军队健康管理人才培养现状

在军队开展健康管理,是适应新形势卫勤体制改革,保障部队官兵健康,提升部队整体战斗的有效措施。在国家深化改革过程中,出台一系列相关法规政策支持,军队和地方健康管理服务无论在学科体系、产业实践,还是在队伍建设、人才培养等方面,都取得长足的进展。随着健康管理服务行业深入发展,专业的健康管理服务人才越来越成为当下军地健康服务行业发展的主要瓶颈。健康管理人才队伍是有效实施健康管理的必要条件,本文就当前军队健康管理人才培养现状以及军队健康管理人才突出问题进行分析,就如何解决当下军队健康管理人才缺失矛盾,加快完善军队健康管理服务体系建设等进行讨论,为军队健康服务人才培养发展提供参考。     

Routine Health Information Utilization and Associated Factors among Health Professionals Working in Public Health Facilities of the South Region,Ethiopia

BackgroundRoutine health information is the pillar for planning and management of health services and plays a vital role in effective and efficient health service delivery, decision making, and the improvement of programs. Therefore, this study aimed to assess routine health information utilization and associated factors among health professionals working in public health facilities of the south region.MethodsInstitution based cross-sectional study design was employed. Data was collected from randomly selected 719 participants using a pre-tested, interviewer administered structured questionnaire. Bivariate and multivariate logistic regression analyses were carried out.ResultThe overall utilization of routine health information was 63.1. Place of residence, HMIS personnel, HMIS code, overwhelming data source, population based data, data quality control, feedback, monitoring chart, 8.467) and data transfer policy were factors significantly associated with utilization of routine health information.ConclusionSix out of ten health professionals had utilized routine health information. Place of residence, HMIS personnel, HMIS code, overwhelming data source, population based data, data quality control, feedback, monitoring chart and data transfer policy had significant associations with routine health information utilization. Therefore, concerned health authorities need to work on these factors to improve the utilization.     

我国健康管理（体检）机构2012年现况调查

目的调查了解我国健康管理（体检）机构发展与内涵建设情况,为研究制定学科规划与行业发展目标提供依据。方法采用问卷调查法,对我国103家健康管理（体检）机构的规模与人员结构、学科与科研、学术与人才培养、信息化与综合服务能力等方面的现状及存在的主要问题进行调查,了解其对我国目前健康管理学科、行业及相关产业发展的看法和自身发展需求。结果76％的机构面积在1000m。以上,机构的年体检量呈逐年递增趋势,2009年平均体检量为3．95万人次,到2011年已增长到5．25万人次;54％的机构目前已开展了健康或疾病风险评估服务,心理体检（测评）服务尚未普开展,目前只占21％;机构在开展科研的过程中遇到的主要困难包括数据挖掘及利用、科研选题及设计等;机构在学术培训方面的需求主要包括慢病风险筛查专项培训、数据标准与数据利用、健康管理适宜技术操作培训等;目前机构信息化建设存在的主要问题和需求包括统一健康管理（体检）指标体系和项目目录,统一健康管理（体检）名词术语,添加问诊问卷及健康自测系统模块等。结论只有不断加强健康管理（体检）机构的学科与内涵建设,才能促进或保持我国健康管理行业及相关产业的可持续发展。     

北京市公共卫生信息化建设中存在问题探讨

目的对北京市公共卫生信息建设发展中存在的主要问题进行分析,探讨北京市公共卫生信息化建设的策略,为加强首都公共卫生体系建设提供参考依据。方法 2017年9月19日-10月18日,通过文献调研和半结构访谈问卷对北京市卫生行政部门和公共卫生专业机构的管理人员及部分公共卫生专家进行深度访谈和焦点组访谈,了解北京市公共卫生信息化建设现状、存在的主要问题并提出发展策略建议等。结果北京市现有公共卫生信息系统多是围绕特定领域和范围建设的,属于相对封闭的系统,信息化建设资源统筹与整合利用、业务协同和数据共享、公共资金投入和信息公开惠民服务建设不足;信息化建设人才缺乏,复合型卫生信息化人才明显缺乏,信息安全建设也面临问题和挑战。结论北京市现有公共卫生信息缺少能满足互联互通、信息共享的信息平台,不能满足全生命周期健康管理服务需求,需要实施符合首都发展特色以及功能定位的公共卫生健康信息管理策略。     

Epidemiological approaches to health planning, management and evaluation

The promotion of health and the prevention of disease depend to a large extent on the good planning and management of health programmes. Good planning and management in turn depend on the availability of reliable, accurate and timely information about the health situation. All countries have institution-based systems for the collection of routine information about health-services delivery. Many countries also use surveys to obtain information about other aspects of the health situation. This issue of the World health statistics quarterly describes two types of surveillance which may be used to supplement (or compensate for the absence of) nationwide routine systems or surveys, and a method for evaluating surveillance systems. It also includes articles on the International Classification of Diseases and Causes of Death (ICD) and the International Health Regulations (IHR) in relation to their use for planning and management. Two alternative surveillance systems are described. One uses institution- or city-based records of incidence of target diseases of the Expanded Programme on Immunization (EPI) in a number of developing countries to determine the impact of minimization on the reduction of disease. In this article, some additional background material is reviewed on sentinel hospitals and cities in India, Bangladesh, Turkey, Malawi and United Republic of Tanzania. The other system is based on district-level household surveys of mortality, morbidity and nutrition-related indicators in Kerala State (India) carried out by trained local personnel who live in the districts.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Canadian health care system: A model for America to emulate?

The American health care system has the world's highest per capita costs and over 30 million citizens uninsured. The neighbouring Canadian system provides coverage for all basic medical and hospital services, at costs per capita that are about US$700 lower. Single-agency public funding allows tighter control of Canadian expenditures, and reduces administrative overheads. Hospitals are run as non-profit private corporations, funded primarily by a fixed annual allocation for operating costs. Most physicians are in private fee-for-service practice, but cannot charge more than the insured tariff negotiated between their provincial government and medical association. This approach, while attractive in its decentralization, tends to separate the funding and management of clinical services. Thus, hospital information systems lag a decade behind the USA, managed care initiatives are few, health maintenance organisations do not exist, and experimentation with alternative funding or delivery systems has been sporadic. Strengths of the system compared to the USA include: higher patient satisfaction, universal coverage, slightly better cost containment, higher hospital occupancy rates, and reduction in income-related rationing with more equitable distribution of services. Weaknesses in common with the United States are: cost escalation consistently outstripping the consumer price index with costs per capita second highest in the world, ever rising consumption of services per capita, inadequate manpower planning and physician maldistribution, poor regional co-ordination of services, inadequate quality assurance and provider frustration. Additional weaknesses include: an emerging funding crisis caused by the massive federal deficit, less innovation in management and delivery of care as compared to the USA, implicit rationing with long waiting lists for some services, and recurrent provider-government conflicts that have reduced goodwill among stakeholders. Thus, while the Canadian model has important advantages, it does not offer a panacea for American health care woes.     

The data for decision making project: assessment of surveillance systems in developing countries to improve access to public health information

OBJECTIVE: By using timely, high-quality information, ministries of health can identify and address priority health problems in their populations more effectively and efficiently. The Data for Decision Making (DDM) project developed a conceptual model for a data-driven health system. This model included a systematic methodology for assessing access to information to be used as a basis for improvement in national health surveillance systems. STUDY DESIGN AND METHODS: The DDM surveillance assessment methodology was applied to six systems in five countries by staff from the US Centers for Disease Control and Prevention (CDC). Ministry of health personnel at national, regional, district and local levels were interviewed using either informal conversation or an interview guide approach, and their methods for collecting and using data were reviewed. Attributes of timeliness, accuracy, simplicity, flexibility, acceptability and usefulness were examined. Problems and their underlying causes were identified. RESULTS: The problems preventing decision makers from having access to information are many and complex. The assessments identified no fewer than eight problem areas that impeded decision makers' access to information. The most common deficiencies were concerning the design of the system, ongoing training of personnel and dissemination of data from the system. CONCLUSIONS: To improve the availability of information to public health decision makers, it is recommended that: (a) surveillance system improvement begins with a thorough evaluation of existing systems using approaches outlined by the CDC and the Health Metric Network of the World Health Organization; (b) evaluations be designed to identify specific causes of these deficiencies; (c) interventions for improving systems be directly linked to results of the evaluations; and (d) efforts to improve surveillance systems include sustained attention to underlying issues of training and staff support. The assessment tool presented in this report can be used to facilitate this process.     

市县级妇幼保健与计划生育服务机构资源整合研究

为推动妇幼保健机构和计划生育服务机构的资源整合,采用现场问卷调查、专题小组访谈、个人深入访谈等方法调查了7个省的5个地市级和9个区县级14所完成了妇幼保健和计划生育整合的实施机构。了解其资源整合模式、资产归属、人员安置和人员薪酬分配等内容,梳理归纳了整合中存在的技术人员未得到有效补充、人员培养和配备不能满足新形势需求、免费计划生育技术服务政策落实受到影响、妇幼保健与计划生育信息整合有待加强、科室设置还需规范等问题,提出建立健全补偿与激励机制、加强人才队伍建设、加强绩效考核和薪酬管理、加强医疗服务机构价格管理和信息化建设、做好生育全程优质服务等建议,为我国妇幼保健和计划生育服务的资源整合提供借鉴。     

Use of Technology to Support Information Needs for Continuity of Operations Planning in Public Health: A Systematic Review

Objectives

Continuity of operations planning focuses on an organization’s ability to deliver essential services before, during and after an emergency. Public health leaders must make decisions based on information from many sources and their information needs are often facilitated or hindered by technology. The aim of this study is to provide a systematic review of studies of technology projects that address public health continuity of operations planning information needs and to discuss patterns, themes, and challenges to inform the design of public health continuity of operations information systems.

Methods:

To return a comprehensive results set in an under-explored area, we searched broadly in the Medline and EBSCOHost bibliographic databases using terms from prior work in public health emergency management and continuity of operations planning in other domains. In addition, we manually searched the citation lists of publications included for review.

Results:

A total of 320 publications were reviewed. Twenty studies were identified for inclusion (twelve risk assessment decision support tools, six network and communications-enabled decision support tools, one training tool and one dedicated video-conferencing tool). Levels of implementation for information systems in the included studies range from proposed frameworks to operational systems.

Conclusion:

There is a general lack of documented efforts in the scientific literature for technology projects about public health continuity of operations planning. Available information about operational information systems suggest inclusion of public health practitioners in the design process as a factor in system success.     

荷兰以人为本整合型卫生服务的实践与启示*

从服务提供、治理机制、组织管理和筹资支付四个维度,分析荷兰实现以人为本的整合型卫生服务的关键要素,包括以全科医生服务团队为核心的网络化医疗卫生服务体系、良性市场竞争机制和广泛的社会参与及多部门合作的治理网络,促进整合的医保支付制度,成熟的全科医生培养体系和互联互通的信息系统,并结合中国实际,提出我国现阶段应将基层医疗卫生服务体系作为建设重点和优先领域,以家庭医生签约服务为抓手,加强医保对服务提供者的激励和约束,破除市场竞争、人才培养和信息共享等方面的体制机制障碍,构建以家庭医生服务团队为核心的网络化服务体系。     

The management of health services in Tanzania: a plea for health sector reform

There are essentially four main approaches used in attempts to strengthen the management of health services in developing countries. These are: information system development; management training; use of planning and evaluation methodologies; and, health sector reform. As part of a collaborative research project based in Kisarawe District, Tanzania, we tested the hypothesis that a combination of the first three of these approaches would be sufficient to ensure that decisions and actions were taken to bring about major improvements in the management of health services. It was assumed that the decentralization, which took place as part of the 1982 reorganization of local government responsibilities, had provided managers with sufficient decision-making autonomy to allow them to bring about improvement in health service performance, provided that the other conditions were met. In fact, it was found that despite being presented with clear evidence of serious inefficiencies and inequities in the allocation of health resources, managers were often highly reluctant to decide upon actions which would alleviate the problems in situations where there were potential losers as well as winners, even if the benefits greatly outweighed the costs. This article argues that interventions based solely on training, information systems, or planning and evaluation protocols will make only marginal improvements to health service management, and that changes to the system as a whole are needed in order to provide managers and health professionals with incentives to rectify performance failings. Some ideas for health sector reform, to give managers power and incentives for improving efficiency and quality of care, are put forward. Since it is likely that the systemic problems of the health sector in Tanzania are shared by many other developing countries, the lessons drawn from this study probably have more general applicability.     

Research gaps in routine health information system design barriers to data quality and use in low‐ and middle‐income countries: A literature review

Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low‐ and middle‐income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases—PubMed, Web of Science, Embase, and Global Health—and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human‐computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design‐user reality gap.     

卫勤优化决策模拟训练信息管理系统研发

针对信息化条件下某校卫勤指挥训练问题,以某校卫生事业管理专业生长型学员、研究生和继续教育学员为对象,依据全军信息化统一技术体制与数据要求,依托卫勤优化决策模拟训练系统,设计并研发了与之配套的信息管理系统,搜集、储存、分析和整理卫勤指挥决策所需要的各类信息资源,为优化决策方案的制定提供有力的数据支撑。     

孕产期保健管理信息系统设计与实现

目的 系统论述孕产期保健管理信息系统开发设计实践,为建设类似信息系统提供参考.方法 基于北京市妇幼保健网络信息系统孕产期保健管理子系统开发建设与升级改造进行案例研究.结果 在需求分析基础上,明确系统建设内容和主要功能,采用适宜的技术架构和网络架构进行开发设计,实现对孕产期保健管理工作的信息化支撑保障.结论 孕产期保健管...     

上海市某区志愿服务现况调查

目的调查上海市某区卫生计生系统志愿服务现状,为促进志愿服务的规范化、常态化发展提供依据。方法采用问卷调查法及关键知情人访谈法,对全区卫生计生系统28家机构开展全标本横断面调查,运用STATA 13.0软件建立数据库并进行统计学分析。结果28家均开展志愿服务工作,人员构成主要有系统内职工及社会爱心人士。志愿者管理措施有制定管理制度、年度计划、激励措施、志愿服务培训,开展的志愿服务有啄木鸟巡查、控烟宣传、导医导诊、健康宣教、医疗义诊、应急保障等。志愿服务管理过程中存在缺乏制度保障、信息化程度不高、志愿者积极性不高等问题。结论志愿服务已广泛开展,建议优化志愿服务项目,提升服务效能;完善激励机制,提高志愿者积极性;建立信息化平台,提升管理精细化水平。     

提高农村基层卫生服务绩效管理水平——中国农村卫生发展项目40县绩效改革设计与效果

世行贷款/英国赠款中国农村卫生发展项目(简称"卫十一项目")于2008年开始在我国8个省40个项目县引入绩效管理的思想,开展以绩效计划、绩效沟通、绩效考核、绩效改进为主要内容的循环管理,以绩效持续改进为目标,建立基于卫生服务绩效的激励机制。经过5年的试点,40个项目县中建成了若干个具有示范意义的绩效管理先进县,在改善卫生服务质量、提高基层医疗卫生机构管理者和员工的积极性、提高卫生服务效率等方面,取得了较好的效果,积累了一定的经验。绩效考核始终以质量为核心;经济激励与非经济激励措施有机结合;全员参与以保证绩效改善的可持续性;系统化的绩效管理思想应得到充分运用,以有效提升农村基层卫生服务绩效管理水平。     

目标管理责任制：改善生育健康服务的有力保证

妇幼卫生服务由无偿向付费、半付费服务转化的一个可能结果是,预防性服务所受重视程度将会减低。可喜的是,在云南省几个县的调研表明,近年云南妇幼卫生系统实行的目标管理责任制在促使各级人员坚持预防性服务方面发挥了重要作用,云南省计生部门目标管理责任制也成绩斐然。在增大对生育健康服务投入的同时,坚持目标管理责任制将保证不断增加的投入发挥出更好的效益。     

我国部分地区社区卫生信息化建设状况的调查与思考

目的基于当前我国一些城市社区卫生服务信息化建设的发展情况,提出社区卫生服务信息化建设中的一些建设性观点与改进措施。方法采用查阅文献和实地采访的方式进行资料收集,对收集的资料进行进一步整理和分析,及时了解当前国内各城市社区卫生服务信息化建设的动态。结果调查地区社区利用信息化手段实现了居民健康档案的建立和更新,基本上实现了"六位一体"的全方位社区卫生服务;但由于社区卫生服务信息化开展程度不均衡,一些地区社区居民电子健康档案发展缓慢,缺少区域性的综合信息交互共享平台,这些地区社区卫生服务信息化建设急需得到进一步改善,以便社区卫生服务朝着"高效率,高质量"的方向发展。结论我国社区卫生服务信息化建设已取得了一定的成效,但社区信息系统还需进一步改善和加强,争取早日实现"记录一生,管理一生,服务一生,受益一生"的终极目标。     

Community health workers for universal health-care coverage: from fragmentation to synergy

To achieve universal health coverage, health systems will have to reach into every community, including the poorest and hardest to access. Since Alma-Ata, inconsistent support of community health workers (CHWs) and failure to integrate them into the health system have impeded full realization of their potential contribution in the context of primary health care. Scaling up and maintaining CHW programmes is fraught with a host of challenges: poor planning; multiple competing actors with little coordination; fragmented, disease-specific training; donor-driven management and funding; tenuous linkage with the health system; poor coordination, supervision and support, and under-recognition of CHWs’ contribution.The current drive towards universal health coverage (UHC) presents an opportunity to enhance people’s access to health services and their trust, demand and use of such services through CHWs. For their potential to be fully realized, however, CHWs will need to be better integrated into national health-care systems in terms of employment, supervision, support and career development. Partners at the global, national and district levels will have to harmonize and synchronize their engagement in CHW support while maintaining enough flexibility for programmes to innovate and respond to local needs. Strong leadership from the public sector will be needed to facilitate alignment with national policy frameworks and country-led coordination and to achieve synergies and accountability, universal coverage and sustainability. In moving towards UHC, much can be gained by investing in building CHWs’ skills and supporting them as valued members of the health team. Stand-alone investments in CHWs are no shortcut to progress.     

基本公共卫生服务信息化绩效考核的探索与实践

随着基本公共卫生服务项目内容的逐渐增多,考核的任务和要求也越来越高.通过完善考核制度、强化设备投入、人员培训和加强资料录入,为基本公共卫生服务信息化管理提供支撑,并依托信息平台开展基本公共卫生服务数量与质量双考核,从而实现了基层卫生机构服务模式逐渐改变,绩效考核效率显著提高,服务数量和质量同步提升.