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目的
探讨北京市“医药分开”改革对临床医师用药行为的影响。方法 以北京市试行“医药分开”的部分医院为研究现场,随机抽取800名临床医师进行问卷调查,分析该项改革对临床医师用药行为的影响。结果 临床医师对“医药分开”改革的知晓率为99.5%。“医院宣传”、“专项培训”、“电视广播”为临床医师了解政策的三大主要途径。改革后,92.1%的临床医师更加重视规范诊疗、合理用药;94.4%的临床医师控制大处方,减少开方用药的数量、金额;89.9%临床医师受开药收入、提成、回扣的影响降低。结论 “医药分开”改革对试点医院临床医师的用药行为产生积极影响,规范医师处方行为,加强合理用药,基本实现了改革预期目标。 相似文献
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目的
进一步明确医药分开政策目的及策略。方法 采用文献回顾性研究法,对医药利益链条及其形成原因,以及解决策略进行系统性地总结和分析。结果 现有研究一是认为医疗服务提供方拥有垄断地位造成利益链条存在,因而提出消除垄断;二是认为扭曲的“白色”或不良的“灰色”激励机制造成利益链条存在,因而提出完善“白色”或消除“灰色”激励机制的综合策略。结论 医药利益链条产生更深层次的原因是,非营利性的公立医疗机构不合理地追求经济利益,医生采用不合理方式追求部分合理经济利益。因此,医药分开目的应是让公立医疗机构真正成为非营利机构,使医生依靠技术获得合理的经济回报,让公立医疗机构、医生、政府、患者、药品企业及流通商间激励相容。建议采用外部补偿和内部薪酬制度为重点的综合改革策略,形成各利益相关方激励相容的良好局面,自然消除公立医疗机构、医生与药品销售间利益链条。 相似文献
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目的 结合我国当前实际,参考国外发达国家的经验,建立先进的医院信息系统,为改善病人就诊环境,赢得最优的服务效率和质量,为各级医院信息化的进一步发展提升提供参考。方法 在广泛收集国内外研究成果的基础上,将理论与实证分析相结合,分析国外发达地区医院信息系统发展与我国的不同及差距,重点分析美国医院信息系统的发展。结果 通过分析可以看出以下方面的差距:(1)政府的作用,(2)医院信息化的投资规模,(3)标准化的推广和保险体制的完善,(4)信息技术应用的深度和广度。结论 通过对比分析,总结经验与教训以及我国须注意和改进的具体问题,得出了对我国有益的启示。 相似文献
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实行医药分开、破除以药补医无疑是公立医院改革的关键领域,不仅有着复杂的历史背景,而且涉及多个利益相关者。在此项改革推进过程中,政府有关部门出台相关政策,探索出了改革支付方式、降低或取消药品加成、实行收支两条线管理、设立独立于医院外的药品管理中心等4种医药分开的实现形式。后以药补医时代,政府责任主要在:通过约束公立医院的逐利性缓解“看病贵”;促使医疗技术服务价格回归价值以改善“看病难”;通过合理财政投入、有力政策保障,主导公立医院落实公益性。 相似文献
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目的 了解薄弱专科医院的财政投入现状,探索落实倾斜政策的路径。方法 现场调研、专家咨询和深入访谈等方式。结果 上海市财政对精神卫生、传染等薄弱专科医院提高了基本建设投入比例、优先扶持科教项目、提高基本支出比例等举措,使这些医院基本实现了收支平衡和医疗服务有序开展。然而,近期基本工资制度和社会保障制度调整、医药分开等改革举措给医院带来新的挑战。结论 现行财政投入政策有一定的作用,但近期改革主要影响人力成本。建议短期内以绩效工资补偿为切入口,根据公益程度、经济运行状况等分梯度对薄弱专科医院进行补偿,同时加强公共卫生的补偿力度。 相似文献
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目的 对上海某三甲医院绩效考核信息化应用进行效果评价。方法 对医院35个临床科室在采用智能化绩效考核信息系统前后的月度绩效考核分值、临床业务指标数据进行对比分析、统计描述及重复测量方差分析,运用SPSS 20.0统计软件。结果 应用智能化绩效考核信息管理系统后,各科室月度绩效考核分值普遍增加且差异有统计学意义,在保持医疗服务量及服务效率增加的情况下,成本及医药费用得到了有效控制。结论 医院绩效考核信息化的应用,对坚持公益性、保持高效率、调动医务人员积极性具有重要意义,能够有效促进公立医院健康可持续发展,更好地满足人民群众日益增长的医疗服务需求。 相似文献
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Weirong Yan Lars Palm Xin Lu Shaofa Nie Biao Xu Qi Zhao Tao Tao Liwei Cheng Li Tan Hengjin Dong Vinod K. Diwan 《PloS one》2013,8(4)
Background
syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings.Objective
this study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system.Methods
ISS was developed based on an existing platform ‘Crisis Information Sharing Platform’ (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting.Results
As of Jan. 31st 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74256, 79701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level.Conclusions
The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China. 相似文献12.
Purpose
From temporary need of help for household chores after a short stay at the hospital to complex healthcare due to chronic conditions, an important number of professional caregivers belonging to different organizations are involved in providing help and healthcare services at home. Despite the well-defined role of each professional, these organizations are complaining of a lack of coordination and visibility of each other work, especially in case of incident. Coordination between organizations appears here as essential but is at the same time the responsibility of all and of no one of the involved professionals. In this context, our research aims at supporting coordination for home care work through the design and implementation of a web platform.Methods
In order to ground the design of an inter-organizational coordination platform (AidAdom), we first studied the work practices and coordination issues of two help services providers through interviews and observation with different stakeholders . Then we have conducted a pilot study at three homes (involving from 6 to 17 caregivers) during one month to evaluate the system use in the field as well as to address implementation issues at both technical and social levels.Results
We provide an account of inter-organizational coordination in home care and identify issues in terms of limited resources for articulation work and basic coordination information sharing requirements. This analysis supports the features of the AidAdom web platform that enable caregivers to easily register data and messages related to their interventions. The pilot study allowed us to identify deployment issues at regional scale.Conclusion
The AidAdom platform provides a lightweight system which enables organizations to share a minimal set of coordination information. Our future work is oriented toward opening the system to new help and healthcare service professionals and organizations. 相似文献13.
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Ted A. Skolarus Sarah T. Hawley Daniela A. Wittmann Jane Forman Tabitha Metreger Jordan B. Sparks Kevin Zhu Megan E. V. Caram Brent K. Hollenbeck Danil V. Makarov John T. Leppert Jeremy B. Shelton Vahakn Shahinian Sriram Srinivasaraghavan Anne E. Sales 《Implementation science : IS》2018,13(1):144
Background
Men with prostate cancer are often castrated with long-acting injectable drugs termed androgen deprivation therapy (ADT). Although many benefit, ADT is also used in patients with little or nothing to gain. The best ways to stop this practice are unknown, and range from blunt pharmacy restrictions to informed decision-making. This study will refine and pilot two different de-implementation strategies for reducing ADT use among those unlikely to benefit in preparation for a comparative effectiveness trial.Methods/design
This innovative mixed methods research program has three aims. Aim 1: To assess preferences and barriers for de-implementation of chemical castration in prostate cancer. Guided by the theoretical domains framework (TDF), urologists and patients from facilities with the highest and lowest castration rates across the VA will be interviewed to identify key preferences and de-implementation barriers for reducing castration as prostate cancer treatment. This qualitative work will inform Aim 2 while gathering rich information for two proposed pilot intervention strategies. Aim 2: To use a discrete choice experiment (DCE), a novel barrier prioritization approach, for de-implementation strategy tailoring. The investigators will conduct national surveys of urologists to prioritize key barriers identified in Aim 1 for stopping incident castration as localized prostate cancer treatment using a DCE experiment design. These quantitative results will identify the most important barriers to be addressed through tailoring of two pilot de-implementation strategies in preparation for Aim 3 piloting. Aim 3: To pilot two tailored de-implementation strategies to reduce castration as localized prostate cancer treatment. Building on findings from Aims 1 and 2, two de-implementation strategies will be piloted. One strategy will focus on formulary restriction at the organizational level and the other on physician/patient informed decision-making at different facilities. Outcomes will include acceptability, feasibility, and scalability in preparation for an effectiveness trial comparing these two widely varying de-implementation strategies.Discussion
Our innovative approach to de-implementation strategy development is directly aligned with state-of-the-art complex implementation intervention development and implementation science. This work will broadly advance de-implementation science for low value cancer care, and foster participation in our de-implementation evaluation trial by addressing barriers, facilitators, and concerns through pilot tailoring.Trial registration
ClinicalTrials.gov Identifier: NCT03579680, First Posted July 6, 2018.15.
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Background
The goal of personalized medicine is to provide patients optimal drug screening and treatment based on individual genomic or proteomic profiles. Reverse-Phase Protein Array (RPPA) technology offers proteomic information of cancer patients which may be directly related to drug sensitivity. For cancer patients with different drug sensitivity, the proteomic profiling reveals important pathophysiologic information which can be used to predict chemotherapy responses.Results
The goal of this paper is to present a framework for personalized medicine using both RPPA and drug sensitivity (drug resistance or intolerance). In the proposed personalized medicine system, the prediction of drug sensitivity is obtained by a proposed augmented naive Bayesian classifier (ANBC) whose edges between attributes are augmented in the network structure of naive Bayesian classifier. For discriminative structure learning of ANBC, local classification rate (LCR) is used to score augmented edges, and greedy search algorithm is used to find the discriminative structure that maximizes classification rate (CR). Once a classifier is trained by RPPA and drug sensitivity using cancer patient samples, the classifier is able to predict the drug sensitivity given RPPA information from a patient.Conclusion
In this paper we proposed a framework for personalized medicine where a patient is profiled by RPPA and drug sensitivity is predicted by ANBC and LCR. Experimental results with lung cancer data demonstrate that RPPA can be used to profile patients for drug sensitivity prediction by Bayesian network classifier, and the proposed ANBC for personalized cancer medicine achieves better prediction accuracy than naive Bayes classifier in small sample size data on average and outperforms other the state-of-the-art classifier methods in terms of classification accuracy.17.
We study the stability and information encoding capacity of synchronized states in a neuronal network model that represents part of thalamic circuitry. Our model neurons have a Hodgkin-Huxley-type low-threshold calcium channel, display postinhibitory rebound, and are connected via GABAergic inhibitory synapses.We find that there is a threshold in synaptic strength, c, below which there are no stable spiking network states. Above threshold the stable spiking state is a cluster state, where different groups of neurons fire consecutively, and each neuron fires with the same cluster each time. Weak noise destabilizes this state, but stronger noise drives the system into a different, self-organized, stochastically synchronized state. Neuronal firing is still organized in clusters, but individual neurons can hop from cluster to cluster. Noise can actually induce and sustain such a state below the threshold of synaptic strength. We do find a qualitative difference in the firing patterns between small (10 neurons) and large (1000 neurons) networks.We determine the information content of the spike trains in terms of two separate contributions: the spike-time jitter around cluster firing times, and the hopping from cluster to cluster. We quantify the information loss due to temporally correlated interspike intervals. Recent experiments on the locust olfactory system and striatal neurons suggest that the nervous system may actually use these two channels to encode separate and unique information. 相似文献
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首都医科大学附属北京世纪坛医院承担了“京医通二期”项目试点工作。项目主要目标是在不改变医保卡介质使用的前提下,让医保患者可以方便使用京医通支付体系,持一张医保卡即可完成在医生诊间、自助终端的便捷支付。同时,借助互联网应用建立京医通微信公众服务号,实现医保及京医通全人群患者在手机微信端进行预约挂号,就诊导诊等功能。试点项目投入使用后,使患者平均在院滞留时间减少16.7分钟,提升了患者就诊体验。以项目建设实践为基础,介绍了整个项目的系统架构设计、医疗机构对接方式、目前系统实现的功能、应用效果等内容,并结合项目建设规划总结项目建设的意义及存在的问题。
相似文献