Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.

Business Process Analysis and Simulation: The Contact Center of a Public Health and Social Information Office

This article proposes a framework, called BP-M* which includes: 1) a methodology to analyze, engineer, restructure and implement business processes, and 2) a process model that extends the process diagram with the specification of resources that execute the process activities, allocation policies, schedules, times of activities, management of queues in input to the activities and workloads so that the same model can be simulated by a discrete event simulator. The BP-M* framework has been applied to a real case study, a public Contact Center which provides different typologies of answers to users’ requests. The simulation allows to study different system operating scenarios (“What-If” analysis) providing useful information for analysts to evaluate restructuring actions.

The nurses’ voice of working in a newly established community based 24-hour support center for people with psychiatric disabilities

This study explores the perceptions of a small group of nurses working at a newly established 24-hour community-based service enter (SC) for users with psychiatric disability using a qualitative approach. Since the mental health reform in Sweden in 1995 where the communities (in Sweden called municipalities) were given the responsibility to establish service and support to people with severe psychiatric disabilities, they have struggled in finding suitable forms of these kinds of areas. In 2010, this led to the creation and development of a new center aiming to provide services and support based on the expressed needs of people with physchiatric disability in a community located in southern Sweden. During 2011, a total of three group interviews were performed to capture the employed nurses’ perceptions of this newly established SC. The interview texts were analyzed by way of qualitative content analysis. A first reading of the interview texts revealed that the nurses’ perceptions of the service center were unwaveringly positive but that their beliefs about who the specific target group were differed. The main finding was summarized by the theme: Making a difference—on an individual, professional, and organizational level. The sub themes were: 24-hour availability, unclear assignment, and preventing mental illness. The findings indicate a need for a community round-the-clock service center in this Swedish community and a more clear definition of the target group.

The lived experience of a 24-hour support center for persons with psychiatric disabilities: Making me feel almost like an ordinary person

This study illuminates nine psychiatric disabled persons’ lived experience of a newly established community-based service center open around the clock. This new 24-hour support center (SC) was established in 2011 in a Swedish community to better match and facilitate the disabled persons’ needs. In order to illuminate the disabled person’s experiences individual interview was performed. A phenomenological-hermeneutical method inspired by Paul Ricoeur was used to interpret the texts. After a naive reading, a structural analysis revealed two themes: 1), becoming aware of myself as a person, and 2) having a lifeline and belongingness. The comprehensive understanding was interpreted as meaning “Making me feel almost like an ordinary person”, which incorporated the person’s past with their present together with a direction for the future and hope for a more fulfilling life.

Development of community health service-oriented computer-assisted information system for diagnosis and treatment of respiratory diseases

Objective:Community health services are an emerging trend.We have found in practice that diagnosis and treatment of respiratory diseases in the community are distinct.The respiratory department’s daily work involves a number of outpatient registration items and a vast workload.The routine manual operation is inefficient and it is not convenient to make effective statistical analysis of the outpatient data to identify the risk factors closely related to diseases.Therefore,it is imperative to process the outpatient information of patients with respiratory diseases effectively and efficiently in a unified manner by means of computer technology.Methods:The design and realization of the Community Health Service-oriented computerassisted Information System for Diagnosis and Treatment of Respiratory Diseases(CHS-DTRD)was completed as part of the community intervention study on bronchial asthma that was carried out jointly by the Nanjing First Hospital Affiliated to Nanjing Medical University and the Hospital of Nanjing University of Science&Technology,and based on 2 years of experience and the needs of an overall analysis.Results:The computer-assisted information system for diagnosis and treatment was developed using Java Server Page(JSP)technology and introducing the advanced Asynchronous JavaScript XML(AJAX)technique and MS-SQL Server was used in the background database.CHS-DTRD was composed of eight functional modules(outpatient data maintenance,outpatient appointment,intelligent analysis for disease risk factors,query and statistics,data dictionary maintenance,database manipulation,access control,and system configuration).CHS-DTRD featured a friendly interface,convenient operation,and stability and reliability.Conclusion:Community health-oriented diagnosis and treatment of respiratory diseases is simple,programmable,and intuitive,thus the workload of physicians is significantly reduced and the work efficiency is improved.This system facilitates an intelligent analysis of disease risk factors using data mining technology,and provides physicians with suggestions on intelligent analysis for diagnosis of disease and conclusion of disease causes.

Efficiency of community health centers in China during 2013-2015:A synchronic and diachronic study

Objective:We aimed to explore the efficiency of community health centers(CHCs)in China from 2013 to 2015,providing policy suggestions for optimizing the allocation of health resources.Methods:Data on the efficiency of CHCs in 30 provinces/autonomous regions/municipalities in China's Mainland(except Tibet)from 2013 to 2015 were collected from China’s Health and Family Planning Statistical Yearbook 2014,China’s Health and Family Planning Statistical Yearbook 2015,and China’s Health and Family Planning Statistical Yearbook 2016.Data envelopment analysis and Malmquist index analysis were performed to investigate the efficiency of sampled CHCs during this period at the national level and the regional level.The applied input indicators include the numbers of CHCs,community health workers,and beds,and the output indicators consist of the numbers of visits and inpatients,the occupancy rate of beds,and the average length of stay.Results:In 2015,the average annual overall technical efficiency,pure technical efficiency,and scale efficiency of CHCs in 30 regions at the national level were 0.715,0.705,and 0.972,respectively.Eight regions(Guangdong,Guizhou,Hainan,Ningxia,Qinghai,Shanghai,Zhejiang,and Chongqing,accounting for 26.7%of the total)had efficient CHCs with overall technical ef-ficiency of 1.000,and the other 22 regions had surpluses of 131 CHCs,5573 community health workers,and 2086 beds on average.In 2015,the average annual technical change index,pure technical efficiency change index,total factor productivity,technical efficiency change index,and scale efficiency change index of CHCs at the national level were 1.034,1.002,1.024,0.990,and 0.988,respectively.Compared with 2013,the former three increased by 3.4%,0.2%,and 2.4%,respectively,while the latter two decreased by 1.0%and 1.2%,respectively.Conclusion:On the whole,efficiency improvements of CHCs were achieved at the national level from 2013 to 2015,but with obvious interregional differences.In regions with inefficient CHCs identified by data envelopment analysis,there was a problem of coexistence of shortage and wastage of community health resources.In view of this,targeted measures should be taken to optimize the allocation of community health resources,and the management of CHCs should be strengthened to improve the efficiency of these institutions.

北京市社区卫生服务中心组织能力对组织绩效的影响研究:基于模糊集定性比较分析

目的:探究社区卫生服务中心组织能力对组织绩效的影响机制,为提升北京市社区卫生服务中心组织绩效提供科学依据。方法:在北京市4个功能区中各随机抽取一个行政区,选择4个行政区内所有社区卫生服务中心(共66家)作为样本案例。采用模糊集定性比较分析(fsQCA),探究组织能力细分的9个二级能力对社区卫生服务中心高组织绩效和低组织绩效的影响。结果:社区卫生服务中心达到高组织绩效和低组织绩效的组态各有3条,加强医疗服务、公共卫生、决策、规范和学习等能力对提高社区卫生服务中心组织绩效具有普适作用。结论:社区卫生服务中心绩效的高低是多种要素相互联动产生的结果,多条路径可以使其达到高组织绩效。社区卫生服务中心可结合自身优势差异化发展,组织绩效较低的社区卫生服务中心可以优先发展医疗服务能力和学习能力,促进组织绩效快速提升。

新时代背景下宁德市金塔组团社区卫生服务设施布局实践路径探析

社区卫生服务设施布局事关社区居民医疗健康服务需要,事关城市和社区的可持续发展。为实现资源的合理配置,提升社区卫生服务设施在点、量、质方面的供给,达到设施建设投入最少、服务效果最好的目的。以宁德市“金塔组团生活圈”为例,运用GIS综合交通网络构建、设施服务区分析和最小化设施点数模型等技术,对社区卫生服务设施布点进行定量优化、建立数据库,并就优化前后结果进行分析评价。结果表明,运用量化技术得到的设施布点,其完整性、便利性得到明显提升。该研究是探求社区卫生服务设施布点实践的新路径,为今后走好“人民城市人民建,人民城市为人民”的人性化、数字化规划之路提供新思路。

综合性大医院与社区卫生服务中心合作切入点的分析

通过对沈阳市沈河区9个社区卫生服务中心进行调查和相关资料分析,探讨大型综合性院与社区卫生服务中心合作的可行性,如人员培训和技术支持,临床检查结果互认,实行"双向转诊"等,为建立新型城市医疗卫生服务体系参考依据。

社区卫生服务中心实施临终关怀的SWOT分析及策略研究

社区卫生服务是实现人人享有初级卫生保健的基本途径,社区卫生服务中心已成为临终关怀服务可利用的资源。本研究在4所社区卫生服务中心部分医务人员和社区居民临终关怀相关知识问卷调查以及文献复习的基础上,运用SWOT分析法对社区卫生服务中心开展临终关怀工作的内部环境的优势、劣势及外部条件的机会、威胁进行系统分析,并提出社区卫生服务中心实施临终关怀的四种应对策略。

新医改背景下安徽省乡镇卫生院运行分析

目的:分析新医改前后安徽省乡镇卫生院发展现状,探讨其存在的问题,为进一步完善基层医改举措提供建议。方法:对乡镇卫生院基本情况、人力资源配置、医疗服务、药占比情况进行分析。结果:乡镇卫生院建设和发展滞后;基层人才匮乏,职称和学历偏低;缺乏补偿和激励措施;药占比依然偏大。结论:科学发展乡镇卫生院,建立激励相容的良性共同体;明确政府责任,完善激励制度;加强人才培养,提高业务水平。

北京市社区全科医生对慢性阻塞性肺疾病的认知现状及影响因素分析

背景目前慢性阻塞性肺疾病(简称:慢阻肺)作为可防可控的慢性疾病,已成为我国最为突出的公共卫生与医疗问题之一,而基层社区对慢阻肺的防治尤为重要。了解社区全科医生对慢阻肺的认知能力及现况,可以更好地为开展基层社区呼吸疾病防治工作提供科学依据。目的调查北京市社区卫生服务机构全科医生对慢阻肺的认知现状,并进行影响因素分析,为开展基层社区呼吸疾病防治工作提供科学依据。方法于2020-09-28至10-04对北京市34家社区卫生服务中心和159家社区卫生服务站在一线工作的在职全科医生进行调查。自行设计调查问卷,共同论证后应用问卷星技术平台形成最终稿在微信工作群发布,问卷内容包括全科医生基本信息、全科医生更新学习专业知识方式、全科医生所在社区开展患者宣教方式、慢阻肺防治能力知识测试(60分及以上为及格,60分以下为不及格)。分析不同人口学特征、专业知识获得方式、所在社区开展患者宣教方式、全科医生慢阻肺防治能力知识测试及格情况,通过二元逻辑Logistic回归分析探讨社区全科医生慢阻肺防治能力知识测试及格与否的影响因素。结果共发放1 226份问卷,回收有效问卷1 226份,问卷有效回收率100.0%。全科医生慢阻肺防治能力知识测试总平均分为(45.5±18.5)分,不及格的医生987名,及格医生239名(及格率19.5%)。其中女性医生及格率高于男性不同学历医生及格率(P<0.05);其中研究生及以上学历医生及格率高于本科生、大专、中专及以下学历医生,本科生学历医生及格率高于大专、中专及以下学历医生(P<0.05)。不同职称等级医生及格率比较,差异有统计学意义(P<0.05);其中高级、中级职称医生及格率高于初级职称医生(P<0.05)。通过在社区卫生服务中心/社区卫生服务站现场听院外专家授课和现场听医学会组织的专家授课的全科医生慢阻肺防治能力知识测试及格率高于不通过现场听院外专家授课和现场听医学会组织的专家授课的全科医生(P<0.05)。开展患者宣教的全科医生慢阻肺防治能力知识测试及格率高于未开展患者宣教的全科医生(P<0.05);通过发放健康教育手册、健康教育讲座及健康咨询对患者宣教的全科医生慢阻肺防治能力知识测试及格率高于未通过发放健康教育手册、健康教育讲座、建立健康咨询对患者宣教的全科医生(P<0.05)。二元逻辑Logistic回归分析结果显示,性别、学历、职称是全科医生慢阻肺防治能力知识测试及格的影响因素(P<0.05)。结论北京市社区卫生服务机构全科医生对慢阻肺认知不足,需进一步加强这方面培训及考核;应重点加强社区男性、低学历及低职称的全科医生在慢阻肺知识方面的培训;获取慢阻肺专业知识的方式中,在社区卫生服务中心/社区卫生服务站现场听院外专家授课及现场听医学会组织的专家授课更为有效;通过发放慢阻肺健康教育手册、进行健康教育讲座及健康咨询来进行患者教育,可以提高全科医生的慢阻肺认知水平。

三种医院和社区协作模式下医务人员认知评价的Ridit分析

目的:通过了解参与协作医务人员的感受和认知评价,比较三种医院和社区卫生服务中心协作模式下机构间协作服务开展情况和过程中存在的问题,为机构间协作模式发展提供建议。方法:选取医院直管社区模式、医疗集团模式和松散协作模式三种国内效常见模式,共调查174名参与协作的医务人员,利用Ridit值法比较不同模式下的评价情况。结果:直管模式在六个评价维度中得分均最高,不同模式下医务人员对机构协作的连续性、业务合作和人员奖惩机制的评价存在明显差异。结论:机构间开展协作内容仍有较大完善空间,应注重设计协作人员的激励机制和相应配套措施。

基于结构变动度的山东省社区卫生服务中心人员总量分析及优化研究

目的:分析山东省社区卫生服务中心人员总量现状及变动趋势,为我省社区卫生服务中心人员配置发展提供参考依据;方法:收集2014-2018年度中国卫生健康统计年鉴及山东统计年鉴中的相关统计数据,利用描述性统计和结构分析法对当前社区卫生服务人员总量现状及变化趋势进行分析;结果:除2014年社区卫生服务中心卫生技术人员总量减少外,山东省社区卫生服务人员总量在2015-2017年度均呈上升态势。总量上,社区卫生服务中心人员2017年比2013年增长8.02%,其中卫生技术人员比2013年增长7.48%;不同年度的总人员及卫生技术人员构成分布占比较为稳定;从结构变动贡献率上看,各类型人员及各类型卫生技术人员变动对总体人员变动的贡献情况各有不同,2013-2017年度没有规律性的变化趋势;结论:山东省社区卫生服务中心人员尤其是卫生技术人员近年来占比较为稳定;按相关政策要求及社会需求看,卫生技术人员总量严重不足,医护比要求未达标;要不断加强以全科医师为主的社区卫生人才队伍建设,继续教育要和高校人才培养两手抓。

基于因子分析法的城市医疗体系协作评价研究

目的探讨不同模式下城市医疗体系协作开展情况,提出改进意见,为未来的协作方式提供参考依据。方法本研究确定了3种主要的协作模式,分别是南京市中大医院、鼓楼医院和所辖社区卫生服务中心的松散协作模式(松散模式);武汉市第五医院直管社区卫生服务中心模式(直管模式);镇江市医疗集团模式(集团模式)。选取这3种协作模式下协作医院和社区卫生服务机构的医务人员与管理者为研究对象。于2013年9月对受访者进行实地调查,问卷内容包括基本信息、协作开展的基本情况及主要障碍、对协作的认知评价等。在文献阅读和专家咨询的基础上,结合课题组前期研究,选取13个指标用于评价协作现状。采用因子分析法提取主要成分,并对不同模式、职业类别受访者对协作现状的评价进行综合分析。结果共提取4个公因子,分别为慢性病预防与管理因子、诊疗服务因子、信息连续性因子、业务学习进修因子。松散、直管、集团模式受访者对协作现状评价的综合得分分别为-0.12、0.17、-0.08,医务人员、管理者对协作现状评价的综合得分分别为-0.02、0.05。结论慢性病预防与管理、诊疗服务、信息连续性、业务学习进修4个因子可对协作模式进行综合评价。不同模式在各个因子上的得分存在差异。管理者和医务人员对协作开展情况的评价不一致,需要建立有效的利益调整策略和适当的激励机制。

上海市市区社区卫生服务中心经济运行状况分析

目的:通过对上海市区社区卫生服务中心1999-2009年经济运行状况和资源利用效率等进行分析,分析其发展中存在的问题。方法:对11年间机构资产负债、收入支出、基本数字等进行描述性分析。结果:上海市区社区卫生服务中心总体经济运行较为稳定,居民疾病负担得到很好的控制,但是存在服务效率、经营效率低等问题。结论:建议继续加大政府投入,完善社区卫生服务价格标准体系和转诊制度等。

不同举办主体社区卫生服务中心经济运行情况比较

目的对比分析2008—2011年不同举办主体社区卫生服务中心的经济运行情况和发展趋势,为政府制定相关政策提供依据。方法利用2011年杭州、合肥、武汉、成都、无锡、铜陵、宝鸡和石河子8个城市现场调研调查社区卫生服务中心的经济运行状况,收集业务收入和服务收费、政府补助情况、药品收入等数据。采用EpiData 3.0录入数据,并使用SPSS 17.0软件进行统计分析。结果 2008—2011年,在人均业务收入方面,政府办社区卫生服务中心环比增长18.2%、1.6%、-2.1%;医疗机构办环比增长21.7%、-2.7%、7.7%;企业办环比增长9.6%、11.3%、6.7%。在政府补助收入占总收入比例方面,政府办的社区卫生服务中心环比增加8.2%、25.4%、17.7%;医疗机构办环比下降26.9%、16.2%、-25.7%;企业办环比增加7.3%、10.3%、69.0%;个人办2008—2010年环比增加8.2%和57.6%,2011年与2010年相比环比下降35.3%。在药占比方面,政府办环比增加3.9%、1.7%、-1.3%;医疗机构办2008—2010年环比下降5.4%和6.1%,2011年与2010年相比环比增加3.9%;企业办环比增加6.5%、-2.2%、4.0%;个人办机构2009年比2008年环比增加8.9%,2010年比2009年环比下降8.7%,2011年与2010年相似。结论 (1)各类机构业务收入均逐年增加,政府办机构人均业务收入高于其他类型机构;(2)政府和企业办的机构政府补助占比逐年增加,医疗机构和个人办的变化趋势不明显;(3)药品收入占医药收入比例的变化趋势不明显,政府办和医疗机构办的药占比较高。建议加强社区卫生服务提供的考核与激励,促进各类机构可持续发展;借鉴先进地区有益经验,进一步落实财政补偿政策;推进社区卫生服务机构综合改革,巩固国家基本药物制度。

医院直管模式下社区卫生服务机构就诊患者对二者服务协作的认知评价研究

目的了解医院直管模式下社区卫生服务机构就诊患者对二者服务协作的认知评价及利益相关者的态度与看法,为完善医疗服务协作提供实证依据。方法于2012年9月17—23日,采用自行设计的问卷对武汉市第五医院直管社区卫生服务中心的512例高血压和糖尿病患者进行调查,内容包括患者基本情况和服务协作知晓情况、认知评价情况及满意度情况,并对利益相关者(包括患者、医生、护士、社区卫生服务中心负责人以及武汉市第五医院负责人)进行了个人深度访谈分析。结果 19.5%(100/512)的患者表示知道社区卫生服务机构与医院有协作,32.8%(37/113)表示对服务协作满意,其中不同文化程度、慢性病治疗结果患者对服务协作满意度评价间差异有统计学意义(P<0.05);50%以上的患者认为在社区卫生服务机构看病不能得到医院医生的诊治、医院开的药不能在社区卫生服务机构买到、医院与社区医生提供的医疗服务并没有连续性、两类机构医生对病情总体沟通情况差等。从访谈结果可以看出,目前还存在信息交流平台不完善等阻碍协作的一些问题。结论患者对两类机构协作的知晓率、认知评价和满意度均偏低。建议应加强信息化建设,建立信息平台;完善转诊制度,尽快完善配套的医保政策,保证医疗服务连续性;健全基本药物制度,满足基层用药需求。

基于DEA的南京市社区卫生服务中心效率分析

目的:通过评估南京市各区社区卫生服务中心的服务效率,为改善社区卫生服务中心的运营管理,进一步提高社区卫生服务中心服务效率提供科学决策依据。方法:选取南京市13个区的社区卫生服务中心作为研究对象,选择机构在岗工作人员数、现有住院床位数、业务用房面积、固定资产总额、机构总支出作为投入指标,门急诊人次数、出院人次数、机构总收入作为产出指标。采用数据包络分析(Data Envelopment Analysis,DEA)的Input-C2R模型,评价南京市社区卫生服务中心服务效率。结果:南京市有9个区的社区卫生服务中心服务效率为DEA有效,4个区(雨花台、建邺、浦口与六合区)的社区卫生服务效率为非DEA有效,均存在不同程度的投入过剩及产出不足的问题。结论:南京市部分区在大力推进社区卫生服务机构建设的同时,应进行有效的资源调整和优化配置,加强相关配套措施的建设,从而提高社区卫生服务效率。