无锡市深化分级诊疗问题分析及对策研究

分级诊疗是新一轮综合医改的重要选择,也是解决人民群众“看病贵、看病难”问题的重要抓手。文章立足无锡市医疗卫生事业发展和分级诊疗推进现状,重点提出在医疗资源配置上存在“平衡”与“均衡”的差距,在医疗联合体建设上存在“结合”与“融合”的差距,在基层医疗机构上存在“功能”与“效能”的差距,在社会就医观念上存在“转变”与“嬗变”的差距,在医疗信息化上存在“支持”与“支撑”的差距,并从完善政策体系、优化资源配置、健全运行机制、突破关键领域、夯实基础环节、强化保障力度等方面提出了针对性意见及建议。     

Using non-linear decomposition to explain the discriminatory effects of male–female differentials in access to care: A cardiac rehabilitation case study

This paper demonstrates the use of non-linear decomposition for identifying discrimination in referral to a cardiac rehabilitation (CR) program. The application is important because the methods are not commonly applied in this context. A secondary data analysis was conducted on a cohort of 2375 patients eligible for referral (as defined) to an Australian hospital outpatient CR program (1 July 1996 to 31 December 2000) on the basis of inpatient discharge diagnosis codes. Data from a population-based disease register were linked to hospital inpatient statistics and CR program records. Cohort selection was established in accordance with first register recorded hospital separations having specified cardiac inpatient diagnoses for which CR was recommended. Using the existing literature as a guide, multivariate logistic regression methods tested the strength of statistical association between independent variables (or ‘endowments’) and CR referral. Compared with males, females had 40% fewer odds of being referred. Non-linear decomposition was performed as a post-logistic regression technique to show the extent to which the sex-based inequality in referral (as defined here) was due to group characteristics (the relative distribution of endowments) compared with other influences not adjusted for in the model. The results showed that approximately 18% of the male–female inequality in referral was not explained by group characteristics, and on this basis was ‘discriminatory’. The extent to which individual endowments contributed to the explained part of the inequality was also of interest. The methods offer potentially useful tools for informing researchers, policy makers, clinicians and others about unfair discriminatory processes that influence access to health and social services.     

北京市42所医院门诊预约挂号现状调查

目的 通过调查医院门诊预约挂号服务的内容、形式、管理模式等情况,为提高医院门诊预约挂号服务质量提供建议.方法 通过对2011-2013年北京市共计42所医院门诊预约挂号服务进行全面统计分析,了解其门诊预约挂号服务现状.结果 目前北京市预约挂号工作呈现覆盖范围广泛、形式多样的特点;患者预约挂号使用率提高,就医习惯逐渐改变.结论 医院应多部门协作,提供完善的配套制度、足够的人力资源等作为保障,推动预约挂号工作进一步发展.     

玉溪市非结防机构网络直报肺结核病人转诊与追踪情况分析

目的了解2005—2009年玉溪市综合医疗机构对疑似肺结核病人的转诊和结核病防治机构对转诊未到位的疑似肺结核病人追踪情况。方法对5年来《中国疾病预防控制信息系统》和《核病管理信息系统》的相关数据进行综合分析和评价。结果 5年内,玉溪市9县区综合医疗机构报告可疑肺结核患者8723例,转诊到结核病防治机构4496例,转诊到位率51.5%,结核病防治机构追踪到位3676例,追踪到位率95.7%,总体到位8407例（包括其他到位的235例）,总体到位率96.4%;到位人数中5697例排除肺结核,排除率为67.8%;2582例登记管理的初治涂阳肺结核病人中,66.8%来自转诊和追踪。结论非结防机构在肺结核病人的发现中起重要作用。进一步提高肺结核/疑似肺结核病人的转诊到位率和转诊质量,将有效提高肺结核病人的发现水平。     

卫生高级专业技术职务聘任实行量化考核的探讨

目的：建立卫生高级专业技术职务量化考核评价体系。方法：通过大量文献评阅选取符合职改文件规定的任职条件的评价指标,与我院高聘委员及部分科主任进行面谈,运用特尔菲法（Telphi）筛选出有效、可行指标,并计算出每项指标的加权总分值,确定指标权重。结论：构建了卫生高级专业技术职务聘任实行量化考核评估的指标体系,且该体系切实可行,客观公正,有利于发挥职称聘任的正向作用。     

深化家庭医生首诊职能的分析与实践

目的深化家庭医生首诊职能的实施。方法设立激励机制,赋予家庭医生使用三级医疗机构资源的权限,对通过家庭医生首诊的患者给予优先处理措施,向家庭医生反馈患者就诊信息。结果接受家庭医生首诊的55名患者对服务的评价较为积极。结论三级医疗机构和社区卫生服务中心均能够通过家庭医生首诊的实施获益。     

Trends in presentation of congenital heart disease in a population-based study in Malta

Differing pathological haemodynamics in cardiac malformations lead to varying modes and timings of presentation. This study identifies historical trends in presentation of congenital heart disease in a population-based study. All patients diagnosed as having congenital heart disease in Malta between 1960–1994 were included (n = 868). Analysis was carried out on trends in referral sources, modes of presentation and birth prevalence. The number of patients diagnosed with congenital heart disease increased over the period under study. For both patients not requiring intervention (n = 283) and those requiring intervention (n=585), the proportion diagnosed prior to hospital discharge increased (p 0.005). There was a decreasing trend for general practitioners to refer cases (p < 0.0001), and an increasing trend for paediatricians to refer such patients (p 0.0003). The commonest presentation to the general practitioner was an incidental finding (92%), while paediatricians referred more patients for cyanosis or heart failure (p 0.005). For lesions not requiring intervention, the commonest lesion referred was ventricular septal defect from all sources. For lesions requiring intervention, the commonest lesion detected prior to hospital discharge was tetralogy of Fallot. Atrial septal defects were the commonest lesions detected after discharge by both paediatricians and general practitioners. An increase in the proportion of hospital diagnoses is attributed to increasing rate of hospital delivery, and greater training and experience in doctors performing neonatal examinations prior to discharge. Patients diagnosed after discharge are increasingly diagnosed by paediatricians due to an increasing pool of paediatricians and better parent awareness and education.     

"先修渠、后分流",妥善安置富余人员--浅谈医院聘用制改革中富余人员的分流

富余人员的安置是聘用制改革工作的重点和难点,本文叙述了医院聘用制改革中妥善安置富余人员的做法,提出了"先修渠、后分流"的办法,对解决聘用制改革中富余人员的分流问题具有一定的参考价值.     

全科医疗特征功能视角下分级诊疗的定义及制度层次

明确分级诊疗定义和内涵是建立和完善分级诊疗制度的逻辑起点,是制度的基础性研究。本文在剖析国际上分级诊疗的相关概念、探求分级诊疗本质的基础上,辨析了国内分级诊疗的定义。认为国内分级诊疗制度存在以下不足:以疾病诊治的单一维度作为三级医疗服务分工依据,忽略了人们对医疗服务体系间接性医疗服务功能的需求;导致服务体系规划忽略了非直接性医疗服务功能,缺失了具有特征功能的全科医疗与专科医疗之间的分化和互补;全科医疗和专科医疗之间功能清晰、界限分明的医疗卫生服务体系结构尚未形成;用组织治理取代了原本属于全科医疗和专科医疗之间的专业治理。最后,本文从全科医疗特征功能视角,完善了分级诊疗的定义;尝试回答了分级诊疗的三个基础性问题,并归纳提出分级诊疗制度应该包括微观、中观、宏观三个层次。     

分时预约挂号系统的实现与应用

介绍我院分时预约挂号系统的设计、实现及应用情况。根据专科、专家进行个性化排班,为患者提供多渠道的分时预约挂号是我院门诊服务特色。我院推行个性化分时预约后,预约量显著增加,就诊环境得到改善,患者满意度提升。继续加大分时预约挂号宣传,不断增加预约号源,提高预约的便利性,是我院今后努力的方向。