医疗服务价格调整对公立医院收入结构的影响研究——基于成分数据分析方法

目的基于三级甲等公立医院运营数据,分析医疗服务价格调整对医院收入结构的影响。方法引入成分数据分析方法,利用浙江省12家三级甲等公立医院(综合医院7家、中医类医院2家、专科医院3家) 2019年1—7月收入结构数据模拟无政策干预下8—12月数据,比较实际数据与模拟数据的差异。结果调价后综合医院、中医类医院和专科医院的医疗服务收入占比分别提高了4.77、4.01和2.54个百分点,检验和检查收入占比分别减少了0.60、0.78和2.94个百分点。综合性医院和中医类医院的药占比降低了1.87和5.29个百分点。各类医院服务收入增加了10 890.14万元,药品收入减少了6 521.79万元,检验检查收入减少了3 065.96万元。结论医疗服务价格调整政策提高了服务收入占比,降低了物耗性收入占比。下一步需建立医疗服务价格动态调整机制,继续控制医疗费用不合理增长,并关注不同类型医院收入结构的差异。     

门冬氨酸钾镁对低氧性肺动脉高压大鼠泡内肺动脉结构重建及内皮素的影响

[目的]探讨门冬氨酸钾镁对低氧性肺动脉高压(HPH)大鼠泡内肺动脉结构重建及肺组织内皮素的影响.[方法]采用动物试验,雄性Wistar大鼠,随机分为3组:正常对照组、低氧组、低氧 门冬氨酸钾镁治疗组.低氧30d测定肺动脉平均压(mPAP)、颈动脉平均压(mCAP),右心室肥大指数(RVHI),放射免疫法测定肺组织中内皮素-1(ET-1)含量,计算泡内肺小动脉肌化程度(MA、PMA比例)及肺小肌型动脉相对中膜厚度(RMT)、相对中膜面积(RMA)百分比.[结果]低氧组mPAP、RVHI、ET-1含量较对照组高(P(0.01),治疗组较低氧组低(P<0.01或P<0.05);低氧组泡内肺小动脉肌化程度、RMT(%)、RMA(%)较对照组高(P(0.01),治疗组较低氧组低(P<0.01).[结论]门冬氨酸钾镁可调节肺组织ET-1含量,可部分逆转肺血管结构重建,降低肺动脉高压,对HPH有防治作用.     

公立医院内部管理水平对技术效率的影响研究——基于偏最小二乘结构方程模型方法

目的：分析公立医院内部管理水平对公立医院技术效率的影响。方法：在应用《中国医院管理调查表-扩展版》（D-CHMS）工具测量63家公立医院管理水平和应用Bootstrap-DEA方法测量其技术效率的基础上,采用偏最小二乘结构方程模型（PLS-SEM）分析医院内部管理各维度对技术效率中纯技术效率和规模效率的影响。结果：模型GoF为0.52,平均R²为0.44,纯技术效率和规模效率的R²分别为0.10和0.36。医院内部人力资源管理水平对规模效率影响的路径系数为0.26,目标管理和领导力管理水平对规模效率影响的路径系数分别为-0.37和-0.44;目标管理水平对纯技术效率影响的路径系数为0.31。结论：公立医院技术效率的主要影响因素是目标管理和人力资源管理水平,加强对公立医院的目标管理、绩效考核和人事制度改革等有利于提高公立医院技术效率。     

Sampling efficiency of modified 37-mm sampling cassettes using computational fluid dynamics

In the U.S., most industrial hygiene practitioners continue to rely on the closed-face cassette (CFC) to assess worker exposures to hazardous dusts, primarily because ease of use, cost, and familiarity. However, mass concentrations measured with this classic sampler underestimate exposures to larger particles throughout the inhalable particulate mass (IPM) size range (up to aerodynamic diameters of 100 μm). To investigate whether the current 37-mm inlet cap can be redesigned to better meet the IPM sampling criterion, computational fluid dynamics (CFD) models were developed, and particle sampling efficiencies associated with various modifications to the CFC inlet cap were determined. Simulations of fluid flow (standard k-epsilon turbulent model) and particle transport (laminar trajectories, 1–116 μm) were conducted using sampling flow rates of 10 L min^?1 in slow moving air (0.2 m s^?1) in the facing-the-wind orientation. Combinations of seven inlet shapes and three inlet diameters were evaluated as candidates to replace the current 37-mm inlet cap. For a given inlet geometry, differences in sampler efficiency between inlet diameters averaged less than 1% for particles through 100 μm, but the largest opening was found to increase the efficiency for the 116 μm particles by 14% for the flat inlet cap. A substantial reduction in sampler efficiency was identified for sampler inlets with side walls extending beyond the dimension of the external lip of the current 37-mm CFC. The inlet cap based on the 37-mm CFC dimensions with an expanded 15-mm entry provided the best agreement with facing-the-wind human aspiration efficiency. The sampler efficiency was increased with a flat entry or with a thin central lip adjacent to the new enlarged entry. This work provides a substantial body of sampling efficiency estimates as a function of particle size and inlet geometry for personal aerosol samplers.