我国综合医院医疗质量评价体系中的弊端

通过系统回顾医疗质量评价体系的发展过程,比较分析了国外主要医疗质量评价体系以及国内医疗质量评价的研究概况,总结我国医疗质量评价指标体系存在的问题,并分析了·国外主要的评价体系对我国的适用性,有利于对我国医院医疗质量评价指标体系的建立提供理论支持。

     

国外老年医疗质量评价研究及其对我国的借鉴意义

随着人口老龄化的发展,老年人医疗服务越来越受到重视。对国外老年医疗质量评价研究进行了系统介绍,并提出应尽快在我国建立适合我国医疗卫生体制的老年人医疗质量评价体系和持续质量改进策略,以满足我国老年人口不断增长的医疗服务需求。     

三级医院医疗质量评价指标体系的构建及优化

目的 在原有医疗质量评价体系的基础上,建立一套科学合理、可操作性强的三级综合性医院医疗质量评价指标体系。方法 采用典型研究方法,通过文献研究筛选初始指标,通过知情人访谈法确定质量评价框架,运用德尔菲法并借鉴平衡积分卡的原理和思想优化并确定指标及权重系数。结果 确定了以医疗基础质量、环节质量和终末质量为基本结构的三级综合性医院质量评价框架和指标体系,由3个一级维度、8个二级维度、24个三级维度指标体系及其相应权重。结论 医疗质量评价指标体系关注医院质量管理中的难点和重点环节,能够满足上海市三级综合性医院医疗质量管理的实际需要。     

国内外心脏疾病医疗服务质量评估现状

心血管疾病作为全球主要死亡和致残原因,给医疗卫生系统带来了巨大负担。世界各国专家已对该类疾病开展了大量的研究,其中极为重要的一项是通过评价心血管病的医疗服务质量来帮助医院发现问题以及找到提高医疗服务水平的突破口。文章总结并讨论了国内外心脏病医疗服务质量评价的方法、目的、内容以及数据来源,为建立和完善中国的心血管疾病医疗服务质量评估体系提供借鉴。     

中西医结合医院临床科室医疗质量评价体系的构建与实施

目的 探索提高中西医结合医院医疗质量的有效途径。方法 建立并实施中西医结合医院临床科室医疗质量评价体系。结果 对医院业务发展以及质量改善起到积极的推动作用。结论 实施临床科室医疗质量评价体系是提高中西医结合医院医疗质量的较好方法。     

50家三级医院医疗质量管理现状问卷调查结果分析

对三级医院医疗质量管理现状进行调查,结果发现：调研医院的职工质量管理观念较为淡薄,管理者未能采用行之有效的现代管理方法进行质量管理;医疗服务流程存在较大缺陷,缺乏完善的质量管理制度、标准及医疗质量的系统评价体系;提出三级医院应以患者为中心,按照患者需求实施流程管理,并通过完善的制度和评价体系,提高医院的整体管理水平。     

国内外心力衰竭治疗质量评价的研究现状

心力衰竭是世界主要的公共卫生问题之一,庞大的心力衰竭患者消耗着大量的医疗资源。近几十年,世界各国专家越来越关注心力衰竭的治疗质量,评价治疗质量已成为医疗体制改革的一项措施。通过总结国内外心力衰竭治疗质量评价的组织机构、评价指标、治疗质量改善项目及有关评价研究,探讨我国心力衰竭治疗质量评价与国外的差距,针对出现的问题,提出相应的建议,为改善我国心力衰竭的治疗质量提供新思路。     

医院评价的国际经验及完善我国医院评价体系的设想

医院评审作为有效的质量评价和管理工具,已得到世界各国的重视。从评价标准、评价方法、评价组织等几个方面对国际上典型的医院评价体系作了归纳,结合我国医院评价体系的发展历程和存在问题,提出我国医院评价体系需要更新总体思路、完善评价标准、改进评价方法。     

我国公立医院自下而上声誉测评机制探讨

目的 探索我国公立医院的声誉测评体系,最终为个人就医和宏观医疗改革提供参考。方法 从声誉理论出发,借鉴美国医院声誉评价成果,探索我国自下而上声誉评价体系。结果 我国公立医院有其特殊性,但基于不完全契约和医院治理委托代理的现实相同,声誉研究方法依旧契合。结论 基于公立医院公益性,综合医疗质量和医疗资源利用效率等构建评价体系。     

医疗授权管理在综合性医院的应用与探讨

为保障医疗质量和医疗安全,制定《医疗授权管理制度》,通过对医疗小组组长、住院总医师等岗位进行授权,实施医疗准入、追踪和全过程管理,落实执业人员岗位责任制,进一步规范医师执业行为,确保临床医疗技术合理应用。同时,建立完整的考核评价体系与退出机制,与绩效挂钩,充分调动被授权者的积极性。     

Acceptance tests of diagnostic displays in a PACS system according to AAPM TG18

In a filmless environment it is necessary to execute acceptance and constancy tests on monitors used for interpretation of medical images. Performances of Barco CRT MGD521 MKII, Barco LCD L685EX monitors have been evaluated. Acceptancepress were executed following AAPM Task Group 18 guidelines. Visual and instrumental evaluations of geometric distortions, reflections, luminances response, contrast, uniformity, resolution, angular response and veiling glare were made. Barco monitors showed optimal performances, while EIZO monitors were accepted with some reserve on their quality level.Finally a comparative evaluation between monitors and film (the actual gold standard) was performed by an interview of ten radiologists: the monitors showed a quality at least equal to film. These monitors are currently in use for routine medical interpretation.     

Medical Tourism: A Cost or Benefit to the NHS?

‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.     

Letter from the Editor

With annual healthcare expenditures on the order of $2 trillion, the US leads the world in spending but has done relatively little research on the effective use of those funds. Other countries, including Australia, Canada, France, Germany, and the United Kingdom (UK) have instituted various types of health technology assessment or evaluation. Sweden was an early adopter with the establishment in 1987 of the Swedish Council on Technology Assessment in Health Care. UK’s National Institute for Health and Clinical Excellence (NICE), which includes the Centre for Health Technology Evaluation, followed in 1999. Economic modeling of cost effectiveness is integral to NICE’s assessment of new medical technologies. The US has not lagged other countries in principle – the Agency for Healthcare Research and Quality (AHRQ) had a medical treatments effectiveness program as early as 1989 - but funding levels for such programs have been low in the past, and comparative effectiveness research (CER) results have generally not had a notable impact on medical or reimbursement policies, in part because Congress has not allowed CER outcomes to impact coverage decisions.     

ANR Inforare : proposition d’un modèle d’identifiant patient individuel pour les patients drépanocytaires

The main objective of INFORARE project is to organize the gathering, assessment and sharing of medical information between sickle-cell anaemia patient and the health workforce. The method is based on the: evaluation of the sickle-cell anaemia patients’ acceptability of the familial data collection; centralised management of medical files which have been rendered anonymous; proposition of an identification model for sickle-cell anaemia patients and the evaluation of first the feasibility of the identification data collection, second the data linkage quality.ResultsSemi-directive interview method undertaken by LEM permitted to interview 43 patients, six association members, and six health workforce personals regarding acceptability of the familial data collection. The informatics platform ensuring the centralised management of sickle-cell anaemia patients’ medical files has been very appreciated by clinicians. The familial component identification model contains anonymous identification data of patients and their parents. Due to data collection difficulties of 692 included patients, this familial component identification model cannot be implemented in terms of linking sickle-cell anaemia patient data with her/his family data.Discussion and conclusionThe information system model for sickle-cell anaemia disease should be extended to other rare diseases which need to organize the federation and sharing of medical information among patients, the health workforce, and patients’ families. The convivial application contains very useful data for clinical, biological and epidemiological studies, thus facilitates the relationship with other research programmes. Taking into account the familial dimension of the information will increase the potential knowledge extraction and utilization of genetic and multifactorial diseases.     

故障模式及危害度分析在上海市医疗质量安全监控系统中的应用探讨

以上海市医疗质量安全监控系统为切入点,系统介绍故障模式效应及危害性分析的程序选择、专家组建、资料准备、危害性分析、根源性分析、措施提出和改善评估等7个步骤在监控系统的应用,以探讨上海市医疗质量安全监控系统分析子系统的定性分析模式。     

疾病诊断相关组在医院绩效评价中的应用探讨

目前,尽管国内外关于医院绩效评价的研究较多,但普遍存在评价结果缺乏可比性的不足。其主要原因是不同医院收治的疾病类型不同、治疗难度和风险差别较大。基于DRGs的医院绩效评价方式为研究打开了思路。本文在明确当前公立医院绩效评价内容的基础上,指出了基于DRGs开展医院绩效评价的两个条件,即统一优质的数据和完善的信息系统,阐述了评价的三个维度,即医疗服务产出、效率和质量,并就上述三个维度内的相关评价指标的计算方法进行了说明。本文最后给出了基于DRGs开展医院绩效评价的五点现实意义:一是有助于优化医院内部成本结构;二是有助于规范科室临床路径工作;三是创新科室或医生的绩效考核方式;四是形成政府与医院间的长效监管机制;五是有助于探索DRGs付费模式在全国的推广。     

以科级质量管理为基础的病历质量考评机制建立

随着医院业务量不断的增长,三甲医院疑难杂症越来越多,出现了病历质量考评覆盖率降低、病历检查专家对专科病历内涵质量不够深入等问题。原有的病历质量考评模式,不能客观反映病历质量情况。建立以科级质量管理为基础的病历质量考评机制,可提高科室及全员病历质量考评参与度、加强科级质量管理能力、不断提升医院病历质量内涵。     

基于住院病案首页数据的医院综合评估框架构建

研究基于住院病案首页信息,以原卫生部重点监测病种和手术作为切入点,从医院的医疗能力、医疗质量和运行效率的三个角度,设计了医院综合评估指标体系框架。根据综合评估框架,进一步计算了各类评估指标和相应权重分数,用于统计模型的多层综合加权。创建的方法能够客观、合理地综合评估医院的总体情况,以及比较不同医院的医疗质量。     

杜仲的研究与应用进展

简要介绍了杜仲这一中药传统习用的补益类抗衰老天然药用植物的分布地域、形态特征、适生条件等生物学习性,详细从传统医学及现代医学角度介绍了杜仲的药理、药效研究结果,重点叙述了杜仲发挥药效的８大主要有用化学成分,介绍了中国、日本、英国在杜仲深度开发方面的１９项公开专利。对杜仲药材生产的现状、存在问题进行了详细的讨论,提出了解决杜仲药材生产供不应求、药材资源合理利用与保护及提高药材品质的途径与对策。