医院三公经费内控管理的思考

“三公经费”是我国事业单位经费中一项主要组成部分,医院作为事业单位,“三公经费”的管理也尤为重要。目前,我国医院的“三公管理”尚且存在一些问题有待解决,该文先就目前三公经费现状与不足三公经费问题成因分析进行简单概述,再对加强医院三公经费管理的对策进行进一步分析。     

城市社区在公共卫生管理中的干预机制构建

公共卫生管理和防控作为基础性、长期性的重大民生工程,对人民群众的身体健康、生命安全有着重要影响。社区作为社会基层,在突发公共卫生事件的防控中成为工作重心。当前城市社区在公共卫生管理和防控中还存在诸多问题,应从激发社区内生动力、精准施策、强化社区主体责任、加强信息化建设、科学舆情疏导等方面着力实施,不断提升社区干预在突发公共卫生事件防控中的治理水平。     

Legiolert酶底物法与传统培养法对公共场所水体样本中嗜肺军团菌检出结果的比较

目的比较Legiolert酶底物法与传统培养法对公共场所水体样本中嗜肺军团菌的检出效果。方法分别利用Legiolert酶底物法与传统培养法对采集于公共场所的冷却水、淋浴水样本进行嗜肺军团菌检测,并对分离株进行验证及血清分型。结果共采集并检测样品68份,传统培养法与Legiolert酶底物法的检出率分别为5.88%(4/68)及35.29%(24/68),差异有统计学意义(χ2=16.41,P<0.01)。两种方法的检测符合率为64.71%(44/68),检测效果的差异有统计学意义(配对χ2=16.41,P=0.000)。分离出的25株嗜肺军团菌血清型以LP1为主(14/25)。结论Legiolert酶底物法对公共场所水体样本中嗜肺军团菌的检出率高于传统培养法。     

RBRVS-KPI模式下公立医院绩效考核体系构建及应用

目的探讨如何将以资源为基础的相对价值比率（RBRVS）与关键绩效指标法（KPI）相结合,运用于公立医院绩效考核体系实践中。方法分析样本医院绩效考核体系的应用效果,根据医院总体目标,经过点值测算、指标选择,建立了一套具有医院特色的改良型RBRVS-KPI模式绩效考核体系。结果经实践,医疗质量和运行效率大幅度提高,在一定程度上促进了医院管理的精细化。结论RBRVS-KPI模式下的绩效考核体系较唯财务导向的绩效模式更能体现医护人员劳动价值,值得探索与推广。     

基于DRGs的医疗服务绩效差异分析:以二级综合医院为例

目的对成都市二级民营综合医院与公立综合医院住院医疗服务绩效进行DRGs分析和比较,找出差异,提出建议。方法收集2019年成都市二级民营综合医院和二级公立综合医院住院病案首页数据,利用四川省DRGs应用平台进行分组计算,使用SPSS 20.0软件进行指标分析。结果成都市二级民营综合医院与二级公立综合医院2019年住院医疗服务绩效在医疗服务（总权重、覆盖DRGs组数和CMI值）、医疗效率（时间消耗指数、费用消耗指数）上并无显著差异,但在医疗质量与安全（中低风险及以下组病死率、标化病死率）上差异明显。结论二级民营综合医院与二级公立综合医院整体医疗服务差距逐渐缩小;二级民营综合医院内部发展不均衡,医疗质量与安全水平低于二级公立综合医院。建议持续提升民营综合医院服务能力,加强民营综合医院医疗质量与安全管理,同时政府须对民营医院强化监管。     

少数民族地区青少年对新冠疫情的认知调查

目的调查少数民族地区青少年对新冠疫情的认知及应对情况。方法采用分层抽样的方法,通过“问卷星”在线平台对香格里拉市1949名在校学生进行调查。结果结果显示,81.94%的学生在2020年1月初之前已知晓疫情;83.12%的学生通过电视和微信知晓疫情;9333%的学生认为病毒通过飞沫传播;94.80%的学生会通过戴口罩、不聚餐等方式进行防护;疫情相关知识的正确率为71.44%。不同年龄、性别、民族、专业、生源地、家庭年收入的学生对部分调查问题的差异有统计学意义(P<0.05)。结论学生对疫情认知整体情况较好,部分问题仍有较大提升空间。学校应做好疫情常态化防控,完善心理疏导体系,多措并举,引导学生做好自我防护。     

对医院办公室工作的思考

面对医疗卫生事业改革的新形势、新任务,医院办公室应该更新观念,树立改革创新意识、大局意识、法制意识、市场竞争意识和以病人为中心的意识;积极参与医院改革、成本核算、组建医疗集团、建立医院信息系统、开拓医疗服务市场、参与市场竞争等医院重点工作;建立和协调好对内对外的关系,在医院改革与发展中发挥积极作用。     

Characterization of urgent versus nonurgent early readmissions (<30 days) following primary bariatric surgery: a single-institution experience

BackgroundStudies on early postoperative readmissions after bariatric surgery (BS) have examined readmissions as a single entity, regardless of urgency. Strategies to lower nonurgent readmissions would reduce unnecessary hospital utilization.ObjectivesTo identify predictors of urgent readmissions (UR) versus nonurgent readmissions (NUR) at 30 days post-BS.SettingSingle academic institution.MethodsPatients undergoing primary BS over 2 years (n = 589) were retrospectively reviewed. Baseline demographic, medical, and hospitalization data were compared between readmitted patients, stratified by urgency, and nonreadmitted patients. Multivariate regression models of UR and NUR were created using variables with a P value ≤ .2 on univariate analyses. A P value ≤ .05 was considered statistically significant.ResultsThere were 39 documented instances of 30-day readmissions, of which 44% (n = 17) were NUR; NUR patients were more likely to be female (100% versus 78.2% male; P = .03) and trended toward being younger, experiencing ≥2 perioperative complications, and having a longer index hospital length of stay (LOS). Patients with URs had a higher baseline BMI (52.5 ± 11.4 kg/m² versus 48.7 ± 8.3 kg/m², respectively; P = .04), were more likely to have sleep apnea (77.3% versus 56.1%, respectively; P = .05), had a longer LOS (3 versus 2 d, respectively; P = .007), and were more likely to have ≥2 postoperative complications (46% versus 17.0%, respectively; P = .003) compared with those with an NUR. Independent predictors of NUR included public insurance (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.17–11.67; P = .03), younger age (OR = 1.05; 95% CI, 1–1.01; P = .04), and female sex, while URs were independently predicted by LOS (OR = 1.3; 95% CI, 1.04–1.5; P = .02).ConclusionsPublic insurance appears to be associated with NURs, while LOS predicts URs after BS. This suggests an important dichotomy within readmissions based on urgency, which has important implications for targeted quality initiatives.     

Un sistema de vigilancia de salud pública para el cambio climático en las ciudades

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.     

中国公众公共卫生安全素养量表的开发研究

目的开发公共卫生安全素养量表, 为我国公众的公共卫生安全素养测评提供适宜工具。方法通过理论构想、指标池构建、现场验证、题项缩减等步骤编制中国公共卫生安全素养初始量表, 转为"问卷星"电子问卷, 随机抽取4个省份共2 809名居民进行现场测试。利用经典测试理论(CTT)和项目反应理论(IRT)进行题项缩减。使用SPSS 23.0软件进行探索性因子分析(EFA)和单维性检验。使用R 4.1.1软件ltm和mirt包进行题项的心理测量学指标分析, 并绘制项目特征曲线(ICC)和信息函数曲线(IIC和TIF)。结果选用专家一致性系数最优的初始量表3, 共30个题项(B1～B30), 测试对象完成1个题项平均需9.8 s。根据CTT分析, 删除校正题项-总相关系数(CITC)<0.3及题项-维度相关系数(IDCC)<0.4的B2题项;删除CITC<0.3、IDCC<0.4及难度指数<0.2的B23题项;删除CITC<0.3及难度指数<0.2的B30题项。删除后量表总内部一致性信度(Cronbach’’sα)值为0.923。EFA提示删除14个因子载荷较小...