医疗保险费用控制的临床路径研究--胰腺炎医疗保险费用结算标准的确定

临床路径是现代医院管理的前沿技术之一,对于提高医疗服务质量和降低医疗费用具有现实意义.通过对急性胰腺炎病人的临床路径研究,探讨了我国临床实践中临床路径的实施方法,并在此基础上进一步研究了该疾病医疗保险费用结算标准的分类标准.     

按病种支付医疗保险费用与病种成本核算研究

医疗服务具有垄断性、委托代理双重性和需求刚性.在利益机制驱动下,医疗项目的选择变成供方偏好,是医疗费用快速攀升的症结之一.变按项目支付为按病种支付,是控制医疗费用快速上涨、深化卫生改革的重要措施之一.最科学的方法是进行病种成本核算.     

大连市某医院脑血管单病种结算标准与医疗费用差异分析

为研究现行单病种结算标准与医院实际医疗费用的差异,促进单病种结算方式发展,以大连市某三级甲等医院为研究对象,收集该医院2012年1月~2014年12月三种脑血管病单病种医疗保险数据444例,应用数理统计法、文献研究法和定性访谈法,对脑血管病单病种的费用特征和定额标准合理性进行分析。结果显示,该医院脑血管病单病种费用普遍超标,定额标准的提高难以弥补医院亏损。因此应当完善单病种界定标准,制定科学合理的结算标准,在确保医疗质量的同时减少医疗费用不合理增长。     

居民门诊费用现状及控制策略研究

近年来,各级政府和卫生部门均在采取措施控制医疗费用的不合理增长,但我国的医疗费用仍然呈上升趋势。门诊费用是医疗费用的重要组成部分,其上升幅度虽然有所下降,但仍高于城乡居民人均收入的增长幅度和同期的物价上涨幅度,对门诊费用的现状及控制策略进行研究,将有助于更有效地解决贫困人群看病难、看病贵问题。     

临床路径管理模式的应用及效果评价

为了评价临床路径的效果,探索符合我国医院实际的临床路径实施办法,对某三级甲等综合医院对两种外科疾病应用临床路径的结果进行统计分析。结果显示:两种外科疾病的平均住院日缩短、住院费用降低、病人满意度提高。由此得出结论,临床路径管理模式能使病人得到高品质、低费用的医疗服务,有利于医疗规范化管理。但其广泛实施受到诸多因素的影响,尚需要结合医院的实际情况,加强各专业科室的协调,加强医院信息管理系统的建设,改革医疗费用支付方式等。     

医疗损害赔偿费用的探讨

《医疗事故处理条例》与《民法通则》确定的赔偿范围和标准不一致。通过《医疗事故处理条例》与《民法通则》的对比,提出医疗损害赔偿的三个原则,即全面赔偿原则、限额赔偿原则、衡平赔偿原则,以及建立医疗损害赔偿费用的统一标准,希望对司法实践有所借鉴意义。     

临床路径管理模式的应用及效果评价

为了评价临床路径的效果,探索符合我国医院实际的临床路径实施办法,对某三级甲等综合医院对两种外科疾病应用临床路径的结果进行统计分析.结果显示:两种外科疾病的平均住院日缩短、住院费用降低、病人满意度提高.由此得出结论,临床路径管理模式能使病人得到高品质、低费用的医疗服务,有利于医疗规范化管理.但其广泛实施受到诸多因素的影响,尚需要结合医院的实际情况,加强各专业科室的协调,加强医院信息管理系统的建设,改革医疗费用支付方式等.     

超高消费住院病例医疗费用研究

分析了1 165例超高消费住院病例医疗费用特点和影响因素.结果显示,超高消费住院病例主要以循环系统疾病和损伤中毒、肿瘤等病种为主,年龄、住院天数,住院次数、抢救次数和护理天数与医疗费用呈非线性正相关.加强对循环系统疾病和损伤中毒等病种的诊治研究、加快床位使用效率、控制药品和材料比例,是控制超高消费住院病例医疗费用的关键点.     

超高消费住院病例医疗费用研究

分析了1165例超高消费住院病例医疗费用特点和影响因素。结果显示,超高消费住院病例主要以循环系统疾病和损伤中毒、肿瘤等病种为主,年龄、住院天数、住院次数、抢救次数和护理天数与医疗费用呈非线性正相关。加强对循环系统疾病和损伤中毒等病种的诊治研究、加快床位使用效率、控制药品和材料比例,是控制超高消费住院病例医疗费用的关键点。     

取消药品加成政策对医疗费用的影响

政府取消医院药品加成政策,增加对医院的补贴,增设药事服务费的做法在降低医疗费用方面难以取得理想效果,因为药品加成政策只是医疗费用高的表面原因,医疗费用高的真正原因是医疗系统的垄断,降低医疗费用必须采取包括放松政府管制、引进民间资本、维护医疗市场秩序、理顺医疗服务价格等综合措施.     

一种基于Rasch模型的Angoff方法及其应用

水平厘定方法在近二十年来发展迅速,其中Angoff方法的应用最为广泛。该文在已有的方法上提出了一种基于Rasch模型的改进的Angoff方法,该方法使用Rasch模型来估计典型学生的位置,通过均方残差等方法剔除不一致的裁判。文章最后详细阐述了该方法在香港全港性系统评估中的应用。     

Anti-Naturalism: The Role of Non-Empirical Methods in Philosophy

Some naturalistic conceptions of philosophical methodologies interpret the doctrine that philosophy is continuous with science to mean that philosophical investigations must implement empirical methods and must not depart from the experimental results that the scientific application of those methods reveal. In this paper, I argue that while our answers to philosophical questions are certainly constrained by empirical considerations, this does not imply that the methods by which these questions are correctly settled are wholly captured by empirical methods. Many historical cases of successful answers to philosophical questions involve strategies and methods that allow the divergence from empirically established results. I develop this idea and then illustrate it with Frege's methodology in his Foundations of Arithmetic.     

Boot night shelter

This article is an outline of the author's work as a volunteer counsellor, and describes some of the methods used and insights obtained in dealing with the special problems of counselling in non-institutionalised and unstructured settings. The general background of this type of counselling and the counselling methods used are illustrated with reference to a case study; there is also an overall evaluation of the contribution that this kind of counselling offers in contrast to more formal and institutionalised counselling methods.     

Reconceptualizing Quantitative and Qualitative Methods: A Case Study Dealing with Place as an Exemplar

A useful framework for understanding methods is to think of them as being on a continuum of holistic and pattern focused to particularistic and specific. This paper argues for this conceptualization rather than thinking of quantitative and qualitative methods as oppositional and potentially contradictory. A case study provides an example of using both quantitative and qualitative methods in a holistic and pattern-focused study, while also attending to the values and goals of community psychology. The substantive research goal is to understand a child's experience of places related to school. Methods include ethnographic long-term participation and observation, interviews, multidimensional scaling, and social network analysis. Most quantitative method variables are generated from study participants; no outside structure is imposed. The quantitative methods extend and inform the qualitative methods, just as the qualitative methods extend and inform the quantitative methods. The quantitative and qualitative methods work reciprocally to extend and inform each other.     

Choosing Methods

This paper begins by adopting a broad criterion of scientific methods, in which a method is some practice in science designed to achieve the goals of science; this allows us to deal with a wider range of questions than has been common in much past philosophy of science, and to discuss some of the more detailed methodological questions of concern to scientists. On this definition, apriori approaches prove insufficient, since many methodological questions require some empirical input to be decided. Laudan has suggested that many such questions can be decided by testing methods empirically, but this encounters the problem that the empirical evidence is often indecisive. A more productive strategy is to utilise scientific theories: there are a wide range of these that are relevant to methodological questions and they are easier to validate. But this does not mean that empirical testing has no place. Instead, our experience with methods can be used to detect specific problems with the methods and to modify them accordingly.     

A tutorial on Bayesian nonparametric models

A key problem in statistical modeling is model selection, that is, how to choose a model at an appropriate level of complexity. This problem appears in many settings, most prominently in choosing the number of clusters in mixture models or the number of factors in factor analysis. In this tutorial, we describe Bayesian nonparametric methods, a class of methods that side-steps this issue by allowing the data to determine the complexity of the model. This tutorial is a high-level introduction to Bayesian nonparametric methods and contains several examples of their application.     

医学人文课程多元评价方法探讨

医学人文课程有必要实施多元评价:内容多元,涵盖知识与技能、过程与方法、情感态度与价值观3个领域的内涵;方法多元,根据不同课程的特点采用不同的评价方式;主体多元,运用教师评价、学生自评、学生互评的方法,使评价体现职业需求和学科特点,促进学生发展,并且有可操作性。     

Implications of direct and indirect range restriction for meta-analysis methods and findings

Range restriction in most data sets is indirect, but the meta-analysis methods used to date have applied the correction for direct range restriction to data in which range restriction is indirect. The authors show that this results in substantial undercorrections for the effects of range restriction, and they present meta-analysis methods for making accurate corrections when range restriction is indirect. Applying these methods to a well-known large-sample empirical database, the authors estimate that previous meta-analyses have underestimated the correlation between general mental ability and job performance by about 25%, indicating that this is potentially an important methodological issue in meta-analysis in general.     

Why and How to Learn Why: Analysis-based Generalization of Procedures

Max Wertheimer, in his classic Productive Thinking, linked understanding to transfer: Understanding is important because it provides the ability to generalize the solution of one problem to apply to another. Recent work in human and machine learning has led to the development of a new class of generalization mechanism, called here analysis-based generalization, which can be used to provide a concrete account of the linkage Wertheimer suggested: these mechanisms all, in different ways, use understanding of examples in the generalization process. In this paper I review this class of mechanism, and describe a method for causal attribution that can produce the analyses of examples that the generalization methods require, in the domain of simple procedures in human-computer interaction. This causal analysis method is linked with analysis-based generalization to form EXPL, an implemented model which is a concrete, though limited, instontiation of Wertheimer s scheme. EXPL constructs an understanding of an example procedure and generalizes it on the basis of that understanding. Results of an empirical study suggest that some of EXPL's attribution heuristics are used by people, and that while a subclass of analysis-based methods, called superstitious methods, seem to provide a more plausible account of people's generalization under the conditions of the study than a contrasting class of rationalistic methods, at least some participants appear to use methods from both classes. The results also show that explanation-based methods, which rely on comprehensive domain theories, must be used in conjunction with a means for extending the domain theory. If thus enhanced, explanation-based methods are able to mimic the effects of other analysis-based methods, and can provide a good account of the data, though combinations of other methods must also be considered. Finally, I return to Wertheimer s ideas to argue that none of the current analysis-based generalization methods fully captures Wertheimer s notion of understanding. Proper choice among different possible analyses of an example is crucial for Wertheimer, but I argue that this problem may be beyond the reach of learning systems.     

Hypnoanalyse – Ein Stiefkind der Psychoanalyse

Goal of this article is to present the manifold methods and techniques of modern hypnotherapy/hypnoanalysis and to show the possibilities for linking them to traditional psychoanalytical methods. In the introduction, clarification of concepts and a short historical overview is given. The phenomenology of the hypnotical state and its assessment from a psychoanalytical and a non-psychoanalytical view either follows. In this connection the topic of meditation is shortly discussed. In the main part a definition of hypnoanalysis is given, the most important hypnoanalytical methods are described and demonstrated by case studies. The question whether psychoanalysis is to be considered as a trance therapy, is also discussed. Free association in hypnotical trance is especially recommended with patients having difficulties to reach their own feelings.