江苏省基层医务人员工作压力研究

对905名基层医务人员进行问卷调查,了解基层医务人员工作压力情况及其影响因素,为建立适合基层卫生机构的良性人才发展机制提供依据。基层医务人员整体工作压力得分为56.54分;单因素方差分析显示,不同性别、年龄、婚姻状况、学历、职称、机构类型、工作量、工作年数、受患者尊重程度和社会地位的医务人员工作压力得分差异具有统计学意义;多元线性回归分析结果显示,社会地位、工作量、工作年数、受患者尊重程度、最高学历和性别对基层医务人员工作压力的影响具有统计学意义。需要着重关注乡镇卫生院医生的工作压力情况,重点应放在提升基层医务人员社会地位、及时关注中坚力量等方面,从而减轻其工作压力,提高工作积极性。     

Data envelopment analysis in the presence of measurement error: case study from the National Database of Nursing Quality Indicators® (NDNQI®)

Data envelopment analysis (DEA) is the most commonly used approach for evaluating healthcare efficiency [B. Hollingsworth, The measurement of efficiency and productivity of health care delivery. Health Economics 17(10) (2008), pp. 1107–1128], but a long-standing concern is that DEA assumes that data are measured without error. This is quite unlikely, and DEA and other efficiency analysis techniques may yield biased efficiency estimates if it is not realized [B.J. Gajewski, R. Lee, M. Bott, U. Piamjariyakul, and R.L. Taunton, On estimating the distribution of data envelopment analysis efficiency scores: an application to nursing homes’ care planning process. Journal of Applied Statistics 36(9) (2009), pp. 933–944; J. Ruggiero, Data envelopment analysis with stochastic data. Journal of the Operational Research Society 55 (2004), pp. 1008–1012]. We propose to address measurement error systematically using a Bayesian method (Bayesian DEA). We will apply Bayesian DEA to data from the National Database of Nursing Quality Indicators^® to estimate nursing units’ efficiency. Several external reliability studies inform the posterior distribution of the measurement error on the DEA variables. We will discuss the case of generalizing the approach to situations where an external reliability study is not feasible.     

弗洛伦斯·南丁格尔与克里米亚战争

弗洛伦斯·南丁格尔被誉为克里米亚战争（1854-1856）的女英雄和现代护理学的主要奠基人。战地记者无情揭露了克里米亚战争中英国军队存在的诸多弊端，促使英国政府派遣南丁格尔护士团前往克里米亚战争前线医院，而南丁格尔在护理教育、军队医疗和卫生改革等方面的贡献都要追溯到她在克里米亚战争中的经历。     

Ethnic intermarriage in longitudinal perspective: Testing structural and cultural explanations in the United States, 1880–2011

Focusing on macro-level processes, this article combines Decennial Census and Current Population Survey data to simultaneously test longitudinal and cross-sectional effects on ethnic intermarriage using structural and cultural explanations. Covering a 130 year period, the results of our multilevel analysis for 140 national-origin groups indicate that structural characteristics explain why some origin groups become more “open” over time while others remain relatively “closed”. Ethnic intermarriage is more likely to increase over time when the relative size of an immigrant group decreases, sex ratios grow more imbalanced, the origin group grows more diverse, the size of the third generation increases and social structural consolidation decreases. Cultural explanations also play a role suggesting that an origin group’s exogamous behavior in the past exerts long-term effects and exogamous practices increase over time when the prevalence of early marriage customs declines. For some of the discussed determinants of intermarriage, longitudinal and cross-sectional effects differ calling for a more careful theorizing and testing in terms of the level of analysis (e.g., longitudinal vs. cross-sectional).     

从利益输送引导的合作到长期合作治理的组织——K村互助基金会的个案研究

文章根据真实的素材,复原了K村互助基金会18年的历程,探究了利益输送怎样引导村民合作以及如何以利益输送为契机组建村民长期合作治理组织的问题,分析了这个内生于村庄社会的治理组织稳健成长的要件和实践的学理意义。研究提示,村民事前能得到组织者的利益输送是村民服从组织并选择合作的一个重要前提;领导者、组织和制度设计是保证村民合作治理的关键;培育合作组织并赋予组织资源是村民合作治理的重要保障;深入村庄的田野调查和体验村庄生活的方法有助于揭示对合作治理有重大影响但被流行的量化实证研究所轻易遮蔽和排除掉的随机因素。     

福建省城镇居民医疗保险运行对策

福建省自实行医疗保障制度改革以来,基本完成了从公费医疗、劳保医疗到社会保险的历史性转变,但仍存在医疗保险覆盖人群有限、医疗卫生体制改革不到位、政府投入不足等问题。进一步完善和发展福建省居民医疗保险制度,必须强化政府在医疗服务体系建设与发展中的作用,发展社区医疗服务,逐步扩大医疗保险覆盖范围,实施第三方对医疗费用和医疗质量的控制。     

社会工作视角下大学生志愿服务长效机制构建

当前我国大学生志愿服务大多属于临时或短期的志愿服务活动,缺乏稳定性和持久性,严重制约了大学生志愿服务的深入及可持续发展。大学生志愿服务长效机制的建立,是保证志愿服务可持续发展的重要条件。个人、志愿服务和学校层面因素对大学生长期参与志愿服务产生着不同影响,通过社会工作视角分析发现,健全志愿者选拔与培训体系、导入社工价值理念、建立监督评估激励机制、创建社工义工联动机制等是构建大学生志愿服务长效机制的重要内容。     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

A longitudinal analysis of the impact of health shocks on the wealth of elders

We investigate the impact of health shocks on wealth, using all four waves of the Health and Retirement Study, and estimate not only the short-term effect but also the long-term effect of health shocks on wealth of the elderly. We find that new health events lower wealth in elders during the period in which such health shocks occur, but the impact tends to disappear over time. We also find that health shocks result in greater wealth depletion when they occur later in life. Together with existing health problems, the overall impact of health problems on wealth increases over time.

The U.S. Health System and Immigration: An Institutional Interpretation1

We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.