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Exploration of rational drug use administration at Beijing Chaoyang Hospital 北京市朝阳医院合理用药管理的探索
Pub Date : 2019-09-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.09.017
Yan Yan, Hui Chen, Zhuoling An
Beijing Chaoyang Hospital of Capital Medical University has been designated as a pilot hospital for introduction of contemporary hospital management system. It actively explored a new model of rational drug use administration, namely setting up chief pharmacists, pharmacists classified management, precision drug use service, and strengthened management of rational drug use. These efforts have efficiently minimized patients′ burden of drug expenditure, and enhanced incentives of the pharmacists, achieving the pharmacy′s functional transformation and value enhancement. Key words: Pharmaceutical services; Rational drug use; Chief pharmacist system; Pharmacist classification
首都医科大学附属北京朝阳医院被确定为引进现代医院管理制度试点医院。积极探索设立主任药师、药师分类管理、精准用药服务、加强合理用药管理等合理用药管理新模式。这些努力有效地降低了患者的药费负担,增强了药师的积极性,实现了药房的功能转型和价值提升。关键词:医药服务;合理用药;总药师制度;药剂师分类
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引用次数: 1
Study on the self-identified overall performance effect of the resources sharing model at a regional medical imaging center under a hospital group 某医院集团区域医学影像中心资源共享模式的自我认同整体绩效效应研究
Pub Date : 2019-09-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.09.016
J. He, Fang Du, H. Chiu
Objective To learn the evaluation of the regional medical imaging resources sharing center by medical staff of a regional hospital group in Shenzhen city. Methods The group established a regional medical imaging resources sharing center in January 2016. One year later, a cross-sectional study was made on its medical staff using questionnaires. Such statistical methods as descriptive statistics and analytic hierarchy process among others were used to learn the self-identified overall effects for such a shared model. Results The questionnaire was responded by 24 medical imaging clinicians, 23 medical imaging technicians and 152 clinical doctors respectively. The comprehensive evaluation weight coefficient of the medical staff to the shared model was 0.692 2, whereas that to the distributed(conventional)model was 0.307 8. With regard to the shared model, 84.3%(43/51)of the clinical doctors held the imaging transmission as faster. 55.3%(84/152), 54.2%(13/24) and 53.6%(12/23) of the clinical doctors, imaging clinicians and technicians held the imaging quality as better than before. Respectively 95.8%(23/24)and 91.3%(21/23)of the imaging clinicians and technicians held their ability to read images or competence as improved. 54.2%(13/24)and 52.2%(12/23)of the imaging clinicians and technicians respectively held the cost performance of income as decreased. Conclusions Compared with the conventional management model, the medical staff tend to embrace the shared management model, but they complained greater stress, and less satisfaction. Key words: Medical image; Shared model; Self-identical overall effects; Questionnaires
目的了解深圳市某区域医院集团医务人员对区域医学影像资源共享中心的评价。方法集团于2016年1月建立区域医学影像资源共享中心。一年后,使用问卷对其医务人员进行了一项横断面研究。描述性统计和层次分析法等统计方法被用来学习这种共享模型的自我识别的总体效果。结果24名医学影像临床医生、23名医学影像技术人员和152名临床医生对问卷进行了回复。医务人员对共享模型的综合评价权重系数为0.692 2,对分布式(常规)模型的综合评判权重系数为0.307 8。关于共享模型,84.3%(43/51)的临床医生认为图像传输更快。55.3%(84/152)、54.2%(13/24)和53.6%(12/23)的临床医生、影像临床医生和技术人员认为影像质量比以前好。95.8%(23/24)和91.3%(21/23)的影像临床医生和技术人员认为他们的图像读取能力或能力有所提高。54.2%(13/24)和52.2%(12/23)的影像临床医生和技术人员认为收入性价比下降。结论与传统的管理模式相比,医务人员倾向于采用共享管理模式,但他们抱怨压力更大,满意度更低。关键词:医学影像;共享模式;自我相同的整体效果;调查表
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引用次数: 0
Standardization-based research on fiscal compensation measurement for communities in Shanghai 基于标准化的上海市社区财政补偿计量研究
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.014
A. Zhang
Objective To determine the standardized workload first of all. Then based on such workload, to establish the government′s resource input and allocation mechanism, and build the post setup, a fiscal compensation system, and the salary distribution mechanism of community medical staff. Methods This study selected 65 community health centers in Shanghai′s downtown area, suburban area and outer suburbs as sample units to investigate with questionnaires such indicators as community medical and health expenditure, standardized workload among others.With the measured workload as basis, item costs of health services at Shanghai′s communities were calculated. Results That of downtown, suburban and suburban areas accounted for 71.60%, 72.13% and 73.14% respectively of the total expenditure on health care.The unit cost of standardized workload varies with areas, while that in suburban and suburban areas was significantly higher than that downtown.The actual fiscal compensation was 20% lower than the target compensation as designed in the reform. Conclusions The ideal investment of basic public health services based on standardized workload can effectively realize the equalization of services among areas and promote effective allocation of resources.At the same time, estimates of the total standardized workload from the perspective of the demand side, and determination of an ideal investment ceiling for the investment of areas′ services budgets, can effectively minimize the waste of resources. Key words: Community health; Cost accounting; Standardized workload; Fiscal input; Shanghai
目的首先确定标准工作量。在此基础上,建立政府资源投入和分配机制,建立社区医务人员的岗位设置、财政补偿制度和薪酬分配机制。方法选取上海市区、近郊区和远郊区的65家社区卫生中心为样本单位,采用社区医疗卫生支出、标准化工作量等指标进行问卷调查。以实测工作量为基础,对上海市社区卫生服务项目成本进行了测算。结果市区、近郊区和近郊区医疗卫生支出分别占医疗卫生支出总额的71.60%、72.13%和73.14%。标准化工作量的单位成本因地区而异,而郊区和郊区的单位成本明显高于市中心。实际财政补偿比改革中设计的目标补偿低20%。结论以标准化工作量为基础的基本公共卫生服务的理想投入,可以有效地实现地区间的服务均等化,促进资源的有效配置。同时,从需求方的角度估计总的标准化工作量,并确定地区服务预算投资的理想投资上限,可以有效地最大限度地减少资源浪费。关键词:社区卫生;成本核算;标准化工作量;财政投入;上海
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引用次数: 0
Literature analysis on the implementation effect of family physicians contracted service policy in China 我国家庭医生签约服务政策实施效果的文献分析
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.009
Meng Cui, Qianqian Yu, Wenqiang Yin, Dong-mei Huang, Kui Sun, Zhongming Chen, Hongwei Guo, Yanli Li, Chun-yan Zhao
Objective To study the implementation effects of China′s contracted service policy for family physicians. Methods Systematic evaluation method was used to extract, describe and analyze the literature information of the research on the implementation effect of family physicians contracted service policy. Results A total of 80 papers of four types were rounded up, including 47 on the effect of health management on patients with chronic diseases, 11 on the effect of health management on the elderly, 15 on the effect on the first diagnosis in the community, and 7 on the effect on the control of medical expenses.The research is mostly distributed in the developed areas in the east.The family physicians contracted service promotes the health management effect of patients with chronic diseases and the elderlies, improves the first visit ratio of residents at their community, and effectively controls the medical expenses.Existing research shows that such a service has achieved initial success.However, the research also identified such common problems as the shortage and low competence of family physicians, low quality, resource integration and inadequate policy publicity. Conclusions The contracted service policy in China has begun to play the role of " health gatekeeper" and " cost gatekeeper" to some extent.It is suggested to strengthen the training of general practitioners, establish and perfect incentive mechanism, and improve the construction of information platform, while the implementation effect of contracted services for family physicians deserve further study in a broader scope, deeper level and design specifications. Key words: Family physicians; Contracted service; Implementation effect; Literature review
目的探讨我国家庭医生签约服务政策的实施效果。方法采用系统评价方法,提取、描述和分析家庭医生签约服务政策实施效果研究的文献资料。结果共收集了四类80篇论文,其中慢性病患者健康管理效果47篇,老年人健康管理效果11篇,社区首诊效果15篇,医疗费用控制效果7篇。研究主要分布在东部发达地区。家庭医生签约服务提高了慢性病患者和老年人的健康管理效果,提高了社区居民的首诊率,有效控制了医疗费用。现有研究表明,这种服务已取得初步成功。然而,研究也发现了家庭医生短缺和能力低下、质量低下、资源整合和政策宣传不足等常见问题。结论我国的签约服务政策在一定程度上开始发挥“健康守门人”和“成本守门人”的作用。建议加强全科医生的培训,建立健全激励机制,完善信息平台建设,而家庭医生签约服务的实施效果值得在更广的范围、更深的层次和设计规范上进一步研究。关键词:家庭医生;承包服务;实施效果;文献综述
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引用次数: 0
Cost accounting of telemedicine service items based on improved activity-based costing 基于改进作业成本法的远程医疗服务项目成本核算
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.015
Yun-kai Zhai, Xinran Liu, W. Lu, Sun Dong-xu, Jie Zhao
Telemedicine can optimize deployment of medical resources and minimize diagnosis discrepancies.Formulation of a rational project pricing and scientific compensation policy will be conducive to its future development.The concept of human resource consumption in RBRVS was used as reference to improve the activity-based costing(ABC)method.The authors sorted out the resource cost repository, identified the activity system, classified the motivation resources into respective activity cost repositories, and calculated the cost of respective cost object distribution.The cost of three telemedicine service items(remote single discipline consultation, remote image consultation and remote pathology consultation were 119.69, 147.03 and 161.61 yuan respectively)was calculated by the improved ABC.It can better indicate project costs than that calculated by the traditional ABC(137.30, 147.17 and 144.08 yuan), and proves more consistent with the existing prices of other province(134.00, 150.00 and 174.00 yuan). Key words: Telemedicine; Activity-based costing; Cost accounting; Medical service
远程医疗可以优化医疗资源的部署,最大限度地减少诊断差异。制定合理的项目定价和科学的补偿政策将有利于其未来的发展。以RBRVS中的人力资源消耗概念为参考,对作业成本法进行了改进。用改进的ABC法计算出远程医疗服务项目(远程单学科会诊、远程影像会诊和远程病理会诊)的费用分别为119.69元、147.03元和161.61元,比传统ABC法计算的项目费用(137.30元、147.17元和144.08元)更能反映项目费用,与其他省份的现行价格(134.00元、150.00元和174.00元)更为一致。关键词:远程医疗;作业成本法;成本核算;医疗服务
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引用次数: 0
Discussion on the doctor-patient relationship under the " Internet+ " scenario based on the concept of value co-production 基于价值共创理念的“互联网+”情景下的医患关系探讨
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.005
Yingchun Peng
Thanks to the advent of " Internet+ medical care" , the conventional doctor-patient relationship is facing changes, mostly the rise of patients′ say in healthcare services.This paper is based on a research hypothesis of the community of interests and value community in the healthcare system as well as a theory of value co-production.On such basis, the author explored how to understand the interests of the medical, patient, and network groups, analyzed the interest linkage mechanism affecting the relationship between doctors and patients, and established the design process of creating doctor-patient value and the cooperation mechanism between doctors and patients.Upon a reasonable realization of the interests of all parties, the effective establishment of an interactive relationship between doctors and patients and the mutual benefit of the interests of all parties should be effectively promoted. Key words: Doctor-patient relationship; "Internet+ "; Value co-production; Interest demands; Patient participation
由于“互联网+医疗”的出现,传统的医患关系正面临着变化,主要是患者对医疗服务的话语权上升。本文基于医疗卫生系统利益共同体和价值共同体的研究假设,以及价值共同生产理论。在此基础上,探讨如何理解医疗群体、患者群体和网络群体的利益,分析影响医患关系的利益联动机制,建立医患价值创造的设计流程和医患合作机制。在各方利益得到合理实现的基础上,才能有效地促进医患互动关系的有效建立,实现各方利益的互惠。关键词:医患关系;“互联网+”;价值合作生产;利益的要求;病人参与
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引用次数: 0
Text analysis of China′s family physicians contracted service policy based on policy tools 基于政策工具的中国家庭医生签约服务政策文本分析
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.008
Ziqiang Wang, Qianqian Yu, Wenqiang Yin, Dong-mei Huang, Kui Sun, Zhongming Chen
Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8%(124/235)mentioned commands and regulatory tool use, 27.2%(64/235)mentioned capacity building tool use, 13.2%(31/235)mentioned information and exhortation tool use, 5.1%(12/235)only mentioned incentive tool use, and 1.7%(4/235)only mentioned system change tool use; while most of them(34.3% and 32.7%)mentioned government and physicians, and only a few(17.6% and 15.4%)mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction. Key words: Family physicians; Contracted service; Policy tool; Text analysis
目的分析与家庭医生签约服务相关的政策文本,探讨我国推进家庭医生签约业务过程中的政策要点和存在的问题,为制度的优化和完善提供参考。方法选取2011-2019年中央政府发布的54份相关政策文本,建立基于政策工具和利益相关者的二维分析框架。通过对政策文本的定量分析和文献研究方法,对相关政策文本进行了分析。结果对54篇文本的研究发现,52.8%(124/235)提到命令和监管工具的使用,27.2%(64/235)提及能力建设工具的使用、13.2%(31/235)提到信息和劝告工具的使用以及5.1%(12/235)只提到激励工具的使用和1.7%(4/235)只提到系统变革工具的使用;大多数人(34.3%和32.7%)提到政府和医生,只有少数人(17.6%和15.4%)提到患者和医疗机构。结论建议优化政策工具组合,增加对医生的激励工具使用,探索新形式的制度变革工具。还提出要更加重视基层医疗机构的资源配置,重视患者的知晓率和满意度。关键词:家庭医生;承包服务;政策工具;文本分析
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引用次数: 0
Discussions on the management of healthcare big data open access 医疗大数据开放获取管理探讨
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.011
Haiyan Mou
Open access of healthcare big data has become a global consensus and trend, as it provides data support for big data analysis and leverages the value of data.This paper introduced the development status of data open access in the UK, US, Canada, Australia and China.On such basis, they explored data open access platforms, as well as the open access mechanism by category, degree and domain.In the end, this paper probed into such key issues as data collection, verification, selection, masking, organization, release, update and maintenance, in order to support the open access of China′s healthcare big data. Key words: Information services; Healthcare big data; Data open; Open access management; Platform architecture
开放获取医疗保健大数据已成为全球共识和趋势,因为它为大数据分析提供了数据支持,并利用了数据的价值。本文介绍了英国、美国、加拿大、澳大利亚和中国数据开放获取的发展现状,在此基础上探讨了数据开放获取平台,以及按类别、程度和领域的开放获取机制。最后,本文对数据的收集、验证、选择、屏蔽、组织、发布、更新和维护等关键问题进行了探讨,以支持中国医疗大数据的开放获取。关键词:信息服务;医疗大数据;数据开放;开放式访问管理;平台架构
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引用次数: 0
Positioning analysis of Shanghai′s tertiary public hospitals in the development of health service industry 上海市三级公立医院在卫生服务业发展中的定位分析
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.019
Zhixin Dai
In the development of Shanghai′s health services, tertiary public hospitals play an important role, and their positioning deserves in-depth research.The authors sorted out the relevant laws and policies of the state and Shanghai, clarified the relevant policy basis of tertiary public hospitals in the development of health service industry on the premise of public welfare, and proposed the functional orientation of these hospitals in the industry. Their roles include namely, proper provision of special medical services, focused efforts on the transformation of medical scientific and technological achievements, active cooperation with private medical institutions on contract basis, and promotion of the cluster development of health service industry chain.At the same time, the authors put forward policy suggestions to support the development of health industry in Shanghai′s tertiary public hospitals. Key words: Hospitals, public; Benefit; Health services industry; Positioning; Shanghai
在上海卫生事业的发展中,三级公立医院发挥着重要作用,其定位值得深入研究。作者梳理了国家和上海市的相关法律政策,明确了三级公立医院在公益性的前提下发展健康服务业的相关政策依据,并提出了这些医院在行业中的功能定位。它们的作用包括适当提供特殊医疗服务,集中力量转化医疗科技成果,积极与私营医疗机构进行合同合作,促进健康服务产业链的集群发展。同时,提出了支持上海市三级公立医院健康产业发展的政策建议。关键词:医院,公共;福利;健康服务业;定位;上海
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引用次数: 0
Effects of long-term studying abroad on scientific research ability of clinical doctors 长期出国留学对临床医生科研能力的影响
Pub Date : 2019-08-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2019.08.017
Chuan Yang, Yilin Gong, R. Zhao, Hui Liu, Huiqing Wang
Objective To analyze whether studying abroad has any influence on clinicians′ scientific research ability, and study the rationality of the indicators reflecting the scientific research ability. Methods A total of 36 clinicians who studied abroad more than 3 months between 2008 and 2010 were selected as the abroad group, and the control group of 36 clinicians was selected from the clinician information database of the hospital by the method of Propensity Score Match.A comparison and analysis were made regarding the number of papers(SCI), grants and scientific and technological achievements between the two groups.Meanwhile, covariance analysis was used to compare the difference in the number of scientific research achievements between the two groups.Logistic regression analysis was used to compare the changes in scientific research achievements of clinicians before and after their abroad study. Results The number of articles(SCI)published and grants obtained in the 3 years after going abroad was significantly higher than that of the control group, and the number of grants obtained in the 4-6 years after going abroad was also significantly higher than that in the control group.The number of papers(SCI)published in the three years after going abroad was more than that in the 3 years before going abroad.The number of grants obtained in the 4-6 years after going abroad was more than that in the 3 years before going abroad.These differences were statistically significant. Conclusions Studying abroad has a beneficial effect on the improvement of clinicians′ scientific research ability.It is reasonable and practical to take the number of SCI articles published as the indicator of short-term changes and the number of funds obtained as the indicator of long-term changes in scientific research ability. Key words: Clinician; Studying abroad; Scientific research ability; Personnel training
目的分析留学对临床医生科研能力的影响,探讨反映科研能力指标的合理性。方法选择2008~2010年出国留学3个月以上的36名临床医生作为出国组,采用倾向评分匹配法从医院临床医生信息库中选择36名临床医生为对照组,两组之间的赠款和科技成果。同时,采用协方差分析法比较两组科研成果数量的差异。采用Logistic回归分析法比较临床医生出国留学前后科研成果的变化。结果出国后3年发表的SCI文章数和获得的资助显著高于对照组,出国后4-6年获得的资助数也明显高于对照组。出国后三年内发表的SCI论文数量多于出国前三年。出国后4-6年获得的助学金数量多于出国前3年。这些差异具有统计学意义。结论出国留学对提高临床医生的科研能力有积极作用。以发表SCI文章的数量作为短期变化的指标,以获得资金的数量作为科研能力长期变化的指标是合理和实际的。关键词:临床医生;出国留学;科研能力;人员培训
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引用次数: 0
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中华医院管理杂志
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