Facilitators and Barriers to Implementing Transitional Care Managers Within a Public Health Care System

Transitional care is crucial to ensure quality of care and safety for elderly patients. In the context of health care reforms promoting a shift from a hospital-centered approach to a home care approach, transitional care becomes a vital component and social workers can play an important role in easing transitions. Most recent studies have focused on the development or improvement of transitional care intervention models or tools, but few have addressed implementation issues. In this study, the implementation process of an innovative intervention aiming to integrate transitional care managers (TCMs) from Health and Social Services Centres (HSSC) within two Canadian hospitals was evaluated. Data collection comprised focus groups (n = 8), direct observations, meeting minutes, activity grids and logbooks. To facilitate the implementation of TCMs, decisions were made to clearly indicate their involvement in patients’ files and concentrated their efforts on a restricted number of units. Barriers included confusion about target clientele, inequitable information exchange between partners, limited powers regarding coordination of care, and organizational constraints limiting additional measures to improve transitional care. Evaluating implementation processes is crucial to efficiently identify obstacles and apply additional implementation strategies to promote the integration of new practices within the health care system.     

2013—2016年南京某三甲医院住院患者疾病构成分析

目的: 分析南京市某三级甲等医院2013—2016年住院患者疾病构成前十位病种顺位、性别、年龄、平均住院日变化的内在影响因素,推测未来的变化趋势。方法: 以ICD-10 为依据对疾病进行分类,利用Excel建立数据库进行统计分析。结果: 冠心病、2型糖尿病、肿瘤化学治疗等六种疾病顺位稳居前十,白内障疾病逐年增多,十种疾病住院患者平均住院日呈减少趋势。结论: 医院要以患者为中心,巩固发展重点学科,开展多学科诊疗模式,积极参与分级诊疗,开展健康教育活动,同时顺应医改,改变医保付费方式,完善内部绩效方案。     

Evaluation of an experience-based program to understand the concept of recovery among hospital-based psychiatric nurses

This study aimed to implement an experience-based program to promote the understanding of the concept of recovery, which is defined as a meaningful life and valued sense of integrity based on subjective and individual viewpoints, among psychiatric nurses working in hospitals in Japan and to evaluate this program. Methods: We conducted a preliminary survey of nurses at six facilities with psychiatric wards. The experience-based program was conducted for 12 nurses who expressed a wish to participate. The program spanned three days and consisted of lectures, assertive community treatment (ACT) staff visits for recovery orientation, and group work. Results: The mean Recovery Knowledge Inventory of nine participants ultimately included was 3.41 points (SD, 0.28) before the program and 3.69 points (SD, 0.24) after the program, indicating a significant difference (p = .004). Categories obtained from ACT support experiences included the following: “Continuing to attend to the need to live in one’s community/home regardless of how bad psychiatric symptoms become without the use of medicines,” “Viewing the person living their life in a place where they belong and in their own individual style,” “Valuing the patient’s wishes is the slow but sure way to a fruitful relationship,” and “Become familiar to the patient and their family’s lifestyle by carefully listening to the family’s feelings”. Discussion: We believe that this program can help establish the concept of recovery in hospital, which tend to rely on the medical model, and enable daily nursing practice to be implemented from a strength-based viewpoint.     

城市中心区医院改扩建规划设计研究

在城市中心区进行医院的改建扩建规划设计时,要结合环境,在限制中寻找突破,围绕功能需求,兼顾医疗服务,分步实施,并可持续发展.文章结合一个实际工程的设计,对此进行了阐述.     

基于患者两阶段医疗服务过程的病床资源优化

随着医疗需求的日益增长，供需不平衡的矛盾日益显著，病床资源短缺已经成为制约医疗服务发展的重要因素之一。针对病床资源供需失衡的问题，本文构建患者两阶段医疗服务过程的病床资源优化模型。考虑患者的医疗服务是一个两阶段串联排队过程，第一阶段是强制治疗阶段，第二阶段是康复阶段。在患者排队系统中，服务台总数固定的前提下，本文利用增补变量方法给出了该排队系统的概率等式，通过求解偏微分方程得出系统的状态概率，并推导出医院拒绝患者的概率、平均康复时间等相关指标。考虑部分患者因病床资源不足而无法入院和康复阶段患者提前出院两种风险因素，本文基于排队指标构建多病种间的病床分配模型，再利用动态规划的求解思路得到病床分配的最优解。最后，本文采用2017年卫生统计数据和模拟数据相结合进行数值分析。研究结果表明与传统单阶段模型相比，两阶段模型对不同病种间病床数差别影响显著，并且患者入院率对病床分配影响较大。进一步，基于数值结果给出了医疗管理建议和研究展望。     

医院固定资产管理存在的问题及对策*

医院的固定资产是医院经营的资本,是国有资产的重要组成部分,分析了医院固定资产运用中存在的问题,从明确固定资产管理的岗位设置与分工,健全固定资产管理机制,完善固定资产的账务管理,搞好医院固定资产的清查盘点,加强对医院固定资产计算机系统管理,加强固定资产维修和报废管理工作等六个方面提出了做好医院固定资产的管理的对策建议.     

On sign-based regression quantiles

A sign-based (SB) approach suggests an alternative criterion for quantile regression fit. The SB criterion is a piecewise constant function, which often leads to a non-unique solution. We compare the mid-point of this SB solution with the least absolute deviations (LAD) method and describe asymptotic properties of SB estimators under a weaker set of assumptions as compared with the assumptions often used with the generalized method of moments. Asymptotic properties of LAD and SB estimators are equivalent; however, there are finite sample differences as we show in simulation studies. At small to moderate sample sizes, the SB procedure for modelling quantiles at longer tails demonstrates a substantially lower bias, variance, and mean-squared error when compared with the LAD. In the illustrative example, we model a 0.8-level quantile of hospital charges and highlight finite sample advantage of the SB versus LAD.     

江苏三级医院抗菌药物管理调查

采用方便抽样与滚雪球抽样的方法,对江苏省内50家三级医院抗菌药物管理现状进行调查?2011年组建抗菌药物管理专业技术团队的医院最多;52%的医院会拨付专项经费支持抗菌药物管理;仅有52%的医院会定期向医师反馈抗菌药物使用情况并进行沟通;门诊未开展抗菌药物处方预审与反馈的占52%,病区为36%;84%的医院计算机系统中使用了抗菌药物管理相关的软件程序;行政干预普遍?以实施抗菌药物管理策略为导向,应进一步完善医院多学科协作的抗菌药物管理团队;为抗菌药物管理活动设立专项经费;注重监测信息的反馈;开发一些应用程序辅助抗菌药物管理;积极开展处方/医嘱预审与反馈;转变管理思路,逐渐弱化行政干预?     

论新形势下医院科室管理干部素质

科室管理干部是医院管理结构的重要枢纽 ,对医院的建设和发展起着举足轻重的作用。目前医院面临激烈的市场竞争 ,科室只有不断提高自身素质 ,注重市场经济规律 ,搞好科室管理 ,才能使科室在未来竞争中赢得主动权 ,保持科室建设的全面发展