Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association.Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms.Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host.There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22.The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided.     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

Implementation of HaemScreen, a workplace-based genetic screening program for hemochromatosis

There is debate as to whether community genetic screening for the mutation(s) causing hereditary hemochromatosis (HH) should be implemented, due to issues including disease penetrance, health economic outcomes, and concerns about community acceptance. Hemochromatosis is a common preventable iron overload disease, due in over 90% of cases to C282Y homozygosity in the HFE gene. We are, therefore, piloting C282Y screening to assess understanding of genetic information and screening acceptability in the workplace setting. In this program, HaemScreen, education was by oral or video presentation in a group setting. C282Y status was assessed by polymerase chain reaction (PCR) and melt-curve analysis on DNA obtained by cheek-brush sampling. Of eligible participants, 5.8% (1.5-15.8%) attended information and screening sessions, of whom 97.7% (5571 individuals) chose to be tested. Twenty-two C282Y (1 : 253) homozygotes were identified and offered clinical follow-up. There were 638 heterozygotes (1 : 8.7). The determinants for participation have been analyzed in terms of the principles outlined in the Health Belief Model. Widespread screening for HH is readily accepted in a workplace setting, and a one-to-many education program is effective. The level of participation varies greatly and the advertizing and session logistics should be adapted to the specific features of each workplace.     

吉林省脑死亡判定自主呼吸激发试验的实施率和完成率分析

目的通过分析脑死亡判定自主呼吸激发试验（AT）的质控指标,探讨改进策略,提高AT的实施率和完成率。方法收集吉林省脑损伤质控中心2017年-2020年脑死亡判定病例相关资料,依据标准进行AT技术质控,分析AT实施率和完成率情况。结果AT实施率由2017年的4.3%提升至2020年的83.5%;完成率由2017年的66.7%提升至2020年的96.1%。实施AT后可出现严重酸中毒、低血压、低血氧、低血钾等风险,未实施AT和未完成AT的原因主要为血压、心率、血氧不稳定。结论通过医师间、医护间的技术合作,有利于提升实施AT的安全性。为进一步提升AT实施率和完成率,建议制定出现AT相关心跳骤停情况的不苛责机制,健全AT相关培训及考核制度。     

“4+7”集中带量采购实施效果分析--基于9试点地区药品销售数据

目的:剖析“4+7”集中带量采购政策的实施效果。方法:基于药品销售数据及中标企业年报数据,对纳入“4+7”集中带量采购范围的药品在政策实施前后的销售额,原研厂家、中标企业及其他企业的销售额及市场占有率进行对比分析,同时对部分中标企业营收情况的变化进行比较。结果:“4+7”集中带量采购实施后,绝大部分纳入集采品种销售额较往年有显著下降,其中,原研企业、其他企业均有较大幅度下滑,中标企业虽涨跌参半,但已形成对仿制药市场的垄断。此外,“4+7”集中带量采购能够在一定程度上起到促进药品生产企业积极转型,加大研发投入的作用。结论:集中带量采购颇有成效,坚持之余要慎防垄断;要完善医保支付标准的建设,健全原研药、仿制药、过专利期原研药的联动机制;集中带量采购的品种选择应由“点”至“面”。     

医疗环境控制思路与措施——《日间手术中心设施建设标准》内容解读

针对团标《日间手术中心设施建设标准》结合日间手术中心的特点,阐述了日间手术环境控制暖通空调方面的编写思路、条文要求与实施措施。     

DRG对住院费用与服务的影响及建议

目的分析实施DRG付费对患者住院费用及服务的影响,为医疗机构提出运行建议。方法利用医院质量监测系统（HQMS）,在全国东部、中部、西部3个地区的16个省（市）376家三级医院中选取患者1 064 314人次,通过双重差分法分析DRG付费实施对患者住院费用及服务的影响。结果DRG付费实施后,患者总费用降低了3.05%（β=1-e-0.03,P=0.01）、自付费用增长了28.11%（β=e0.33-1,P=0.02）、医疗费用降低了5.13%（β=1-e-0.05,P=0.04）、药品费用降低了5.13%（β=1-e-0.05,P=0.01）、平均住院日缩短了4.08%（β=1-e-0.04,P＜0.01）,而对患者住院检查费用、耗材费用、是否使用抗生素、31天是否再住院、是否手术的影响不显著。结论实施DRG付费能够合理控制患者住院费用增长,提高医疗服务质量,建议医疗机构进一步简化流程,提高床位周转率,关注高CMI值患者费用,优化临床路径,确保治疗效果。