推行医疗风险管理提高医疗服务质量

为探讨医疗风险管理在医院医疗服务中的应用,本阐述了增强医疗风险管理的意识;医疗风险与医疗事故的关系;医疗风险与医疗质量的关系;医疗风险管理的积极性;医疗风险管理的制度;医疗风险管理的措施。为医院采用医疗风险管理提供经验。     

医疗服务项目成本核算方法探讨

2012年版《全国医疗服务价格项目规范》将服务项目所需物资消耗、基本人力消耗及耗时、技术难度和风险程度等定价因素考虑在内。文章结合新医院会计制度,利用项目权数法,探讨医疗服务项目成本核算的思路,为医疗服务项目定价提供参考。     

医疗意外险的医疗风险分担效用探讨

作者将法理研究与现况调查相结合,通过调查分析江苏某三甲医院住院手术患者对于医疗风险的认知、医疗意外的知晓程度以及对医疗意外风险分担的期望,提出医疗意外险在完善风险分担机制、减少医患争议、保护医患合法权益三个方面可以发挥积极效用.     

从医疗服务项目归并看规范医疗服务行为的必要性

国家计委、卫生部印发的《全国医疗服务价格项目规范》(以下简称《规范》)经过两年多的反复讨论与修改已正式下发各省。同时,国家要求各省在认真学习和掌握《规范》的基础上,将本地区现行医疗服务价格项目调整归并入《规范》所列项目中。从2002年1月1日起,全国各级各类医疗机构要按照《规范》规定的医疗服务价格项目名称和服务内容提供医疗服务,收取服务费用。根据这一精神,我局在省卫生厅和省物价局的直接领导下,开展了医疗服务收费项目规范和价格调查工     

武汉市医疗服务价格指数测算研究

医疗服务价格指数是医疗服务价格调整和管理的重要工具。2019年医疗服务项目价格调整后，武汉市医疗服务项目定价整体提高，总价格指数为126.67%；体现更高技术劳务价值的一般医疗服务、一般检查治疗、手术治疗等项目价格涨幅较大，超声检查类与检验类项目价格下调；占总项目数16.87%的项目，其累计收费金额占总收费金额的80%，用这些项目计算的价格指数为120.68%。建议动态调整医疗服务价格指数计算的项目，并以成本为依据，合理调整医疗服务项目价格，适应医疗技术、医保政策等变化带来的影响。     

PPP医疗项目风险分担定性分析

近年来,发达国家运用PPP提供公共医疗基础设施和服务的做法受到了普遍关注。这些国家采用PPP的主要原因包括:一方面翻新、维护和运营医疗基础设施的费用在不断增长,另一方面财政预算因为经济下行而被缩减。因此,政府需要资金来弥补投入不足,并依靠私营部门的专业技术和管理经验来分担经营风险。本文通过文献研究初步获得18个PPP医疗项目的风险因素,然后通过向专家发放调查问卷的方式得到专家对风险分担的定性判断结果。最后得出PPP医疗项目的风险分担方案,为PPP项目成功实施提供参考。     

医疗服务价格调整对医院收入结构的影响分析

目的分析福建省沿海某市医疗服务价格调整对公立医院医疗收入结构的影响。方法抽取26家公立医院,分析比较调价前后一年全部医院、不同类别、不同级别公立医院医疗收入结构的变化情况。结果医疗服务价格的调整有助于优化公立医院的医疗收入结构,尤其是诊查费的调整使诊查收入占总的医疗收入比例大幅度提升,有利于体现医务人员技术劳务价值,调动积极性,但手术项目、检查化验项目调整未达到预期效果。结论调价取得了一定的成效,但建议逐步建立合理地医疗服务价格体系,拉开不同级别医院医疗服务项目价格的差距,推进分级诊疗制度的落实,同时控制医疗费用过快增长。     

军民区域协同医疗服务的实践

1项目背景 近二十几年以来．美国、英国、加拿大、澳大利亚等国家先后开展了国家级及地方级的区域卫生信息化建设,希望推动以电子医疗数据共享为核心的区域性卫生信息网络建设,以提升整体医疗服务质量,提高医疗服务可及性,降低医疗费用．减少医疗风险。     

新增医疗服务价格项目定价影响因素、作用机理与锚定效应

科学适宜的医疗服务项目定价机制是影响新医疗技术广泛应用的重要因素之一。文章在回顾国家层面新增医疗服务价格项目管理相关政策的基础上,结合地方实践,梳理了公立医院立项试行新增医疗服务价格项目自主定价的影响因素：按作用机制分为促进因素（测算成本、技术难度、风险程度）和制约因素（现行技术难度、风险程度相近项目价格,物耗、设备折旧占比,外省份批准设立新增医疗服务价格项目价格,医院等级,医师级别,财政补助,本地经济发展水平,患者承受能力）。发挥新增医疗服务项目价格锚点作用,促进价格合理形成的政策建议包括：出台新增医疗服务价格项目管理指导意见,统一成本测算样表和取数口径;评估新增医疗服务价格项目价值,重大创新技术按绿色通道审核并允许溢价;监测和报告新增医疗服务价格项目试行期的服务量和运行成本,促进转正项目定价。     

医疗设备的安全风险管理

医疗设备安全管理现状不容乐观,如果政府、医疗设备生产企业、医院等各环节积极采取相应措施,重视医疗设备的监管、生产、使用,医疗设备的安全风险一定会降低,医疗服务质量一定会提高。     

医用镇痛泵技术新发展及其应用

介绍了局部麻醉用镇痛泵的基本应用和原理,按照其驱动方式和功能介绍了各种类型医用镇痛泵,详细分析了各种镇痛泵的使用指标和优缺点,对医用镇痛泵技术的发展趋势作了简要介绍。     

Between professional values and the social valuation of patients: The fluctuating economy of pre-hospital emergency work

A number of authors have shown how medical decisions are influenced by social values; others have minimized the putative influence of values and have argued that medical decisions are predominantly constrained by the organization of medical work. Based on fieldwork in France and the USA observing pre-hospital resuscitations, we seek to resolve these views by showing that while judgments about the social value of a patient do influence professional decisions, so do judgments about the work that must be accomplished to manage a case. Pre-hospital emergency work has many facets that are variably valued by different professionals at different moments of an emergency's trajectory. These values compete with each other in what we call a “fluctuating economy”. This article analyses the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work. We show how these values may conflict or align with each other, forcing professionals to constantly establish priorities during an emergency trajectory.     

Models of stress and meanings of unemployment: reactions to job loss among technical professionals

The same potentially stressful event may have different meanings to different individuals. Such variation may be explained by reference to different models of stress. Two such models, one based on the concept of person-environment 'transactions' and the other on that of a 'psychosocial transition,' are applied to studies of reactions to job loss among technical professionals.     

河北省放射卫生技术服务机构现状调查与分析

目的 进一步加强对放射卫生技术服务机构的管理,规范其服务行为,探索对放射卫生技术服务机构的监管对策.方法 设计调查表,对服务机构的基本情况、专业技术人员、设备配置及开展检测项目、工作量等进行了调查.结果 至2019年底,我省共有放射卫生技术服务机构23家,其中疾控和职防院所类8家,占34.8％,第三方(民营)机构类15...     

Impact of 3 years of contract implementation on the quality of cataract surgery

OBJECTIVE: To assess the adequacy to clinical practice of cataract procedures contracted in the Gipuzkoa Health Area (in public as well as concerted hospitals) from 1995. A second aim is to identify the achievements obtained three years after its implementation comparing the data with those of 1994, a year before. METHODS: Before its implementation a multidisciplinar team established the number of surgical procedures to be contracted each year by age and sex, as well as the technical and quality conditions (out-patient surgery, loco-regional anaesthetic, facoemulsification, etc.). Data used for the assessment: Cataracts Registry of the Ophthalmologic Unit, Patient Management Categories and surgical waiting lists. RESULTS: During the period studied, 8,073 cataract operations were performed, 9% higher than expected. The distribution by age and sex was as estimated. Technical and quality standards were fulfilled, except for the surgical waiting list, in at least 75% of the procedures. The surgical technique mainly used was facoenmulsification, increasing from 15% in 1994 to 76.5% in 1997. CONCLUSION: The contracting of cataract surgery has allowed the assessment, reordering, and establishment of standards of care for all the professionals involved in the process. There were improvements in clinical practice during the period studied. This has given raise to the homogenisation of care in all the units following technical and quality standards, meaning better equity for the patients in need of the procedure.     

Reproductive demands and health care for people living with HIV/AIDS: limits and possibilities within the context of specialized health services

This qualitative study discusses how professionals in specialized health care services in the city of S?o Paulo have responded to the reproductive demands of people living with HIV/AIDS. Participant observation was the main methodological strategy; the concept of health demands was an important theoretical reference in the analysis. According to the health professionals, reproductive health demands were raised exclusively by women and related to mother-to-child HIV transmission. Reproductive issues were not recognized as patients needs, nor were they included among the objectives of collective staff work. Distinct technical, ethical, and moral rationalities were observed. Among health professionals, to control the epidemic was the prevailing logic, while among patients, exercising lifestyle choice was the key issue, materialized in the "unexpected advent of pregnancy". In order to formulate health care strategies that respect human rights and reduce the risks of HIV transmission, it is necessary to recognize the autonomy of people living with HIV/AIDS in relation to reproductive decisions.     

艾滋病疫情估计与预测方法研究进展

近年来,由于艾滋病监测系统的不断完善以及监测资料来源的多样性,艾滋病疫情估计与预测方法已成为了解艾滋病流行状况及预测发展趋势的重要工具,为此国内外学者采用了多种方法对艾滋病疫情进行了估计与预测。本研究对目前常用艾滋病疫情估计与预测方法的基本原理、适用条件、应用、优点及局限性进行综述,为疫情估计方法的选择与应用提供参考。     

The work of the mid-level nursing professional in the new mental health care services

The study consists of a bibliographic survey covering mid-level nursing professionals in alternative mental health services, with the objective to reflecting on their work, considering the psychosocial model and its care intervention actions, based on the theoretical reference framework of the so-called "light technologies". It was observed that there is a transition process from the traditional to the psychosocial model, from a technical model to the model of satisfying user needs and the importance of reviewing these professionals' training process, pointing out a new attitude of the nurse-teacher, who should aim for critical-reflective teaching that is aimed at the ideals of the Psychiatric Reform.     

外科医疗损害事件影响因素研究

目的研究外科医疗损害事件发生特点及影响因素,为提高医疗安全水平和医疗服务质量提供参考。方法采用描述性分析方法对162例涉及外科的医疗损害鉴定总体情况进行分析,采用二元Logistic回归对医疗损害相关 影响因素进行分析。结果单因素Logistic回归分析结果显示,首诊科室、认知与技术水平、药物使用、误诊问题以及其他因素对是否构成医疗损害事件有统计学意义（P＜0.05）;多因素Logistic回归分析结果显示,认知与技 术水平、药物使用、误诊问题、其他因素对医疗损害的发生均呈正向预测作用。结论医疗机构需采取措施遏制外科医疗纠纷与损害事件的高发趋势,重点关注外科医疗损害事件高发人群、医院及科室,切实提高医务人员的诊 疗技术水平并规范诊疗行为,建立医疗损害风险因素监测与预警机制。     

The logistics of abortion services in the absence of restrictive criminal legislation in the United States.

In anticipation of the expected rise in demand for induced abortion (estimated to reach 500 abortions per 1000 live births within 5 to 10 years) planning should be for provision of public education, patient counseling, safe surgical care, and contraceptive counseling and services. Planning should include the establishment of health department standards with investigation of abortion complications, guidelines for individual selection of abortion procedures for each woman, and supervision of personnel. The possibility of technical training of non-professional personnel to assist in abortion, research in abortion technology, funds for the care of indigent women, and examination of the attitudes of health professionals are other topics discussed.