新建综合性医院医护人员患者安全文化研究

目的了解某新建综合性医院医护人员患者安全文化现状,寻找薄弱环节和潜在隐患,为患者安全文化水平持续改进与不断提升提供参考依据。方法采用美国医疗服务质量和研究组织通行的患者安全问卷调查法,计算正性回答率,获得该医院患者安全文化数据,和AHRQ同类医院正性反应率进行比较。结果该医院部门/区域安全等级评分正性反应率为75.5%。差错的反馈和交流、组织文化-不断改善、科室内部团队合作3个维度为患者安全优势领域。对差错的非惩罚性处理、人员配备、不良事件上报频率、科室间团队合作4个维度,为患者安全待改进领域;正性反应率最低的维度及与AHRQ差值最大的维度差错的非惩罚性处理、不良事件报告频率,提示为制约新建医院患者安全文化建设的关键环节及影响因素。结论建立公正文化,可促进不良事件上报,提升患者安全水平。     

乡镇卫生院医疗器械临床使用安全管理

本文通过对12家乡镇卫生院设备及人员配置的调查,分析了其存在的不足及原因,并提出了乡镇卫生院的医疗器械临床使用安全管理的对策。     

乡镇卫生院医疗器械临床使用安全管理探讨

通过对12家乡镇卫生院设备及人员配置的调查,分析了其存在的不足及原因,并提出了乡镇卫生院的医疗器械临床使用安全管理对策。     

新疆乡镇卫生院基础建设现况调查

目的了解新疆乡镇卫生院的基础建设情况及存在问题,为改善乡镇卫生院配置现状提供参考。方法从新疆南北东疆随机抽取6个县的18个乡卫生院进行定量调查。结果被调查的乡镇卫生院中总建筑面积有1个乡未达标;住院部、门诊部使用面积均符合标准;医技科室使用面积均不符合标准;公共卫生用房面积只有9个乡达标;医疗卫生用房面积有13个乡未达标;床位配置符合规定的有7个乡。乡镇卫生院在34项基本装备器械中能达到要求的有32个,均没有双目显微镜与简易呼吸机;在14项基本配套设备中有13项达到了要求,均未设置太平间。结论加大医疗设备投入比例;制定乡镇卫生院医疗设备配置标准;改善乡镇卫生院用房现状,满足新形势发展需要。     

Assessment of Contributions to Patient Safety Knowledge by the Agency for Healthcare Research and Quality-Funded Patient Safety Projects

Objective. To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)'s patient safety portfolio and assess their aggregate potential to contribute to knowledge development.
Data Sources. Information abstracted from proposals for projects funded in AHRQ's patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects.
Study Design. This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model.
Principal Findings. The 234 projects funded through AHRQ's patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products.
Conclusions. The projects funded in AHRQ's patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results.     

我国城乡医院联动现状及动力分析

新医改方案提出要发挥县医院的“龙头”作用,建立城市医院对口支援农村医疗卫生工作的制度。各个地区纷纷开展了城市医院对口支援县医院的工作。太白“团队整体帮扶模式”、洛川医院“紧密型整体托管模式”和中国医科大学附属第一医院“协作医院模式”均取得了良好的效果。在分析了3种模式联动的特征、内容和效果的基础上,运用利益相关者理论指出了城乡医院联动的动力所在,同时提出了新形势下加强城乡医院联动,推进县医院建设的相关建议。     

Rural Relevant Quality Measures for Critical Access Hospitals

Purpose: To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Methods: Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6‐member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. Findings: The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. Conclusions: All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting.     

Birth Outcomes and Infant Mortality by the Degree of Rural Isolation Among First Nations and Non-First Nations in Manitoba,Canada

Context: It is unknown whether rural isolation may affect birth outcomes and infant mortality differentially for Indigenous versus non-Indigenous populations. We assessed birth outcomes and infant mortality by the degree of rural isolation among First Nations (North American Indians) and non-First Nations populations in Manitoba, Canada, a setting with universal health insurance. Methods: A geocoding-based birth cohort study of 25,143 First Nations and 125,729 non-First Nations live births to Manitoban residents, 1991-2000. Degree of rural isolation was defined by an indicator of urban influence (no, weak, moderate/strong) based on the percentage of the workforce commuting to urban areas. Findings: Preterm birth and low birth weight rates were somewhat lower in all rural areas regardless of the degree of isolation as compared to urban areas for both First Nations and non-First Nations. Infant mortality rates were not significantly different across areas for First Nations (10.7, 9.9, 7.9, and 9.7 per 1,000 in rural areas with no, weak, moderate/strong urban influence, and urban areas, respectively), but rates were significantly lower in less isolated areas for non-First Nations (7.4, 6.0, 5.6, and 4.6 per 1,000, respectively). Adjusted odds ratios showed similar patterns. Conclusions: Living in less isolated areas was associated with lower infant mortality only among non-First Nations. First Nations infants do not seem to have similarly benefited from the better health care facilities in urban centers, suggesting a need to improve urban First Nations’ infant care in meeting the challenges of increasing urban migration.     

Implementing Patient Safety Initiatives in Rural Hospitals

ABSTRACT:  Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in 8 small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of 3 patient safety interventions: the Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey, use of personal digital assistants (PDAs), and sharing of emergency room protocols. The experience suggested that a collaborative model between rural hospitals, a payer, a hospital association, a quality improvement organization, and academic institutions can effectively support patient safety activities in rural hospitals. Successful implementation of the 3 patient safety interventions depended on leadership provided by nursing and patient safety/quality managers and open, trusting communications within the hospitals.     

Meaningful Use of Health Information Technology by Rural Hospitals

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data from the American Hospital Association (AHA) Annual Survey IT Supplement were analyzed, using t tests and probit regressions to assess whether implementation rates in CAHs and other rural hospitals are significantly different from rates in urban hospitals. Findings: Of the many measures we examined, only 4 have been met by a majority of rural hospitals: electronic recording of patient demographics and electronic access to lab reports, radiology reports, and radiology images. Meaningful use is even less prevalent among CAHs. We also find that rural hospitals lag behind urban institutions in nearly every measure of meaningful use. These differences are particularly large and significant for CAHs. Conclusion: The meaningful use incentive system creates many challenges for CAHs. First, investments are evaluated and subsidies determined after adoption. Thus, CAHs must accept financial risk when adopting health IT; this may be particularly important for large expenditures. Second, the subsidies may be low for relatively small expenditures. Third, since the subsidies are based on observable costs, CAHs will receive no support for their intangible costs (eg, workflow disruption). A variety of policies may be used to address these problems of financial risk, uncertain returns in a rural setting, and limited resources.     

重庆市统筹城乡医疗保障制度的实践探索

改革开放30年来,我国基本医疗保障体系框架已初步形成,但在公平性、可及性和费用负担方面存在着严重的城乡二元失衡现象.2007年年底重庆市开展了统筹城乡医疗保障的实践探索.文章分析总结了重庆市实践探索的背景、探索中所取得的成绩和存在的问题,并针对存在的问题提出了相应的政策建议.     

从宜城市拍卖卫生院看我国农村卫生体制改革的思路

介绍了2002年湖北省宜城市拍卖14家乡镇卫生院的情况。经过近两年多的运转，被拍卖的乡镇卫生院并没有达到改革的预期目标。讨论了产权改革并不是乡镇卫生院改革的唯一出路。农村卫生体制改革要坚持政府主导、统筹兼顾，逐步推进。     

Training a Patient Safety Work Force: The Patient Safety Improvement Corps

Objective. Evaluate short-term effects of the Patient Safety Improvement Corps (PSIC), an Agency for Healthcare Research and Quality–sponsored program to train state teams in patient safety skills/tools, to assess its contribution to building a national infrastructure supporting effective patient safety practices.
Data Source. Self-reported information gathered from (1) group interviews at the end of each year; (2) individual telephone interviews 1 year later; (3) faxed information forms 2 years later.
Study Design. Program evaluation of immediate and short-term process and impact (use of skills/tools, information sharing, changes in practice).
Data Collection. Semistructured interviews; faxed forms.
Principal Findings. One year after training, approximately half of Year 1 and 2 state agency representatives reported they had initiated or modified legislation to strengthen safe practices, and modified adverse event oversight procedures. Approximately three-quarters of hospital representatives said training contributed to modifications to adverse event oversight procedures and promotion of patient safety culture. Two years posttraining, approximately three-quarters of Year 1 trainees said they continued to use many skills/tools.
Conclusions. The PSIC contributed to building a national infrastructure supporting effective patient safety practices. Expanded training is needed to reach a larger fraction of the population for which this training is important.     

陕西省6所三级医院患者安全文化现状及影响因素研究

目的了解陕西省三级医院患者安全文化现状,分析影响因素,为推动医院文化建设、实现医院安全管理提供参考。方法于2018年7月-9月向陕西省6所三级医院的医务人员发放问卷进行横断面调查,运用SPSS 22.0软件对所获数据进行统计分析。结果调查医务人员共计1 065名。患者安全文化总体评分为（3.74±0.41）分,83.00%的医务人员认为患者安全等级“非常好”或“很好”。患者安全等级的影响因素有性别、最高学历、用工形式、参与6S培训（P＜0.05）。对错误的反馈与交流、医院交接班与转科程序、医院管理支持、对患者安全的全面理解和医院各部门之间的协作等维度与患者安全等级呈正相关（P＜0.05）。结论参与调查的医院患者安全文化总体水平中等偏上。医院应积极使用质量管理工具,针对不同人员采用个性化措施,加大管理支持力度,重视差错事件的持续改进,以不断提升患者安全管理水平。