实施单病种临床路径缩短患者平均住院日

为研究单病种临床路径应用效果,对宫颈癌患者39例、输卵管妊娠患者29例实施,临床路径。结果显示,手术并发症发生率降低,平均住院日和住院费用、药品费、药占比均下降,并具有统计学意义（P〈0．05）。因此,应用单病种临床路径,能降低患者住院日和费用、提高医护工作效率、增加医院竞争力。     

慢性阻塞性肺疾病急性加重期临床路径应用效果评价

评价临床路径管理在慢性阻塞性肺疾病急性加重期（AECOPD）的应用效果。通过采用回顾性调查,比较进入临床路径（路径组）和没有进入临床路径（对照组）两组患者在住院费用、住院时间及治疗效果3项指标上的差别。结果显示实施临床路径患者（路径组）的平均住院费用、平均住院日等指标均有不同程度的下降,而治愈率有所上升。从而得出临床路径在AECOPD病种的应用能够规范医疗行为,提高医疗护理质量的结论。     

临床路径在慢性硬膜下血肿患者的效果分析

探讨临床路径在慢性硬膜下血肿钻孔引流术患者中应用的可行性和效果评价.将66例慢性硬膜下血肿钻孔引流术患者随机分为实验组和对照组,每组各33例.实验组按制订好的临床路径表实施每日的主要诊疗工作、重点医嘱、主要护理工作、病情变化记录;对照组采用传统医疗护理方法.结果实验组患者的平均住院时间、平均术前时间、平均住院费用、平均药费明显低于对照组,患者满意度明显高于对照组(P＜0.01).病种临床路径可以规范医疗行为,提高医疗执行效率,降低医疗成本,提高医疗质量,提高患者及家属参与治疗过程的主动性,提高患者满意度,缓和医患关系.     

广西肝恶性肿瘤患者住院费用的研究

为探讨肝恶性肿瘤患者住院总费用情况,对广西2010年～2012年间肝恶性肿瘤患者的住院费用资料进行统计学分析,比较肝恶性肿瘤患者3年住院总费用的变化情况,并采用多重线性回归分析方法,分析肝恶性肿瘤患者住院总费用的影响因素.结果显示广西肝恶性肿瘤住院患者逐年增多,住院费用逐年增高;住院天数、有无手术、有无合并症、有无院内感染、性别、年龄6个因素是住院总费用的影响因素.我们应加大预防控制肝恶性肿瘤的力度,建立单病种诊疗规范和费用控制标准,推进临床路径管理,以减轻患者的经济负担.     

慢性硬膜下血肿患者临床路径实施效果分析

临床路径是确保医疗质量、控制医疗成本和优化医疗服务流程的管理工具.本文通过对实施临床路径前后的各项管理指标进行对比分析,探讨临床路径在慢性硬膜下血肿患者中的应用成效.研究表明通过实施临床路径,缩短了住院时间,降低了住院费用,提高了患者满意度,提高了医疗资源的有效利用率,降低了医疗资源消耗,有利于促进医院质量管理持续改进.     

单病种平均住院日影响因素分析

为探讨单病种平均住院日的影响因素,采用多元逐步回归分析,对住院构成前5位病种的平均住院日影响因素进行分析。结果显示,有10个影响因素进入回归方程,不同病种平均住院日影响因素略有不同,是否转科对平均住院日影响最大。在医院管理过程中,需不断加强医院流程管理与改造,实施临床路径,合理制定医院平均住院日指标。     

显微神经外科技术治疗脑胶质瘤的效价分析

为了探讨应用显微神经外科手术技术治疗神经胶质瘤的疗效评估.将240例脑胶质瘤患者随机分为显微外科手术组和常规手术对照组各120例,比较两组患者并发症发生率、病残/死率、平均住院天数、平均住院花费以及平均恢复工作时间的差异.结果显示,应用显微神经外科手术技术治疗脑胶质瘤具有并发症少,病残率低,疗程短,住院花费少等特点,明显提高生存质量,具有显著的社会学意义.     

显微神经外科技术治疗脑胶质瘤的效价分析

为了探讨应用显微神经外科手术技术治疗神经胶质瘤的疗效评估,将240例脑胶质瘤患者随机分为显微外科手术组和常规手术对照组各120例,比较两组患者并发症发生率、病残／死率、平均住院天数、平均住院花费以及平均恢复工作时间的差异。结果显示,应用显微神经外科手术技术治疗脑胶质瘤具有并发症少,病残率低,疗程短,住院花费少等特点,明显提高生存质量,具有显著的社会学意义。     

FOCUS超声刀与电刀在甲状腺手术中的比较研究

探讨FOCUS超声刀在甲状腺手术中的应用价值。选取2012年12月～2013年12月在我院乳甲外科住院手术甲状腺病例180例作为研究对象,其中FOCUS超声刀组90例,电刀组90例。比较两组手术时间、术中出血量、术后伤口引流量、术中气管前及腺体周围线结数量、手术并发症发生率。结果超声刀组在甲状腺手术平均时间（58．4±7．7）min ,术中平均出血量（24．8±8．1）ml,术后伤口引流量（41．5±6．7）ml,气管前及腺体周围线结数量（1．8±1．2）个,与电刀组比较,差异均有统计学意义（P＜0．05）。术后并发症发生率超声刀组与电刀组均较低。FOCUS超声刀在甲状腺手术中比传统电刀具有明显优势,安全、有效且不增加并发症发生率,值得在临床工作中推广。     

社区卫生服务中心手术功能的经济学研究

社区卫生服务中心是否应当保留或设置手术功能。调研南京市社区卫生服务中心手术功能科室的成本—效益和费用,及医院和社区卫生服务中心费用的不同。大多数中心设置外科手术功能,能维持成本;3甲医院、综合医院单病种手术平均住院费用明显高于社区卫生服务中心。社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

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。     

结节性甲状腺肿手术路径质量管理成效研究

本文通过对比分析临床路径实施前后各项质量相关指标,研究临床路径模式在精细分科部门中结节性甲状腺肿手术患者质量管理的应用成效。结果显示临床路径在质量管理过程中取得显著成效,尤其是在缩短平均住院日方面,但对于费用的控制还有待进一步提高,因此应对实施中的临床路径进行不断地持续改进,为患者提供更优质的服务。     

Encouraging patient participation in general practice consultations: Effect on consultation length and content,patient satisfaction and health

Abstract

Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultations than those in the control group and tended to ask more questions but there was no significant effect on patient satisfaction. The doctor tended to feel that he had a better understanding of patients in the intervention group. Overall there was no significant effect on SF-36 scores but, for patients under the age of 40, and for those in higher social classes the scores of patients in the intervention group improved to a significantly greater degree than did those for the control group. The intervention did not have any effect on the number of GP visits made by patients in the subsequent year. The study results show that a relatively simple leaflet can have an impact on patients' behaviour during the consultation, even though there were no effects on patient satisfaction with the consultation or in the number of GP visits in the following year.     

Cost-effectiveness of providing insurance benefits for posthospital psychiatric halfway house stays

A model insurance benefit package of post hospitalization psychiatric halfway house care was developed and administered to 32 hospitalized mentally ill persons. The therapeutic and cost effectiveness of providing a 120-day benefit package was examined over a 14-month post-hospitalization period. This was compared with the effectiveness of hospitalization benefits alone for the same patients over the 42 months prior to halfway house admission. In terms of therapeutic efficacy, there was no significant deterioration after hospitalization release in either the symptom or behavioral coping scales, except for an increase in somatization. Yearly hospital recidivism rates fell from 79% to 29%, and the average yearly length of hospital stay per patient fell from 83 days to 18 days. In terms of cost-effectiveness, halfway house benefits saved the insurers 59% of their hospitalization costs. The implications of these findings are discussed.     

Predictors of improvement in maximum security forensic hospital patients

In a maximum security forensic hospital population (n = 376), relationships between three groups of patient factors (diagnostic data patient histories, and hospital course) and two indicators of treatment effectiveness (length of hospitalization [LOH] and restoration of competency to stand trial) were analyzed. Schizophrenia, previous hospitalizations, felony charges, drug treatment refusal, involuntary medication, physical restraint, and absence of personality disorders were associated with increased LOH. Nonschizophrenic patients without histories of previous incarceration, and, paradoxically, drug treatment refusers were relatively successful with competency restoration. Implications of these findings and questions for future research are discussed.     

Predictors of distress following an acute stroke: Disability,control cognitions,and satisfaction with care

Abstract

Whilst clinical predictors of distress following acute stroke have been identified (e.g., lesion site), this study hypothesised that greater prediction would be achieved by addressing individual differences in patients' cognitions (e.g., perceived control, satisfaction with care, recovery confidence) and coping responses. We examined these relationships in a longitudinal study of 71 survivors of acute stroke. Measures were collected at three time points: 10-20 days after the stroke, and one month and six months after hospital discharge. Stepwise multiple regression analyses were performed using only significant bivariate correlates and where the dependent variables were residualised scores which controlled for baseline levels of anxiety and depression. Satisfaction with treatment and confidence in recovery at one month predicted anxiety outcome at six months, and satisfaction with advice and confidence in recovery at one month predicted depression outcome at six months. These results offer tentative suggestions for interventions targeting patient cognitions and improving patient satisfaction.