A Systematic Review of Health Care Efficiency Measures

Objective. To review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods.
Data Sources. Review of the MedLine and EconLit databases for articles published from 1990 to 2008, as well as search of the "gray" literature for additional measures developed by private organizations.
Study Design. We performed a systematic review for existing efficiency measures. We classified the efficiency measures by perspective, outputs, inputs, methods used, and reporting of scientific soundness.
Principal Findings. We identified 265 measures in the peer-reviewed literature and eight measures in the gray literature, with little overlap between the two sets of measures. Almost all of the measures did not explicitly consider the quality of care. Thus, if quality varies substantially across groups, which is likely in some cases, the measures reflect only the costs of care, not efficiency. Evidence on the measures' scientific soundness was mostly lacking: evidence on reliability or validity was reported for six measures (2.3 percent) and sensitivity analyses were reported for 67 measures (25.3 percent).
Conclusions. Efficiency measures have been subjected to few rigorous evaluations of reliability and validity, and methods of accounting for quality of care in efficiency measurement are not well developed at this time. Use of these measures without greater understanding of these issues is likely to engender resistance from providers and could lead to unintended consequences.     

大型综合公立医院效率特征及变动研究

目的:从静态与动态两个层次分析大型综合公立医院的效率特征及变动趋势。方法:采用数据包络分析的C~2R-DEA和BC~2-DEA模型与Malmquist指数模型,利用50家大型公立医院2006—2012年的人员、设备、资产、医疗服务等投入—产出指标,构建适宜分析模型。结果:约10%~12%样本医院处在相对有效运行状态,其配置效率均值与规模效率均值分别为0.956与0.943,接近效率前沿,其效率表现相对较好;而纯技术效率均值、技术效率均值、成本效率均值与整体效率均值分别为0.796,0.784,0.714和0.714,与效率前沿差距较大,其效率表现相对较差。同时,样本医院处于规模报酬递减状态的医院由7.69%增加到26.31%,而处于规模报酬递增状态的医院由80.77%下降到58.34%;其技术进步与Malmquist生产率指数、技术效率指数、纯技术效率指数与规模效率指数的变化保持比较稳定的一致性,并呈现持续改善与稳步发展的趋势。结论:大型公立医院正面临着发展动力与激励机制的转换,不仅需要转变医院管理理念与发展模式,也需要构建有关结构、过程和结果的最佳效率评价标准,以促进包括政府职能在内的医院治理与发展模式的转变。     

朱晓男分期辨治湿热毒盛糖尿病足

朱晓男教授认为糖尿病足多因消渴日久,气阴受损,脉道不利,血行瘀滞,瘀久化热,热盛肉腐或在某些外因诱发下局部感染毒邪所致;病位在血脉,病性为本虚标实;气阴两虚为本,湿热蕴阻、脉络瘀阻为标,湿热、瘀血即是气阴两虚的病理产物,又是消渴导致脱疽的病理因素。湿热毒盛糖尿病足发病迅速,易于变化,若失治、误治易出现损筋坏骨等严重病理变化;又因足部皮薄近骨且间隙较多,常引起深部组织及骨关节间化脓性感染而出现损筋坏骨等严重病理变化;虽属"疽"的范畴,又兼具"疔"的特点,临症要有"走马看疔"的态度,严密观察,病不容缓,及时应对,不可贻误;分为急性期、缓解期、恢复期,中西医结合综合内外兼治,标本合治,适时祛腐切开引流,清脉康洗剂浴足,内服糖足方,外用一效膏、油调膏等,各有侧重,注重局部,兼顾整体。     

我国社区卫生服务中心相对效率评价DEA研究综述

目的 通过对2004—2014年期间发表的中国社区卫生服务中心效率数据包络分析法(DEA)研究的所有密切相关文献中的投入产出指标进行系统分类和综述,以提高中国社区卫生服务中心效率DEA研究投入产出指标选取的合理性.方法 利用文献研究法分析通过相应检索策略和依据研究对象与目的选取的文献,对其投入产出指标进行汇总与分类.结果 投入指标可分为6大类(人力资源类、床位类、货币计量类、房屋面积类、公共卫生服务类及其他类);产出指标可分为4大类(服务量类、货币计量类、公共卫生服务类和其他类).结论 DEA分析社区卫生服务中心效率过程中,存在投入产出指标使用混杂,筛选指标过程不严谨,未分清技术效率和配置效率指标,选取能够代表中心特色的指标较少等问题.     

四川省雅安市雨城区地震灾后居民医疗服务需求与利用分析

目的：分析居民的经济情况及健康状况,分析地震对居民造成的影响,评估后续医疗服务需求,为制定医疗救助政策提供政策建议。方法：采用问卷调查的方法,对雅安市雨城区437户家庭的1631名居民的医疗服务需求与利用情况进行调查。结果和结论：不同性别、年龄、文化程度、经济收入的灾区居民两周患病率均存在不同程度的统计学差异;灾区居民对医疗卫生服务的利用有限,经济因素是一个重要因素。建议 加强对灾区居民的心理干预和健康教育;加大政策衔接力度,扩大医疗保障覆盖范围;注重医疗救助同其他救助工作的协调,提高救助体系系统效率。     

抗菌药物专项整治前后我院抗菌药物使用情况分析

目的:评价抗菌药物专项整治活动对我院抗菌药物应用的影响。方法:收集我院在专项整治前(2011年1-6月)、后(2012年1-6月)抗菌药物的使用数据,并进行统计分析。结果:我院经过抗菌药物专项整治后,除门诊抗菌药物用药频度有所增长(增长了21.9%)外,其他抗菌药物使用指标均有所下降:抗菌药物使用金额占药品使用总金额比例下降了1.5%,门、急诊使用抗菌药物处方百分率分别下降了1.5%和0.8%,住院患者抗菌药物使用率、用药频度和使用强度分别下降了10.5%、20.3%和16.7%,I类切口手术抗菌药物使用率下降了11.5%。结论:抗菌药物专项整治活动促进了我院抗菌药物的合理使用,降低了抗菌药物在我院的使用率,但住院患者抗菌药物使用强度和I类切口手术抗菌药物使用率仍未达到卫生部要求,还需加强管控和宣教。     

Prevalence, predictors, and service utilization of patients with recurrent use of Veterans Affairs substance use disorder specialty care

Although substance use disorders (SUDs) are chronic conditions for many patients, the prevalence, predictors, and health care utilization patterns of those who reenter SUD specialty care are understudied. We identified 1,640 patients who initiated SUD specialty care at 1 Veterans Affairs (VA) medical center and categorized them, using their subsequent 24 and prior 60 months receipt of VA SUD care, as index episode only (35.7%, 33.5–38.1), index and prior episode(s) (24.6%, 22.5–22.7), and index and postindex episodes (39.6%, 37.3–42.0). Compared with the index episode-only group, the postindex episode(s) group had modestly higher percentages of men, divorced/separated, and alcohol use, cocaine use, bipolar disorder, and psychotic disorders. Patients with postindex episodes averaged 2 times more postindex emergency visits and mental health hospitalizations than patients with an index only episode. Results document the prevalence, overall health care utilization, and limited predictability of SUD treatment reentry and support development of new models of care for these complex patients.     

波利特治疗胃食管返流病40例临床疗效观察

目的　观察波利特 (雷贝拉唑 )治疗胃食管返流病 (GERD)的临床疗效。　方法　随机将 80例 GERD患者分为两组 ,治疗组 4 0例 ,给予波利特 10 mg,口服 ,每日 1次 ;对照组 4 0例 ,给予奥美拉唑 2 0 mg,口服 ,每日 1次 ;疗程 8周。记录服药前后病人烧心、反酸、胸骨后灼痛等症状积分的改变 ,按症状积分下降值及内镜检查结果对比分析疗效。结果　治疗组的 GERD患者服药后 1d、 3d、 7d、 14 d、 2 8d症状积分下降值分别为 13.9± 6 .4、 10 .8± 6 .6、 9.7± 5 .7、 6 .3± 5 .7、 5 .4± 4 .9;而对照组分别为 14 .4± 5 .3、 14 .1± 5 .7、 13.9± 5 .2、 13.6± 5 .9、 7.8± 5 .1;两者的差异有显著性 (P<0 .0 5 )。治疗组和对照组的食管黏膜损害愈合率分别为 72 .5 %和 6 2 .5 % ,有效率为 97.5 %和 92 .5 % ,差异均无显著性意义 (P>0 .0 5 )。　结论　波利特是一种治疗胃食管返流病速效且安全的质子泵抑制剂(PPI)。     

尼莫地平纳米脂质体包封率测定方法的研究

目的　建立尼莫地平纳米脂质体的包封率测定方法。方法　以高效液相色谱法为分析手段 ,采用反透析法测定尼莫地平纳米脂质体的包封率。结果　反透析法透析平衡时间为 6h ,游离药物回收率符合要求 ;此法测得自制尼莫地平纳米脂质体的平均包封率为 85 6 9%± 3 13% ,10h内无渗漏 ,方法重现性好。结论　反透析法便捷、准确 ,适用于脂溶性药物尼莫地平纳米脂质体的包封率测定。     

A Web-Based Tool for Finding Optimal Designs for the Michaelis–Menten Model and an Overview

The Michaelis-Menten model has and continues to be one of the most widely used models in many diverse fields. In the biomedical sciences, the model continues to be ubiquitous in biochemistry, enzyme kinetics studies, nutrition science, and in the pharmaceutical sciences. Despite its wide-ranging applications across disciplines, design issues for this model are given short shrift. This article focuses on design issues and provides a variety of optimal designs of this model. In addition, we evaluate robustness properties of the optimal designs under a variation in optimality criteria. To facilitate use of optimal design ideas in practice, we design a web site for generating and comparing different types of tailor-made optimal designs and user-supplied designs for the Michaelis-Menten and related models.