Analysis of Professional Quality Cultivation Strategies for Infant and Child Care Service Talents from the Perspective of Collaboration of Medical Care,Parenting,and Education,and Integration of Industry and Education

The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements related to the infant care industry chain.This integration targets pediatrics talent training in nine infant care positions,including nursing,infant health care and management,and child rehabilitation,to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children.This article briefly explains the background of the“collaboration of medical care,parenting,and education,and integration of industry and education.”It analyzes the necessity of cultivating infant and child care service talents based on the perspective of“collaboration of medical care,parenting,and education,and integration of industry and education.”Based on this perspective,we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.

Implementation Strategy of“Eight in One”of Integrated Medical and Care Service System in China:A Case Study of Anshan City of Liaoning

With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.

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.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

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.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Mobile EMR Use for Epidemiological Surveillance on a Medical Service Trip in Honduras: A Pilot Study

Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.

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。

我国养老产业发展“拐点”研判——基于多案例研究的典型事实

随着人口老龄化进程加速,我国的养老需求结构正在从生存型向发展型转变,这将为养老产业的发展带来广阔的市场空间,但当前我国养老产业发展相对滞后,仍面临严重的发展困境。我国养老产业发展的“拐点”何时到来?为回答好这个问题,本文以案例研究和实证分析相结合的研究框架,首先,以法、德、日、美四国为例,系统梳理其养老产业发展历程,总结归纳出养老产业发展“拐点”出现的共性特征;其次,聚焦日本养老产业发展轨迹,重点关注其介护险实施前后养老产业相关重要指标变化;最后,选取九个养老产业相关指标,基于指数平滑、灰色模型等方法对中国养老产业未来情况进行预测,并与日本可比时期指标情况进行比较,判断中国养老产业“拐点”出现的可能时间。研究发现:养老产业发展“拐点”的出现具有四个共性特征,分别是三支柱养老金体系改革、长护险制度全面实施、多元化服务助推医养结合、代际转换背后的产业增量机会,而中国养老产业发展“拐点”可能出现的窗口期将在2026—2030年间。

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。

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。

人口老龄化背景下农村医养结合服务的现状与对策——以唐山市乐亭县为例

以唐山市乐亭县农村医养结合服务模式和现状为例,针对目前农村地区医养结合服务存在的供需失衡、“医”与“养”资源融合不足、设施落后、缺乏专业服务人员等问题,提出完善政策体系和保障制度,强化医养衔接,开展多层次医养结合服务,加强人才队伍建设,构建医养结合信息化系统的对策建议,从而推动农村医养结合的发展。

基于米特-霍恩模型的中医药政策在医养结合执行中的分析研究

目的分析我国中医药政策在医养结合执行过程中存在的问题,为完善中医药政策提供借鉴,以此更好地推动医养结合服务的发展和进步。方法采用米特-霍恩模型:政策标准与目标、政策资源、执行方式、执行机构特性、执行人员价值取向、系统环境六大因素为框架,分析中医药政策在医养结合服务执行中存在的问题。结果中医药政策越来越受重视,但在执行中仍受到政策目标不清晰、资源不足、执行方式单一、执行机构特性缺乏规划、执行人员价值取向低和复杂的系统环境等因素的影响。结论为解决中医药政策在医养结合执行中存在的问题,提出建议:完善顶层设计,细化政策实施目标;强化资源保障,提升政策执行效率;丰富执行方式,确保执行效果;多部门联动,加强沟通交流;优化政策执行环境。

健康老龄化视域下“医养结合嵌入式”养老服务的质量评价研究

健康老龄化视角下的嵌入式医养结合养老模式是未来老年人养老质量的保障,也体现了老年人对未来老年幸福美好生活的需求。但对该模式的研究多集中在理论研究层面,对实证的研究较为缺乏。本研究基于医养结合的嵌入式养老服务的评价方法和评价原则,对构建嵌入式医养结合养老模式的评价指标体系进行了较为详尽的阐释。发现目前嵌入式养老机构重在养老轻在医疗,医疗机构与养老机构之间存在着衔接不足的问题,具体表现在医护人员的服务主体不够专业、服务项目不够落实、医疗机构与养老机构的资源整合碎片化以及机构管理的多头监管等问题。研究针对相关问题提出了建议,对我国医养结合的嵌入式养老模式的进一步实施具有一定借鉴意义。

农村医养结合型养老服务政策的演进逻辑

伴随着健康中国战略的稳步推进,我国农村医养结合型养老服务体系经历了从供给不足到供需相对均衡的发展过程,逐步形成了与经济社会持续健康发展相协调的高质量社会养老服务体系,在满足公众需求、缓解社会矛盾、促进社会公平、增进老年福祉等方面发挥了重要作用。深入挖掘其在政策目标、政策内容、价值取向等方面的阶段性特征和变化趋势,通过社会网络分析发现,我国农村医疗卫生与养老服务相结合由点到面逐步拓展,二者由彼此独立走向有机融合,其结合、融合与整合的体制机制逐渐成熟,二者相结合由逐步成熟向深度融合阶段迈进。为了促进医养结合政策的有效衔接,我国应加快推进农村医养结合型养老服务体系建设,以县域医共体为核心发展农村医养结合型养老服务,探究不同类型政策工具之间的合理匹配,全方位提高农村医养结合型养老服务质量,不断提升老年人健康保障水平。

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。

“互联网+医养”综合管理系统设计与应用

目的:巩固宁夏回族自治区(以下简称宁夏)“互联网+医疗健康”示范区建设成果,提升医养结合服务能力。方法:结合宁夏本地医养服务现状,应用大数据和互联网技术,构建基于互联网医疗的医养综合服务信息化体系,搭建适用于不同层级医养结合机构的医养协同综合服务信息化平台。结果:面向医养结合机构、社会养老机构、社区居家养老人群提供多方位联合体机制,形成线上线下一体化的全流程医养服务及管理模式,可为老年人提供全方位多层次连续性的医疗、养老等服务。结论:“互联网+医养”综合管理系统实现了医养融合互联互通全流程管理,是“互联网+医养”融合服务模式的积极探索。

The health status of China’s elderly and their demand for healthcare services

This paper,based on data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey(CLHLS),reports on the health status of China’s elderly,and their needs for care and use of medical services.The proportion of the elderly in 2018 who reported being satisfied with their current lives was 67.1%,a proportion signifi-cantly higher than that reported by CLHLS 2002.Some 73.1%of the elderly self-rated their health as good or fair.There were ten types of chronic diseases with prev-alence rates higher than 5%,among which hypertension was the most common,with 46.2%of survey respondents self-reporting suffering from it.The daily lives of some people suffering from chronic diseases were seriously affected.Most elderly people(93.2%)were able to complete without assistance all of the ADL items surveyed by CLHLS 2018,while 63.6%were able to do so with IADL items.Only 19.1%of the elderly reported that they were unable to perform at least one IADL item.Family members were still the main source of primary care.The satisfaction of the elderly with primary caregiver and helps they received was quite high.The data shows that the average weekly cost of care was RMB 651.1 yuan,with a median of RMB 180.0 yuan.The median hours children or grandchildren helped their elderly parents(grandparents)in the week prior to being interviewed was 0,and the mean value was 10.3 h.Because 86.5%of elderly survey respondents were covered by some type of medical insurance,more than half of the elderly had their medical expenses covered by insurance,and most elderly people had access to adequate medical services.