Objectives of Contexts and Contexts of Objectives. A Comparative Study of Private and Public Education in Greece and Sweden

In contemporary Europe the possibilities to practice widespread ideals of modern family life, reflecting new material conditions and ideologies, have been shown to be highly dependant on society's macro level characteristics and formal support system. To broaden the empirical understanding of these processes the European Families in the 90's Projectfocus upon the interactive forms and contexts of modern family patterns. With The Ecology of Human Development Theory working as a conceptual framework, information has been collected from a sample of 100 families each of 12 countries, all with young children regularly in full time public child care. The article presents information on the relations between family members and between the family and its local and general context in two contrasting countries, Sweden and Greece. In the analysis two hypothesis, concerning the general and specific forms of the macro-micro system level relations are tentatively tested. The results indicate that while the ideal educational objectives of the studied type of family mainly correspond in the two cultures, the offered contextual possibilities to practise these ideals vary between them. There are also traces indicating a general difference concerning potential of adjustment between types of relations. While new relations, like the one between family and day care setting, are expected to adjust to practical life circumstances, the traditional roles of mothers and fathers remain more untouched.     

富锦市农村基本公共卫生服务项目的实践与体会

在大量调查的基础上,通过梳理富锦市基本公共卫生服务均等化的现状,以及项目实施中存在的管理问题,提出了针对重点管理问题,实施＂精细化管理＂的新模式。＂精细化管理＂模式在富锦市实施三年来,农村居民健档率96.7%,重点慢性病患者规范管理率达到92.8%,群众满意度达到95.4%,服务人员工作质量和积极性大大提升,得到了领导和百姓的认可和好评。通过项目实施深深体会到,加强工作机制,注重细节管理,强化监管服务,加强部门协调是确保做好基本公共卫生服务的先决条件。精细化管理模式的探索为进一步促进经济欠发达地区的基本公共卫生服务均等化的开展提供一定的参考和借鉴。     

Evidence on Scaling in Health and Social Care: An Umbrella Review

Policy Points

• More rigorous methodologies and systematic approaches should be encouraged in the science of scaling. This will help researchers better determine the effectiveness of scaling, guide stakeholders in the scaling process, and ultimately increase the impacts of health innovations.
• The practice and the science of scaling need to expand worldwide to address complex health conditions such as noncommunicable and chronic diseases.

• Although most of the scaling experiences described in the literature are occurring in the Global South, most of the authors publishing on it are based in the Global North. As the science of scaling spreads across the world with the aim of reducing health inequities, it is also essential to address the power imbalance in how we do scaling research globally.

     

智慧医院在公立医院高质量发展中的角色与定位

智慧医院是未来医院信息化建设的主旋律.本文以公立医院高质量发展的目标为出发点,通过对智慧医院建设背景、内涵、目标的剖析,指出智慧医院建设与公立医院高质量发展的契合点,明确智慧医院的角色与定位,提出适合医院自身高质量发展的智慧目标.     

卫生财政学概念的涵义、范围领域、基本特征与地位作用(上)

我国的医药卫生体制改革总体方案设计正处于关键时期．卫生筹资模式、卫生总费用构成状况和政府在卫生保健服务中承担的责任是当前的核心议题，卫生财政和卫生财政学应运而生卫生财政（包括医疗财政）是财政体制创新的必然结果，是财政体制处于由以分税制为基础的分级财政体制向公共财政体制转型的过渡性产物，通过简要讨论卫生财政概念及其内涵、外延，描述卫生财政学的学科体系．确定卫生财政学的研究范围、研究领域和关键性研究议题，概括卫生财政的基本特征和国际发展历史经验．分析卫生财政的基本功能与地位作用等基础理论政策议题，为医药卫生体制改革和构建和谐社会、和谐医惠关系提供了崭新的改革思路。     

Mechanisms behind privatization: A case study of private growth in Swedish elderly care

For many years the Swedish Welfare State has been associated with a welfare model in which the public sector dominates both the provision and financing of the elderly care system. However, influenced by the ongoing trend of New Public Management, the past 15 years have been characterized by governmental regimes encouraging competition and as a result there has been a substantial increase in private providers. This case study on elderly care in Sweden provides new insights into the mechanisms behind the spread and growth of privatization. Our results show that in 1990 only 1% of the labour force in the elderly care sector was employed by private organizations, in comparison to 2003 when the private share had increased to 13%. The accompanying organizational changes have been controversial and are often criticized. In general, left-wing politicians have frequently defended the traditional welfare model dominated by public providers, whereas right-wing politicians have urged for a larger share of alternative providers. In this study, statistics between the years 1990 and 2003 were used to model the relationship between privatization and a number of economic, political and social/demographic variables. The results from regression and diffusion analysis imply that privately managed elderly care has established itself mainly in metropolitan areas dominated by right-wing regimes. Surprisingly, neighbouring municipalities tend to follow these pioneers irrespective of their political colour or economic situation. In fact, after shifting political power many of those neighbouring municipalities dominated by left-wing regimes not only maintain an abundance of private contractors but also encourage a continued process of contracting out publicly managed elderly care units. As a result, clusters of municipalities with an increasing degree of privatization arise despite political and economic differences. In conclusion, geographical proximity seems to be an important variable in addition to population density, ideology and financial situation when privatization reforms are implemented in the Swedish elderly care system.     

公立医院回归公益性的改革

卫生服务体制改革是全球性的议题,医院改革是其中重要的一环。世界各地的公立医院都程度不等地为服务效率低下和质量低劣的问题所困扰。在控制医疗开支的前提下为民众提供更优质的医疗服务,成为公立医院改革的共同目标。本文重点从卫生服务体系结构调整、管办分离、控制医疗费用三个方面为我国公立医院改革提出建议。     

流动人口孕妇社区管理研究

目的了解北京市流动人口孕产妇社区管理现状,建立适合流动人口特点的孕妇保健社区管理模式。方法在北京市朝阳区、海淀区、丰台区的城乡结合部5个社区,采用专题小组讨论的方法,了解现有社区孕产妇保健管理情况采用社区流动车,为686名流动人口孕妇提供免费卫生服务。结果研究地区妇幼保健人员数量不足,管理流动人口难度大,而社区计划生育部门网络健全。在社区相关部门的配合下,实施社区流动检查车服务形式,定期到社区为流动人口孕妇提供免费服务,受到群众的欢迎,取得良好效果。结论各级政府应为流动人口孕产妇保健给予政策上的支持和必要的资金、人力投入,建立社区流动人口管理协作机制,使流动车持续发展下去。     

某三级公立医院绩效评价体系实证效果研究

目的研究三级公立医院基于平衡计分卡的绩效评价体系的推广实施和结果运用对医院业务发展的促进作用。方法收集某三级公立医院2015—2019年间的基于服务满意、业务开展、财务成本和内部成长四个维度的绩效评价结果及相应领域的实际业务开展情况,分析绩效评价体系对医院长期战略目标的作用。结果研究期间,总体绩效评分从75.6分持续增长至81.3分,年均增长1.5%。医院业务总体运行的发展情况与绩效评分增长趋势基本一致,医院总体运行情况与医院战略目标基本一致。结论基于BSC的医院绩效评价体系有助于协调长期与短期目标、集体与岗位目标,评价结果推动医院日常业务运行向既定的战略目标发展。     

A Multicenter Study to Identify Clinician Barriers to Participating in Goals of Care Discussions in Long-Term Care

ObjectivesLong-term care (LTC) is an important setting for goals of care (GoC) discussions. Understanding clinician barriers to GoC discussions could identify opportunities for LTC-specific interventions to improve quantity and quality of GoC discussions in the context of serious illness.DesignA multicenter, cross-sectional survey study.Setting and Participants1184 LTC clinicians from 34 Ontario LTC homes were invited to participate.MeasuresThe questionnaire assessed (1) clinician barriers related to the LTC resident power of attorney (POA), the health care provider, and the health care system; (2) willingness to engage in GoC discussions; and (3) suggestions to address identified barriers. Responses were rated on a 7-point scale (1 = extremely unimportant/unwilling, 7 = extremely important/willing). A linear mixed-effects model determined significance between mean importance ratings for each barrier and the willingness to engage in GoC discussion between physicians and nurses. A simple content analysis was performed on written suggestions to address GoC discussion barriers.ResultsThe overall response rate was 49% (581/1184). The top 3 rated barriers were (1) POA's difficulty accepting their loved one's poor prognosis, (2) POA's difficulty understanding the limitations and complications of life-sustaining therapies, and (3) lack of adequate documentation of prior discussions with LTC resident or POA. Barriers related to the health care provider, and the health care system, were deemed statistically more important by nurses. LTC physicians were more willing to exchange information, be a decision coach, and participate in the final decision than nurses. Suggestions to improve GoC discussions include a dedicated team to have these conversations in LTC, and updating policies to mandate and standardize these conversations at all family meetings.Conclusions and ImplicationsThis study has identified key LTC clinician–identified barriers to GoC discussions. Developing targeted interventions to these barriers could be the foundation for developing new interventions that support high-quality GoC discussions.     

我国医院的发展趋势

随着我国国民经济持续、稳定的发展,卫生事业取得了长足的进步,医院工作得到了全面发展。医院面临着人民医疗卫生需求快速增长,同时与国际社会接轨的双重挑战。因此,必须了解其发展趋势,适应其发展变化:1.医院基本任务的变化;2.服务体制的改革;3.服务观念的转变;4.医院内部管理模式的变化;5.人事管理的改革;6.管理手段现代化;7.实施区域医疗规划,合理使用卫生资源。     

野战传染病医疗所医护作业系统设计与研制

针对战时传染病伤病员救治的要求,分析野战传染病医疗所医护作业需求,设计并研制“野战传染病医疗所医护作业系统”,包括2个分系统,共14个软件模块和4类硬件设备,通过实兵演习应用,有效提高了野战传染病医疗所伤病员救治效率。     

The Nature of Emerging Practice in Occupational Therapy: A Pilot Study

The profession of occupational therapy is responding to changes in the health care system by expanding the contexts and models for service provision, typically referred to as emerging practice. As a pilot study, a survey was completed by 174 occupational therapists to gather information and opinions about emerging practice. Results indicated occupational therapists hold diverse perceptions about emerging practice settings and services as well as the role and significance of emerging practice within the profession. Occupational therapists engaged in emerging practice described numerous rewards and challenges inherent within the process of developing and delivering services. The findings indicate continued professional dialogue and research are needed to support the development and efficacy of occupational therapy services in emerging settings and roles.     

天津市内六区公厕现状及发展趋势

调查了天津市内六区公厕的分布现状,分析了其存在的问题,并提出了与天津市城市发展目标相适应的对策及发展方向。     

构建西部民族地区农村新型公共卫生服务体系

建立适宜于西部民族地区农村新型公共卫生服务体系．对保障西部民族地区人民群众身体健康,为建设边疆民族地区社会主义新农村。文章在分析目前存在问题的基础上,提出的包括“六个体系”和“两个机制”的农村新型公共卫生服务体系,是一个适应西部民族地区农村且有效、可行的公共卫生服务系统。     

A Randomized,Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients

Objective

To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients.

Setting

Forty randomly selected, geographically diverse home health care centers in the United States.

Design

Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization.

Data Collection

Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients’ baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements.

Principal Findings

A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89–1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, p = .01) compared to the usual care group.

Conclusions

This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days.     

Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review

Introduction

Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date.

Methods

PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage.

Results

Thirty measures—23 satisfaction and 7 experience—were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs.

Conclusion

Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development.

Patient or Public Contribution

This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.     

三级甲等医院患者忠诚度影响因素研究

摘要：目的 探讨影响三级甲等医院患者忠诚度的因素,为提高患者忠诚度、增强医院实力、促进医院健康持续发展提供参考依据。方法 采用横断面调查法。在某三级甲等医院门诊和病区分别随机抽取10个科室,对2009年10月—2010年1月间的诊疗患者或陪护人员随机发放调查问卷,完成有效问卷2188份。结果 调查对象对该医院各项医疗服务的满意度均大于90.0%;忠诚度为83.1%。 结论　患者忠诚度与医疗水平和服务质量、医院品牌、交通便捷性、医患人际关系、投诉渠道通畅性、患者满意度等因素有关。