利益相关者视角下的远程医疗发展策略研究

远程医疗是一个多维的复杂的系统,它涉及众多不同利益主体,包括政府、各级卫生行政部门、医院、医生、患者和软硬件企业等。本研究依据利益相关者理论,首先将远程医疗利益相关者进行分类,然后分析他们的利益诉求,最后提出促进远程医疗发展的有效策略。     

基于远程医疗的异地转诊就医一体化实践探索

为探索借助远程医疗解决异地转诊就医一体化的问题，为异地转诊就医患者提供医疗保障。某医院成立专科疾病医联体，借助远程医疗对异地转诊就医患者提供医疗服务，总结某医院借助远程医疗，以专科疾病医联体进行精准转诊、异地就医，提供医疗保障的实践经验。某医院借助远程医疗，以专科疾病医联体为抓手，制定了精准转诊的规章制度，为异地就医患者提供了更加方便快捷的服务，同时降低了医疗费用，节省了医疗基金的开支，实践效果显著。借助远程医疗，成立专科疾病医联体，可以很好的实现患者精准转诊、精准医疗，解决异地就诊患者“看病难、看病贵”问题，为异地就医患者提供更好的医疗保障，助推实现全国异地就医一体化的大健康战略。     

收益管理理论在医院管理应用的可行性

几十年来,国际上关于收益管理理论的研究日趋成熟,而将其引入医院管理还是一个新的课题。通过从医疗服务业的特征入手分析医院运用收益管理的可行性,以期平衡医院的需求和供给,有效管理医院相对固定的服务能力,从而实现医院收益价值即社会贡献度、患者满意度和经济效益最大化目标。     

大型综合医院医疗服务半径研究

目的：探讨大型医院神经内科医疗服务半径的基本情况及变化趋势,为科室健康发展、合理配置医疗资源提供科学依据,并以此为基础建立一个临床科室服务半径的分析模型。方法：利用军队医院信息管理系统中病案管理子系统建立数据库,对住院患者病案首页信息的基本情况进行单因素统计分析,并利用地理信息系统直观描述该院患者来源分布频率,定量研究医院服务半径的影响因素。结果：在2007—2010年收治的26528例地方患者中,男性多于女性,60岁以上老年人居多;本市住院病人数量呈逐年下降的趋势,而距离西安市较远的地区和外省病人数量呈逐年上升趋势。定量研究医院服务半径的影响因素发现,可能的影响因素有患者年龄、疾病病种、是否手术、住院日、医疗费用、医疗性质等方面（P〈0．05）。结论：在医疗服务市场竞争中,医院医疗服务半径的拓展与医疗服务满意度、社会经济发展、新医改的不断推进、品牌营销策略等影响因素密切相关。     

基于认知水平的非使用价值支付动机研究

非使用价值是环境与资源价值的重要组成部分,非使用价值的支付动机研究是环境与资源价值研究的重要内容,遗产价值、选择价值、存在价值是非使用价值的三大支付动机.传统的自上而下或自下而上非使用价值支付动机研究方法会出现顺序效应等问题.根据社会心理学理论,消费者支付意愿的大小与其支付动机强度成正比,为此提出了基于认知水平的非使用价值支付动机分析方法,将对支付动机的直接评估转为对动机认知水平的评估.论文以鼓山风景区为例进行了实证分析,并与传统方法进行比较,结果显示,基于认知水平的支付动机研究方法可大大减低受访者回答的难度,并能精确地量化受访者3种支付动机间的差异,同时克服了顺序效应问题,从而提高了研究结果的科学性.     

医疗服务分档评估指标体系评分标准的制订

医疗服务创造了人类健康价值,是社会繁荣的前提和基础,其价格水平影响基本医疗服务的可及性和公平性。研究在前期以不同等级非营利性医疗机构为研究对象,建立了一套科学、有效、全面、可行的综合反映医疗服务分档的评估指标体系,为医疗服务分档定价提供参考依据。将针对医疗服务分档评估指标体系制定相应的评分标准。     

患者满意评价指数模型研究

医院是社会文明服务的窗口,医德医风关系到医院和医务人员自身的声誉。患者对于医疗服务的满意度对医院的生存和发展有着重要影响,随着医疗机构之间的竞争愈演愈烈,医疗服务的满意研究受到了更多的重视。患者的满意度与医院忠诚度二者是相辅相成的关系,只有满意的患者才能成为医院的忠诚顾客,再通过这些忠诚顾客的口碑影响其他患者,医院的形象才能得以提升。目前医院患者的满意研究出现了一个特殊的现象：对各类病人的满意研究得出了高的满意率,但社会对医院服务的强烈批评却屡见不鲜。本文分析了目前患者满意评价体系存在的问题,并以服务管理领域顾客满意理论为指导,通过分析患者满意的影响要素以及各要素的相互关系,探讨医院患者满意评价模型构建方法。     

医学新技术临床应用患者参与决策及其影响因素分析

目的 研究通用概念的医学新技术及无创产前检测技术临床应用中的患者参与决策,分析相关影响因素。方法 采用多阶段分层抽样,选取东西部的上海、福州、泉州、成都、南充5城市18家医院为样本点,对医院妇产科孕妇及其他科室患者进行调研,问卷为自主设计,包含通用新技术及具体新技术（NIPT技术）两个视角,采用logistic回归分析进行影响因素分析。结果 共调查233名孕妇和554名其他科室患者;69名（占41.12%）孕妇和310名（占64.32%）患者的参与决策量表得分为“较高”;孕妇受教育程度、医疗保险情况、医疗服务满意度,对孕妇参与决策程度有统计学意义（P<0.05）;对于通用新技术,城市地区、是否本地人员、患者对新技术的态度、医疗服务满意度有统计学意义（P<0.05）。结论 多数患者参与了新技术诊疗决策,但其实际程度仍待提高;多因素影响患者决策参与,对于不同新技术有不同的影响因素。建议多途径促进患者合理地参与决策,推动医患共同决策模式的建立。     

区域远程影像信息系统建设与实践

在基层医疗机构,医学影像学检查存在检测技术水平有限,缺乏人才培养机制等问题。本文基于远程会诊应用模式,针对我市沙坪坝区的医疗资源分布不均的现状,构建区域远程影像信息系统,有效提高了资源利用率,为患者提供了更便捷的区域化医疗服务。     

医保单病种付费对患者满意度影响的研究进展

通过文献回顾分析,归纳了当前对该医保支付手段的患者满意度进行评价涉及的几个研究方向,如医疗服务、医疗质量、医疗费用以及患者个人因素,对其研究进展以及研究中存在的问题进行了评述,归纳了一些旨在进一步完善单病种付费满意度研究的建议。     

Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation

Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence.     

Scientists@Home: What Drives the Quantity and Quality of Online Citizen Science Participation?

Online citizen science offers a low-cost way to strengthen the infrastructure for scientific research and engage members of the public in science. As the sustainability of online citizen science projects depends on volunteers who contribute their skills, time, and energy, the objective of this study is to investigate effects of motivational factors on the quantity and quality of citizen scientists'' contribution. Building on the social movement participation model, findings from a longitudinal empirical study in three different citizen science projects reveal that quantity of contribution is determined by collective motives, norm-oriented motives, reputation, and intrinsic motives. Contribution quality, on the other hand, is positively affected only by collective motives and reputation. We discuss implications for research on the motivation for participation in technology-mediated social participation and for the practice of citizen science.     

Soft networks for bridging the gap between research and practice: illuminative evaluation of CHAIN

Objectives To explore the process of knowledge exchange in an informal email network for evidence based health care, to illuminate the value of the service and its critical success factors, and to identify areas for improvement.Design Illuminative evaluation.Setting Targeted email and networking service for UK healthcare practitioners and researchers.Participants 2800 members of a networking service.Main outcome measures Tracking of email messages, interviews with core staff, and a qualitative analysis of messages, postings from focus groups, and invited and unsolicited feedback to the service.Results The informal email network helped to bridge the gap between research and practice by serving as a rich source of information, providing access to members'' experiences, suggestions, and ideas, facilitating cross boundary collaboration, and enabling participation in networking at a variety of levels. Ad hoc groupings and communities of practice emerged spontaneously as members discovered common areas of interest.Conclusion This study illuminated how knowledge for evidence based health care can be targeted, personalised, and made meaningful through informal social processes. Critical success factors include a broad based membership from both the research and service communities; a loose and fluid network structure; tight targeting of messages based on members'' interests; the presence of a strong network identity and culture of reciprocity; and the opportunity for new members to learn through passive participation.     

Insecurities of Women Regarding Breast Cancer Research: A Qualitative Study

Objectives

Only 1.2%–11% of all potential study participants participate in cancer studies. Low participation rates can result in bias or in a failure to obtain data saturation. Subject-scientific psychology assumes that reasons for acting are based on individual premises. The objective of this study was to render reproducible individual reasons of female breast cancer patients to participate or not participate in breast cancer studies using a qualitative approach.

Methods

Problem-based interviews were conducted with female breast cancer patients. The selection of interview partners continued until theoretical data saturation was achieved.

Results

As main arguments against participation emotional overload and too many medication side-effects were stated. Improvement of health-related values, long-term protection and comprehensive follow-up exams were stated as arguments for participation. Trust in the attending physician was mentioned as influencing both participation and non-participation.

Conclusions

A significant influential factor determining willingness to participate in studies was one''s contentment with patient-physician communication. In order to guarantee an adequate patient decision-making process, keeping existing standards for patient briefings is absolutely mandatory.     

基于社会总体偏差和同伴效应修正的海洋生态修复偏好研究

公众参与海洋生态修复对我国海洋环境保护与生态安全具有重要意义。利用单边界二分式引导技术评估青岛市居民海洋生态修复偏好,并从内疚和抵抗心理两方面就社会总体偏差与同伴效应对修复偏好的影响机理进行分析,为政府激发公众参与海洋生态修复的积极性提供理论依据与技术指导。结果表明:①青岛市居民平均每年愿意为海洋生态修复捐赠184.386元,考虑属性重要程度结果表明生物数量的改善可显著提高公众海洋生态修复支付意愿,而公众对改善海水水质和海岸环境并未表现出显著差异性偏好。②社会总体偏差和同伴效应均对公众海洋生态修复支付意愿表现出显著正向影响。③社会总体偏差和同伴效应可通过激发受访者的内疚感提高生态修复支付意愿,但也会导致抵抗心理抑制参与积极性;主观规范正向调节社会总体偏差和同伴效应对支付意愿的影响。研究揭示了公众在海洋生态修复中的偏好和竞争性心理对陈述偏好的影响,可为促进公众参与海洋生态修复和提高海洋环境资源价值评估准确性提供参考。     

Abstracts

ABSTRACT

Interactions between dogs and humans, including participating in physical activities and dog-sport events, are beneficial for both parties. Self-Determination Theory was used as a framework to explore dog-sport competitors' motivation to participate in dog-sport events. Eighty-five competitors completed surveys including demographic questions, a measure of frequency of engagement in dog-sport competitions, open-ended questions regarding motivators, and the Sports motivation Scale, adapted to dog-sport participation. Seventy-eight percent of participants were aged 45 to 74 years, and the majority were female. Seventy-seven percent of participants reported participation at ≥ 12 competitions per year, while 23% reported attending ≤ 6 competitions. The logistic regression model was significant (η²₍₆₎=16.68, n = 84, p < 0.05) and explained 18% (Cox and Snell R Square) to 27.4% (Nagelkerke R Square) of the variance in number of competitions selected. Intrinsic motivation (IM-to experience) and self-determined extrinsic motivation (EM-identified) were the two predictors that contributed significantly to the model. Data from open-ended survey questions indicated that participants valued and enjoyed dog sports and reported similar benefits for themselves and their dogs. Participants perceived the benefits associated with participation in dog sports as motivators for continued engagement. Self-determined motivation appeared to differentiate between people who competed more frequently at dog-sport competitions and those who competed less frequently. Understanding motivation to participate could help when promoting dog-sport competition to dog owners who do not participate or participate less frequently, including younger men and women. The Sports motivation Scale adapted to dog sports is a good survey tool to elucidate information regarding motivation to participate in dog sports.     

密云水库流域“稻改旱”生态补偿农户参与意愿分析

近年来,北京市政府在密云水库上游实施"稻改旱"生态补偿项目,确保城市供水安全,而上游农户能否积极参与,是该项目成功的关键。基于农户调查数据,运用选择实验模型分析了密云水库上游河北省丰宁县3个乡镇农户"稻改旱"项目的参与意愿特征。定量估计了"合同期限"、"是否可以中途退出"、"参与项目土地比例"、"化肥减量使用"、"是否可以浇水"和"补贴金额"共6个选择属性对农户参与意愿的影响。除"参与项目土地比例"外,其余属性均对农户项目参与意愿有显著影响。以此为基础,估计出各个具有显著影响选择属性的边际效应和边际接受意愿。结果表明:(1)农户青睐"可以中途退出"和"短合同期"的选择属性,反映出项目蕴藏的可持续性风险。可通过创造更多符合本地劳动力特点的非农就业机会加以解决;(2)"不可以浇水"和"减少化肥使用"已成为阻碍农户参与的两个因素。现阶段可先通过技术培训的方式,从改善农户环境意识入手,以减少农户生产行为对项目成效的不利影响;(3)补偿金额对于动员农户参与的效果较为有限,而其它几个选择属性却表现出较好的农户动员参与特性。因此,可尝试增强农户自主参与决策,并引入弹性合同机制,以有效吸引农户参与,同时节约补偿资金使用;(4)不同乡镇对"稻改旱"项目表现出差异化的参与意愿。与农业乡镇相比,非农产业乡镇的补偿期望相对较高。因此,今后应考虑改变以往不分区域"一刀切"的做法,设计多样化的补偿策略。     

Demographic determinants of participation in strength training activities among U.S. adults

This study used a health services approach to examine the demographic correlates of participation in strength training activities among U.S. adults. The purpose of this study was to develop a profile of adults who participate in strength training activities and analyze the demographic factors that predict strength training participation. The study was a secondary data analysis employing a nonexperimental correlational design. Subjects for the study were derived from the data source, the 2003 National Health Interview Survey, a multistage probability survey that produced a U.S. representative sample of 29,783 adults capable of participating in strength training. The prevalence of strength training participation among adults was calculated, and a logistic regression equation was used to develop a multivariate model of factors that influence participation. Twenty-one percent of adults participated in strength training activities on at least 2 days of the week. In the regression, participation was associated with age, sex, ethnicity, marital status, level of education, and census region. The likelihood of participating in regular strength training activities was lower among older adults and women but higher with increasing levels of education and with participation in other aerobic type exercise. Strength training professionals should employ public health methodologies to promote continuation of this type of activity among those who were shown to participate regularly and to improve participation among those subgroups with lower levels of activity.     

干旱区绿洲城市生态文明建设公众参与意识研究——以“一带一路”沿线城市乌鲁木齐为例

生态文明是人类文明发展的新阶段,其强调人与自然的协调发展。基于公众科学理论框架,采用模型模拟方法、实地问卷调查、多元回归方法,分析了乌鲁木齐居民参与城市生态文明建设的自我感知、满意程度、参与意愿,并构建了结构方程模型(SEM),探讨了居民参与城市生态文明意愿的可行路径,分析了居民参与城市生态文明建设的意愿与其相关因素间的关系,揭示了居民参与城市生态文明建设主要限制因素。结果表明:(1)居民自我感知与城市生态文明建设参与意愿呈显著正相关,满意程度与参与意愿呈显著负相关;(2)45.36%的受访者表示非常愿意参与城市生态文明建设;(3)居民主体意识和支持度占比分别为72.92%、72.04%,生态认知、生态关注及参与信心占比分别为43.08%、64.33%和55.14%;(4)受访者对城市生态文明建设状况满意度的平均偏效应为2.32,各项满意度均值情况为:城市绿化状况(2.51)政府环境信息公开程度(2.41)城市空气状况(2.35)城市垃圾处理与分类状况(1.99)。研究成果以期为建立和推进城市生态文明建设提供科学参考。     

Assessing the promise of user involvement in health service development: ethnographic study

Objectives To understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice.Design Ethnographic study using participant observation, interviews, and collection of documentary evidence.Setting A multiagency modernisation programme to improve stroke services in two London boroughs.Participants Service users, National Health Service managers, and clinicians.Results User involvement in the programme was initiated and led by professionals. Professionals determined the areas of service improvement service users could participate in. A wide range of activities were considered “user involvement,” from patient satisfaction surveys to service users delivering peer support. Involvement tended to be most active in the least technical areas and areas with least input from clinicians. Factors that might explain this included organisational structure, the vagueness of the concept of user involvement, the value attributed to service users’ experiential knowledge, and variations in professional and service user understandings of and commitment to involvement. The gains of involvement were harder to identify in terms of impact on services. More evident were the personal gains for those involved: satisfaction of feeling listened to by professionals, social opportunities of meeting others in a similar situation, and increased knowledge about stroke and services available.Conclusions User involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.