DRGs付费是当前国际上公认的比较先进和科学的付费方式,其强化了医保对医疗行为的引导、制约和监管作用,对医院管理提出了更高要求.自2018年沈阳市医保实施DRGs付费以来,某大型三级公立医院各相关部门协同配合,结合医院自身特点,积极探索管理办法,采取多种措施,逐步适应了医保支付方式改革,在控制医疗费用增长、提高医疗质量和效率方面都取得了良好效果.文章将某医院DRGs管理办法、经验进行整理,旨在为公立医院更好适应医保支付方式改革提供借鉴.
目的 了解退休后医务人员的生存质量,与其他行业退休老人相比是否存在差异.方法 选取上海市某市级医院的退休医务人员和医院所在地街道的社区老人共495人用WHOQOL-OLD量表进行测量和统计学分析.结果 该区域中,退休医务人员生活质量与社区老人相比更差.医院退休医务人员、子女数量≥3个、后勤保障类岗位、完全不能生活自理的生活质量更差.结论 医务人员的职业现状和退休后的生活质量需要得到改善和提高."养儿防老"的观念正逐步弱化,现代养老模式和理念将成为主流.积极老龄化、成功老龄化应该成为衡量老龄事业发展的倡导.
近年来,干细胞治疗已经成为一个极具发展前景的前沿科学研究领域,其治疗方法的发展给患者及家属带来了极大的期望.然而,随着我国干细胞临床研究项目数量的不断增加,干细胞临床研究与应用中存在的伦理和安全问题日益突出,使我国监督管理部门和研究机构面临着前所未有的挑战.本文通过分析我国干细胞临床研究的管理现状和存在的问题,探讨加强干细胞临床研究监督和研究机构内部管理规范的措施,为有效推进我国干细胞临床研究的有序、规范发展提出相应对策.
目的 探索住院患者医疗安全不良事件发生的规律、原因,以期找到管理医疗不良事件的有效措施,为医院管理者提供参考.方法 对某三级综合性医院2018年1月至12月上报的住院患者医疗不良事件进行回顾性研究分析.结果 发生不良事件的患者中男性多于女性,其平均年龄高于住院患者平均年龄,存在显著性差异;不良事件发生有两个高峰期,分别为8:00-11:59和14:00-15:59;不良事件发生率与CMI值呈正相关,r=0.539;药品管理类(40.75％),护理管理类(16.99％),医技管理类(14.48％),医疗管理类(12.66％)发生不良事件占比最高,其中,医嘱错误类、处置治疗类、医技检查类不良事件发生较多.结论 无惩罚不良事件上报机制对医院风险管理有实效,医院应坚持无惩罚不良事件上报机制,评估医疗管理制度的执行效果并采取措施改进,建立交接环节的标准作业程序,为医务人员提供有关沟通的人文教育,适当调配人员进行高峰时段的工作支持,建立高风险人群管理机制,可以有效减少医疗不良事件发生.
笔者从文化传承的视角,介绍了苏北人民医院在2018年开展的一项以“记忆、传承与发展”为主题的“苏北最美档案”征集活动,阐述了活动的主要做法以及所取得的成效.通过该项活动的开展,可以丰富医院的历史档案资料,加强院史研究,传承医院文化,激发广大职工爱院爱岗热情,为医院在新时代的高质量发展助力.
县级医生服务分工与协作是推进分级诊疗最重要的靶点之一,也是保障居民获得连续性医疗服务的关键作用点.建立县级医生服务分工与协作PEST-SWOT分析模型,分析得出县级医生服务分工协作面临政策、技术支持的机遇,但在经济、管理模式方面威胁众多.结合上述模型,分析甘肃、安徽、湖北三省助力县乡服务分工协作的医改政策,甘肃省政策符合WO争取型建议特征,但容易导致县级医生推诿高医疗费用病人;安徽省政策整体内容偏向ST抗争型建议,但无法消除县乡医生的利益竞争关系;湖北省医改模式符合SO开拓型建议,创新性明显.综合分析得出亟待利用政策技术机遇调整医院战略导向,改革医生绩效监督管理机制,完善分工保障机制.同时应激活基层医疗机构,提高县乡两级医生之间的信息通达度,管理规范医生行为解决诊疗固化问题.
目的 通过调研汉中市医疗废物产生、储存、运输、处置等环节的管理,对存在问题较多、监管覆盖较弱等问题,提出相应的对策.方法 放发问卷154份,回收有效问卷132份.问卷主要内容为医疗废弃物组织制度、分类收集、包装、登记、暂存、转运、处置、防护以及最终去向等项目,用Excel表进行统计分析、分类汇总.结果 选取汉中市汉台区七里中心卫生院作为试点进行医疗废物规范化管理,经过10个月的规范培训运行,取得了比较满意的效果.结论 后期将逐步向全市各县区基层医疗机构推行.
目的 构建适合我国公立医院的病人安全文化测评量表,并分析我国公立医院病人安全文化现状.方法 对我国东、中、西部3省(市)54所公立医院员工进行问卷调查.结果 中国版医疗机构病人安全文化调查量表信、效度可以接受;我国公立医院病人安全文化处于中上水平(总体平均分为3.80分);在“害怕受责备与惩罚”“害怕受羞辱”“提供安全的医疗保健”和“组织安全资源”的维度上,评分相对较低;不同地区、不同等级公立医院病人安全文化存在一定差异.结论 我国公立医院病人安全文化尚未达到令人满意的程度,政府卫生主管部门和医院管理者需要营造更好的病人安全文化,尤其应加强西部地区医院和二级医院的病人安全文化建设.
以苏北医院医联体基层医疗机构临床骨干人才的培养模式为例,结合SWOT分析法,对这种模式的内部资源和外部环境进行分析,探讨适应苏北医院医联体基层单位临床骨干人才培养的相关改进和整合措施,为医联体人才培养提供决策支持.
目的 分析住院精神病患者自杀行为的原因,针对性总结防范措施与干预方法.方法 回顾性分析2013年1月至2015年1月间我院200例精神病患者自杀行为的原因,制定相关的针对性干预措施,对比针对性危机干预实施前和实施后患者的自杀行为发生率及生活质量评分.结果 经调查发现,疾病因素(37例)、个人因素(45例)、家庭因素(63例)、社会因素(32例)、医疗因素(23例)等是引起住院精神病患者自杀行为的主要因素.针对性危机干预实施后患者的自杀行为发生率(5.0％)显著低于实施前(1 6％);且针对性危机干预实施后患者的生活质量评分(86.13±2.01)显著高于实施前(60.03± 1.91).结论 医生与护士要针对精神病患者病史与精神状态进行准确的分析,掌握病人特点,培养对危机行为的预判能力,针对重点患者实施有效的监护措施,尽可能把不良行为的发生概率降至最低.
目的 探讨护士人格特征、职业倦怠与应对方式的现状及相关性.方法 采用个人一般情况调查表、艾森克人格问卷、职业倦怠量表、简易应对方式量表,对172名护士进行问卷调查,并对数据进行统计学分析.结果 护士的人格特征得分高于我国女性常模,职业倦怠检出率达75.3％.在应对方式上,积极应对分数高于消极应对分数,人格特征、职业倦怠及应对方式具有相关性.结论 受测护士人格特征突出,职业倦怠情况严重,对待事物常采取积极的应对策略.人格特征是职业倦怠不可忽略的影响因素,并对应对方式有影响,有效应对方式能减少职业倦怠的产生.
Objective To analyze and evaluate the implementation effect of the basic drug system. Method Using the factor analysis method to explore the potential structure dimension of evaluation of influence of essential medicines effect,screening the key evaluation index. Result We extracted the three common factors through exploratory factor analysis method:rationality drug use factor,income structure in basic medical institutions factor,residents' economic burden of disease factor. After the implementation of the essential medicines system, the indicators of rationality drug use have greatly improved in township hospital in Chongqing, antibiotic usage rate have significantly decreased, all to achieve the minimum standard of using the WHO recommendations for developing countries. The ratio of essential medicines after implementation of volatility between 32.12% and 43.33%, finances between 30.22% and 35.16%.Conclusion Rationality drug use factor have improved significantly. After the implementation of the essential medicine system,income structure of basic medical institutions factor also is gradually approach reasonable. The improvement of residents' afford ability factor is lesser. This article suggests that the increased investment of policy should be considered in further,perfecting the related cost control measures and health monitoring indicator.
Objective Through surveys of the operation statue of four newly built public hospitals in suburbs in Shanghai, to evaluate the relationship of fee and amount-of-service of these hospitals. Methods The data of these hospitalsu0027 2013—2014 outpatient and emergent services and in-hospital services were collected. Results The fee of these four newly built hospitals increased rapidly in 2013—2014. The main reason of the increase was the development of amount-of-service. Comparing with the original hospitals in downtown,the newly built hospitals had more rational increased relationship. Conclusion Building the public hospital in suburbs can improve the suburban health care system and achieve the better availability of high-quality medical resources. There are still many insufficient aspects and further reform needs to be implemented.
心血管内科作为基层综合性医院的重要学科之一,如何创建和巩固学科的领头地位,不断发展壮大自身综合实力,以适应新医改要求和社会需求,是迫切需要解决的课题.2008年以来,新泰市人民医院心血管内科借鉴其他医院学科建设的先进经验,结合医院和科室实际,在实践中以科技为先导,以临床为中心,以教学为目标,凝心聚力培养精英团队,瞄准发展方向,打造学科领先水平,创造和树立起学科的重要地位,成为市级重点学科,以及医院优势和特色突出的代表学科.
As the main part of medical education after graduation,contradictory in the coexistence of standardized training for resident doctors and education for postgraduate students w ith professional degree in clinical medicine exists,w hich causes the w aste in educational resources. The authors discuss the necessity,feasibility,implementing ideas and difficulties,and suggest the scientific unity of the tw o for the establishment of thecombined training modelsuitable w ith the educational training after graduation.
The important subject of medical insurance management in hospitals is to use drugs scientifically and rationally,control drug expenses,standardize the behaviors of the patients seeking medical treatment and the doctors provi-ding medical treatment,and increase service efficiency of medical insurance fund. The authors introduce the settling of clin-ical pharmacists in the First Hospital Affiliated to Nanjing Medical University and explain the functions of clinical pharma-cists,which promotes clinical drug use.
Objective To research the relative degree and factors of the professional quality and organizational commitment to provide constructive comments and improvement countermeasures.Method Questionnaire survey was taken among the 150 residents from 2012 to 2013.The research got 149 effective questionnaires,with the response rate of 99.3%.The correlation and impact on the professional quality and organizational commitment of residents was analyzed by multiple linear regressions.Result Based on the research,the general level in the professional quality reached middle level.The residents got low score of self-assessment in leadership,adversity quotient and work environment indicators.Meanwhile,the general level in the organizational commitment reached lower middle level.The degree of correlation to organizational commitment from strong to weak was humanistic relationship,work environment,adversity quotient and core values.Conclusion Residents' overall professional quality is just Ok,but the residents take a dim view of the status of organizational commitment.The suggestion is to improve the standardized training of residents,and to set up early-warning system to prevent the loss of outstanding residents.
Objective To evaluate the effect on application of information technology in the hospital performance appraisal.Method Analyzing 35 clinical departments' performance appraisal scores,clinical service data before and after applying intelligent performance appraisal information system by comparative analysis,statistics description and repeated measurement,and using SPSS20.0 statistical software. Result The scores increased which has a statistically significant difference after using the intelligent performance appraisal information system. Under the circumstance of improving medical services and efficiency,cost and medical expense are controlled effectively. Conclusion Application of information technology in the hospital performance appraisal has an important significance to insist on the commonwealth,keep the high efficiency and arouse the initiative of medical workers. It can effectively promote sustainable development of public hospital and better satisfy the people's growing demand of medical services.
Public hospital performance assessment is a major part of performance management in health sector, which is an effective management method to improve healthcare quality, control hospital costs, improve hospital economic and social benefits and increase patient satisfaction. However, in the context of public hospital reform, there are some problems for performance assessment on public hospitals, such as incomplete post management, job classification management is not fully implemented, unreasonable setting of performance assessment index, the role of performance assessment results is single and unsound government financial compensation mechanism. This paper will discuss the achievement and problems of performance assessment and put forward suggestions.
