"三医联动改革"中的集团利益分析

“三医联动改革”是一项系统工程 ,医疗保障制度的改革占有主导的地位 ,而医疗卫生和药品流通两个方面的体制改革则是城镇职工医疗保险制度改革的基础。三医联动改革就是要通过部门间的协调和合作 ,选择最佳行动计划 ,寻求三项改革收益或效用的最大化。本文运用集团利益分析的方法对医保、价格、卫生、医院、药品生产、药品监督、患者等多部门的集团利益进行了分析。最后提出了解决各集团利益矛盾的一些政策建议。     

Exploring the challenges and successes of the Lecturer Practitioner role using a stakeholder evaluation approach

RATIONALE: Plans for NHS reform include strategies to reduce the gap between theory and the realities of clinical practice, with the aim of improving patient care. The role of Lecturer Practitioners (LPs) as educators for nurses who 'bridge' the theory-practice gap forms a central part of this strategy. Given the amount of investment in the role and its potential, this study sought to evaluate the impact of the LP role within the education and practice setting from the perspective of key stakeholders. METHODOLOGY: The study, which included five LPs from a range of backgrounds, followed the principles of stakeholder evaluation. Each LP and their line manager identified six informants who were familiar with the LP's role. The total sample consisted of 36 participants. Semi-structured interviews were used to gain the perceptions of stakeholders about the LP role. The emerging themes were then discussed, consensus reached, and a collaborative project report produced. FINDINGS: The findings were derived from the perceptions of the stakeholders. Minimally interpretive analysis of the data resulted in identification of five themes: (i) general overview of LP's individual qualities; (ii) preconceived notions of the post; (iii) reality of the post; (iv) areas of concern; and (v) developing the role. CONCLUSIONS: The findings indicated that the LP role provides a credible and valuable link between theory and practice and, as such, is an important contribution to the modernization agenda of the NHS. It was apparent, however, that there are a number of areas in which developments are needed, and that organizational and individual actions are necessary in order to achieve the most from these posts.     

Stakeholder perspectives on the development of a virtual clinic for diabetes care: qualitative study

Background

The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users.

Objective

The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management.

Methods

Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized.

Results

Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described.

Conclusions

Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study.     

An exploratory study of barriers to inclusion in the European workplace

Background: The European Disability Strategy (2010–2020) seeks to significantly raise the proportion of people with disabilities working in the open labour market. The ERGO WORK project is a collaboration of academic and industrial partners in six European countries, focused on understanding and tackling barriers to workplace inclusion for workers with disabilities.

Methods: This study sought to explore the perceptions and needs of stakeholders in terms of workplace adaptation to the needs of employees with disabilities. An exploratory online survey was completed by 480 participants across six countries.

Results: The analysis suggests that workplaces could be further improved to meet the needs of employees with considerable scope for training within companies to raise awareness about employees’ needs, employers’ obligations and workplace adaptation.

Conclusions: This snapshot suggests there is still a gap between intent and reality in workplace inclusion and further strategies are needed to improve the opportunities for employees with disabilities. The paper argues that ergonomics may have a key role to play in tackling these challenges and adapting the workplace environment and job design to suit the needs of individual employees.

• Implications for rehabilitation

• This study suggests there is considerable scope for workplace adaptation and improvements to meet the needs of employees with disabilities.

• Employers need and want further specialist practitioner guidance to facilitate workplace inclusion and support adaptation to individual needs.

• Organisations would benefit from training to raise awareness about potential solutions and approaches that would support more widespread employment of people with disabilities.

     

基于利益相关者理论和博弈论的公立医院利益补偿分析

应用利益相关者理论和博弈论对现实条件下公立医院利益补偿进行分析,认为公立医院利益补偿制度安排必须满足"激励相容"原则,使得政府、医院与患者的目标函数趋于一致,才能使医院、患者等利益相关者彼此的效用都最大化,从而缓解利益相关者的矛盾冲突。鉴于KP医疗集团有效的运作模式,建议在我国部分地区建立由政府主导,整合预防保健、社区医疗、住院服务及保险功能于一体的非营利性医疗集团,来解决医患利益一致性问题,达成降低医疗成本、提高医疗质量的社会目标,为医药卫生改革提供思考路径。     

基本药物制度的利益相关者分析

目的分析基本药物制度的各个利益相关者,使这一制度能够获得可持续的发展。方法运用利益相关者理论进行分析。结果与结论只有正确处理各利益相关者的关系,引入利益相容机制和善治原则,并充分发挥媒体的作用,才能保证基本药物制度的可持续发展。     

Impact of the palliative care clinical nurse specialist on patients and relatives: a stakeholder evaluation

Within the last decade, there has been a rapid expansion in the United Kingdom of clinical nurse specialists (CNSs), yet there has been limited evidence of their effectiveness. The clinical area of palliative care has one of the largest numbers of CNSs which has particularly started to escalate in the acute hospital setting. Following the Calman-Hine Report and the more recent NHS Cancer Plan, it is anticipated that the number of CNSs in palliative and cancer care is likely to grow. In light of the current policy emphasis of Clinical Governance and Clinical Effectiveness, there is an urgent need to demonstrate the contribution that CNSs make. This paper presents the qualitative findings of an evaluation study on the impact of the CNS within a palliative care team in a large acute hospital in the North-West of England. A stakeholder evaluation that encompassed tape-recorded semi-structured interviews to explore how the stakeholders saw the impact of the CNS within palliative care was performed. Twenty-seven interviews were conducted with stakeholders across the hospital setting including senior nurses, consultants, junior doctors and nurses representing the different grades. Data were analysed for emerging themes utilizing a case and cross-case analysis. The results indicated that the CNSs within palliative care in an acute hospital are seen to be potentially beneficial for both patients and relatives. This paper will focus on exploring these perceived benefits, which included symptom control, psychological care and being an advocate for patients and relatives.     

Informing Patient-Centered Care Through Stakeholder Engagement and Highly Stratified Quantitative Benefit–Harm Assessments

ObjectivesIn a previous project aimed at informing patient-centered care for people with multiple chronic conditions, we performed highly stratified quantitative benefit–harm assessments for 2 top priority questions. In this current work, our goal was to describe the process and approaches we developed and to qualitatively glean important elements from it that address patient-centered care.MethodsWe engaged patients, caregivers, clinicians, and guideline developers as stakeholder representatives throughout the process of the quantitative benefit–harm assessment and investigated whether the benefit–harm balance differed based on patient preferences and characteristics (stratification). We refined strategies to select the most applicable, valid, and precise evidence.ResultsTwo processes were important when assessing the balance of benefits and harms of interventions: (1) engaging stakeholders and (2) stratification by patient preferences and characteristics. Engaging patients and caregivers through focus groups, preference surveys, and as co-investigators provided value in prioritizing research questions, identifying relevant clinical outcomes, and clarifying the relative importance of these outcomes. Our strategies to select evidence for stratified benefit–harm assessments considered consistency across outcomes and subgroups. By quantitatively estimating the range in the benefit–harm balance resulting from true variation in preferences, we clarified whether the benefit–harm balance is preference sensitive.ConclusionsOur approaches for engaging patients and caregivers at all phases of the stratified quantitative benefit–harm assessments were feasible and revealed how sensitive the benefit–harm balance is to patient characteristics and individual preferences. Accordingly, this sensitivity can suggest to guideline developers when to tailor recommendations for specific patient subgroups or when to explicitly leave decision making to individual patients and their providers.