医院整体医疗管理模式探索历程与实施成效

医院整体医疗管理模式是以医学整体论、生物—心理—社会医学模式为指导,为满足社会民众的健康需求而创新的医院医疗管理新模式。经过10多年的实践与探索,拓宽了院前院后医疗保健功能,提升了医疗质量与医疗服务效能,融洽了医患关系,为医院赢得了良好的声誉,成效显著。     

门诊医疗服务水平提高的路径分析与实践

门诊医疗服务水平直接反映医院的整体医疗水平和综合服务能力,通过分析门诊医疗服务中存在的主要问题及其问题产生的原因,探寻提高门诊医疗服务水平的可行路径,提出应在充分发挥医院信息系统的作用、强化医务人员服务意识和加强门诊医疗服务质量管理等方面提高门诊医疗服务水平。     

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。     

军队医院医疗质量管理存在的问题及对策

随着我国医疗体制改革的不断推进,医院面临着自身管理体系和管理方式的重要革新。在新形势下,如何保证医疗质量管理更加规范、管理体系更加完善是医院管理者普遍重视的问题。医疗质量是医疗技术和医疗服务的核心、是医院竞争力的实质、是医院发展的根本。医院医疗质量的水平直接影响着患者的受益程度,也影响着医院自身的声誉和效益。因此,加强医疗质量管理可以有效地保证患者的利益,提高医院竞争力,促进医院可持续发展。随着社会的发展、科技的进步、医学模式的转变及国防建设的需要,军队医院的职能和作用也发生了变化,其不仅为军人提供医疗服务,也为地方群众就医提供便利。军队医院的医疗质量管理直接关系着军人的健康保障,也影响着地方群众的治疗效果。本文通过分析军队医院医疗质量管理存在的问题提出相应的对策,部队医院医疗质量管理部门应与时俱进,顺应国家医药卫生体制改革的同时,着眼于未来发展,建立健全医疗质量管理体系,改进管理模式,从而提高医疗质量,创造更高的经济效益和社会效益,以实现科学的可持续发展。     

基于省级平台的远程医疗系统设计

提出了一种基于省级平台的远程医疗系统的设计方案,主要从系统整体架构设计、网络结构设计、功能规划以及系统的业务流程设计几个方面进行了详细分析。通过建立省级远程医疗服务平台,可完成省内各医院之间远程医疗服务的统一调度和费用结算,各医院所建立的远程医疗业务平台完成医院间的各种远程医疗服务,系统可实现省内其他医院和省外医院的无缝接入。     

我院临床多学科联合会诊情况分析

多学科会诊是救治疑难危重病人经常启用的会诊形式,会诊质量的高低是衡量医院整体医疗质量、综合服务能力的重要指标,直接关系到患者的生命安全。建立健全多学科会诊制度,提高多学科会诊质量和效率,有利于集中优势资源,提高医疗质量、保障医疗安全,同时促进学科间的交流与合作,进一步提升医院的综合服务能力。

     

基于云平台的公立医院延伸医疗服务新模式的探索

深圳市人民医院成立全国首家基于云平台的网络医院,形成依托网络保健中心+健康小屋的新型医疗服务管理模式,以此拓展公立医院医疗服务功能。在此模式下,组建了有多级医护人员组成的医疗服务团队,对院外亚健康人群、慢病人群、多发病人群进行有效的随访管理。通过新型管理模式将医疗保健服务延伸到居民家庭,有效整合了医疗资源,为解决群众“看病难、看病贵”的问题作出有益尝试。     

我国医院非医疗安全管理存在的问题及治理对策

医疗安全管理、非医疗安全管理是医院安全管理的两大系统。随着医药卫生体制改革深化,就医模式改变,非医疗安全管理的内涵和外延发生变化,非医疗安全管理领域面临更多危险因素和安全隐患。结合医院非医疗安全管理现状,分析非医疗安全管理存在的问题并提出相关改进建议。     

上海市中心城区医联体模式的探索和实践

根据上海市中心城区的特点,经过3年探索和实践,构建了“以三级医院为依托、区中心医院为平台、社区卫生服务中心为基础”的“静安医联体模式”。分析了该模式在管理体制、运行机制、分配补偿机制等方面进行的创新举措,以及在慢性病管理、提高医疗服务质量、促进基层医疗机构建设、引导患者分级就诊等方面取得的成效,为医疗联合体改革的深入推进提供参考。     

探讨现代医院药剂管理的思路及意义

随着我国医疗体制的改革,医院也面临着新形势下自身管理体系和管理方式的改革和创新。现代医院的管理模式也发生很大变化,从传统经验管理型逐步转变为现代管理型。现代医院管理采用科学的管理方法和管理技术,广泛地运用现代自然科学和社会科学的研究成果使管理手段现代化、科学化。现代医院药剂管理是医院管理工作的重要组成部分,对医疗质量及用药安全起着重要的作用。医院药剂管理的现代化可以保证用药的安全性,提高医疗质量,提高医院的核心竞争力,促进现代市场经济体制下医疗水平的提升和医院的发展。现代医院药剂管理的关键在于如何实现新模式下的管理目标及如何提高新模式下的药剂管理水平。本文结合我院在医疗改革背景下逐渐创新各个环节的管理模式,完善管理体系,突破管理瓶颈而获得的实践体会,进一步探讨现代医院药剂管理的方法及意义,为医院药剂管理工作提供理论指导。     

我国医疗联合体主要运行模式及存在的问题

我国医疗联合体运行模式包括集团化模式、委托代管模式、院办院管模式、医疗协作模式、联合兼并模式、股份制合作模式等。但无论采用哪种模式,目前医疗联合体在实施过程中普遍存在概念不明确、缺乏配套政策及监督管理机制不完善、缺乏协调机制、社会对医疗联合体的认知不足等诸多问题。政府应正确定位角色,建立健全协调、监督、评价机制,并采取加大对基层医疗机构支持力度、建立信息共享平台等措施,确保医疗联合体工作取得切实成效。     

加强军队医院非现役编制医务人员卫生勤务保障能力的重要性

目的:调查军队医院非现役编制医务人员的军事素质和卫勤保障意识,探讨提升该群体卫勤保障能力的重要性和必要性,为军队医院卫勤管理提供参考。方法:采用问卷调查的方式对我院154名非现役编制医务人员进行调查,主要包括军事理论、卫生勤务、突发事件应急管理及战伤急救等,分析非现役编制医务人员缺乏的基本军事素质,并提出针对性的加强军队医院文职人员卫生勤务保障能力的可行性培训计划,在培训结束时对医护人员的军事素质进行测评。结果:问卷调查结果:非现役文职人员的军事素质评分为(3.70±0.46)、卫生勤务能力评分为(2.48±0.91)、突发事件应急管理评分为(2.61±0.53)、战伤急救技能评分为(2.42±1.02)。测评结果:军事理论知识评分为(4.11±1.04)、卫生勤务能力评分为(4.78±1.37)、突发事件应急意识评分为(4.56±0.56)、战伤急救技能评分为(4.68±0.91)。培训后,非现役医务人员的卫勤保障能力显著提高,差异具有统计学意义(P0.05)。结论:非现役文职作为军队医院的聘用制人员已成为医务工作的主要力量,因此军队医院应加强非现役医务人员的卫生勤务保障能力,提高我军后勤医疗保障的坚固力量。     

探讨现代医院药剂管理的思路及意义

随着我国医疗体制的改革,医院也面临着新形势下自身管理体系和管理方式的改革和创新。现代医院的管理模式也发生很大变化,从传统经验管理型逐步转变为现代管理型。现代医院管理采用科学的管理方法和管理技术,广泛地运用现代自然科学和社会科学的研究成果使管理手段现代化、科学化。现代医院药剂管理是医院管理工作的重要组成部分,对医疗质量及用药安全起着重要的作用。医院药剂管理的现代化可以保证用药的安全性,提高医疗质量,提高医院的核心竞争力,促进现代市场经济体制下医疗水平的提升和医院的发展。现代医院药剂管理的关键在于如何实现新模式下的管理目标及如何提高新模式下的药剂管理水平。本文结合我院在医疗改革背景下逐渐创新各个环节的管理模式,完善管理体系,突破管理瓶颈而获得的实践体会,进一步探讨现代医院药剂管理的方法及意义,为医院药剂管理工作提供理论指导。     

北京市公立医院试点医事服务费调查

北京市在公立医院试点医药分开,取消药品加成、挂号费和诊疗费,收取医事服务费。对试点医院门诊调查发现,医院改变传统管理和经营模式,从关注创收转变为控制成本,从多开药转变为合理用药,门诊患者数量明显增多,多数患者对现行的医事服务费政策支持并感到满意。部分医院管理者认为采用医事服务费并取消药品加成没有真正切断医生和药品之间的利益关系,对医院和医护人员长期影响有待进一步观察。     

Communication systems in healthcare

The care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention and the clinical adoption of even simpler services like voice-mail or electronic mail is still not commonplace in many health services. There remain enormous gaps in our broad understanding of the role of communication services in health care delivery. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the interface between primary care and hospital services. Given this lack of specific information about laboratory communication services, this paper will step back and generally review the components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarise some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery.     

Factors and Models Associated with the amount of Hospital Care Services as Demanded by Hospitalized Patients: A Systematic Review

Background

Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients'' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings.

Methods

We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis.

Results

From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added.

Conclusions

A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care.     

Role of the general practitioner in managing patients with myocardial infarction: impact of thrombolytic treatment. Report of a British Heart Foundation Working Group.

Thrombolytic treatment, combined with aspirin, has been shown to reduce mortality by half in patients in hospital with suspected acute myocardial infarction if it is given early after the onset of symptoms. This fact adds to the importance of prompt and skillful intervention. At present in the United Kingdom the median time for receiving suitable management for this condition is about four to six hours. With better organisation this delay could, in most areas, be reduced to two or three hours. A major change in the care of patients with myocardial infarction is needed in which the general practitioner should have a crucial role. Health authorities, hospital physicians, general practitioners, and the ambulance services must coordinate their efforts if the potential reduction in mortality is to be realised. The district medical officer should consult colleagues and draw up guidelines for organising the care of patients who have had heart attacks. The management of patients who have had heart attacks in the community and in hospital should be continually audited. There are dangers inherent in the use of thrombolytic treatment, particularly when conditions other than myocardial infarction are treated in error. This treatment should be given only when the diagnosis is highly probable and when close observation of the patient can be ensured during the ensuing hours. Thrombolytic treatment should not, therefore, be given out of hospital except when trained, equipped personnel are in attendance. Treatment can be given in any hospital (including community hospitals) provided there are adequate diagnostic facilities and suitably experienced nursing staff.