美国零售诊所商业模式创新的研究

2008年以前,美国零售诊所是以没有保险的底层顾客为目标市场,依靠自身资源提供经济便捷的基本医疗保健服务,这种单一收入来源无法实现盈利。2008年以后,通过与医院、医生和各种协会构建合作关系网络,美国零售诊所转变为以广大的偏好便利的患者为目标市场,提供基本医疗保健服务、慢性病治疗、美容等更全面的服务。通过利用医院系统的资源,美国零售诊所改善了服务过程,消除了患者顾虑,构建了更长的价值链,从而也获得了多种可持续的盈利来源。这种创新实质上是在信息通信技术推动下的合作网络创新,也是未来零售企业创新的机会和方向。     

Bi‐Criteria Scheduling of Surgical Services for an Outpatient Procedure Center

Uncertainty in the duration of surgical procedures can cause long patient wait times, poor utilization of resources, and high overtime costs. We compare several heuristics for scheduling an Outpatient Procedure Center. First, a discrete event simulation model is used to evaluate how 12 different sequencing and patient appointment time‐setting heuristics perform with respect to the competing criteria of expected patient waiting time and expected surgical suite overtime for a single day compared with current practice. Second, a bi‐criteria genetic algorithm (GA) is used to determine if better solutions can be obtained for this single day scheduling problem. Third, we investigate the efficacy of the bi‐criteria GA when surgeries are allowed to be moved to other days. We present numerical experiments based on real data from a large health care provider. Our analysis provides insight into the best scheduling heuristics, and the trade‐off between patient and health care provider‐based criteria. Finally, we summarize several important managerial insights based on our findings.     

The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

2型糖尿病相关单核苷酸多态性c/t位点相似性分析

2型糖尿病（非胰岛素依赖型糖尿病）具有明显的家族遗传特点,但它的基因起源很大程度上并未得到深入了解。几种遗传因素共同影响提高了患2型糖尿病及相关代谢性疾病的风险性。通过对与2型糖尿病相关联的单核苷酸多态性位点（SNPs）做相似性分析来揭示2型糖尿病的基本机制,并作为标记来定位和识别与这一疾病相关的基因。     

2型糖尿病、肥胖症与内源性大麻素系统的生化作用

内源性大麻素的合成与分解酶，以及大麻素受体组成了内源性大麻素信号系统，这个系统参与着血脂、血糖代谢不同水平的控制。摄取能量的失衡，内源性大麻素系统就会出现调节障碍，在一些脏器的自身能量平衡方面会出现过度活跃，特别是腹内脂肪组织，这种调节障碍将有助于腹部脂肪堆积和脂联素释放减少，成为心脏代谢、肥胖症和糖尿病的危险因素。     

Reducing waiting times in the Italian NHS: The case of Emilia-Romagna

In 2015, the Emilia-Romagna Regional Government implemented a plan to reduce waiting times for elective outpatient procedures. The objective set by the regional government establishes that at least 90 per cent of specialist services are to be provided within the following maximum waiting times: 30 days for the first specialist consultation, and 60 days for diagnostic tests. The plan adopted by the Emilia-Romagna Regional Government is of particular interest because it encompasses a combined strategy. Some of the interventions envisaged in the plan aim at increasing the supply of specialist services. Others address the demand side, seeking to reduce inadequate requests and discourage no-shows by patients. And others focus on combining supply and demand and neutralizing the effects of some perverse incentives. The Emilia-Romagna plan appears to have had a successful outcome. In the first 4 years of implementation, the 90 per cent target has not only been achieved but also widely exceeded.     

综合医院门诊部大厅设计浅议

综合医院门诊部门厅是医院的公共空间 ,除了功能上要合理外 ,还需要以人为本 ,尽可能创造一个舒适、安静、优雅的空间环境。     

200例糖尿病患者血清检测结果分析

目的 :评价 2 0 0例糖尿病患者血中检测指标在诊断中的意义。方法 :对 10 0例正常对照组、2 0 0例糖尿病组进行血糖、尿素、肌酐、糖化血红蛋白、胰岛素、尿微量白蛋白、C 肽测定。结果 :10 0例正常组、2 0 0例糖尿病组结果比较差异显著 ,阳性率分别为 6 4 %、4 5 %、4 4 %、72 .5 %、4 2 .5 %、5 5 %、38.5 %。结论 :血糖、尿素、肌酐、糖化血红蛋白、胰岛素、C 肽的联合检测有助于糖尿病的诊断。     

Prevalence and correlates of diabetes mellitus among homeless veterans nationally in the Veterans Health Administration

Abstract

Background: Homeless people are at high risk for many chronic medical conditions although their risk of diabetes has not been well studied. Current epidemiological studies of diabetes prevalence among homeless adults have been based mostly on self-report data not supported by clinical assessments.

Objectives: To determine the prevalence and risk factors for diabetes mellitus (DM) among homeless veterans in the Veteran Health Administration (VHA).

Methods: The sample included 3?464?364 veterans with documented body mass indexes (BMI), 137?720 (4%) of whom had been homeless. Logistic regression models were used to determine the odds of having DM among homeless veterans compared to non-homeless veterans. Bivariate and multi-variate analyses were then used to identify potential risk factors for DM among homeless veterans.

Results: The prevalence of DM in homeless veterans was 19%. Homeless veterans with DM, compared to those without it were older, more likely to have a BMI?>?40 and more likely to have DM-related co-morbidities.

Conclusions: There is a high prevalence of DM among homeless veterans in the VHA compared to previous reports for homeless adults (8%). Tailored approaches to improve access to DM screening, prevention, and treatment could benefit homeless veterans.     

加强村卫生所建设 缓解农民“看病难、看病贵”

分析村卫生所目前存在设备简陋,服务能力有限、定位不准,管理不到位,乡村医生待遇不高、后继无人等问题,从改善卫生服务条件、明确村医职责、加强人才培训等方面对卫生所建设提出对策与建议,以缓解农民“看病难、看病贵”问题。