基本卫生技术包应用研究概述

影响卫生服务提供绩效的主要因素之一是服务提供的过程（即临床诊疗流程）及所需的各类卫生技术（包括人力资源、设备、设施、药品等）.基本卫生技术包（EHTP）是一种优化临床诊疗流程和卫生技术配置的管理工具,可通过这种核心技术,对卫生技术实施优化干预,以促进和改善服务提供的绩效.作者介绍了基本卫生技术包的方法学原理、技术路线、研究设计和其在单病种质量管理中应用的可行性,以便为决策者提供循证依据,将有限的卫生技术投入到最具成本效果的服务项目上.     

嘉兴市农村小学生伤害流行病学调查

目的了解农村小学生伤害发生原因及其流行病学特征,为预防农村小学生伤害的健康促进提供方向和指导依据。方法采用整群抽样的方法,运用统一设计的调查问卷,对嘉兴市3 385名农村小学生进行伤害流行病学调查。结果嘉兴市农村小学生伤害发生率为24.38%,居前3位的是跌伤、动物咬伤、运动创伤,其发生率分别为31.2%,10.8%和9.6%。伤害发生原因有25种,居前3位是玩耍、运动、骑车,分别占19.2%,19.1%和11.2%;伤害程度中,中、重度伤占20.3%;平均每位学生每年因伤害支出的医疗费用为25.49元。结论嘉兴市农村小学生伤害发生是多因素的,要采取多部门合作的综合防治措施进行预防。     

温州地区脑卒中住院患者费用分析

目的 分析温州地区脑卒中患者的住院费用构成及其影响因素，为降低脑卒中患者的住院费用提供依据。方法：疗法采用回顾性分析方法，对温州地区1037例脑卒中患者住院总费用进行构成比分析及采用单因素方差、多元逐步回归分析影响总费用的主要因素。结果 脑卒中患者住院总费用中构成比最大的是药费，占48．62％；其次是治疗费，占15．85％。影响住院费用的主要因素是住院天数、呼吸道感染、意识障碍、尿失禁、上消化道出血、尿路感染、卒中类型、入院科室、入院时改良的Rankin评分（modified rankin scale，mRS）。结论 对脑卒中患者应采取科学有效的诊疗措施，减少无效住院日及规范用药是降低住院费用的关键。     

2001年～2003年广东省泌尿生殖系统用药分析

目的:研究广东省2001年～2003年泌尿生殖系统用药金额,以了解广东省泌尿生殖系统药物的应用状况及其变化趋势.方法:本文采集"广东省药学会医院用药信息网"收集的购药统计数据,对广东省部分医院2001年～2003年泌尿生殖系统药物用药金额进行统计、排序,并加以分析.结果与结论:泌尿生殖系统药物在销售总金额中比例基本保持不变,各亚类药物的用药结构相对固定,促排卵药的比例相当高.外资、合资药厂产品所占比例较高.     

Medicaid care management: Description of high-cost addictions treatment clients

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals < 90th percentile of AODTx expenditures (n = 41,054); high-cost clients in the top decile of AODTx expenditures (HC; n = 5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals.     

Palliative and hospice care in gynecologic cancer: A review

Despite the increasing availability of palliative care, oncology providers often misunderstand and underutilize these resources. The goals of palliative care are relief of suffering and provision of the best possible quality of life for both the patient and her family, regardless of where she is in the natural history of her disease. Lack of understanding and awareness of the services provided by palliative care physicians underlie barriers to referral. Oncologic providers spend a significant amount of time palliating the symptoms of cancer and its treatment; involvement of specialty palliative care providers can assist in managing the complex patient. Patients with gynecologic malignancies remain an ideal population for palliative care intervention. This review of the literature explores the current state of palliative care in the treatment of gynecologic cancers and its implications for the quality and cost of this treatment.     

Priority-setting and rationing in healthcare: Evidence from the English experience

In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching ‘correct’ resource allocation decisions); and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.     

Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin,Ireland

ObjectiveIdentify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics.MethodResearcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland.ResultsPatient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant’s age, service satisfaction and level of education.ConclusionPatient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels.Practice implicationsThe best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further.