医院成本管理在物资管理中的作用及效果

随着医疗改革的不断深入,成本管理逐步显示出其在医院管理中的应有地位。笔者结合医院物资管理的实践,探讨医院成本管理在物资管理中的作用及意义。     

对《2007年医院管理年活动方案》的认识与思考

针对新出台的2007年医院管理年活动方案，文章归纳了2007年管理年活动的主要内容和重点要求，并针对当前我国医院实际，紧密结合《医院管理评价指南（试行）》，从理念、质量、服务和管理4个方面着重分析了医院管理者应当关注的问题，以更好地贯彻落实管理年的有关精神和要求，科学制定出适合各级医院特点的更为具体和更具操作性的实施细则，促进我国公立医院管理水平不断提升。     

废弃物处理——一个刻不容缓的问题

介绍了香港环保署通过１０年努力的完整的固体废弃物收运，处理及处置系统，以及他们为实现废弃物减量化和资源化所采取的策略与行动。由此提出上海浦东新区在固体废弃物管理和环卫设施建设上应加强关注；逐步按规划实施；采用多种形式设计，建造，营运环卫设施以及开展全方位宣传教育活动的建议。     

试论门诊管理

结合门诊管理的实践,对如何加强门诊管理进行了论述。主要为:①掌握门诊特点,确定门诊管理重点;②做好工作计划,实施目标管理;③充分发挥门诊部办公室的作用,承上启下,及时协调;④健全门诊管理组织,完善门诊管理规定;⑤抓好服务质量,方便病人就医;⑥加强质量考核,确保门诊工作质量。     

住院医师规范化培训过程管理的实践与探索：基于信息化管理平台

本研究基于信息化管理平台的建设,深入探索了住院医师规范化培训过程管理方法。研究结合管理实践,对过程管理内容进行了梳理和分析,并将过程管理理念与内容融入信息化管理平台的开发建设中。通过信息化平台的建设,实现了科学有效的住培过程化管理,以过程管理为核心的信息化管理平台不仅有助于住培制度的更新与落实,还构建了多角色关联互动的桥梁,保证了信息的准确性,推动了质量保障体系的建设。该研究为保障培训质量提供了有效工具,对培养卓越医学人才具有重大意义。     

国外经典慢性病管理模式对我国慢性病管理的启示

随着城镇化加快、生活方式变化及全球人口老龄化,慢性病带来的危害日益严重。慢性病的服务提供是卫生服务系统的难题之一,而慢性病管理模式为其创设了一个新的框架。本文主要介绍慢性病照护模式、慢性病自我管理计划和创新型慢性病照护框架3种国外经典慢性病管理模式,从特点、应用效果、局限性等方面进行比较,发现其核心要素包括多方协同、连续性服务、患者自我管理、循证决策、信息技术支持等。以上经验为我国的慢性病管理工作提供了新思路：建立政府主导、多元协同的管理制度,以家庭医生签约服务为“抓手”提高服务连续性,借力智慧医疗并强化患者赋能等,以期取得更好的慢性病管理效果。     

分级诊疗背景下多病共存患者就医机构选择行为及其影响因素研究

背景 近年来,国内针对多病共存患者在分级诊疗背景下就医机构选择行为的研究较少,研究多病共存患者的就医机构选择行为有重要的现实意义。目的 以分级诊疗为视角,分析多病共存患者就医机构选择行为及其影响因素,为进一步落实分级诊疗制度和合理配置医疗资源提供研究参考。方法 采用随机抽样法,选取2019-06-01至2020-01-01在上海市杨浦区中心医院医疗联合体（上海市杨浦区中心医院和上海市杨浦区定海、延吉、长白社区卫生服务中心）就诊的多病共存患者为研究对象。采用自设问卷对其进行调查,收集多病共存患者的一般资料,了解其对分级诊疗政策的认知情况及实际遵守情况、在不同疾病控制状况下至社区卫生服务中心首诊的意愿,以及其选择就诊医疗机构时考虑的因素等。采用二分类Logistic回归分析多病共存患者此次因病就医是否选择至社区卫生服务中心首诊的影响因素。结果 共发放1 100份问卷,回收有效问卷1 072份,有效问卷回收率为97.45%。1 072例多病共存患者中,老年（≥60岁）多病共存患者占85.07%(912/1 072)。624例（58.21%）患者表示知晓分级诊疗制度;940例（87.69%）患...     

An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System)

To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

Benefits of the DICOM Modality Performed Procedure Step

A few years ago, the Digital Imaging and Communications in Medicine standard introduced a network transaction that is initiated by modality equipment, mainly at the beginning and at the end of the acquisition. This transaction, the Modality Performed Procedure Step (MPPS), is sent to the Picture Archiving and Communication System and/or to the Radiology Information System. It carries information about what really has been performed by the modality equipment during acquisition. In this paper, we present MPPS and discuss its benefits. We show how MPPS enables efficient radiology workflow and how it ensures accuracy and completeness of imaging information. We think our paper helps bridge the gap between MPPS implementation and deployment. By understanding all the MPPS benefits, the end user becomes aware of the great enhancement in patient care that this transaction provides.