对微信公众号医师自媒体科普现状进行了调查,对医生进行了深度访谈.研究分析了523个公众号,使用k均值聚类的方法,根据原创文章数量、发表文章间隔将医师的科普投入分为最低到最高4个组.医师在科普中的投入程度与存在推销行为及时政热点评论行为存在一定程度的相关性.研究认为,公立医院医师自媒体科普的内容应具备公益性、科学性和诊疗科目相关性.应鼓励公立医院医师开展科普,进行多主体的治理,引导产出符合人民和时代需要的科普内容,合力托举人民健康.

In recent years, artificial intelligence has become a key direction of medical and health-related research and a hot spot of international competition. In order to investigate the current situation and challenges in hospital-led artificial intelligence researched, this study selects 14 national pilot hospitals to promote the high-quality development of public hospitals as samples, adopts a combination of quantitative and qualitative methods, analyzes the research articles related to artificial intelligence published by the sample hospitals in recent years, and analyzes the technical challenges in the hospital-led artificial intelligence research. The results show that although the number of hospital-led artificial intelligence research papers is increasing, in which 55% of the research is of prospect and expectation, while the quality of research could be improved. Meanwhile, the number of authorized AI related patent is rather small. The technical difficulties of hospital-led artificial intelligence research lie in the steep learning curve of artificial intelligence technology, high costs from computation iteration, difficulties in transferring clinical multimodal data into research data, and weak explainability. Hospitals should actively respond to policy promotion,reallocating resources to cultivate artificial intelligence coordinators, organize multi-modal data resources, and promote research and outputs.

目的:基于DRG工具对因非计划再次手术增加的时间和费用成本进行分析.方法:对样本医院2016—2021年非计划再次手术住院患者开展研究,基于患者的DRG组、出院时间等变量,遴选出可比的患者群,统计因非计划再次手术导致增加的平均住院日、费用等,并进行敏感性分析.结果:2016—2021年,共有767例非计划再次手术患者纳入分析.非计划再次手术的平均住院日增加1.4倍,住院费用增加1.0倍.结论:非计划再次手术较明显地增加了患者住院成本,医疗机构应积极应用DRG工具,继续加强对非计划再次手术的管理,减轻患者就医负担.

孕产妇的刚性就诊需求加大了医院COVID-19疫情防控压力,为了保障孕产妇和医务人员安全,医院在疫情期间有针对性地制定了孕产妇就诊的感染管控措施,重点管控孕产妇及陪同就诊家属,询问其流行病学史、呼吸道症状,优化诊区布局,检查重点区域感染风险,持续改进疫情防控措施.

目的:以北京市某三级综合医院为样本,分析北京市医药分开综合改革对该院门诊服务利用的影响.方法:使用描述性分析、间断时间序列等方法,对该院门诊人次、门诊次均诊疗费用进行分析,将改革引发的变化分解为改革瞬间水平变化和改革后趋势变化两个部分;使用配对t检验,对改革前后门诊本地患者占比和经常就诊患者的服务利用强度进行差异检验.结果:医改后,该院门诊人次在改革瞬间显著下降3万人次,改革后增速为2307人次/月,较改革前显著上升;门诊次均费用在改革瞬间显著提高75.63元/人次,改革后呈现出显著下降趋势.医改后,本地患者占比较改革前提高近1％.该院经常就诊患者的人群规模缩小约24.41％,服务利用强度显著下降5.30人次.结论:北京市医药分开综合改革使患者对该院门诊服务利用水平下降,为分级诊疗的实现提供了必要条件.

目的:研究北京市医药分开综合改革对二三级公立医院经济运行的影响机制,为改善公立医院的经济运营提供政策建议.方法:应用描述性分析方法对北京市不同类型二三级公立医院改革前后的收支变化及补偿情况进行分析.结果:改革后二三级公立医院医疗收入增长率明显下降,二级公立医院医疗支出增长率下降明显,但三级医院医疗支出增长率下降不明显.改革后二三级公立医院平均收支结余率分别为-2.11％和-4.12％,二级医院比改革前上升0.82个百分点,三级医院比改革前下降1.46个百分点.肿瘤医院和传染病医院医疗服务补偿率分别仅为6.59％和-36.66％.结论:三级综合医院医疗收支结余有下降的趋势,不同类型医院的医疗服务补偿率和财政补偿率差异明显.需加快建立财政分类补偿机制和推进医疗服务价格调整,补偿发生政策性亏损的医院,维持公立医院经济运营的稳定.

临床路径是兼顾医疗质量和效率的科学管理模式.以某三甲医院从临床路径试点、常规开展、完成二期优化、启动三期优化的实践经验为基础,介绍医院结合自身特点,以“来源于临床、服务于临床”为指导,提出在顶层设计、路径定义、执行操作、质控管理和团队配合5个方面进行临床路径本土化改进的方法和策略.

目的:评价北京市医药分开综合改革的实施对于门急诊患者就医流向的影响.方法:对北京市卫计委信息中心收集的2016年1月-2017年10月的各级医疗机构门急诊就诊人次数据的变化趋势进行分析,并采用间断时间序列分析(Interrupted Time Series,ITS)方法分析北京市医药分开综合改革对其影响.结果:2017年4-10月,三级医院平均每家医疗机构门急诊人次同比下降12.11％;二级医院平均每家医疗机构门急诊人次同比下降2.10％;基层医疗卫生机构平均每家机构门急诊人次同比上升11.49％.结论:北京市医药分开综合改革通过医事服务费的调整和基层用药目录与三级医院对接等主要措施,使得门急诊患者就诊流向发生明显变化,长期下去需要引起注意的是基层是否有动力接收病人,以及能否接住病人的问题.

Objective:To evaluate the impact and analyze the mechanism of separating drug sales from medical services reform on the total medical expenditure containment of outpatient services in Beijing. Methods:The monitoring data and historical data from 89 third-level,78 second-level public hospitals,and 206 primary health institutions and community health service agencies,which participated in the reform,were analysed to estimate the impacts on outpa-tient service utilization and service price. The analysis was based on the data of the first and second quarters of 2016 outpatient and emergency department fee changes,and analysis of service utilization and service price factors on the im-pact of changes in outpatient and emergency services mechanism. Results:The total outpatients'expenditure in Beijing in the second quarter of 2017 was 17.38 billion yuan,representing a slight decrease of 1.14% than the expenditure in 2016. The growth rate reduced by 2.46%. Expenditure in third-level and second-level hospitals decreased by 2.82% and 3.02%,respectively,with reductions in growth rates of 4.06% and 3.74% respectively. Expenditure in primary institutions increased by 17.09%. The increase rate in the second quarter of 2017 was 26.28%,representing a remark-able increase compared to the rate in 2016(15.84%). The contribution from the medical institution service prices and service utilization to the change of outpatient and emergency medical expenditure containment was 6.98% and -7. 65%,respectively. For third-level hospitals,the contribution was 10.37% and -12.00%,respectively;second-level hospitals were 0.72% and -3.35%,respectively;and the primary health institutions was 6.08% and 9.57%. Con-clusions:Beijing's comprehensive reform of separating drug sales from medical services reform has effectively controlled the rising medical expenditure of outpatient services,mainly by adjusting outpatients service utilization between differ-ent level healthcare institutions.

To promote the integrated health and social care is an essential approach to the well-being of the elderly.The development of such integrated care is on the basis of both existing and new policies .Six aspects of national and Beijing policies were reviewed:providers, provi-sion patterns, contents, prices, payments and administrative organizations.The integrity,coherence and feasibility of policies were generally good . There is a vacancy of the policy on integrated care designed for the elderly who adopt community-based or home-based aged care.The policies should be improved based on understanding of the needs of elders .An inter-ministerial working mechanism can be developed .Policy feasibility can be enhanced by addressing issues such as the limitation of providing medical service , the unreasonable service price setting, and the harsh standard of setting a nursing institution ,and so on.