Demands and influencing factors of digital transition care service in discharged older patients:a cross-sectional study

Objective:To identify the group classification of discharged older adults’digital transition care demands and analyze its influencing factors.Methods:From July to August 2022,we used stratified random sampling to recruit older patients who were discharged between July 2021 and July 2022 from tertiary hospitals in Shanghai.We used latent profile analysis to classify the older patients into distinct groups based on their service demands:low,medium,and high.We use multiple logistic regression to explore the factors influencing the different demand levels.Results:The degree of discharged older patients’demand was classified as low(Category 1(C1),34.2%),medium(Category 2(C2),49.5%),high-demand levels(Category 3(C3),16.3%).Compared to those have C2,older adults in C1 are more likely to be male(Odds Ratio(OR)=2.81,P=0.02),have 2 chronic diseases(OR=3.91,P=0.03),and are less likely to be junior high and below(OR=0.09,P=0.00),hospitalized for 1–2 times in the past year(1 times:OR=0.19,P=0.07;2 times:OR=0.14,P=0.02),living with children(OR=0.32,P=0.05),have less insurance(OR=0.48,P=0.03),less understanding of digital transitional care(OR=0.47,P=0.01),have less eHealth literacy(OR=0.80,P=0.00),have less degree of importance attributed by family(OR=0.52,P=0.03);Compared to those have medium demand level,older adults in high demand level are more likely to have self and spouse as primary income(self:OR=26.35,P=0.00;spouse:OR=24.06,P=0.02),walking to the nearest health facility(self:6.74,P=0.03),have higher eHealth literacy(OR=1.88,P=0.00),degree of importance within the family(OR=5.19,P=0.01),higher self’s influence on medical decisions-making(OR=5.69.P=0.01).They are less likely to be in 60–79 years group(OR=0.00–0.37,P=0.00–0.03),Household Annual Income<5,000 CNY(OR=0.05,P=0.02).Conclusion:Digital transitional care demands of discharged older patients can be divided into three categories.Constructing a digital transitional care service system that aligns with the demands of discharged older patients is essential.Communication,care plan development,and follow-up are the most fundamental services.Additionally,it is essential to understand the characteristics of high-demand populations to provide tailored services and identify vulnerable populations from health and social perspectives to offer cost-effective transitional care services.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Evaluation and Analysis of Hospital Disaster Preparedness in Jeddah

Introduction: Disaster damage to health systems is a human and health tragedy, results in huge economic losses, deals devastating blows to development goals, and shakes social confidence. Hospital disaster preparedness presents complex clinical operation. It is difficult philosophical challenge. It is difficult to determine how much time, money, and effort should be spent in preparing for an event that may not occur. Health facilities whether hospitals or rural health clinics, should be a source of strength during emergencies and disasters. They should be ready to save lives and to continue providing essential emergencies and disasters. Jeddah has relatively a level of disaster risk which is attributable to its geographical location, climate variability, topography, etc. This study investigates the hospital disaster preparedness (HDP) in Jeddah. Methods: Questionnaire was designed according to five Likert scales. It was divided into eight fields of 33 indicators: structure, architectural and furnishings, lifeline facilities’ safety, hospital location, utilities maintenance, surge capacity, emergency and disaster plan, and control of communication and coordination. Sample of six hospitals participated in the study and rated to the extent of disaster preparedness for each hospital disaster preparedness indicators. Two hazard tools were used to find out the hazards for each hospital. An assessment tool was designed to monitor progress and effectiveness of the hospitals’ improvement. Weakness was found in HDP level in the surveyed hospitals. Disaster mitigation needs more action including: risk assessment, structural and non-structural prevention, and preparedness for contingency planning and warning and evacuation. Conclusion: The finding shows that hospitals included in this study have tools and indicators in hospital preparedness but with lack of training and management during disaster. So the research shed light on hospital disaster preparedness. Considering the importance of preparedness in disaster, it is necessary for hospitals to understand that most of hospital disaster preparedness is built in the hospital system.

The Prevention and Control Measures of COVID-19 in the People’s Hospital of Pingchang County

COVID-19 (COVID-19) or COVID-19 is pneumonia caused by the novel coronavirus infection in patients in 2019. COVID-19 pneumonia epidemic is widespread, wide, and deep. To effectively combat the further spread of COVID-19: the overall protocol of the hospital: “three lines of defense” of community prevention and control, fever clinic and face-to-face treatment;grasp the good three-time limits: “2 hours, 12 hours and 24 hours”;do a good job of three key points: key areas and places and groups;carry out four early prevention and control measures: early detection, early reporting, early isolation and early treatment;management of confirmed, suspected, fever, close contact “four types of personnel”;implement l responsibility system;doing all receivable, should be treated, should be checked, should be separated by “four should be”;do investigation, control, supervision, education, and care “five in place”. Through the above methods, the People’s Hospital of Pingchang County has effectively controlled COVID-19.

Financial Sustainability of a Public or Private Health System,a Condition for a Romania With a Healthy Population

Can Romania have a sustainable health system,so that the population can choose medical services at a state hospital or at a private hospital?A healthy state,with a healthy population,can ensure a viable balance with a secure future.Each country ensures its health system through levers,policies,and well-defined sources of funding,determined by demographics,geographical position,culture,nationality,has the necessary sources to implement its own health system,whether it is public or private.The programs that can be implemented in the health system start from the quality of medical services,which must be provided so that each patient can be sure that medical needs are achievable.We have a people with diverse traditions,a beautiful culture,specialized doctors and yet the medical system is still fragile.Funding programs must help us start this health system,build many private hospitals,so from prevention to services specialized,surgical,to be able to bring in the country specialized medical staff to us but gone to many states of the world.Any change can lead us to what we want,the health of our population in the village,the city,the majority of the population,the identification of possibilities to revive the health system.The market of private health systems,diversified by international players,bank brokers,manages to bring important changes in the health system.From a technical point of view,health insurance has its originality in the impossibility of being able to predict the insured’s illness and the costs necessary for recovery.Any risk related to personal injury,illness,temporary incapacity for work,can be identified,assessed in the form of medical expenses,loss of income,as a result,disability,borne by both the individual and the family,due to the inability to insure a normal activity,daily existence.Insurance can be considered as a method of controlling the health risk.The current situation regarding the disease of the population whit COVID often makes us understand that we must be prepared at all times.The situation of the pandemic SARS-COV 19 found a timely solution through the private health system.

医防融合的关键问题、机制创新与实现路径

我国医疗服务与公共卫生服务相互割裂的问题由来已久,医防融合是新时代背景下实现健康中国战略的重要举措。当前,在医防融合试点实践中,存在医疗卫生服务体系多头管理、紧密型医联体尚未真正形成、医院“重医轻防”理念仍未转变、医防信息不能互联互通等问题。对此,可以借鉴宿迁的经验,从组织管理、医防服务供给、卫生筹资、医防人才与医防信息等方面入手,实现医防融合的机制创新,在此基础上,将医防融合作为常态化制度持续向纵深推进。

中国基层医疗服务发展对老年人健康的影响

实现健康老龄化是我国积极应对人口老龄化的一项重要战略任务。老年人的健康状况和医疗服务需求特点决定了基层医疗服务在促进老年健康中的重要地位。基层医疗服务发展对老年人健康具有重要影响。分析评估我国基层医疗服务发展的成就和不足,更好地发挥基层医疗服务在促进健康老龄化和建设健康中国中的作用具有重要的现实意义。本文从老年人感知的基层医疗服务可及性、服务可得性和服务适配性三个维度构建反映基层医疗服务发展水平的综合指标,利用2015年和2018年中国健康与养老追踪调查(CHARLS)数据,实证检验和分析我国基层医疗服务发展水平对老年人健康的影响及其作用机制。研究发现老年人感知的基层医疗服务发展水平越高,自评健康水平就越高,自评健康改善状况也越好,说明基层医疗服务发展对老年人健康具有积极作用,且结论具有稳健性。基层医疗服务发展会改善医疗服务便利性,降低医疗服务费用,促进老年人的医疗服务利用,降低老年人医疗服务需求未满足的程度;基层医疗服务还担负着向辖区居民开展疾病预防与控制、健康教育、居民健康档案管理、慢性病患者健康管理、老年健康与医养结合服务等初级卫生保健服务的职责,可以改善老年人健康管理水平;基层医疗服务发展能够提高老年人健康素养,有助于培养健康生活方式与行为,最大限度消除健康危险因素,从而促进老年人健康。机制检验发现医疗服务需求满足程度、健康管理状况、健康素养与行为在基层医疗服务发展影响老年人健康过程中发挥了部分中介作用。异质性分析结果表明基层医疗服务发展对老年健康的影响在不同地区、不同年龄阶段、不同收入水平和健康状况的老年群体之间存在显著差异。中西部地区和农村地区老人、中低龄老人、低收入老人和罹患慢性病的老人从基层医疗服务发展中受益更大。政府应进一步优化基层医疗资源配置,增强基层医疗服务能力,增加服务供给,在提高老年人医疗服务需求满足程度的同时提高老年人健康管理水平,提升老年人健康素养,培养健康行为方式,更好地发挥基层医疗服务促进老年人健康的作用。

突发公共卫生事件背景下公立医院医疗物资供应冲突管理

文章基于突发公共卫生事件状态下公立医院医疗物资供应冲突发生的环境、事发经过、情境结果及冲突条件等要素,运用冲突管理有关理论探索冲突的构成要素及其结果、冲突中人员管理的一般性方法及冲突解决途径。在研究中不难发现,强制型管理风格在应对医疗物资全方位供应复杂性工作面前适用性略显不足,知识型员工在保健与激励因素共同负强化下使得人员管理更加如履薄冰,合作型冲突管理能够较为有效地解决冲突窘境。组织中的各类冲突在所难免,冲突的发生与领导管理风格、组织目标一致性、团队成员的激励程度、人际关系的维系与促进等因素息息相关,应关注冲突的管理方法,通过替代性方案建设性地加以解决至关重要。

中国社会医疗保险制度未来发展的挑战与创新建议

中国社会医疗保险制度发展至今,已覆盖了95%以上的人口,筹资和报销待遇都达到了与国民经济所处的中等收入国家地位相称的水平,但也存在不同人群待遇相差悬殊、医保基金使用效率不高的问题。未来需要从实现公平的国民待遇、进行科学的医保筹资规划、制定统一的医疗服务价格、设计合理的医保报销政策、明确划分中央与地方政府的职责等方面,正视挑战,创新发展,避免医保制度发展的中等收入陷阱。

新一代人工智能驱动档案信息化建设的现状和趋势探讨——基于医疗机构的考察

探讨新一代人工智能技术在档案信息化建设中的应用现状和趋势,并以医疗机构为调查对象进行实证分析。通过分析新一代人工智能技术在档案信息化建设中的应用现状和趋势,结合在医疗机构的调查分析,提出了调查设计和方法,并进行了调查结果统计和分析。探讨了医疗档案信息化建设的特点和需求,分析了新一代人工智能技术在医疗档案信息化建设中的现状、趋势、挑战和未来的发展方向,提出了新一代人工智能技术驱动档案信息化建设建议和展望。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

四川省区域康养旅游发展的动因、现状与对策

康养旅游的异军突起和强劲发展,是康养业与旅游业深度融合发展的必然结果,凸显了社会大众对健康生活的追求。我国地大物博、人口众多,有发展康养旅游的优越资源条件和强大的现实需求。目前来看,我国康养旅游还是一片蓝海,有着巨大的发展潜力和发展前景。以四川省康养旅游发展为主线,探讨区域康养旅游发展的动因、现状,因地制宜提出了几大策略:顶层设计持续发力,提高康养旅游产业发展的政策供给效率;深挖区域特色资源,不断创新开发特色康养旅游的品牌产品;强化医疗技术创新,提高康养旅游医疗服务供给水平;加快信息化技术运用,探索构建智慧康养旅游产业的新模式。以期为区域经济发展和康养旅游的发展注入新活力。

ABC分类绩效管理法对医务人员服务质量、心理健康及工作满意度的影响

目的:探究基于ABC分类绩效管理法对医务人员的影响。方法:选取2021年3月-2022年3月某院200名在职医务人员,随机分为对照组和观察组,各100例,对照组采用统一医院绩效管理模式,观察组给予基于ABC分类绩效管理法。比较两组服务质量[医疗服务质量量表(CQS)]、心理健康[焦虑自评表(SAS)和抑郁自评表(SDS)]、主观幸福感[主观幸福感量表(GWB)]、工作满意度[明尼苏达工作满意度问卷短式量表(MSQ)]及同情疲劳状况调查[职业生命质量量表中文版(ProQOL)]。结果:干预后与对照组相比,观察组CQS各维度评分明显较高(t=-6.944,-6.920,-7.220;P<0.05),SAS评分和SDS评分明显较低(t=4.894,4.145;P<0.05),GWB各维度评分明显较高(t=-8.548,-4.699,-5.972,-6.778,-9.472,-6.377;P<0.05),MSQ各维度评分明显较高(t=-7.939,-8.925,-7.151;P<0.05),ProQOL各维度评分明显较低(t=10.441,9.667,5.661;P<0.05)。结论:针对医务人员给予基于ABC分类绩效管理法,可明显改善其服务质量,促进心理健康,增加主观幸福感,提升工作满意度,改善同情疲劳状况。

我国城市社区医生医疗服务能力现状问题与对策研究

背景:随着新医改的推进,社区卫生服务机构的首诊、双向转诊等分级诊疗措施的开展已成为我国分级诊疗制度落实的重要载体,要实现社区首诊,重点在于社区医生的医疗服务能力建设。目的:通过调查我国城市地区基层医生医疗服务能力现状,探讨提升社区卫生服务机构医疗服务能力的策略。方法:采用多阶段分层抽样和典型抽样相结合的方法,选取我国东中西部城市社区卫生服务机构的2372名医生开展线上问卷调查,使用课题组既往开发的基层医生卫生服务能力体系指标,选取其中医疗服务部分的指标为依据设计问卷调查,了解社区医生对常见病、多发病诊治,危急重症处置,医疗服务协同,社区康复服务以及中医药服务等5个方面的医疗服务综合能力具备情况。结果:共回收问卷2473份,将涉农区的村卫生室和乡村医生从本次调查中剔除101份,实际参与分析问卷为2372份,问卷有效率为95.91%。2372名社区医生中,以本科及以上学历为主,占67.7%(1606名),其次是大专学历,占24.6%(583名)。年龄以30~44岁为主,共1391名占58.6%。有1860名(78.4%)、1686名(71.1%)、1400名(59%)1276名(53.8%)、1330名(56.1%)社区医生具备常见病、多发病诊治,危急重症处置,医疗服务协同,社区康复服务以及中医药服务能力。在医疗服务能力具备率方面,社区医生在医疗服务综合能力方面尤其是危急重症应急处置能力、社区康复服务以及中医药服务等能力具备方面相对薄弱。结论:我国社区医生队伍素质总体水平需进一步提升,常见病、多发病诊治能力具备情况较好,社区医生医疗服务存在短板与不足,各地区应从完善政策和加强培训等方面有针对性地进行“短板”集中“补钙”,使其能承担起社区医疗服务的责任。

养老服务新体系下推进医养与康养衔接发展的思考

人口老龄化程度加剧带来了老年人健康需求的变化,医养与康养相融合成为当前养老服务体系建设的重要内容之一,因此要通过两者的有效衔接实现服务的均等化、可及性、延伸拓展、资源共享,但是由于管理体系不顺畅、资源配置不合理、服务项目不融合、保障措施不力、主动健康认识不足等因素造成了医养与康养衔接的现实障碍。文章提出了要将医养与康养有效衔接作为促进健康老龄化的积极行动、将管理协同和有效作为推动医养与康养衔接的重要力量、将政策推动和协同作为推动医养与康养衔接的保障基础、将资源整合和可及作为推动医养与康养衔接的关键动力、将医养与康养衔接作为高质量发展“银发经济”的有效途径等建议,为养老服务新体系下推进医养与康养衔接的发展提供政策依据。

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

社会工作介入医养结合养老照护服务的优化路径研究

从社会工作的视角分析医养结合养老照护服务问题是回应健康中国规划和人口老龄化现状的重要内容。通过分析医养结合和照护轨迹的内涵,审视当前社会存在的医养结合的养老照护服务中的困境,发现当代社会的医养结合照护服务的制度和政策存在发展功能性障碍,医养结合养老照护服务体系缺乏整合机制,人才队伍建设跨学科合作存在区隔界限,社会支持网络结构功能失调。为此,经过前期的理论和实践探索,建议以社会工作方法嵌入的方式构建医养结合养老照护服务的政策保障,发挥协调整合的社会工作专业角色建构多元化的整合机制,从跨专业合作的角度探索医养结合养老照护服务的人才建设模式,通过“医务社工+志愿者”的联动机制实现医养结合养老照护服务的社会支持网络平衡。从而最终实现医养结合模式的养老照护服务优化路径的系统性重构和整体性重塑的长效跃升发展。

基于SHA 2011的天津基层医疗卫生机构基本公共卫生服务开展情况分析

[目的]强化经常性卫生费用核算数据政策分析,为基本公共卫生服务项目后续开展提供依据。[方法]以天津市2016-2019年基层医疗卫生机构预防服务费用核算结果为基础,分析基层医疗卫生机构基本公共卫生服务项目开展情况和存在问题。[结果]2016-2019年,天津市基层医疗卫生机构预防服务费用呈逐年增长趋势,由2016年的14.25亿元增加至2019年的18.04亿元。预防服务费用主要流向预防接种项目、慢性病管理和老年人健康管理项目;预防服务费用筹资来源仍以政府筹资方案为主,但家庭卫生支出占比呈快速增长趋势,主要是由于二类疫苗接种费用的快速增长所致。[结论]天津市基层医疗卫生机构预防服务费用流向与其基本公共卫生工作重点一致,但基层医疗卫生机构传染病防控投入程度与其职能不匹配。基层医疗卫生机构二类疫苗接种服务家庭卫生支出负担过重。

新冠疫情期间某三级甲等医院北京冬奥会医疗保障模式案例分析

冬季运动会项目特定环境及运动本身的特性,决定了冬季大型运动会医疗保障是极具特殊性的工作。北京冬奥会是我国承办国际体育竞技的盛事,举办期间恰逢新冠病毒大流行,这使得传染病防控成为今后冬季大型运动会医疗保障的重要课题。文章介绍了某三级甲等医院探索建立“促、防、诊、控、治、康”连续一体化医疗照护,同时依靠多学科会诊提供高质量照护的基本模式,为大型医院参与冬季运动会医疗保障提供经验参考。