南京市公立医院医务人员内外部工作动机对工作投入的影响研究

目的 分析公立医院医务人员的内外部工作动机对工作投入的影响机制及内外部动机之间的关系,为提高医务人员的工作投入提供借鉴。方法 利用工作动机量表和工作投入量表,采用分层抽样方法,选取南京市3家三级医院、4家二级医院和16家社区卫生服务中心的医务人员进行问卷调查。结果 结构方程模型显示,内部动机和外部动机对工作投入的各个维度的路径系数分别为0.42、0.35、0.33（P＜0.001）和0.21、0.23、0.29（P＜0.001）,内部动机和外部动机的交互项对工作投入的路径系数为- 0.13（P = 0.003）。说明医务人员内部动机、外部动机对工作投入各维度:工作活力、工作奉献和工作专注都有正向影响;外部动机与内部动机协同影响医务人员的工作投入。结论 医院应关注医生内部动机与外部动机间的差异以及工作动机对医生工作投入的影响的不同,有针对性地采用不同的激励手段,全面提升医务人员的职业素养。     

探讨文明创建对医院发展的作用

“全国文明单位”称号是国家综合评比一个单位精神文明建设成果的最高褒奖。良好的医院形象是提升医院综合实力、增强其竞争力的重要手段。医院每年制定文明创造重点,明确文明创造的目标、任务和重点,将文明创造工作与业务工作结合起来进行规划、实施、考核和奖惩。医院设有精神文明建设领导小组和办公室,隶属党办,负责精神文明建设的日常协调和指导工作。文明永无止境。文明创造是一项系统工作,它整合全院资源,整合党、工团、妇委会等各种力量,“青年文明号”“巾帼文明岗”不断树立品牌支持创建工作。医院积极营造“文明单位、共建共享、全员参与、人人受益”的良好氛围。文明建设扎实推进,医院建设更加健康有序。结合福建省肿瘤医院连续三届获评“全国文明单位”的创建经验,从医院人员素质、中心工作、社会责任、文化、决策和环境等方面入手,阐述医院文明创建对医院发展的作用。     

高校附属医院文化建设和党建工作的关系研究

文化建设与党建工作之间存在着一定的关联,随着经济的不断发展,我国卫生管理体制改革也不断深入,在此过程中,对于高校附属医院文化建设和党建工作提出更高水平的要求。从医院层面来看,通过加强文化建设以及发展党建工作,能够有效提高医院的凝聚力,促进医院树立良好的形象、培养优秀的医护人员等。文化建设和党建工作息息相关,在医院管理与发展的过程中,两者之间相辅相成。文章在研究的过程中,采用访谈法、问卷调查法等方法,通过访谈法、问卷调查法对医院各个方面人员进行调查,根据调查结果总结高校附属医院文化建设和党建工作的关系。     

Nutrition Screening,Reported Dietary Intake,Hospital Foods,and Malnutrition in Critical Care Patients in Malawi

In low-income countries there are few data on hospital malnutrition. Reduced food intake combined with nutrient-poor foods served in hospitals contribute to nutritional risk. This study investigated whether reported dietary intake and disease state of hospitalized adults in critical care units was related to malnutrition determined by mid-upper arm circumference (MUAC). Adult in-patients (n = 126) in tuberculosis, burn, oncology, and intensive care units in two public tertiary hospitals in Malawi were screened for nutritional status using MUAC and a question on current dietary intake. The hospital menu was reviewed; portion sizes were weighed. The prevalence of moderate and severe malnutrition was 62%. Patients with organ-related diseases and infectious diseases had the highest rates of reduced reported dietary intake, 71.4% and 57.9%, respectively; however, there was no association between reported dietary intake and MUAC. In those unable to eat, however, the rate of severe malnutrition was 50%. The menu consisted of porridge and thickened corn-based starch with fried cabbage; protein foods were provided twice weekly. There was a nutrient gap of 250 calories and 13 gm protein daily. The findings support the need for increasing dietetic/nutrition services to prevent and treat malnutrition in hospitals using simple screening tools.     

A Multidisciplinary,Community-Based Program to Reduce Unplanned Hospital Admissions

ObjectivesTo evaluate the effect of Hospital Admission Risk Program (HARP) on unplanned hospitalization, bed days, and mortality of enrolled individuals and to evaluate the cost-effectiveness of HARP.DesignA retrospective longitudinal analysis of hospital administrative data.InterventionIndividuals at risk of hospitalization were provided with multidisciplinary, community-based care support managed by care coordinators including integrated care planning, education, monitoring, service linkages, and general practitioner liaison over 6-9 months.Setting and ParticipantsIndividuals who were enrolled into 1 of 8 HARP chronic disease management programs between July 1, 2017, and June 30, 2018, at the Royal Melbourne Hospital, Australia.MethodsHospital admissions between 18 months before and 18 months after HARP enrollment were analyzed. Total hospital costs were compared between 18 months before and 12 months after HARP enrollment.ResultsA total of 1553 individuals with a median age of 71 years (interquartile range 60-81), 63.4% males, were admitted to HARP. Both unplanned hospitalizations and bed days were reduced during the HARP intervention compared to within 3 months before enrollment in each of the HARP management programs. After the HARP intervention, cardiac coach, cardiac heart failure, chronic respiratory, diabetes comanagement, and medication management programs had higher hospitalizations and bed days than individuals’ baseline of at least 3 months before HARP enrollment. Individuals in cardiac heart failure and chronic respiratory management programs had a higher mortality rate than other HARP chronic disease management programs. Individuals in cardiac coach, diabetes comanagement, and medication management programs had lower hospital costs during the HARP intervention compared to within 3 months before HARP enrollment.Conclusions and ImplicationsHARP reduced unplanned hospitalization and bed days but did not return individuals’ hospital use to baseline before the intervention. The variations in mortality between HARP chronic disease management programs implies that condition-specific goals between programs is preferable.     

Diagnostic Testing in Long-Term Care and Resident Emergency Department Visits: A Retrospective Cohort Study

ObjectivesTo investigate the association between rapid access to radiographs, blood tests, urine cultures, and intravenous (IV) therapy in a long-term care (LTC) home with resident transfers to the emergency department (ED).DesignRetrospective cohort study.Setting and Participants21,811 residents living in 162 LTC homes in Ontario, Canada.MethodsWe administered a survey to LTC homes to collect wait times for radiographs, basic blood tests, urine culture, and IV therapy. Rapid availability was defined as typically receiving test results within 1 or 2 days, or same-day IV therapy. We linked the survey results to administrative data and defined a cohort of residents living in survey-respondent homes between January and May 2017. We followed residents in the linked administrative databases for 6 months, until discharge, or death. Two physicians identified diagnostic codes for ED visits that were potentially preventable with rapid availability of each of the 4 resources. Multilevel logistic regression models estimated associations between potentially preventable ED visits and rapid diagnostic tests and intravenous access while controlling for demographic characteristics, illness severity, LTC home size, chain status, and physician availability.ResultsRapid blood tests, radiographs, urine culture, and IV therapy were available in 55%, 47%, 34%, and 45% of LTC homes, respectively. LTC homes that were part of multihome chains were less likely to have rapid access to the 4 resources. Of the 4736 residents (27%) who visited an ED during follow-up, individuals from homes with rapid access to radiographs (odds ratio 0.79, 95% confidence interval 0.66-0.97), urine culture (0.88, 0.72-1.08), blood tests (0.83, 0.69-1.00), and IV therapy (0.93, 0.70-1.23) tended to have fewer potentially preventable ED visits.Conclusions and ImplicationsRapid access to diagnostic testing and IV therapy in LTC reduced ED visits. Improving access to these resources may prevent ED visits and allow residents to stay home.     

2000~2019 年我国境内20 起医院空调系统火灾统计分析

将2000~2019年20起我国境内医院空调系统火灾数据进行统计并分析火灾的时间、起火医院的类型和等级、起火部位和点位的特点及产生的原因,希望给同行一些警示。     

区域互联网医院建设与运营服务思考

全民健康信息化进入新阶段,结合卫生健康行业现状的梳理及政策走向,积极探索利用新兴信息技术引领医疗服务模式的变革。本研究提出区域互联网医院建设的概念界定、主要建设内容,以及建设运营和服务模式。旨在通过区域卫生专网和5G移动网络,利用最新信息技术成果,创建并利用区域互联网医院建设,优化配置医疗资源,缓解三级医院服务压力,提高基层医疗机构服务能力,通过信息技术引领医疗服务模式转型,解决医改过程中的诸多堵点问题。     

山东省县级综合医院绩效考核评价研究

目的全面评估山东省县级综合医院的整体服务与技术水平,进一步落实县级综合医院的功能定位,引导其发展方向。方法以文献研究为基础,综合应用专家咨询法、倍数环比法确定指标构成及权重,并通过TOPSIS法、定量分析与对比分析等方法,研究山东省111家县级综合医院的绩效考核情况。结果山东省县级综合医院发展水平参差不齐,运营效率与持续发展方面存在明显劣势。结论各县级综合医院应根据实际情况调整未来发展重心,加强规范化管理,促进各指标协同发展。同时,政府应继续落实对县级综合医院的扶持政策。     

精神病专科医院经济运行调查和建议

精神卫生专业机构既是我国精神卫生服务体系的重要组成部分,也是精神卫生防治工作的主体。精神障碍发病率逐年增加,已经成为严重威胁我国居民健康的一类疾病。在新冠疫情防控期间,精神病专科医院在维持社会稳定方面起到的作用不可或缺。与综合医院和其他专科医院相比,精神病专科医院无论是在运营成本还是运营能力上都有所欠缺。研究揭示了精神病专科医院运行存在的一系列问题,建议社会和政府在要求精神病专科医院"公益"服务的同时,应切实了解精神病专科医院的运行现状并给予足够的支持。