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The changing landscape of health care financing and delivery: How are rural communities and providers responding?

MILBANK QUARTERLY 1999年第4期77卷 485-+页

作者： Mueller, KJ Coburn, A Cordes, S Univ Nebraska Med Ctr Nebraska Med Ctr 984350 Coll Med Omaha NE 68198 USA Univ So Maine Portland ME 04103 USA Univ Washington Seattle WA 98195 USA Univ N Dakota Grand Forks ND 58201 USA Univ Missouri Columbia MO 65211 USA US Dept Hlth & Human Serv Washington DC 20201 USA

Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking;the creation of new strategies for managing patient care;and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices;a few were signing contracts fbr capitated fare, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health fare organization and financing reach the levels achieved by urban communities.

关键词：社区网络/经济学社区网络/组织和管理病人医护连续性/组织和管理合同业务财务管理/组织和管理卫生保健部门卫生服务研究医院乡村/经济学医院乡村/组织和管理医院乡村/发展趋势保险健康补偿管理医疗规划/组织和管理 Medicare/组织和管理明尼苏达纽约俄克拉何马组织状况研究组织改革乡村卫生服务/经济学乡村卫生服务/组织和管理乡村卫生服务/发展趋势南卡罗来纳田纳西美国华盛顿老年人人类

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What is necessary for high-quality discharge summaries?

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AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第4期14卷 160-169页

作者： van Walraven, C Rokosh, E Univ Ottawa Ottawa Civic Hosp Clin Epidemiol Unit Loeb Res Inst Ottawa ON K1Y 4E9 Canada Univ Ottawa Ottawa Civic Hosp Dept Med Ottawa ON K1Y 4E9 Canada

The objective of this study was to determine what physicians perceive to be necessary for high-quality dis charge summaries. One-on-one surveys of 100 hospital-based physicians in-training and community family physicians were conducted. Participants indicated the amount that 56 items contributed to discharge summary quality on a 15-category ordinal scale. Results were transformed to a continuous scale, extending from -6.6 ("item makes summary useless") through 0 ("item has no effect on discharge summary quality") to 10 ("item is so essential that summary is useless without it"). Quality decreased significantly when summary length exceeded 2 pages and when the delay from patient discharge to summary delivery increased. Summary content that increased quality most included admission diagnosis (mean 8.2;95% confidence interval [7.7, 8.6]), pertinent physical examination findings (6.6 [6.0, 7.2]) and laboratory results (6.8 [6.3, 7.4]), procedures (7.1 [6.7, 7.6]) and complications in hospital (7.1 [6.6, 7.5]), discharge diagnosis (8.8 [8.4, 9.1]), discharge medications (7.9 [7.4, 8.4]), active medical problems at discharge (7.8 [7.4, 8.2]), and follow up (6.6 [6.0, 7.1]). With minor exceptions, hospital and family physicians agreed on contributors to summary quality. For this sample of physicians, summaries were of high quality when they were short, delivered quickly, and contained pertinent data that concentrated upon discharge information.

关键词：方差分析医务工作者的态度病人医护连续性/组织和管理数据收集文献工作/标准病案/标准医务人员医院/心理学病人出院/标准医师家庭/心理学质量保证卫生保健可重复性结果美国人类

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The role of the emergency physician in emergency medical services for children

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 206-215页

作者： Gausche-Hill, M Johnson, RW Warden, CR Brennan, JA Univ Calif Los Angeles Geffen Sch Med Dept Emergency Med Torrance CA 90509 USA Univ Calif Los Angeles Little Co Mary Hosp Ctr Med Torrance CA USA Childrens Hosp Mission Mission Med Hosp Reg Med Mission Viejo CA USA Oregon Hlth & Sci Univ Doernbecher Mem Hosp Children Pediat Emergency Serv Portland OR 97201 USA Univ Med & Dent New Jersey Dept Emergency Med New Brunswick NJ USA St Barnabas Hlth Care New Brunswick NJ USA

Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergency Physicians policy paper "The Role of the Emergency Physician in Emergency Medical Services for Children," describes the development of the federal EMS for Children Program, the importance of the integration of EMS for children into EMS systems, and the role of the emergency physician in EMS for children.

关键词：儿童保健服务/组织和管理儿童福利临床方案病人医护连续性/组织和管理数据库事实型急救医疗服务/组织和管理急救医学/教育急救医学/组织和管理卫生政策美国国立医学研究所医疗差错/预防和控制模型组织管理儿科学/教育儿科学/组织和管理医师的作用学会医学全面质量管理/组织和管理美国美国卫生和人类服务部儿童人类

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Integrated institution - community rehabilitation in developed countries: a proposal

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DISABILITY AND REHABILITATION 2000年第6期22卷 266-274页

作者： Eldar, R Loewenstein Hosp & Rehabil Ctr Fleischman Unit Study Disabil Rehabil Ctr IL-43000 Raanana Israel

Purpose: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. Methods: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries;presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. Results: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. Conclusion: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

关键词：社区卫生服务/组织和管理病人医护连续性/组织和管理发达国家残疾人以色列康复/组织和管理人类

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Knowledge and attitude assessment and education of prehospital personnel in child abuse and neglect: Report of a National Blue Ribbon Panel

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ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 91-103页

作者： Markenson, D Foltin, G Tunik, M Cooper, A Matza-Haughton, H Olson, L Treiber, M Columbia Univ Coll Phys & Surg Harlem Hosp Ctr New York NY 10037 USA Harlem Hosp Med Ctr Ctr Pediat Emergency Med Natl Child Protect Educ Project New York NY 10037 USA Bellevue Hosp Ctr Ctr Pediat Emergency Med New York NY 10016 USA Bellevue Hosp Ctr Pediat Emergency Med Program New York NY 10016 USA NYU Sch Med New York NY USA Ctr Pediat Emergency Med Natl Child Protect Project New York NY USA Univ Utah Natl Emergency Med Serv Children Data Anal Resour Intermt Injury Control Res Ctr Salt Lake City UT USA Univ Utah Dept Pediat Salt Lake City UT USA

[Markenson D, Foltin G, Tunik M, Cooper A, Matza-Haughton H, Olson L, Treiber M. Knowledge and attitude assessment and education of prehospital personnel in child abuse and neglect: report of a National Blue Ribbon Pa... 详细信息

关键词：医务工作者的态度虐待儿童/立法和法学虐待儿童/预防和控制病人医护连续性/组织和管理急救医疗服务/方法急救技师/教育健康知识态度实践法定报告诊疗准则(主题)/标准职业作用职业家庭关系美国儿童人类

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Maternal substance abuse and infant health: Policy options across the life course

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MILBANK QUARTERLY 1999年第4期77卷 531-+页

作者： Frohna, JG Lantz, PM Pollack, H Univ Michigan Sch Med Dept Internal Med Taubman Ctr 3110G Ann Arbor MI 48109 USA Univ Michigan Sch Med Dept Pediat Ann Arbor MI 48109 USA

Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

关键词：青少年保健服务/组织和管理年龄因素儿童保健服务/组织和管理综合保健/组织和管理病人医护连续性/组织和管理卫生政策婴儿福利产妇卫生保健服务/组织和管理妊娠并发症/流行病学妊娠并发症/预防和控制产前保健/组织和管理物质相关性障碍/流行病学物质相关性障碍/预防和控制美国/流行病学妇女卫生青少年女(雌)性人类婴儿新生妊娠

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Mental health services utilization in a children's mental health managed care demonstration

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第1期23卷 80-91页

作者： Summerfelt, WT Foster, EM Saunders, RC VANDERBILT UNIV VANDERBILT INST PUBL POLICY STUDIES1207 18TH AVE SNASHVILLETN 37212 USA

Service delivery under two systems of care-a traditional Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) reimbursement system and an innovative continuum of care-was examined along six dimensions: access, type, mix, volume, timing, and continuity of services received by children and adolescents. It was found that the Demonstration sewed over three times as many children as the Comparison. In addition to sewing more children, the Demonstration also provided more and different types of services to each child treated. Finally, the Demonstration appears to have delivered services in a more timely fashion and made a considerable effort to match children's and families' needs with services.

关键词：青少年保健服务/利用儿童保健服务/利用病人医护连续性/组织和管理政府机构保健福利计划雇员/利用卫生服务易得程度精神卫生服务/利用军事医学模型组织管理北卡罗来纳/流行病学试点项目疾病严重程度指数青少年儿童人类

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小儿体外循环术后整体护理评价

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中国校医 2011年第11期25卷 846-847页

作者：苗春华徐州市儿童医院江苏徐州221002

目的评价小儿体外循环术后整体护理的最佳护理措施。方法 2008年1月—2009年9月共收治280例心脏体外循环术的患儿,通过将护理临床业务和护理管理各环节系统化进行整体护理。结果经准确的术前决策、充分的术前准备、严密的术后系统化整... 详细信息

目的评价小儿体外循环术后整体护理的最佳护理措施。方法 2008年1月—2009年9月共收治280例心脏体外循环术的患儿,通过将护理临床业务和护理管理各环节系统化进行整体护理。结果经准确的术前决策、充分的术前准备、严密的术后系统化整体护理,患儿痊愈出院,成功率100%。结论系统化整体护理模式能有效地预防并发症,有利于改善病人行为和心理,密切护患关系,值得临床推广应用。

关键词：儿童心脏缺损,先天性/外科手术体外循环病人医护连续性/组织和管理

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Making the link - An impact evaluation of one Dublin hospital's accident & emergency department's liaison nurse service

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Accident and Emergency Nursing 2003年第1期11卷 39-48页

作者： McBride, Louise Kavanagh College of Nursing Mater Misericordiae Hospital Dublin 7 Ireland

The Accident & Emergency (A&E) liaison nurse service (LNS) was introduced at the Mater Misericordiae Hospital, Dublin as a quality improvement initiative in June 1996. It aimed to improve and enhance communication channels between the hospital and general practitioners (GPs) in the hospital's catchment area. A quantitative study was conducted to evaluate the A&E LNS, in partial fulfilment of a Master's degree in Nursing Science at the University of Dublin, Trinity College, Dublin. The primary users (90 GPs and 52 A&E staff, n=142) of the service were asked to complete a questionnaire comprising open and closed questions. Descriptive analysis using parametric and non-parametric tests was carried out, using the Statistical Package for the Social Sciences (SPSS version 9), on the collected data. Content analysis was used to analyse the open-ended questions. The findings of the study suggest that the A&E LNS positively affects communication between the hospital and GPs, and favourably affects the continuity and quality of patient care. The study respondents strongly supported the provision of an A&E LNS and expressed positive attitudes towards the quality of the service provided. This piece of research provides a basic understanding of the role, function and scope of practice of the A&E liaison nurse specialist. Implications for practice and areas for improvement are also outlined and identified. © 2003 Elsevier Science Ltd. All rights reserved.

关键词：信息交流病人医护连续性/组织和管理急诊室医院/标准家庭医学医院医生关系爱尔兰护理部医院卫生保健质量转诊和会诊/组织和管理统计学非参数全面质量管理人类

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Health care clusters in hospitals: The market audit and frameworks for planning

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Journal of Hospital Marketing 1993年第2期7卷 61-76页

作者： Gruca, Thomas S. Kaltenbach, Katherine M. Nath, Deepika University of Iowa Iowa City IA 52242 United States Alexian Brothers Medical Center Elk Grove Village IL United States York University Toronto Canada

Many hospitals are turning to cluster relationships to gain the benefits of diversification without the troubles of increased capital costs and management conflicts. The goal of healthcare clusters is to provide a continuum of care to a defined geographic region through integration of referral and payment systems. To aid in successful planning for healthcare clusters, a market audit and frameworks for examining the current healthcare market are presented. © 1993 Taylor & Francis Group, LLC.

关键词：卫生服务范围综合保健/组织和管理综合保健/标准病人医护连续性/组织和管理病人医护连续性/标准评价研究医院计划卫生服务使用研究模型组织管理多机构系统/组织和管理美国

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