY AND ENVY: A PSYCHOANALYTIC VIEW OF NHS PRIMARY CARE MENTAL HEALTH SERVICES TODAY

The Labour government's response to the Layard (2004 ) report was to implement the ‘Improving Access to Psychological Therapies’ (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to ‘well‐being work’ risks distorting the unconscious anxiety‐containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of Menzies Lyth (1959 ) and later work by Stein (2000 ), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split‐off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team.     

SELF‐STIGMA AND QUALITY OF LIFE AMONG PEOPLE WITH MENTAL ILLNESS WHO RECEIVE COMPULSORY COMMUNITY TREATMENT SERVICES

The present study was designed to examine the relationship between self‐stigma and quality of life over a one year time period for 71 people with mental illness who were receiving compulsory community mental health treatment. It was hypothesized that, over time, self‐stigma would have the direct effect of eroding quality of life among people with mental illness who were receiving compulsory community treatment; however, this relationship was not confirmed by the data. Although the cross‐sectional analyses revealed a moderate, negative relationship between self‐stigma and quality of life, the longitudinal analyses indicated that self‐stigma was not a significant predictor of quality of life. Among the variables measured in the current study, psychiatric symptom severity was the strongest predictor of quality of life.     

COPRODUCTION FOR SUSTAINABILITY: SEEKING THE PERSPECTIVES OF INFORMAL DEMENTIA CARERS’ ON CAPACITY BUILDING FOR COMMUNITY SERVICES

Dementia is a worldwide health priority and much of the burden of care for people with dementia is placed on family members and informal systems of care in the community. The perspectives of 36 informal dementia carers on current and future community‐based services for people with dementia in Tasmania, Australia, are reported using a mixed methods design. Qualitative data were collected, thematically analyzed, and double coded. Quantitative data were collected and analyzed to determine carers’ level of satisfaction with services. Three main themes were identified: (a) quality support for carers and people with dementia; (b) adaptive, tailored, and flexible organizations; and (c) development of the workforce. Although most carers were highly satisfied with the current support services they received, they wanted organizational and workforce changes to meet their varied and complex needs. Results suggest a community‐driven agenda for a coproduction approach for aged and dementia care reform in Australia.