浅析公立医院战略绩效形成机制

组织绩效的内涵决定了公立医院绩效的基本形态,公立医院的本质属性和社会责任决定了公立医院战略绩效的内容方向,公立医院战略绩效的内涵特征使得分析绩效形成十分困难。通过建立简约化模型,分阶段讨论,排除特殊状态,形成了常态下公立医院战略绩效形成分析模型,该模型对科学管理绩效具有一定指导作用。     

天津市三级医院医疗设备管理现状调查

目的 比较天津市三级甲等医院和三级乙等医院医疗设备管理质量考核结果,为医院提高医疗设备管理质量提出建议。方法 采用现场调查法,并对考核结果应用Fisher确切概率法进行对比统计分析。结果 在管理制度实施、人员技术培训以及科室抢救设备定期安全检查记录的考核中,三级甲等医院与三级乙等医院达标率差别有统计学意义(P<0.05),前者高于后者;在另外几项的考核中,三级甲等医院与三级乙等医院达标率差别无统计学意义（P《0.05）。结论 各医院要针对自身存在的问题,采取相应措施,提高医疗设备管理质量水平。     

What is a Hospital? Future Roles and Prospects for Success: The Business of Medicine: A Course for Physician Leaders

As hospitals consolidate and take on more financial and clinical risk, they face numerous obstacles. While the past can provide answers to solving many of the challenges, some issues are new and require innovative approaches. This article, from a speech delivered to The Business of Medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012, discusses the models for these hospital organizations and the pitfalls they will face in coordinating care. The insights will help these systems overcome potential problems and enhance their chances of success.     

Sleep Loss and Performance of Anaesthesia Trainees and Specialists

Fatigue risk associated with work schedules of hospital doctors is coming under increasing scrutiny, with much of the research and regulatory focus on trainees. However, provision of 24 h services involves both trainees and specialists, who have different but interdependent work patterns. This study examined work patterns, sleep (actigraphy, diaries) and performance (psychomotor vigilance task pre‐ and post‐duty) of 28 anaesthesia trainees and 20 specialists across a two‐week work cycle in two urban public hospitals. Trainees at one hospital worked back‐to‐back 12 h shifts, while the others usually worked 9 h day shifts but periodically worked a 14 h day (08:00–22:00 h) to maintain cover until arrival of the night shift (10 h). On 11% of day shifts and 23% of night shifts, trainees were working with ≥2 h of acute sleep loss. However, average sleep loss was not greater on night shifts, possibly because workload at night in one hospital often permitted some sleep. Post‐night shift performance was worse than post‐day shift performance for the median (t₍₁₃₁₎=3.57, p<0.001) and slowest 10% of reaction times (t₍₁₃₄₎=2.91, p<0.01). At the end of night shifts, poorer performance was associated with longer shift length, longer time since waking, greater acute sleep loss, and more total work in the past 24 h. Specialists at both hospitals had scheduled clinical duties during the day and were periodically scheduled on call to cover after‐hours services. On 8% of day shifts and 14% of day+call schedules, specialists were working with ≥2 h of acute sleep loss. They averaged 0.6 h less sleep when working day shifts (t_(23.5)=2.66, p=0.014) and 0.8 h less sleep when working day shifts+call schedules (t_(26.3)=2.65, p=0.013) than on days off. Post‐duty reaction times slowed linearly across consecutive duty days (median reaction time, t₍₁₃₁₎=?3.38, p<0.001; slowest 10%, t₍₁₆₀₎=?3.33, p<0.01; fastest 10%, t₍₁₃₈₎=?2.67, p<0.01). Poorer post‐duty performance was associated with greater acute sleep loss and longer time since waking, but better performance was associated with longer day shifts, consistent with circadian improvement in psychomotor performance across the waking day. This appears to be the first study to document sleep loss among specialist anaesthetists. Consistent with observations from experimental studies, the sleep loss of specialists across 12 consecutive working days was associated with a progressive decline in post‐duty PVT performance. However, this decline occurred with much less sleep restriction (< 1 h per day) than in laboratory studies, suggesting an exacerbating effect of extended wakefulness and/or cumulative fatigue associated with work demands. For both trainees and specialists, robust circadian variation in PVT performance was evident in this complex work setting, despite the potential confounds of variable shift durations and workloads. The relationship between PVT performance of an individual and the safe administration of anaesthesia in the operating theater is unknown. Nevertheless, the findings reinforce that any schedule changes to reduce work‐related fatigue need to consider circadian performance variation and the potential transfer of workload and fatigue risk between trainees and specialists.     

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals.     

Airborne fungi in the hospitals of metropolitan Delhi

Summary The fungal airspora of a large hospital in Delhi Metropolis was studied from May 1989 – April 1991, using Andersen Six Stage Volumetric Sampler and Burkard Personal Slide Sampler. Simultaneously, samples were also collected from outside the hospital to act as a control. Samplers were operated for 10 min. each time, at 10 - day intervals. Additional samples were also collected from different sections of 3 other hospitals. Some of the dominant forms encountered wereCladosporium spp.,Aspergillus flavus, Smut,Fusarium spp.,Aspergillus niger, Alternaria spp.,Penicillium citrinum, Aspergillus versicolor, andPenicillium oxalicum. Aspergillus flavus showed significantly high concentration inside hospital (n=66, x=53 CFU m^–3, p<0.05) as compared to outside air. The peak period for fungi was observed to be from June – September. The spore concentration was much lower in hospital units receiving filtered air as compared to control environment, but in naturally ventilated hospitals the concentration was similar to that of outside air.     

三甲综合性医院住院医师抑郁现状调查及影响因素

目的:调查三甲综合性医院住院医师抑郁现状并分析其影响因素,为提高临床住院医师生活质量及工作效率提供依据。方法:选择三甲综合性医院临床各科室住院医97例为研究对象,调查其性别、年龄、文化程度、婚姻状况等基线资料,采用抑郁自评量表(SDS)对其基线资料进行分析,并采用logistics回归分析住院医师抑郁状态发生的影响因素。结果:97例住院医师SDS评分为(48.99±9.78)分显著高于人群常模(41.85±10.57)分(t=3.212,P0.05),其中抑郁的发生率(35.05%)显著高于正常人群(16.07%)与护士人群(22.55%)(x2=9.437,4.124;P0.05);多因素分析显示,未取得执业医师证书(OR=2.241,P0.05)、不喜欢医生职业(OR=3.722,P0.05)及对工作不满意(OR=7.713,P0.05)是住院医师发生抑郁的危险因素。结论:三甲住院医师的抑郁发生率处于较高水平,未取得执业医师证书、不喜欢医生职业、对工作不满意是住院医师发生抑郁的危险因素。     

基于“诊断相关组”评估医院诊疗技术的综合能力

目的 探索评价医院诊疗技术综合能力的技术方案。方法 从“北京市公共卫生信息中心”主管的“出院病人病案首页数据库”提取该市23所三级综合医院2009年全年出院病案首页数据。以“北京版诊断相关组（BJ-DRGs）”为风险调整工具,从“治疗病例数量”和“诊疗技术难度”2个维度构建“能力指数”作为评价指标,分专业比较这些医院的“能力指数”。结果 W医院的缺失及能力指数低的专业最多,诊疗技术综合能力最差;而医院C既无缺失的专业,又无能力指数低的专业,诊疗技术综合能力最强。
结论 医院之间进行多个专业“能力指数”的比较能够反映医院综合能力的状况。     

不同地区医院与其他公共服务领域融资模式借鉴与分析

在目前的医疗服务提供体系中,非营利性医院占据绝对主体地位,为提供基本医疗卫生服务、维护国民健康作出了巨大贡献。然而,近年来医院过分依赖业务收入的发展模式制约了医院的发展,也加重了整个社会的医疗费用负担。在医改新环境下如何理顺非营利性医院的融资机制,拓展筹资渠道,筹集足够的资金用以弥补成本,使医院可以更好地关注社会效益,回归公益性的本途,是政府需要重点思考的问题。