Health care for children in foster care

Every month 6,600 children in Oklahoma live under the custody of the state, most as result of being abused or neglected by their own families. The state provides medical care to these children via the Medicaid program. The American Academy of Pediatrics(AAP) has set forth a guideline for optimal care of these children. We discuss the current Oklahoma health care system for foster children and suggest changes that may move Oklahoma in the direction of the AAP recommendations. A more uniform, organized medical system may not only meet a foster child's medical needs but may also provide a degree of continuity to an otherwise discontinuous process.     

Linking primary care with adult care homes

This commentary describes a pilot program wherein a community health center is partnering with Community Care of North Carolina to create a system of integrated care management and "treatment-in-place" visits for aged residents and disabled residents of adult care homes, with the goal of improving the quality of care and reducing unnecessary visits to emergency departments.     

重症监护治疗学（12）：——重症监护的组织构成

重症监护始于 1 952年 ,由于当时脊髓灰质炎在哥本哈根流行 ,接受胸甲通气治疗的患者死亡率高达 90 %,而通过气管切开实施手动正压通气治疗 ,并联合将患者集中到一个特定病区进行特殊监护的方法 ,可使死亡率降至 40 %。这种病床旁的持续监护虽然提高了监护质量 ,但却增加了医疗费用 ,而对于某些患者 ,只是推迟了死亡时间。这些成果对现代重症监护仍有影响。重症监护技术发展非常迅速 ,目前几乎每个医院都拥有不同形式的重症监护病房。关于重症监护的质量和费用、重症监护病房的大小和位置、医疗护理人员和重症监护床位的数目 ,以及如何利用…     

National health care surveys and health care management

The bulk of medical care in the United States is provided in hospitals, physicians' offices, and nursing homes. The National Center for Health Statistics conducts three health record surveys that collect information on patient and provider characteristics and the services provided in these three settings. This paper describes each of these three surveys in terms of background (scope and data set), design, collection, processing procedures, and data dissemination. In addition, specific examples of how the survey data have been or can be used for management purposes in terms of monitoring, evaluating, and planning the utilization of health care in the United States are given.     

Managed care and physicians' provision of charity care

Context  Health system changes may be affecting the ability of physicians to provide care with little or no compensation from patients who are uninsured and underinsured and may result in decreased access to physicians for uninsured persons. Objective  To examine the association between managed care and physicians' provision of charity care. Design  The 1996-1997 Community Tracking Study physician survey. Setting and Participants  A nationally representative sample of 10,881 physicians from 60 randomly selected communities. Main Outcome Measure  The number of hours in the month prior to the interview that the physician provided care for free or at reduced fees because of the financial need of the patient. Results  Overall, 77.3% of respondents provided an average of 10.3 hours of charity care per week. Physicians who derive at least 85% of their practice revenue from managed care plans were considerably less likely to provide charity care and spend fewer hours providing charity care than physicians with little involvement in managed care plans (P=.01). In addition, physicians who practice in areas with high managed care penetration provided fewer hours of charity care than physicians in other areas, regardless of their own level of involvement with managed care (P<.01). Differences in charity care provision were also shown for other important factors, including ownership of the practice and practice arrangements (more charity care occurred in solo and 2-physician practices; P<.01). Conclusion  Physicians involved with managed care plans and those who practice in areas with high managed care penetration tend to provide less charity care.      

伤口护理中的营养护理实践

现代伤口护理理论认为，营养护理应贯穿伤口护理的始终。实践证明，动态估计患者的营养状况，并区分营养不良的危险性和程度，是制订和实施个体化营养计划的基础；动态监测与评价营养状况是确保营养护理安全有效的重要环节。本文重点介绍有关伤口护理中营养护理的方法、内容、判断标准、监测指标及并发症预防。