The impact of the internal market on hospital efficiency, productivity and service quality

In this paper we use nonparametric mathematical programming models to compute and decompose Malmquist indices of productivity and quality change, which are used to evaluate the reforms in the UK National Health Service in the early nineties. We focus on acute hospitals and we study them over the first five years of the reforms. The findings of the study indicate that there was a productivity slowdown in the first year after the reforms but productivity progress in the subsequent years and thus, overall there was a net gain in productivity over the entire period considered. Productivity trends were dominated by technical change rather than hospital relative efficiency changes, as hospitals were already largely relatively efficient at the time of the introduction of the reforms. In fact, over the last four years in the period studied there was small relative efficiency regress and this does not bear out the argument that the reforms would increase hospital efficiency. The productivity changes are similar when service quality is incorporated in the analysis but the magnitude of these changes diminishes. Quality of service followed different trends to productivity change and this may have been the price for the productivity gains achieved.     

Modell eines computergestützten qualitätssicherungssystems in der verbrennungsintensivtherapie

Zusammenfassung Ausgehend von Überlegungen für ein angemessenes Qualitätssicherungssystem im intensiv-medizinischen Bereich werden die Voraussetzungen für ein ganzheitliches Qualitätsmanagementsystem im Krankenhaus entworfen. Die Grundlage für ein dynamisches Qualitätssicherungssystem ist auf der dokumentatorischen Ebene eine umfassende Datenbasis, die auf einer zeitlich und datentechnisch unbegrenzten Patientenakte basiert. Die notwendige Hard- und Softwarestruktur wird durch die konsequente Anwendung einer Client-Server-Architektur gewährleistet. Die ständige Überprüfung der bestehenden Qualitätsziele in einem ökonomischen Regelkreis benötigt ein System mit flexiblen Abfragemechanismen. Dieser informatorische Datenzugriff auf jeder Hierarchieebene der Krankenhausstruktur wird durch das Konzept des Data-Warehouse ermöglicht, das als Datenbanksystem mit subjektorientierten, integrierten, zeitvariablen und beständigen Informationen konzipiert ist.

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A computer-assisted quality-assurance model for burn intensive care applications

The prerequisites for an integrated quality management system for hospitals were developed as a result of considerations regarding the necessity of an appropriate quality-assurance system for the intensive care sector. The basis for a dynamic quality-assurance system on the documentational level is a comprehensive data base containing patient files unlimited in terms of time and data technology. The necessary hardware and software structure will be provided by consistent application of a client-server architecture. Permanent surveillance of existing quality objectives within the scope of an economic close-loop system requires a system with flexible query mechanisms. Informational data access from all hierarchical level within the hospital organization is facilitated by the data warehouse concept, a data base system with subject-oriented, integrated, time-variable, and persistent data.

     

Drug discovery information integration: virtual humans for pharmacokinetics

The ‘virtual human’ refers to simulation models based on explicit mathematical models of mammalian physiology. When applied to pharmacokinetics (PK), the virtual human embodies models that can be parameterised for different species, different individuals and populations of individuals, and that allow simulation of PK from measured and/or predicted in vitro properties. The models are independent of the properties of any specific drug, and can be used for the prediction of drug behaviour in specific human individuals and in pre-clinical species. The hope is that these models will allow the prediction of PK throughout the drug discovery and development process, enabling effective targeting of synthetic chemistry efforts to compounds with the required therapeutic effect, careful evaluation of multiple candidates for development, assessment of the potential for drug-drug interactions, evaluation of multiple formulations, efficient clinical trial design and other benefits, including reduction of animal usage in drug discovery. However, we believe that the biggest impact on drug discovery productivity would accrue from achieving two clear objectives: an estimate of human in vivo activity on every compound synthesised and a reliable prioritisation, based on predictions of human in vivo activity, for the next round of synthesis. It is realistic to believe that the benefits of delivering these objectives could, through shortening the time to decision and increasing the chance of success, lead to a five- to ten-fold increase in discovery output. It is also now possible to demonstrate that a combination of virtual human simulation software and industrial-scale absorption, distribution, metabolism and elimination (ADME) testing can deliver both of these objectives.     

In vitro evaluation study of the membrane autotransfusion system experimental prototype: MATS-I

Abstract: Membrane Autotransfusion System (MATS) utilizing plasmapheresis technology has been developed in our laboratory. A specially designed polyethylene hollow fiber membrane was utilized. This study was conducted to evaluate performance of the first experimental prototype, MATS-I. The results of this study showed that the MATS-I could concentrate diluted blood at 10% of the initial hematocrit concentration (HCTi) into over 40% after passing through the system at a transmembrane pressure of 70 mm Hg. Moreover, the MATS-I can continuously treat 10,000 ml of diluted blood at various HCTi levels without deteriorating its performances. Even though the MATS-I met all required performances as an autotransfusion system, several areas of improvement of the system were necessary to meet various clinical needs. The next prototype, MATS-II, can be designed based on experiences obtained from the MATS-I. The MATS is smaller, more atraumatic and continuous, and is a faster system when compared to the currently available centrifugal autotransfusion devices.     

试论方剂功效表达的历史沿革及现代研究意义

方剂的历史悠久，但真正将方剂作为研究对象，出现方剂功效的描述则始自金代成无己，并在明清时期有了较大的发展，而直到建国后才形成一定的规范。目前古方中还存在大量的方荆只有简单的组成与主治，而没有详细的方论，包括方剂功效。文章最后论述了方荆功效理论研究的重要性与可行性。     

同水平析因设计矩阵的分解结果及其特点

目的介绍同水平析因设计矩阵的分解方法、分解结果及其特点,为多因素试验设计提供一种有效方法.方法以n水平(n≥3)的同水平多因素析因设计矩阵为基本的设计矩阵,不增加任何限定条件,仅考察各试验点对其余试验点的影响,采用"主成分分析、聚类分析和规则归纳"等数据挖掘技术相结合的方法,可将此矩阵分解成一系列彼此互不重叠的独立设计矩阵.结果独立设计矩阵具有一些很好的特点,有些本身就是正交设计,有些本身就是均匀设计,还有些是它们所不包含的特殊设计,这些设计一般都是比较理想的多因素试验设计.结论独立设计不仅涵盖了多因素析因设计、分式析因设计、正交设计、均匀设计,还有一些是具有实用性的特殊设计,它是一类具有很高理论研究价值和实际应用前景的综合性极强的多因素试验设计方法.     

农村地区常规免疫接种率报告数据质量研究

目的评价农村地区常规免疫接种率报告数据质量。方法采用按容量比例概率抽样法,于2004年11~12月对伊通、建德、宿松、扶风4个县10月份常规免疫接种报告数据质量,按报告、统计、调查接种率3个层面进行研究。结果总的趋势是上报接种率高于统计接种率,统计接种率高于调查接种率。应种人数以调查为高,实种人数以报告为高。调查应种人数比报告应种人数多15.97%,调查实种人数比报告实种人数低15.54%。报告与统计应种人数符合率为55.83%,实种人数符合率为63.18%。报告与调查应种人数符合率为51.21%,实种人数符合率为61.89%。报表统计人员测试结果与上报报表统计正确性无关(χ2=1.54,P>0.05),村级人员制作报表的准确性明显比乡级低(χ2=7.79,P<0.01);报表数据质量乡级高于村级(χ2=8.64,P<0.01)。结论农村地区常规免疫接种率报告数据质量有待提高,其措施是提高报表统计人员责任心,统一由乡级统计报表,改善培训及督导方法。     

广域病案质量管理系统研制报告

目的该研究项目目的是要建立一个广域的病案质量信息管理平台,规范病案质控工作.使病案质控逐步走向规范化、系统化,在广域环境里整体提高病案质量水平.方法该系统总体设计上分为微观管理端和宏观管理端两个层次,组成广域病案质量数据管理平台;在病案质量内容上,该系统独创了一个多层多段多维的数学模型,利用它来对病案质量情况进行描述和管理;在程序编写上,采用了Delphi 7.0和SQL数据库.结果由于从宏观与微观上同时入手,且引入了现代质控方法和概念,该系统投入使用后能在省市级水平上大幅提高病案质控的管理水平.目前支持该设计的计算机软件系统已做完α测试,并进入协作组内部β测试阶段.     

数据仓库在军字一号工程药品信息管理分析中应用研究

目的探讨如何应用数据仓库技术构建军字一号工程药品信息统计资源库。方法运用Oracle9.2和OWB9.0数据仓库生成软件,构建药品信息统计资源库,并利用Oracle9iDiscoverer工具进行数据挖掘。结果从药品信息统计资源库中挖掘出大量的管理信息,并生成了相应的报表和视图。结论应用数据仓库技术构建医院药品信息统计资源库,可从中得到丰富的辅助决策信息,拓展了HIS信息资源利用空间。     

儿童医院下呼吸道感染经济损失的病例对照研究

目的　了解儿科住院患儿发生医院下呼吸道感染所造成的直接经济损失。方法　采用 1∶1病例对照研究的方法 ,调查 1 0 1对住院患儿的医疗费用 ,计算医院感染的直接经济损失。结果　病例组的平均医疗费用为3430 .5 3元 ,对照组为 2 1 34.0 5元 ,两组比较 ,差异有显著性 (P <0 .0 5 )。中西药费占总增加费用的 4 3.0 3% ;治疗费、化验费和床位费分别占总增加费用的 2 8.1 7% ,9.31 % ,5 .79%。心血管内科医院感染病例医疗费用最高 ,平均每例增加 4 2 36 .93元 ;新生儿内科次之 ,平均每例增加 1 736 .93元。感染患者的平均住院天数为 1 3.0 9d ,比对照组的 8.1 6d高 (P <0 .0 5 )。结论　医院感染的发生增加了患儿的医疗费用 ,延长了住院日 ,降低了病床周转率 ;认真做好医院感染监控工作可获得经济效益和社会效益