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中国医疗供给侧改革之路任重而道远,在当前逐步推进革新的医疗体制下,如何利用“互联网+”开启医疗供给侧改革之路,为国家13亿多人口的医疗问题提供有效的解决办法,是一项重要的改革课题。
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目的
构建新型、双向交互式、远程医疗随访平台,完善心脏术后临床数据的收集,并为患者提供可靠优质的随访服务。方法 运用现代通信、计算机及网络技术,开发与移动网兼容的随诊数据库及软件,以术后随访率、术后重要指标的随访质量,作为评估随访系统的标准。结果 系统正式运行1年余,共录入术后患者1392例,总随访率80.1%,其中超声心动图1065人次,心电图953人次,胸片567人次,国际标准化比值3856人次。结论 三爱医疗随访平台能有效地进行临床资料的收集,并将医疗服务延伸,给患者带来更多的帮助。 相似文献
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??????? 目的
初步构建基于“患者体验”的医疗服务质量关键指标体系。方法 通过检索国内外相关文献,构建指标体系框架和专家咨询表并进行2轮专家咨询,确定了基于“患者体验”的医疗服务质量关键指标体系。结果 构建基于“患者体验”的医疗服务质量关键指标体系,一级指标有有形性、可靠性、反应性、保证性、关怀性和连续性6个,二级指标28个,三级指标83个。结论 基于患者体验的医疗服务质量关键指标体系具有很强的实用性,为患者体验量表开发奠定基础。研究结果对于改进我国医疗服务质量评价手段和策略具有重要意义。 相似文献
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目的 采取有效的防范措施,最大限度地减少医院内跌倒和因跌倒导致的伤害事件的发生。方法 对跌倒事件采用柏拉图分析法进行分析,区分“少数重点因素”和“大量微细因素”。结果 病人的身心疾病、病人独自行动以及病人不愿求助和不安全的环境是防范病人跌倒时尤其要关注的因素。结论 根据柏拉图分析法,修订病人跌倒/坠床危险因子评估表,落实个体化的跌倒防范措施,营造安全的设施及环境,加强病人及家属的教育,有助于防范医院内病人跌倒的发生。 相似文献
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Reporting of medical adverse events is an important measure to prevent recurrence of adverse events and improve the quality of medical care. Through starting with policies about medical adverse event reporting system, existing medical adverse event reporting system is summarized and analyzed, the characteristics and defects are summed up, and the prospect of improving the reporting system of adverse events is made. 相似文献
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Daniels JP Hunc K Cochrane DD Carr R Shaw NT Taylor A Heathcote S Brant R Lim J Ansermino JM 《CMAJ》2012,184(1):29-34
Background:
Identifying adverse events and near misses is essential to improving safety in the health care system. Patients are capable of reliably identifying and reporting adverse events. The effect of a patient safety reporting system used by families of pediatric inpatients on reporting of adverse events by health care providers has not previously been investigated.Methods:
Between Nov. 1, 2008, and Nov. 30, 2009, families of children discharged from a single ward of British Columbia’s Children’s Hospital were asked to respond to a questionnaire about adverse events and near misses during the hospital stay. Rates of reporting by health care providers for this period were compared with rates for the previous year. Family reports for specific incidents were matched with reports by health care providers to determine overlap.Results:
A total of 544 familes responded to the questionnaire. The estimated absolute increase in reports by health care providers per 100 admissions was 0.5% (95% confidence interval −1.8% to 2.7%). A total of 321 events were identified in 201 of the 544 family reports. Of these, 153 (48%) were determined to represent legitimate patient safety concerns. Only 8 (2.5%) of the adverse events reported by families were also reported by health care providers.Interpretation:
The introduction of a family-based system for reporting adverse events involving pediatric inpatients, administered at the time of discharge, did not change rates of reporting of adverse events and near misses by health care providers. Most reports submitted by families were not duplicated in the reporting system for health care providers, which suggests that families and staff members view safety-related events differently. However, almost half of the family reports represented legitimate patient safety concerns. Families appeared capable of providing valuable information for improving the safety of pediatric inpatients.It has been estimated that adverse events occur in about 1% of children treated in hospital and that, on average, 60% of these events are preventable.1 To increase institutional awareness of adverse events, hospitals have implemented systems to encourage health care providers to report adverse events.2 The reporting of adverse events can be improved by making electronic systems for reporting readily accessible3 and by ensuring a “just culture,” which includes nonpunitive reporting policies.4 However, adverse events reported by health care providers account for only a small fraction of total adverse events as determined by chart review.5 Time pressures to treat patients, fear of punishment, lack of belief in the benefit of reporting and differing opinions of what defines a reportable event contribute to low reporting rates.6 However, patients and their families are readily available, keen and motivated observers who may not be subject to these reporting barriers. Family members are capable of observing and reporting adverse events in a variety of clinical settings.7 It is known that the interpretation of safety events and the threshold for reporting differ among health care disciplines and individual health care providers.6 However, it is not clear how families of pediatric patients interpret safety-related events or what their threshold would be for reporting events.The purpose of this study was to test whether the introduction of an adverse event reporting system for use by families of pediatric patients at the time of discharge from a surgical ward would significantly change the rate of reporting of adverse events by health care providers. We also evaluated the types of events that families reported, the relevance of these events with respect to patient safety, families’ desires for anonymous reporting and families’ assessments of institutional responses to reported events. We anticipated that health care providers’ reporting rates would rise with the introduction of the family reporting system, on the assumption that greater attention would be paid to reporting safety-related events on the ward. We also anticipated that families would provide useful information about safety-related events, at least some of the time. In particular, we thought that facilitating communication from the patient’s family directly to the study institution’s Quality, Safety and Outcome Improvement Department would allow more opportunities to improve safety through changes in practice. 相似文献17.
Objective
Adverse event reports (AERs) submitted to the US Food and Drug Administration (FDA) were reviewed to assess the muscular and renal adverse events induced by the administration of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) and to attempt to determine the rank-order of the association.Methods
After a revision of arbitrary drug names and the deletion of duplicated submissions, AERs involving pravastatin, simvastatin, atorvastatin, or rosuvastatin were analyzed. Authorized pharmacovigilance tools were used for quantitative detection of signals, i.e., drug-associated adverse events, including the proportional reporting ratio, the reporting odds ratio, the information component given by a Bayesian confidence propagation neural network, and the empirical Bayes geometric mean. Myalgia, rhabdomyolysis and an increase in creatine phosphokinase level were focused on as the muscular adverse events, and acute renal failure, non-acute renal failure, and an increase in blood creatinine level as the renal adverse events.Results
Based on 1,644,220 AERs from 2004 to 2009, signals were detected for 4 statins with respect to myalgia, rhabdomyolysis, and an increase in creatine phosphokinase level, but these signals were stronger for rosuvastatin than pravastatin and atorvastatin. Signals were also detected for acute renal failure, though in the case of atorvastatin, the association was marginal, and furthermore, a signal was not detected for non-acute renal failure or for an increase in blood creatinine level.Conclusions
Data mining of the FDA''s adverse event reporting system, AERS, is useful for examining statin-associated muscular and renal adverse events. The data strongly suggest the necessity of well-organized clinical studies with respect to statin-associated adverse events. 相似文献18.
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ObjectivesTo examine the feasibility of detecting adverse events through record review in British hospitals and to make preliminary estimates of the incidence and costs of adverse events.DesignRetrospective review of 1014 medical and nursing records.SettingTwo acute hospitals in Greater London area.Results110 (10.8%) patients experienced an adverse event, with an overall rate of adverse events of 11.7% when multiple adverse events were included. About half of these events were judged preventable with ordinary standards of care. A third of adverse events led to moderate or greater disability or death.ConclusionsThese results suggest that adverse events are a serious source of harm to patients and a large drain on NHS resources. Some are major events; others are frequent, minor events that go unnoticed in routine clinical care but together have massive economic consequences. 相似文献
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A. S. Mitchell D. A. Henry R. Sanson-Fisher D. L. O'Connell 《BMJ (Clinical research ed.)》1988,297(6653):891-893
To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts'' views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs. 相似文献