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Strategy of hospital logistic support to the battle against novel coronavirus pneumonia/ 中华医院管理杂志 抗击新型冠状病毒肺炎的医院后勤保障策略中华医院管理杂志
Pub Date : 2020-02-13 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.0002
Changgui Chen, Junfang Xuan, Xiaohua Huang, Hongyan Shou, Jinhong Fu, Gongyi Wang, Zhaobin Cai
Nowadays hospitals have been at the forefront fighting against novel coronavirus pneumonia, with diagnosing and treating of patients as a top priority. In order to ensure the smooth progress of diagnosis and treatment, and prevent the occurrence of nosocomial infection, logistics support needs to make allowances for the isolation ward in time from the perspectives of logistics, facilities and equipment, and to transform the in-and-out double channels of ward access as required, thus setting up the partition of the three zones. Secondly, logistics support needs to optimize the logistics service workflow, including the medical waste management, the environmental disinfection isolation, and to optimize the catering service within hospitals to reduce the gathering and flow of personnel. Thirdly, logistics support needs to increase personnel training, and to eliminate psychological panic as well as to stabilize the logistics support team by putting logistics management cadres on the front line. Meanwhile, the logistics department needs to take over the hospital access screening work, strictly manage those who enter the hospital, maximize the safety and reliability of the logistics support within the hospital, and ensure the smooth progress of the epidemic prevention work. Key words: Hospitals; Novel coronavirus pneumonia; Logistical support; Process reengineering; Epidemic prevention
如今,医院一直站在抗击新型冠状病毒肺炎的最前线,诊断和治疗患者是重中之重。为了保证诊疗工作的顺利进行,防止院内感染的发生,后勤保障需要从后勤、设施、设备等方面及时为隔离病房做好准备,并根据需要改造进出病房的双通道,从而设置三区分区。其次,后勤保障需要优化后勤服务工作流程,包括医疗废物管理、环境消毒隔离,并优化医院内的餐饮服务,以减少人员聚集和流动。第三,后勤保障需要加强人员培训,消除心理恐慌,把后勤管理干部放到第一线,稳定后勤保障队伍。同时,后勤部门需要接管医院出入筛查工作,严格管理进入医院的人员,最大限度地提高医院内部后勤保障的安全性和可靠性,确保防疫工作的顺利进行。关键词:医院;新型冠状病毒肺炎;后勤保障;流程再造;防疫
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引用次数: 0
Study on the driving factors and forming mechanism of the willingness for primary doctors to make initial diagnosis 基层医生初诊意愿的驱动因素及形成机制研究
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.016
Y. Qian, Xiaohe Wang, Jie Chen, Jiajun Ren, Gangmei Cheng, Wen Pan
Objective Based on the KAP and Prospect theory, to explore, construct and verify the theoretical model and formation mechanism of driving factors of primary care doctors′ willingness to carry out the primary diagnosis. Methods Using the random cluster sampling method, from April to May 2019, a questionnaire survey was conducted among doctors at 20 primary medical and health service institutions in Hangzhou. The survey covered the primary care doctors′ cognition level of primary diagnosis, their self-evaluation of primary medical care capabilities, evaluation of policies and systems, expectation of primary medical care, and their job satisfaction. Descriptive statistic, multiple linear regression and structural equation model were used to analyze and explore the driving factors and formation mechanism of their willingness to carry out the primary diagnosis. Results Primary care doctors′ willingness rate for primary diagnosis was 76.4%(308/403). Positive expectation(beta=0.309), cognition level(beta=0.216), evaluation of policies and systems(beta=0.184), and self-evaluation of primary diagnosis capability(beta=0.170), all of which directly affect the said willingness. The total effect of the five types of driving factors on the willingness of the primary diagnosis was as follows: cognitive level of the primary diagnosis(0.536), evaluation of the policy system(0.494), self-evaluation of the primary diagnosis capability(0.436), positive expectations of the primary diagnosis work(0.186), job satisfaction(0.146). Conclusions The cognition of the primary diagnosis, the capability of the primary diagnosis, the policy system and the positive expectation are the important premises, key driving forces, and a strong guarantee and motivation to drive primary care doctors to carry out the primary diagnosis. It is suggested that the government and medical institutions should further improve the cognition level of primary care doctors, focusing on systematically improving the service capability of primary care doctors′ primary consultation, coordinating to improve policy guidance measures such as financial input, medical insurance reimbursement and referral system, establishing and improving incentive measures such as career development, performance appraisal, salary and welfare of primary care doctors. Key words: Initial diagnosis at primary level; Intention of initial diagnosis; Driving factors; Mechanism; Structural equation model
目的以KAP和Prospect理论为基础,探索、构建和验证初级保健医生进行初级诊断意愿驱动因素的理论模型和形成机制。方法采用随机整群抽样方法,于2019年4月至5月对杭州市20家基层医疗卫生服务机构的医生进行问卷调查。调查涵盖了初级保健医生对初级诊断的认知水平、对初级保健能力的自我评价、对政策和制度的评价、对初级医疗保健的期望以及他们的工作满意度。采用描述性统计、多元线性回归和结构方程模型,分析和探讨他们愿意进行初级诊断的驱动因素和形成机制。结果基层医生对基层诊断的意愿率为76.4%(308/403),积极期望(β=0.309)、认知水平(β=0.216)、政策制度评价(β=0.184)、基层诊断能力自评(β=0.170),均直接影响基层诊断意愿。五类驱动因素对初级诊断意愿的总体影响如下:初级诊断认知水平(0.536)、政策体系评价(0.494)、初级诊断能力自我评价(0.436)、对初级诊断工作的积极期望(0.186),工作满意度(0.146)。结论对初级诊断的认知、初级诊断的能力、政策体系和积极期望是推动初级保健医生进行初级诊断的重要前提和关键驱动力,是推动初级诊断的有力保障和动力。建议政府和医疗机构进一步提高基层医生的认知水平,重点系统提升基层医生基层会诊服务能力,协调完善财政投入、医保报销、转诊制度等政策引导措施,建立健全基层医生职业发展、绩效考核、薪酬福利等激励措施。关键词:初级阶段的初步诊断;初步诊断意图;驱动因素;机制;结构方程模型
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引用次数: 0
Research on operation mechanism of precision medical service system based on the actor network theory 基于行动者网络理论的精准医疗服务系统运行机制研究
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.004
Jie Zhao, Yixuan Yang, Tianlin Wang, Jinghong Gao, Yun-kai Zhai
The actor network theory, with reference to systems science, sociology and management science, offers a new perspective for research of the technology-society binary view. This theory as introduced by the authors, analyzed the constituent bodies and their relationship of the operation of the precise medical service system, and studied the translation process of the actor network. The analysis showed that the main factors affecting the operation of the precision medical service system were hospitals, patients, governments, scientific research institutions, technology-based enterprises, and universities, which were suppliers, demanders, managers, funders, and technical supporters of precision medical services. Among them, 82.72%(335/405) of clinicians believed that hospitals were the core actor that affected the operation of precision medical service system. 71.60%(290/405) of the clinicians thought that the training of medical workers was the current focus of the hospital, i. e., the mandatory access point for this actor network. Through training, the accurate medical service ability of medical workers and hospitals can be improved. Key words: Precision medicine; Service system; Actor network theory; Operation mechanism
行动者网络理论借鉴了系统科学、社会学和管理学的理论,为技术-社会二元观的研究提供了新的视角。作者介绍了这一理论,分析了精准医疗服务系统运行的组成主体及其相互关系,研究了行动者网络的翻译过程。分析表明,影响精准医疗服务体系运行的主要因素是医院、患者、政府、科研机构、科技型企业和高校,他们是精准医疗服务的提供者、需求者、管理者、资助者和技术支持者。其中,82.72%(335/405)的临床医生认为医院是影响精准医疗服务系统运行的核心行动者。71.60%(290/405)的临床医生认为医护人员的培训是目前医院的重点,即该行动者网络的强制性接入点。通过培训,可以提高医务工作者和医院的精准医疗服务能力。关键词:精准医疗;服务体系;行动者网络理论;运行机制
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引用次数: 0
Analysis on the application status of artificial intelligence in healthcare 人工智能在医疗保健中的应用现状分析
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.012
Chenyang Wang, Xi-long Pan, Manqi Wu, Yonggang Li
The combination of healthcare and artificial intelligence is an important direction of medical development. The authors summarized the application of artificial intelligence in such fields as diagnosis, treatment, prevention, scientific research, teaching among others. The analysis covers the problems and challenges facing the development of artificial intelligence, and looks forward to the application prospect of artificial intelligence. Key words: Information service; Artificial intelligence; Healthcare; Application area
医疗保健与人工智能的结合是医学发展的重要方向。作者总结了人工智能在诊断、治疗、预防、科研、教学等领域的应用。分析了人工智能发展面临的问题和挑战,并展望了人工智能的应用前景。关键词:信息服务;人工智能;医疗保健;应用领域
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引用次数: 0
Progress in the applications of standardized patients in medical education and healthcare research 标准化患者在医学教育和卫生保健研究中的应用进展
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.017
Jiahui Li, Cenyi Shao, Tai-Seale Ming, Zhiruo Zhang
As a standard component in medical education in many countries, standardized patients have become professionals who provide valuable opportunities for training and evaluation of clinical skills among medical students and physicians. This paper reviewed the application of standardized patients in health care, discussed its advantages and disadvantages, and advocated continuation of in-depth research on standardized patients in China, and acceleration in the establishment of a formal system of standardized patients in medical education and health systems, so as to improve the quality of medical care. Key words: Medical education; Standardized patients; Health care; Application
作为许多国家医学教育的标准组成部分,标准化患者已成为专业人员,为医学生和医生的临床技能培训和评估提供了宝贵的机会。本文回顾了规范化患者在医疗保健中的应用,探讨了规范化患者的利弊,主张继续在中国深入开展规范化患者研究,加快在医学教育和卫生系统中建立规范化患者的正式制度,以提高医疗服务质量。关键词:医学教育;标准化病人;卫生保健;应用程序
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引用次数: 0
Analysis on the experience of inpatients at tertiary hospitals in Shanxi province 山西省三级医院住院患者经验分析
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.014
Xiaocheng Wang, Zhi Zhao, Jingyi Zhao, Linger Shen, Wenjing Hao, Xiaoqiang Ren
Objective To evaluate the medical services of tertiary hospitals in Shanxi province from the perspective of patients and provide references for improving the quality of medical services. Methods From April to December 2018, 1 358 patients at 8 tertiary hospitals in Shanxi province were selected for the survey of medical service quality evaluation scale based on patient experience, while the status quo of patient experience in tertiary hospitals in Shanxi province was evaluated, and the multivariate mixed linear model was constructed based on the three-level model of hospital-department-patient to analyze the relevant factors of patient experience. If the quantitative data conform to the normal distribution, it was expressed as ±s. Otherwise, it was expressed as M(QR). Results The patient experience score was 626±126, which was in the middle level. Whether the hospital was directly affiliated to the teaching hospital, and patient factors(marriage, occupation, education, medical insurance, number of hospital stays, etc.)were the main factors that affect the patient experience score(P<0.05). Conclusions Through the investigation, the influence characteristics of patients′ medical experience were discussed to improve the medical service and the overall service level. Key words: Health services administration; Tertiary hospitals; Patient experience; Influencing factors; Shanxi province
目的从患者角度评价山西省三级医院医疗服务质量,为提高医疗服务质量提供参考。方法2018年4 - 12月,选取山西省8家三级医院的1 358名患者进行基于患者体验的医疗服务质量评价量表调查,同时对山西省三级医院患者体验现状进行评价,并基于医院-科室-患者三级模型构建多元混合线性模型,分析患者体验的相关因素。如果定量数据符合正态分布,则表示为±s。否则表示为M(QR)。结果患者体验得分为626±126分,处于中等水平。是否隶属于教学医院、患者因素(婚姻、职业、学历、医疗保险、住院次数等)是影响患者体验评分的主要因素(P<0.05)。结论通过调查,探讨患者就医体验的影响特点,提高医疗服务水平和整体服务水平。关键词:卫生服务管理;三级医院;病人的经验;影响因素;山西省
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引用次数: 0
Discussions on medical quality monitoring auxiliary system based on clinical big data 基于临床大数据的医疗质量监测辅助系统探讨
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.013
Manqi Wu, Xi-long Pan, D. Cheng, Chenyang Wang, Yonggang Li
With the development of big data, the Internet and information technology, artificial intelligence is gradually being applied to the field of hospital management. The authors used advanced artificial intelligence technology to conduct structured collection and monitor the hospital′s current medical quality data, identifying key points and key events affecting medical quality and safety from the link, and providing medical personnel′s behavior with pre-warning, process monitoring and post-evaluation to improve hospital medical quality management. Key words: Information service; Artificial intelligence; Medical quality; Medical safety; Auxiliary system
随着大数据、互联网和信息技术的发展,人工智能正逐步应用于医院管理领域。采用先进的人工智能技术,对医院当前医疗质量数据进行结构化采集和监测,从环节上识别影响医疗质量安全的关键点和关键事件,为医务人员行为提供预警、过程监控和事后评价,提高医院医疗质量管理水平。关键词:信息服务;人工智能;医疗质量;医疗安全;辅助系统
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引用次数: 0
Formation mechanism of the weakening of village clinic′ s medical service capacity in Shandong province 山东省村卫生室医疗服务能力弱化的形成机制
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.008
Zhongming Chen, Guifang Ren, Wenqiang Yin, Lingyu Li, Dong-mei Huang, Hongwei Guo, Lili Zhu
Objective To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform. Methods Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity. Results 29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken. Conclusions The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic. Key words: Village clinic; Village doctor; Medical service; Grounded theory; Vulnerability; Shandong province
目的探讨新医改背景下乡村卫生室医疗服务能力弱化的形成机制。方法采用目的抽样方法,于2015年10月至2015年11月对38名农村医生和农村卫生院、卫生所管理人员进行访谈。并运用扎根理论分析了乡村卫生室医疗服务能力弱化的原因及其机理。结果共编制出29个一级分类和7个二级分类。随着医改的实施,财政、政策、技术等方面的支持力度明显加大,但由于改革的意外负面效应、干扰和无效支持的叠加积累等综合作用,村卫生室的医疗服务能力开始减弱。结论村卫生室医疗服务能力下降是3个原因综合作用的结果。这种状况的持续将加剧农村卫生服务体系的脆弱性,不利于分级医疗政策和乡村振兴战略的实施。优化基本药物制度,建立村卫生室基本医疗服务和基本公共卫生服务综合评估机制,加强医疗保险战略购买,完善财政补偿机制,完善村医培训体系,促进村卫生室可持续发展。关键词:村卫生室;乡村医生;医疗服务;扎根理论;漏洞;山东
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引用次数: 2
Study on compensation mechanism reform of primary healthcare institutions in Zhejiang province 浙江省基层医疗卫生机构薪酬机制改革研究
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.002
Minzhuo Huang, Yuanyuan Li, Xiaoqian Hu, Yuxuan Gu, X. Zhen, Xueshan Sun, Jingming Wei
Objective To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas. Methods Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis. Results This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms. Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable. Key words: Primary healthcare institutions; Compensation mechanisms; Work equivalents; Evaluation; Zhejiang province
目的从公平性、实效性、激励机制和可持续性等方面对浙江省基层医疗卫生机构薪酬新机制进行评价。方法基于利益相关者理论、公平理论、期望理论和可持续发展理论构建评价指标。与利益相关者进行焦点小组访谈,并通过问卷调查收集定量数据。同时,收集四个试点地区该类机构的经济报酬、收支和工作当量数据,定量数据采用描述性分析。结果研究发现,改革利用了不同基层医疗卫生机构合理的资金分配比例(职工基本工资比例低于50%)和调整因子(1.0 ~ 1.8),保证了改革的公平性;工作当量的增加(试点县医务人员人均工作当量由上年的38435万增加到4259万工作当量)反映了改革的成效。改革的激励和可持续性是薄弱环节。这主要是由于基层医疗机构内部分配制度没有进行相应的改革。结论以等值法为基础的补偿机制改革,改变了医务人员对资金分配的看法。“多劳多得”的原则和利用信息技术获取工作等值,提高了基层医务人员的积极性和机构的运行效率,改革总体上是科学合理的。关键词:基层卫生保健机构;补偿机制;工作等价物;评估;浙江省
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引用次数: 0
Connotation of village doctors′ vulnerability based on Delphi method 基于德尔菲法的村医脆弱性内涵分析
Pub Date : 2020-01-02 DOI: 10.3760/CMA.J.ISSN.1000-6672.2020.01.006
Wenqiang Yin, Ziying Chen, Longde Zhou, Cheng Cheng, Hongwei Guo, Dong-mei Huang, Qianqian Yu, Lili Zhu, Zhongming Chen
Objective To define the connotation of village doctors′ vulnerability. Methods On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015. Results Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%. Conclusions The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors. Key words: Health human resource; Village doctor; Vulnerability; Connotation
目的明确乡村医生脆弱性的内涵。方法在文献分析的基础上,采用德尔菲法对2015年10月至2015年11月村医脆弱性内涵进行咨询论证。结果共会诊专家20人,会诊专家16人。根据这些咨询,专家对7个咨询单位的接受率从74.29%提高到93.16%。结论村医的脆弱性是指其对外部环境的自我能力和支持能力无法应对所面临的干扰的状态,而脆弱性是由干扰和村医的应对能力共同决定的。关键词:卫生人力资源;乡村医生;漏洞;内涵
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引用次数: 1
期刊
中华医院管理杂志
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