医务人员临床工作绩效内涵及指标体系构建:基于工作职责和个体绩效结构演化的探析

 目的 深化对医务人员临床工作职责及其绩效内涵的认识,提升个体绩效理论在制定绩效评价指标体系中的应用价值,为医务人员临床工作绩效评价研究提供新的视角和途径。方法 基于临床工作职责,结合个体绩效研究成果,界定医务人员临床工作绩效内涵。结果 (1)医务人员临床工作绩效包含工作能力、工作表现和取得的工作成果。(2)医务人员临床工作绩效评价指标体系可包含专业诊治、医患交流、职业自律3个一级指标;诊疗产出、诊疗行为、诊疗能力、沟通成效、沟通行为、沟通能力、自律成就、自律行为和自律能力9个二级指标。结论 将工作职责与“结果—行为—能力”三因素绩效结构模型相结合提取绩效评价指标,可强化指标层级之间的逻辑关联,具有一定的科学性和合理性。初步构建的医务人员临床工作绩效评价指标体系有待进一步细化、验证和完善。     

Reduced healthcare utilization following successful hepatitis C virus treatment in HIV‐co‐infected patients with mild liver disease

New direct‐acting antivirals (DAA) for hepatitis C virus (HCV) infection have achieved high cure rates in many patient groups previously considered difficult‐to‐treat, including those HIV/HCV co‐infected. The high price of these medications is likely to limit access to treatment, at least in the short term. Early treatment priority is likely to be given to those with advanced disease, but a more detailed understanding of the potential benefits in treating those with mild disease is needed. We hypothesized that successful HCV treatment within a co‐infected population with mild liver disease would lead to a reduction in the use and costs of healthcare services in the 5 years following treatment completion. We performed a retrospective cohort study of HIV/HCV‐co‐infected patients without evidence of fibrosis/cirrhosis who received a course of HCV therapy between 2004 and 2013. Detailed analysis of healthcare utilization up to 5 years following treatment for each patient using clinical and electronic records was used to estimate healthcare costs. Sixty‐three patients were investigated, of whom 48 of 63 (76.2%) achieved sustained virological response 12 weeks following completion of therapy (SVR12). Individuals achieving SVR12 incurred lower health utilization costs (£5000 per‐patient) compared to (£10 775 per‐patient) non‐SVR patients in the 5 years after treatment. Healthcare utilization rates and costs in the immediate 5 years following treatment were significantly higher in co‐infected patients with mild disease that failed to achieve SVR12. These data suggest additional value to achieving cure beyond the prevention of complications of disease.     

Screening for depression in older medical inpatients

BACKGROUND: Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. Previous studies, mainly outside the UK, report widely differing rates for depression that do not usefully inform UK practice. Thus the aim of this study is to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. METHODS: A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample (n = 223) was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. RESULTS: The weighted prevalence estimate of ICD-10 depressive disorder was 17.7% (95%CI: 12.9-22.5). Forty-four percent of participants scored above the normally recommended cut-point of >or=5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at >or=7 (sensitivity 0.74, specificity 0.81). CONCLUSIONS: This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is >or=7.     

An update on airborne contact dermatitis: 2007–2011

Background. Reviews on irritant and allergic airborne contact dermatitis have been previously reported in the literature. Materials and methods. Here, we present an update based on recently published airborne‐induced skin reactions. For this survey, we screened the journals Contact Dermatitis, Dermatitis, and included relevant articles from other journals during the period January 2007 to December 2011. We also present the airborne cases observed in our department during the same time period. Results. This survey provides an updated list of causal agents that have produced airborne allergic contact dermatitis, and briefly mentions some other types of skin reaction induced by airborne exposure. The sources of the reactions are multiple: drugs; plants, natural resins, and wood allergens; plastics, rubbers, and glues; preservatives and other chemicals; and metals. Conclusions. Airborne contact dermatitis is frequent, and most of the airborne allergens (and irritants) identified are in occupational settings. Drugs and preservatives have recently become more important causes. Dermatologists and occupational physicians need to be aware of them.     

Retaining Experienced Hospital Administrators: A Neglected Topic in Healthcare

The sharp increase in the present need for healthcare services has been attributed to the expanding population of older adults (those above the age of 65 years) and the increasing number of aging healthcare professionals seeking retirement without enough qualified replacements. In this regard, retaining experienced healthcare professionals, especially hospital administrators, may be the key to managing this growing demand for healthcare services at present and for the future. Veteran hospital administrators have many years of experience and can offer a wide array of skills and competencies to their organization. As such, organizations should make every effort to retain these individuals and implement efforts for their continued contribution to the healthcare industry. Given the nature of their work and the various changes accompanying aging, experienced hospital administrators may have specific personal and professional challenges that may be compelling them to consider retirement options. The authors’ primary focus was to identify the unique issues associated with retaining experienced hospital administrators and to propose certain accommodations and recommendations to promote their continued and valued contributions to the healthcare industry.     

Assessing the Impact of Medical Laboratory Resource Allocations on Hospital Finances

The relationship between resource allocation decisions within medical laboratory cost centers and overall hospital financial performance is empirically investigated using a panel of critical access hospitals in Washington State (2014–2016). In order to increase accessibility to hospital managers and health policy makers, a managerial finance perspective (defining performance using simple financial accounting ratios) is adopted. Results indicate that resource allocation decisions within the medical laboratory cost center have a significant impact on the financial performance of the hospital as a whole. However, the nature of the impact depends on the type of financial metric utilized. For instance, the proportion of the typical medical laboratory’s budget that is allocated to rent is negatively and significantly related to the hospital’s return on assets. Concomitantly, medical laboratory cost centers that have a larger footprint in the hospital (as measured by square footage) exhibit a significant, positive association with the hospital’s current ratio. Thus, physically larger medical laboratories may allow the hospital to better manage its liquid assets.     

Supply Chains in Healthcare Organizations: Lessons Learned from Recent Shortages

This paper examines the need for better management of supply chains in healthcare facilities. Recent shortages have highlighted the need for better supply chain systems. The reasons for the shortages are false scarcity, natural disasters, medical lawsuits, production process problems, and group purchasing organizations (GPO). These problems have occurred with increasing frequency. There are three possible solutions available to handle the shortages. First, better use of supply chain management, including multiple suppliers and safety stock. Second, there needs to be better cooperation between suppliers, consumers, and government entities. Finally, healthcare facilities should develop teams of individuals responsible for monitoring critical areas and developing contingency plans.     

Central Service: How to Get Results from an Interview

According to a recent national survey of Hospital chief executive officers, financial challenges are their top concern, especially government reimbursement. Moreover, the patient faces greater deductibles forcing hospitals to prioritize price transparency. The Triple Aim program is a tool available to hospital management to help address these challenges. This study indicates that the Triple Aim is valuable to healthcare providers and patients by reducing medical errors, improving healthcare quality, and reducing costs on a per capita basis. Managerial implications are discussed for hospitals and health systems considering this approach to addressing financial challenges.