Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.     

某大型军队医院人员编配方法探讨

本文在军队医院编制体制的文献回顾的基础上,确定人员编配应遵循的原则和依据;通过专家咨询法和皮尔生长曲线模型、三次指数平滑等数理统计方法,预测某大型军队医院的展开床位数、门诊量和住院人数,并结合医院不同类型卫生人员实际工作特点,测算该院人员的理论编配值。通过对该院卫生人员理论配置值和实际配置值之间的比较,分析医院各类卫生人员配置的合理程度,并对今后定编工作提出相应的建议。     

实施临床路径的保障体系研究

为了有效推进临床路径工作,结合上海申康医院发展中心的工作实践,提出组织保障、政策保障、机制保障等6项保障措施,形成完整的实施临床路径的保障体系。     

医务人员对三级公立医院绩效考核推进分级诊疗制度的态度研究

目的探讨医务人员对三级公立医院绩效考核推进分级诊疗制度落实的态度现状。方法采用多阶段随机抽样调查法。从我国东部、中部、西部3个地区各随机抽取一个省级行政区,再从每个省级行政区按绩效考核等级各选取一家三级公立医院进行医务人员政策评价调查。采用Stata 15.0软件对医务人员态度相关数据进行统计学描述、非参数检验、二元Logistic回归分析等。结果共收集调查问卷12 835份。有95.20%的医务人员认为三级公立医院绩效考核对推进分级诊疗制度具有一定促进作用。高年龄段、硕博士研究生、高级专业技术职称以及从事临床医疗的医务人员认为三级公立医院绩效考核对推进分级诊疗制度无促进作用的比例更高。医务人员在三级公立医院绩效考核推进分级诊疗制度的促进程度方面,年龄、最高学历、从事专业类别、地区变量上差异具有统计学意义（P＜0.05）。结论三级公立医院绩效考核工作在推进分级诊疗制度落实以及优化监测指标层面有一定的提升空间。还需关注政策与医务人员的利益相关性,打破各级医疗机构间壁垒,促进形成整合协调的医疗服务体系。     

2011年长沙市医院工作人员吸烟现况及相关知识调查

目的 了解长沙市医院工作人员的吸烟状况及相关认知与态度,为制定无烟医院政策提供科学依据. 方法 2011年9-10月,采用分层随机抽样方法抽取长沙市10所医院的1000名工作人员进行吸烟相关的问卷调查.结果 长沙市医院工作人员吸烟率为24.0％,现在吸烟率为16.8％,吸烟者日平均吸烟量为15.22支,60％以上吸烟者自称在起床后1h内吸第一根烟.医院工作人员二手烟暴露率高达86.3％.调查中,仅有13.7％的被调查者表示未遭受被动吸烟.被调查者认同吸烟可能导致心脏病发作、中风、阳痿的比例为79.6％、80.4％和81.0％.医院工作人员对医院禁烟普遍持支持态度,但仍有32.8％的被调查者认为应该允许在医院内卫生间吸烟. 结论 长沙市医院工作人员中男性现在吸烟率较高,对单位室内完全禁烟支持率较高,在烟草与疾病认知方面还需要进一步提高,应对医院工作人员的吸烟行为进行干预,加强控烟知识培训,充分发挥医院和医院工作人员在烟草控制工作中的表率和支持作用.     

医务人员对三级公立医院绩效考核政策的认同研究

目的调查医务人员对国家三级公立医院绩效考核政策的认同度及其影响因素。方法采用多阶段随机抽样法,从我国东部、中部、西部3个地区各随机抽取一个省级行政区,再从每个省级行政区分别随机选取绩效考核等级为“优秀”“良好”“一般”的各一家三级公立医院进行政策认同度研究。采用SPSS 23.0软件对数据进行统计学描述、主成分分析和多因素线性回归分析。结果共纳入13 211份问卷。超过80%的医务人员对国考政策各维度表示认同;年龄、最高学历、从事专业类别、有无行政管理职务、地区和医院绩效考核等级是影响医务人员政策总体认同度的因素。结论医务人员对国考各维度的政策总体认同度较好,但对“医务人员满意度”维度的政策认同度有待提升。建议关注重点人群诉求,重视政策实施方式的科学性,进一步提高医务人员对国考政策的认同度。     

我国医院质量管理现状——基于五省调研

本研究通过对5个省开展实地调研,发现我国三级医院、县级医院、民营医院之间医疗质量管理的发展水平有很大差距。三级医院的质量管理体系最为健全;县级医院由于人力资源匮乏和运营压力而无力完善薄弱的质量管理体系;民营医院的医疗质量管理水平则呈现两极分化的趋势。其中存在的具体问题包括:省级质量监管机构监管能力薄弱,运行缺乏保障;医院内部质量管理组织架构不完善,专业质管人员缺乏,人员培训不足;医院信息化发展程度不均衡,信息共享不足。针对上述问题,本文建议:提升第三方监管机构的隶属层次,加强对质控中心的运行保障;完善县级医院、民营医院内部质量管理组织架构,保障人员配置,加大经费投入,开展全员质量管理培训;制定医院信息化建设的基本框架,加强对县级医院、民营医院信息化建设的经费补贴,尽快颁布全国统一的疾病编码,促进医院信息共享。     

Hospital response to the implementation of prospective payment.

This research examined the competing effects of regulatory intensity (Prospective Payment System) and inertial pressure on US hospitals' cost of medical materials, shifting of services from inpatient to outpatient settings, size of the administrative component, and use of new technology. Among the expected findings, regulatory intensity was associated with reduced medical material costs, less new technology and a greater administrative component. Inertial pressures were associated with higher medical material costs, more new technology and less shifting of services from inpatient to outpatient settings. It was concluded that US hospitals respond to regulatory pressures within the context of strong inertial forces. The stronger the inertial forces, the less dramatic a hospital's response to regulatory pressures is likely to be.     

The roles and responsibilities of the medical staff organization

The increasing complexity of hospitals and the emergence of corporate responsibility calls for greater trust amongst the Board, Administration and Medical Staff. Physicians will play a more important role in the hospital decision-making process. Boards will expect the medical staff organization to better define and monitor processes for physician credentialling, evaluation, peer review and discipline. Because these issues are complex and sensitive, only the organized medical staff can appropriately address them. Clarification of roles and responsibilities of the President of the Medical Staff, the Chief of Staff and the medically qualified administrative officer is crucial in the development of appropriate relationships and processes.     

Variation in management of community-acquired pneumonia requiring admission to Alberta,Canada hospitals

Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay.     

传染病医院面对新型冠状病毒肺炎疫情应急管理策略

在新型冠状病毒肺炎疫情流行期间,全国所有传染病医院积极参与到疫情防治工作中。作为新型冠状病毒肺炎病人省市定点收治单位,第一时间应急反应,转移安置原有病人、有序安排收治新型冠状病毒肺炎病人、治愈出院和后期随访等工作,科学管理,有效保证了病人的救治能力和医务人员安全。     

浙江省精神病医院省级专项经费投入的卫生经济学评估

目的评估浙江省精神卫生专项经费对精神卫生专业机构的卫生经济学效果.方法通过对省内15家接受精神卫生专项经费资助和13家未接受资助的精神卫生专业机构的对比,比较其5年来在服务功能、经济效益和资产结构方面差异以及资助前后的增长率.结果专项经费资助使受资助精神卫生专业机构在服务功能、经济效益、资产结构和职工收入等方面普遍获益,尤其是门诊、住院服务功能,医疗收入和职工收入,固定资产的获益更为明显.结论本次经费有助于使受资助精神卫生专业机构走上更加良性化运作的道路,符合成本效益原则.     

The Canadian health care system: an overview

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governments and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occurred in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.     

加强医院感染管理的实践与体会

随着医院诊疗水平的发展,医院收治的重病患者越来越多.医院感染已成为影响医疗安全和患者生命健康的重要因素。本文总结在医院感染管理的实践中的经验和体会,认为落实医院感染管理的各项法律法规的要求,提供医务人员对医院感染相关知识的认识是保障医疗安全的基础,落实各相关人员的责任制是控制医院感染的必要条件,掌握有效的监测方法才能及时发现医院感染的苗头,控制医院感染事件的发生。     

论区域后方医院协作发展机制

本文探索了区域后方医院协作发展机制,通过成立组织领导机构、调整病种收治任务、实行药品器材互通共用、加强医学人才流动使用、开展技术协作交流等方法,优化了医院资源配置,提高了服务保障质量,激发了人才队伍活力,促进了学科功能定位和医院共同发展。     

A survey of staff attitudes to increasing medical undergraduate education in a district general hospital

INTRODUCTION: Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching--their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching--as both student numbers and service workloads continue to rise. METHODS: Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. RESULTS: The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. CONCLUSIONS: This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative.     

Impact of critical care outreach services on the delivery and organization of hospital care

OBJECTIVES: To evaluate the impact of critical care outreach services on the delivery and organization of hospital care from the perspective of staff working in acute hospitals. METHODS: One hundred semi-structured interviews were undertaken with hospital staff who were either members of, or who came into contact with, the outreach service in eight hospitals in England. RESULTS: Outreach services had two main impacts on the delivery and organization of hospital care, reflecting the organizational and educational aims of the policy. First, on the organization of patient care: it was suggested that care was more timely, there were fewer referrals to the intensive care unit (ICU) and ICUs felt more able to discharge patients to hospital wards. There were also perceived to be improved links between ward nurses and medical teams and improved morale among ICU nurses. Second, on the confidence and skills of ward staff (nurses and junior doctors): increased contact on the wards resulted in more opportunities to share critical care skills. However, there remained concerns about the sustainability of improved skills and some respondents felt that junior doctors were becoming de-skilled. CONCLUSION: Critical care outreach services have had a positive impact on the delivery and organization of hospital care. In attempting to share critical care skills, however, these services can experience a tension between the aims of service delivery and education - a tension which is partly resolved by sharing skills in the clinical and organizational context of direct patient care.     

Control and support: what physicians want from hospitals

It has been asserted that physicians hold the key to success in hospital efforts to increase admissions and contain costs. While there is a great need to forge a partnership with the medical staff in achieving mutual goals, little is known about what physicians want from hospitals. A survey was completed by 177 physicians in two Cleveland-area hospitals that assessed their preferences on issues concerning hospital governance and control, hospital services, and hospital employment of physicians. Results showed that physicians want greater involvement in hospital decision making and desire services that facilitate their practice of medicine. Responses varied significantly according to physician age, specialty, HMO participation, and multiple-staff membership. Greater effort on the part of hospital administrators to assess and understand medical staff needs is suggested.     

医疗保险信用等级制度对医院的约束作用分析

本文一方面分析了医疗保险信用等级制度对医院业务量和收入的影响,比较该制度实施前后医疗保险管理机构对定点医院经济约束作用的变化;另一方面分析了该制度对医院信誉认知的影响、医院员工对信用等级重要性认知和医院员工提高信用等级意愿等方面的内容,确定信用等级制度对医院社会声望方面的影响以及医疗保险机构对定点医院制约作用的变化。综合以上两个方面的分析得出结论:信用等级制度对于不同医院的服务量和业务收入以及社会声望具有显著影响,医院员工具有为使医院获取社会声望而提高信用等级的明显倾向,医疗保险管理机构对定点医院的约束作用进一步增强。