The situation of primary care institutions under the background of new medical reform in China

[目的] 分析新医改背景下我国基层医疗卫生机构的发展现状,探讨存在的问题,为进-步完善基层 卫生事业改革发展提供参考.[方法]利用2008 - 2 0 1 2年中国卫生统计年鉴数据,对基层医疗卫生机构基础设 施、人才配置和卫生服务利用状况进行分析.[结果] 2008 - 2 0 1 2年我国基层医疗卫生机构总数量年平均增速 为 1.55%,其中西部地区的机构数量最少、但年平均增速最快,中部地区的数量比西部多比东部少;在三大基 层医疗卫生机构当中,社区卫生服务中心（ 站）、乡镇卫生院和村卫生室机构数量年平均增长率分别为8 . 4 4 %、 -1.3%和 1.6%; 三大基层机构卫生技术人员数量年平均增长率分别为2 0 . 2 5 %、3% 和 5 . 0 2 % ; 三大基层机构 诊疗人次数年平均增长率分别为2 3 . 6 8 %、3. 96% 和 8. 92 %.截至2 0 1 2年 ,社区卫生服务中心卫生技术人员的 学历以大专为主（占40. 9%）,职称以师级/助理为主 （占32. 8%）; 乡镇卫生院卫生技术人员的学历以中专为 主 （占51. 3%）,职称以士级为主（占40. 2%）.[结论]新医改后我国基层医疗卫生机构发展迅速,但资源分 布仍不均衡;基层卫生技术人员数量不断增加,但学历职称层次仍偏低;基层医疗卫生机构卫生服务利用增 加 ,但患者就医仍缺乏有效引导.

Model of Healthcare-Associated Infection Control in Primary Health Care Institutions:A Structural Equation Modeling

The purpose of this study was to construct the model of organization system,managemcnt,training and surveillance in healthcare-associated infection prevention and control(IC)of primary health care institutions and identify its efleet on patient safety and decreasing economic burden by standardizing IC.A cross-sectional survey was conducted with questionnaires.Data were collected from 268 primary health care institutions in Hubei province,China.Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling.The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels:root mean square error of approximation(RMSEA)=0.071;comparative fit index(CFI)=0.965;tucker lewis index(TLI)=0.956:weighted root mean square residual(WRMR)=1.014.The model showed that organization system had a direct effect on management(β=0.311.P<0.01),and training(β=0.365,P<0.01).Management and training played an intermediary role that partially promoted organization system impact on surveillance.Results also showed that institutional factors such as the number of physicians、the ninnber of nurses,the designated capacity of beds,the actual number of open beds and surgery trips had positive impacts on management(β=0.050,P<0.01;β=0.181,P<0.01;β-0.111.P<0.01;β=0.064,P<0.01;β=0.084,P=0.04);nd training(β=0.21,P=0.03;β=0.050,P=0.02;β=0.586.P=0.01;0=0.995,P=0.02;β=0.223.P=0.03).In conclusion.the model of organization system,managemcnt,training and surveillancc in IC of primary health care institutions is valuable tor guiding IC practice.

A Study on the Quality of Life of Elderly Nurses in Two Selected Elderly Care Institutions in Shandong Province

Objective: To comprehensively understand the impact of the quality of life of elderly nurses in two selected elderly care institutions in Zibo city, Shandong province, and to provide a scientific basis for improving the professional quality of life of elderly nurses. Methods: The convenient sampling method was used to investigate the professional quality of life (proQOL) questionnaire Version 5 and the self-designed demographic data of 82 elderly nurses working in two elderly care institutions. Result: From this score, it can be seen that the occupational burnout problem of elderly nursing staff in the two nursing homes is the most significant, with empathy and secondary trauma emergency at a moderate level. After controlling the demographic variables, the working hours and monthly income level had a significant impact on nurses’ job burnout. Conclusion: Due to the particularity and high intensity of elderly nurses’ work, their physical and mental health faces many challenges, which affect their quality of life. At present, efforts will be made to reduce work pressure, increase wages and benefits, and thereby improve the quality of life.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

Estimating the impact of antenatal care visits on institutional delivery in India: A propensity score matching analysis

Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutional delivery has been overlooked by the researchers. Therefore this paper aims to examine the net impact of ANC visits on subsequent utilization of institutional delivery after removing the presence of selection bias using recent round of National Family Health survey data. The analysis has been carried out in two separate models, in the first model 1-2 ANC visits been compared with no visit and in the second model three or more antenatal care visits with no visit. The propensity score matching analysis used in this study sheds new light into this line of research which provides an effective strategy for controlling the confounding influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher chance to deliver in an institution compared to women who made no visit. In addition, if a woman visited health centre three or more than three times, her chances were 31 percent higher to deliver in an institution. Result based on sensitivity analysis suggests that selection bias on unobserved covariates would have to be around 40 percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions which plan to increase institutional delivery should target pregnant women who come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of visits, as our results indicate that three or more ANC visits significantly change the women’s attitudes towards institutional delivery.

Socially Excluded Children： Listening to the Experiences of the Inmates of the Institutional Care

Children without parents are not only among the most vulnerable members of society--their care and protection also present a major child-care policy challenge. In spite of this, they are all but doomed to have their special needs ignored and their rights abused in many cases. Children without a biological family, who are cared for in some forms, also run the risk of a life which holds fewer possibilities for healthy development and a supportive environment than that of their peers with families. The range of threats is wide, from extreme neglect （lack of access to education, medical care, a balanced diet, etc.） to social stigmatization and marginalization and the fact that the loss of a family represents a serious trauma that stays with a person throughout his/her life and can potentially be seriously damaging if the person has not had any support in coping with it in childhood. The present study is conducted among the inmates （children） admitted in the ashrams （orphanages） who come from underprivileged socio-economic backgrounds. Information was collected from two orphanages of Sambalpur district situated in the western part of Odisha. These are Dhankauda Kanyaashram （for girls） and Dhankauda Balashram （for boys）. The paper examines a wide range of care interventions for orphans, including family care, institutional care, community-based care, and rights-based care. A lack of direction, inadequate care, ignorance, and discrimination can make the trauma experienced by orphans more intense and ultimately ensure that they really do not succeed.

Research on the institutional design of the long-term care insurance in Shanghai

Shanghai went into the ranks of the aging society in 1979, as the first area which entered into the aging society in China. Along with the arrival of the ageing, the nursing problems of the old man and disabled elderly become the important factors which affect social development. The establishment of the legal system, System integration to realize resource optimal allocation, Division of multilevel optimization services provide new pattern can make it happen.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.

中国式养老的历史变迁与现代重构——基于“家国一体”视角的考察

中国传统养老模式具有家国共责的双层构造及社会伦理支撑。社会主义计划经济时期开启了以单位为载体的社会养老方式的结构化,社会主义市场经济时期以社区为载体的养老方式再结构化,实现了由传统养老模式向现代社会养老服务体系的转化,其实质是中国“家国一体”养老的现代延展。当前,城市社区嵌入式养老和农村社区链式养老成为社会服务体系融合发展的新趋向。为此,本文从“家国一体”的视角出发提出新时代推动中国式养老发展的方略,即倡导新时代老龄文明,构建养老服务共同体;从“居家养老社区化”和“机构养老社区化”两条发展路径,促进养老服务高质量发展。

智慧医疗情境下四方主体隐私行为的交互机理及演化趋势研究

[目的/意义]本文针对智慧医疗情境下隐私行为研究在博弈主体、模型参数等方面的不足,探寻患者、医疗机构、智慧医疗平台和政府四方主体之间的隐私行为交互机理与演化趋势。[方法/过程]基于演化博弈理论,构建患者、医疗机构、智慧医疗平台和政府四方博弈模型。根据不同参数调节下各方行为策略的收益、成本、损失等计算收益矩阵,求解主体的演化稳定策略,并考虑不同因素对主体行为策略及系统稳定状态的影响。[结果/结论]患者的隐私披露行为与披露隐私后获得的服务收益密切相关,医疗机构的隐私保护投入成本和隐私泄露概率对其隐私保护行为有显著影响,智慧医疗平台的政府奖惩、罚款收益和投入成本是影响其严格管理行为的关键因素,政府的监管行为与奖惩机制等因素密切相关。通过应用本文模型和方法,可以动态调整隐私保护机制,明确各方职责,推动智慧医疗可持续健康发展。

福利多元主义视角下医养结合协同治理研究——以广州市A医院托管养老机构为例

目的研究医养结合的协同治理模式,以促进医疗机构参与医养结合服务,提供对策建议。方法基于福利多元主义的视角,结合广州市A医院托管养老机构的实践经验,探讨政府、市场、社区和家庭等不同福利主体在医养结合服务体系中的作用。结果医养结合面临政府在场地、医保等方面保障力度不足的问题,市场上社会资本参与医养结合的活力不足,医养结合机构与社区组织之间的联动不强,以及老年人家庭对医养结合服务的负担较重等问题。结论政府应完善顶层制度设计,市场需优化医养结合服务供给,社区应发挥平台的枢纽作用,家庭则要营造尊老爱老的良好氛围。

基于博弈论-可拓云模型的养老机构消防安全韧性评估

为评估养老机构消防安全韧性水平,首次系统构建了由4个一级指标、25个二级指标组成的养老机构消防安全韧性评估指标体系。其后运用博弈论理论,综合了分别以G1法和CRITIC法计算的指标权重,构建了养老机构消防安全韧性博弈论-可拓云评估模型。最后,应用该评估指标体系和模型实证研究了西安市某养老机构的消防安全韧性,得出其消防安全韧性等级为Ⅲ级(较高韧性),通过了可信度评价,且其结果与基于博弈论-物元可拓模型评估结果一致,表明该评估体系的适用性和有效可靠性,研究结果可为养老机构消防安全韧性评估提供一种新方法。

养老机构老年人跌倒风险综合评估工具的研制与检验

背景我国自1999年宣布进入老龄化社会以来,人口老龄化程度日益严重,养老机构成为老年人养老热门选择,但跌倒问题频发且现有评估工具效果不佳。目的研制养老机构老年人跌倒风险综合评估工具并检验其信效度。方法2021年3—12月,通过文献回顾、半结构式访谈、2轮专家函询及预调查,形成量表初始条目,并在养老机构随机选择老年人和养老护理员进行调查。采用SPSS 26.0和AMOS 26.0软件进行信效度分析和评价,采用相关系数法、临界比值法、内部一致性分析及探索性因素分析进行条目分析和筛选,选用内在信度、分半信度、评定者间信度和同质性信度检验评估工具的信度,选用表面效度、内容效度、效标关联效度、结构效度和区分效度检验评估工具的效度,采用受试者工作特征曲线检验评估工具的预测能力。结果构建的评估工具包括3个子工具:(1)老年人跌倒风险评估量表;(2)老年人跌倒史风险追踪调查表;(3)老年人跌倒风险每日检查清单。老年人跌倒风险评估量表总Cronbach'sα系数为0.73,评定者间系数为0.85;探索性因子分析提取3个公因子,累识方差贡献率为57.95%;验证性因子模型拟合度参数中的卡方自由度比值(χ^(2)/df)、拟合优度指数(GFI)、调整后拟合优度指数(AGFI)、基于标准化适度指标(NFI)、比较拟合指数(CFI)、Tucker-Lewis系数(TLI)、近似误差均方根(RMSEA)分别为2.43、0.95、0.91、0.89、0.93、0.91、0.07,区分效度经验证存在统计学意义(P<0.001)。预测能力分析结果显示,以Morse跌倒评估表(MFS)≥55分为标准时,受试者工作特征曲线下面积(AUC)为0.87;以MFS≤25分为标准时,AUC为0.84。老年人跌倒史风险追踪调查表和老年人跌倒风险每日检查清单经专家和养老护理员的评价后,形成最终版本。结论本研究开发养老机构老年人跌倒风险综合评估工具,包含3个子量表,三者间相辅相成,完善养老机构从评估到预防的全路径,具有良好的信效度和预测能力,可为日后我国养老机构跌倒预防及管理提供参考。

基于改进两步移动搜索法的南京市养老机构空间可达性研究

空间可达性是评价一个城市养老服务设施配置科学性的关键指标之一,精准衡量城市养老机构的空间异质性、合理规划养老公共空间,是实现城市稳定健康发展的重要保障。以南京市为例,基于多源数据构建随机森林模型将南京市2022年常住人口格网化,结合改进的两步移动搜索法进行养老服务设施的可达性分级测算,通过构建养老机构空间自相关探究其空间分异特征。结果表明:南京市养老机构空间可达性整体较好,但区域配置差异明显;主城区和副中心城区的可达性高,城乡结合部和边缘农村区域可达性较差。

宁夏养老机构服务人员职业发展现状研究

目的了解宁夏养老机构服务人员职业发展现状,为稳定养老服务人才队伍、提高养老服务质量提供参考。方法采用自编问卷,抽取全区24家养老机构的76名服务人员,对其职业发展现状进行调查,并分析影响因素。结果专业和从业年限是养老机构服务人员工作压力的影响因素(P<0.05),工作压力与职业晋升信心和职业期望符合度均呈负相关(r=-0.244,P<0.05;r=-0.305,P<0.01);专业和从业年限是养老机构服务人员职业晋升信心的影响因素(P<0.05),职业晋升信心与职业期望符合度呈正相关(r=0.231,P<0.05);月均收入是养老机构服务人员职业期望符合度的影响因素(P<0.05),职业期望符合度与职业认同感呈正相关(r=0.592,P<0.01)。结论养老机构服务人员工作压力大,职业晋升信心不足。应加大政府支持力度,改善福利待遇和社会地位,开通晋升渠道,加强心理疏导与支持,推动全区健康养老产业可持续发展。

上海市家庭病床服务供给现状调查研究

目的:分析上海市家庭病床服务的供给现状和存在的问题,为家庭病床服务高质量发展提供参考。方法:采用定性、定量相结合的研究方法,选取上海市城郊4个行政区的91家社区卫生服务机构,分析其2021年家庭病床服务床位、人力资源、服务项目相关情况。同时对44名家庭病床服务的供方和需方相关人员进行访谈,对10名专家进行咨询,分析上海市家庭病床开展现状和存在的问题。结果:上海市家庭病床服务网络较为完善,呈稳中向好态势。但服务中存在药物配送渠道不畅通、设备配置较基础、城郊人力资源配置不均、缺乏针对性的绩效考核制度、诊疗操作不规范、市场化发展不成规模等问题。结论:上海市家庭病床服务需加强人力、物力、信息系统建设,激发医护人员提供服务的动力,并给予社会办医疗机构更多政策支持,以鼓励其提供家庭病床服务。

中医药服务参与医养结合机构的困境与出路

随着中医药文化传播和健康老龄化观念普及,中医药逐渐开展医养结合发展模式研究。目前,中医药与养老产业融合尚不紧密,本文通过走访调查、政策分析、文献梳理等方法,揭示中医药参与医养行业实践现状及存在问题,探索具有中医药特色的医养结合模式。

长期护理保险试点中的主要问题及对策研究

建立长期护理保险制度,是我国健全社会保障体系的重要制度安排。研究基于重点城市实地调研、关键知情人访谈及政策文本分析等,围绕筹资、服务、评估、监管、支付等核心模块分析总结我国现有城市试点过程中的主要问题并提出对策建议。研究发现,我国长护险试点总体缺乏独立的筹资来源,参保人群与保障对象地区差异大,专业化服务产业水平不高制约了试点推进,待遇支付标准不统一、苛刻与优厚并存,缺乏统一的老年照护需求评估体系和信息化监管体系等。建议以附加税建立全国统一的长期护理保险制度,在此基础上鼓励各省因地制宜合理确定基本保障范围,通过提高护理服务供给能力和水平、建立全国统一的信息监管服务系统等方式提高长期照护水平。

长期护理保险与医疗卫生服务:两体系的边界辨析与发展路向

长期护理因其自身具有的长期性以及一旦发生几乎无法逆转的特点,与医疗卫生服务有比较明显的边界。但由于慢性疾病等原因引发的照护也具有长期护理的特征,使得长期护理与医疗卫生服务具有一些先天的“黏性”。国际上选择推行独立长期护理保险的国家,不仅深度认同老年失能为独立的社会风险,而且认为长期护理与医疗卫生服务体系的融合会诱发照护的医疗化。我国正处于长期护理保险试点阶段,部分试点城市出现了对于长期护理保险内涵认识不一致,以及长期护理保险与医疗卫生服务体系边界重叠、衔接不顺畅等问题。从理论上厘清两体系各自的内涵与边界,并基于我国的实际情况设计长护险的保障内容,不仅更利于长期护理保险制度的框架定型与资源优化,同时对于防止老年人照护医疗化、保障老后自立与照护尊严也具有现实价值。