医疗器械使用管理的几个焦点

医疗器械的不正确选择、管理和使用导致医疗费用的显著增加已经引起各国的广泛关注,2010年由世界卫生组织（WHO）组织的第一届全球医疗器械论坛针对医疗器械使用管理中的几个问题开展了广泛的讨论．文中对讨论的几个焦点问题进行了综述。     

关于农村医疗保障的历史思考与政策建议

医疗保障形式是与生产力水平、生产组织形式和分配制度相适应的。我国农村的医疗保障曾创造过举世瞩目的成就 ,它的重构面临严峻挑战 ,这一问题的解决不能脱离农村的实际情况。政府应本着成本效益原则 ,从设施、人员、资金等基本要素抓起 ,构建多元化、多层次的农村医疗保障体系。     

医院质量管理体系构建在保障医疗安全中的作用研究

通过医疗质量控制网络及信息系统建设、临床路径实施、质量文化建设、不良事件报告及手术病人的安全管理、重大阳性结果及检验危急值的实时处理追踪系统的建立、不合理用药的及时干预和超常预警机制的建立,多层面揭示医院质量管理体系构建在保障医疗安全中的主要作用。     

Quality assurance methods for performance-based assessments

Performance assessments are subject to many potential error sources. For performance-based assessments, including standardized patient (SP) examinations, these error sources, if left unchecked, can compromise the validity and reliability of scores. Quality assurance (QA) measures, both quantitative and qualitative, can be used to ensure that candidate scores are accurate and reasonably free from measurement error. The purpose of this paper is to outline several QA strategies that can be used to identify potential content- and score-related problems with SP assessments. These approaches include case analyses and various comparisons of primary and observer scores. Specific examples from the ECFMG Clinical Skills Assessment(CSA®) are used to educate the reader concerning appropriate statistical methods and legitimate data interpretations. The results presented in this investigation highlight the need for well-defined training regimes, regular feedback to those involved in rating/scoring performances, and detailed statistical analyses of all scores.This revised version was published online in October 2005 with corrections to the Cover Date.     

我国医疗保障制度发展的历程回顾与评价

人人享有社会医疗保障,是社会文明进步的重要组成部分。我国把基本建立覆盖城乡全体居民的社会医疗保障体系,作为构建社会主义和谐社会的目标和主要任务。刚刚出台的新医改政策将如何实施,我国的医疗保障制度未来如何发展。显然已经成为人人关注的民生问题。本文对建国近60年以来医疗保障制度走过的发展道路进行回顾,以期为探索我国社会医疗保障未来发展的方向提供借鉴。     

临床科室医疗质量管理模式研究

传统的临床医疗质量管理模式存在一定的弱点,为探索一种更加有效的临床医疗质量管理模式,我们建立了一种由临床医学专家与行政管理人中相结合的管理模式,根据工作中存在的实际问题,确定了以下几项管理重点：住院病历质量,规模医生医疗行为,人均住院费用,医疗缺陷。在规范医疗行为中重点加强了对三级医师查房、三级医师手术范围、会诊和危重病人抢救等关键环节的管理,做到简明明确,重点突出。通过临床医学专家与行政管理人员的优势互补,更好地加强了临床医疗过程中各个环节质量的控制,增强了管理的力度和时效性,提高了医院的竞争力。     

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.     

CT生产厂家应为QA做些什么

本文通过总结几年CT检测的经验，阐述了CT设备质量保证的意义，根据实际CT应用质量检测的需要，对CT应具备的几个功能提出了要求，以保证检测结果的客观性。     

调强放射治疗技术及其质量保证

调强放射治疗是一种更先进的放射治疗方法,它通过使用计算机控制的先进治疗方式来改善剂量分布和肿瘤形状的适形度.调强放疗的质量保证是调强放射治疗成功的关键.     

批质量检验抽样方法及其正确应用

近年来，批质量检验抽样方法渐被引用于卫生研究。由于该方法与一般假设检验稍有不同，因而易被误用。本文通过实例加以说明。     

Involving mental health service users in quality assurance

OBJECTIVE: This study compares the process and outcomes of two approaches to engaging mental health (MH) service users in the quality assurance (QA) process. BACKGROUND: QA plays a significant role in health and care services, including those delivered in the voluntary sector. The importance of actively, rather than passively, involving service users in evaluation and service development has been increasingly recognized during the last decade. DESIGN: This retrospective small-scale study uses document analysis to compare two QA reviews of a MH Day Centre, one that took place in 1998 as a traditional inspection-type event and one that took place in 2000 as a collaborative process with a user-led QA agenda. Setting and participants The project was undertaken with staff, volunteers and service users in a voluntary sector MH Day Centre. Intervention The study compares the management, style, evaluation tools and service user responses for the two reviews; it considers staff perspectives and discusses the implications of a collaborative, user-led QA process for service development. RESULTS: The first traditional top-down inspection-type QA event had less ownership from service users and staff and served the main purpose of demonstrating that services met organizational standards. The second review, undertaken collaboratively with a user-led agenda focused on different priorities, evolving a new approach to seeking users' views and achieving a higher response rate. CONCLUSIONS: Because both users and staff had participated in most aspects of the second review they were more willing to work together and action plan to improve the service. It is suggested that the process contributed to an evolving ethos of more effective quality improvement and user involvement within the organization.     

临床路径医疗质量管理模式对医疗机构监管的意义与展望

鉴于当前我国医疗质量监管存在忽视医院医疗服务行为的日常监管、监督执法能力不全以及缺乏完善的监督评估标准和长效机制,提出了应用临床路径的医疗质量管理模式对医疗机构的医疗质量实施有效监管的建议。     

改良包罗模型在乳腺癌医疗质量评价中的应用

目的通过评价乳腺癌治疗的医疗质量,促进医院重视医疗质量管理,不断提高医疗质量和医院效率。方法运用改良包罗模型,对江苏省肿瘤医院1998年1月—2007年9月的3048例乳腺癌住院患者的病案首页和临床诊疗资料,从病例分型、医疗缺陷和医疗转归3个方面进行了病例医疗质量分级评价。结果计算出乳腺癌病例的医疗质量代用值在80%～100%之间,均值为95.51%;据此评价病例质量等级,优级1021例(33.50%),良级1818例(59.65%),中级209例(6.86%),低级、劣级无。结论包罗模型是一种比较全面的病例医疗质量的评价方法,运用改良包罗模型评价乳腺癌病例的医疗质量等级很好。建议医院应实现医疗质量标准化,严格落实工作环节,强调病例分型,全面加强医院质量管理。     

医院建立医疗设备质量控制与安全保证体系的探索

本文阐述如何从医疗设备的购置、使用、医学计量和维修等管理方面,建立医疗设备质量控制与安全保证体系。     

医用电子直线加速器照射野的日常质量保证

目的通过分析照射野特性相关参数的日检数据的变化趋势．探讨医用电子直线加速器照射野的日常质量保证方法的可行性和必要性。方法每天放射治疗前．用二维电离室矩阵Daily QA3测量加速器照射野特性相关参数与预设标定值的偏差．辅以IBA公司的剂量仪DOSl进行绝对剂量验证和用慢感光胶片进行光野一致性的二次验证．并对以上各项日常检测数据（2009年11月28日-2011年4月8日）进行回顾性分析。结果X线和电子线输出剂量均随着时间的增加逐渐增大．光野一致性、射野平坦度及对称性基本保持不变。结论一年多的实践表明．本文论述的照射野日常质量保证方法是有效和可行的．它在保证每日放疗精确执行的同时,也为加速器的长期校准提供了依据。     

医疗器械和技术引进的技术评价方法

本文在阐明技术评价的理论和方法的基础上，论述了医疗器械的技术引进和实施效果的技术评价方案和程序及其在医疗器械管理和器械总体规划方面的应用前景。     

儿童保健一体化技术和质量保证

目的:为0～3岁儿童基本保健服务提供技术支持和操作平台。方法:依据相关文件和规范,结合工作实践,确定测查项目、评价标准和指导内容,通过计算机信息系统辅助实施。结果:建立了以"测查——评价——指导"为核心的适宜技术、质量保证机制及服务平台,并在实际工作中得到了较为广泛的应用。结论:"测查——评价——指导"一体化技术及其质量体系的建立,可为儿童提供规范、便捷、全面的保健服务。     

六六六、滴滴涕分析质量控制样品的制作

[目的]研制六六六、滴滴涕分析质量控制样品。[方法]向纯净的色拉油中添加六六六、滴滴涕标准溶液，观察样品的均匀性和稳定性。[结果]通过近半年的检测结果反映出样品的均匀性和稳定性均符合要求。[结论]该样品可以作为分析质量控制样品。     

Quality assurance in nutrition and dietetic service provision

This paper reviews published work on quality assurance, gives an outline of the methods that can be used in implementing and monitoring a quality assurance programme and assesses the implications for nutrition and dietetic departments and dietetic practitioners.     

Process versus outcome indicators in the assessment of quality of health care.

This paper reviews the relative strengths and weaknesses of outcome and process measures as performance indicators in health care. Differences in outcome may be due to case mix, how the data were collected, chance, or quality of care. Health care is only one determinant of health and other factors have important effects on health outcomes, such as nutrition, environment, lifestyle and poverty. The advantages of process measures are that they are more sensitive to differences in the quality of care and they are direct measures of quality. However, outcome measures are of greater intrinsic interest and can reflect all aspects of care, including those that are otherwise difficult to measure such as technical expertise and operator skill. Outcome indicators can be improved if efforts are made to standardize data collection and case mix adjustment systems are developed and validated. It is argued that this is worth doing only where it is likely that variations in health care might lead to significant variations in health outcome and where the occurrence of the outcome is sufficiently common that the outcome indicator will have the power to detect real differences in quality. If these conditions are not met, then alternative strategies such as process measurement and risk management techniques may be more effective at protecting the public from poor quality care.