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June 2013, Volume 16, No.16 Abstracts

 Construction of Incentive and Restraint Mechanism of Dual ReferralFrom the Angle of Basic Medical Care Insurance
LEI Guang-he.Guangdong Medical College,Dongguan 523808,China
Abstract Lack of the support of incentive and restraint mechanism of basic medical care insurance is one of the important factors to the inefficient operation of the dual referral between urban hospital and community health service institutions.This paper analyses the situation of the combination of basic medical care insurance with the dual referral,and then puts forward suggestions in terms of organization guarantee,establishment of the incentive and restraint mechanism of basic medical care insurance,and formulation of the workable referral standard.
Key words Dual referral;Basic medical insurance;Incentive;Restraint

Study on Community Nurses Manpower Deployment of Community Health Service Team:Based on Job Analysis

SU Ning, PENG Ying-chun. Beijing Centers for Diseases Control and Prevention,Business Management Office,Beijing 100013,China

Abstract Objective To predict the needed amount of community nurses,discover the personnel placement problems in the community health service institutions,and put forward suggestions for improvement.

Methods All the 8 community nurses of all the 8 community health service teams in a community health service center in Beijing were selected as the subjects.Such methods in job analysis as field inspection,self recording,and interview analysis were applied in combination with statistical analysis to determine the quantitative work items,one-year workload,work time,and work saturation,then one-year working time was calculated.The improved formula of health manpower demand was used to predict the needed amount of community nurses.

Results This community health service center should be staffed with 18 community nurses,and now there are 8.The personnel demand index is 0.44.

Conclusion The amount of community nurses is not enough in the community health service center,and the community nurses allocation is imbalanced in four of the community health service stations.It is necessary to supplement the gap of community nurses,and carry out the on-the-job training for improving the service ability so as to relieve the pressure due to quantitative shortage of personnel to a certain degree.

Key words Community health services;Community nursing;Manpower deployment;Job analysis

Costing Study on Community Health Service Center

LU Fang,SANG Xiu-yan.Research Center of Health Policy,Public Health Administration School,Nanjing Medical University,Nanjing 210029,China

Abstract Objective To investigate the cost in Yaxi Community Health Service Center so as to obtain the total cost,departmental cost and project cost in order to provide reference for local government to formulate the allowance criteria of community health services.

Methods A questionnaire was developed for collect information.The full costing and project costing methods were used to calculate the cost of community health services.

Results Yaxi Community Health Service Center provide services for a population of 59 600,with a floor area of 1 013 m2,and regular employees of 52 people.The sub-center of public health service assumed the public heath services,the function which was the same as that of prevention and health care department,with its servicing population of 59 600,a floor area of 180 m2,and regular employees of 10 people.The total service expenditure was RMB 2 359 400 yuan.Of which 2 063 400 87.45% yuan was the medical costs,and 296 000 12.55% yuan was the prevention health care costs.The balance of payment for the community health service center was -741 100 yuan,of which the financial earmarks was 322 600 yuan.The balance of payment for the sub-center of public health service was -59 400 yuan,of which the financial earmarks was only 40 000 yuan.

Conclusion The condition of the community health service organization remains to be improved,and it is in poor operating condition.The community health services compensation is inadequate for public health service cost.The medical treatment cost is higher than the preventive health care cost.The main cost of Yaxi community health service is for the labor service and the drug operating.It is necessary for the government to increase financial investment,change the idea that medical treatment is more impotent than preventive health care,improve work efficiency,and reduce unnecessary output.

Key words Community health services;Cost analysis;Public health service;Project costs

Employees Satisfaction on the Performance Management in Community Health Service Organizations

WANG Xian-chu,HAO Xiao-ning,WU Yun-hui,et al.Shenzhen Guangming New District Peoples Hospital,Shenzhen 518106,China

Abstract Objective To explore the effect of the implementation of the performance management of community health services(CHS) in the view of the employees satisfaction,and to provide the solutions for further improving the CHS performance management.

Methods The questionnaire survey was conducted among 256 health workers from all the 21 CHS organizations in Gongming community about their satisfactory on performance management.

Results The staffs satisfaction on the work burden and the income was the lowest,with the very unsatisfied and relative unsatisfied ratios being 58.2% and 57.5respectively.The satisfaction on the performance management and assessment was lower,with a unsatisfied ratio being 38.3.The satisfaction on the job competency was the highest and the unsatisfied ratio was only 2.3%.

Conclusion The employees satisfaction on the performance management is not high.It is necessary to improve the performance assessment system,emphasize the principles of inspiration,and make up the gap of the high self-assessment score with the high workload and low income,so as to accelerate the realization of integrated performance and guarantee a virtuous cycle of performance management.

Key words Community health services;Performance management;Performance assessment;Satisfaction

Influencing Factors of Patients Satisfaction with Community Health Services in Xicheng District of Beijing

FENG Shi,LI Wei,LU Xiao-qin.Capital Medical University,Beijing 100069,China

Abstract Objective To investigate the influencing factors of patients satisfaction with community health services in Xicheng District of Beijing.

Methods Continuous sampling was used to select patients visiting the community health center/station and residents encountered in November 2011.The subjects were surveyed with questionnaire on demographics, medical insurance, and satisfaction with community health service.

Results The overall satisfaction rate was 95.9%(940/980). The logistic regression analysis results showed that factors influencing patients satisfaction included medical environment, doctors professional level, opening hours, types of drugs, geographic location, and doctors explanation of the illness(P<0.05).

Conclusion The patients in Xicheng District have a relatively high satisfaction rate with the community health services, but there is still room for improvement. Government officials should take measures to address the major problems indicated by the influencing factors so as to promote sustainable development of the local community health services.

Key words Community health services;Satisfaction;Influencing factors;Logistic regression analysis

Allocation of Health Resource and Service Evaluation Based on New Medical Reform in Urban Communities in Nantong

GENG Jin-song,HUANG Li-min,DONG Jian-cheng,et al.Medical School of Nantong University,Nantong 226001,China

Abstract Objective To investigate the conditions of health resource allocation and health service in urban communities in Nantong,so as to provide an evidence for improving urban community health service system.

Methods Totally 15 centers and 30 stations of urban community health services(CHS) from 3 districts of Nantong city were randomly chosen as the investigation subjects.And questionnaire survey was conducted to investigate the conditions of health resource allocation and implementation of health policies.

Results All the 15 centers and 93.3%(28/30) stations of CHS provided access to basic medical insurance of both urban employees and residents.The house area was more than 1 000 m2 of CHS centers and more than 150 m2 of CHS stations.Some 40.0%(18/45) of the CHS organization implemented performance salary system.All of the 15 centers and 20.0%(6/30) of the stations practiced national essential drugs system and "zero-profit drug sale" policy.

Conclusion Although certain achievements of CHS had been made in Nantong city,there are still some problems such as easier referral upward but more difficult referral downward,and impediment in implementation of essential drugs system.It is necessary to actively deepen comprehensive reform of CHS organizations so as to give full play to their roles.

Key words Community health services;Resource allocation;Questionnaire survey;Nantong

Clinical and Coronary Angiography Characteristics of Coronary Heart Disease Patients with Different Glucose Tolerance

XU Qian,XUE Yan-mei,LIU Kuan-zhi,et al.Department of Endocrinology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China

Abstract Objective To investigate the characteristics of the coronary heart disease(CHD) with different glucose tolerance in clinical presentation,laboratory tests and coronary angiography,so as to study the influence of plasma glucose and other risk factors on the condition and prognosis of the CHD patients.

Methods A total of 143 CHD patients confirmed with coronary angiography and hospitalized in the Cardiology Department of our hospital were enrolled.They were divided into three groups according to different plasma glucose levels,namely simple coronary heart disease(CHD) group(n=56),coronary heart disease with impaired glucose regulation(IGR) group(n=32),coronary heart disease with diabetes mellitus(DM) group(n=55).The differences in clinical data and coronary artery lesions among the three groups were compared,and Logistic regression analysis was conducted about risk factors.

Results The constituent ratios of lesions of single-,double-,and triple-branch coronary artery were respectively 46.4%,35.7% and 17.9% in CHD group;18.7%,37.5% and 43.8% in IGR group;and 18.2%,25.4% and 56.4% in DM group P0.05.The constituent ratios of moderate and severe stenosis as well as total occlusion of coronary vessel were respectively 41.1%,51.8% and 7.1% in CHD group;53.1%,46.9% and 0 in IGR group;and 7.3%,74.5% and 18.2% in DM group P0.05.The incidence of diffuse vascular lesions in the 3 groups were respectively 17.9%,43.8% and 45.5% P0.05.Duration of diabetes,fasting blood glucose(FPG),2-hour postprandial blood glucose(2 hPG) and total cholesterol(TC) were independent risk factors for triple-branch lesion of coronary artery;FPG and 2 hPG were independent risk factors for diffuse lesion of coronary artery;and TC was an independent risk factor for severe stenosis of coronary artery P0.05.

Conclusion IGR or DM can both aggravate the degree of coronary lesion.FPG and 2 hPG are the independent risk factors for triple-branch lesion and diffuse lesion of coronary artery.

Key words Coronary heart disease;Impaired glucose regulation;Diabetes mellitus;Angiocardiography;Prognosis

Correlation of Chronic Obstructive Pulmonary Disease and Bronchogenic Carcinoma

GAO Zhi-guo.Department of Respiratory Diseases, Xingtai Peoples Hospital, Xingtai 054000, China

Abstract Objective To investigate the clinical characteristics of patients with chronic obstructive pulmonary diseaseCOPDcombined with bronchogenic carcinoma, in order to provide guidance on early diagnosis and treatment of this comorbidity.

Methods Clinical data of 140 patients(study group) of COPD combined with bronchogenic carcinoma treated in our hospital between January 2009 and January 2012, including age, sex, smoking history, number of cigarettes smoked per year, symptoms and signs, site and pathological type of the carcinoma were retrospectively reviewed.The control group included 170 patients with only COPD selected using random number table.The clinical data were analyzed using the SPSS 17.0.

Results The prevalence of COPD-combined and non-COPD-combined bronchogenic carcinoma were 14.24% and 0.51%, respectively(P<0.001).The most common clinical symptoms in the study group included fever, cough, expectoration, dyspnea, and debilitation, which showed no significant difference from the control group(P0.05).There were statistically significant differences in chest pain, hemoptysis, weight loss, hoarseness, pleural effusion, and atelectasis between the study and control group(P0.05).Among the 140 cases of COPD, there were 97 cases(69.3%) of squamous cell carcinoma, 20(14.3%) adenocarcinomaand 23(16.4%) small cell lung cancer.There was no statistically significant sex difference in each pathological type(P0.05).

Conclusion Squamous cell carcinoma is the most common physiological type of bronchogenic carcinoma.COPD-combined bronchogenic carcinoma is liable to occur in older men with smoking habits.This comorbidity lacks specific manifestations and has low early diagnosis rate.COPD patients with long smoking history, chest pain, hemoptysis, weight loss, hoarseness, pleural effusion and atelectasis may be predisposed to have bronchogenic carcinoma.

Key words Pulmonary diseasechronic obstructiveLung neoplasmsRetrospective analysis

The Correlation of H Type Hypertension and Prognosis of Patients with Acute Cerebral Infarction

WANG Jing,LIU Jing-jing,WU Yang,et al.Department of Neurology,the First Hospital of Harbin,Harbin 150010,China

Abstract Objective To investigate the correlation of H type hypertension with prognosis of patients with acute cerebral infarction(ACI).

Methods A total of 324 ACI patients with hypertension admitted in our hospital between January 2010 and January 2012 were enrolled in this study.The patients were divided into the H type hypertension group(Hcy10 μmol/L;n=241) and the control group Hcy<10 μmol/L;n=83 according to the level of homocysteine(Hcy) measured upon admission.The clinical characteristics of the patients were compared between the two groups.National institute of health stroke scale(NIHSS),Barthel index(BI),and modified Rankin scale(mRS) were used to evaluate the functional disability and prognosis of patients upon admission and at 90 days after discharge.

Results No significance was found between the two groups in age,sex,systolic blood pressure,history of diabetes,smoking,and hyperlipemia,as well as the level of blood fat,blood glucose,D-Dimer,and hs-CRP upon admission and mortality at 90 days P0.05.H type hypertension group had higher NIHSS score,lower BI score,and lower proportion of 0-2 scoring in mRS than the control group both on admission and at 90 days(P0.05).Logistic analysis results showed that H type hypertension OR =2.44795% CI1.878,5.248,P=0.027 was an independent risk factor for poor prognosis of ACI.

Conclusion ACI patients with H type hypertension have serious neurological dysfunction and poor diagnosis.

Key words HypertensionHyperhomocysteinemiaBrain infarctionPrognosisRelationship

Impact of Red Cell Distribution Width on Prognosis in Elderly Patients with Chronic Heart Failure

YI Xin HU Feng-huan.Department of Cardiology,Huimin Hospital,Beijing 100054,China

Abstract Objective To explore the impact of red cell distribution width(RDW) to prognosis of elderly chronic heart failure(CHF) patients.

Methods Totally 60 CHF patients were,according to the grades of cardiac function of New York Heart Association(NYHA),divided into three groups:NY (n=20),NY (n=19) and NY (n=21).The levels of RDW and serum NT-proBNP were compared among the 3 groups.And then the patients were again divided as normal RDW group(n=42) and abnormal RDW group(n=18),and the incidence of cardiac events was compared between the two groups.

Results The difference in RDW showed significant among the 3 groupsP0.05,and so did between each two groups P0.05.The difference in NT-proBNP level showed significant among the 3 groupsP0.05,and so did between each two groups P0.05.In the abnormal RDW group there 6 33.3% patients who got malignant arrhythmia,8 44.4% with repeated heart failure,and 3 16.7% who died;while in normal RDW group there were respectively 1 2.4%,2 4.8% and 1 2.4%.The incidence of cardiac events was significant higher in abnormal RDW group that in normal RDW group P0.05.

Conclusion The increase of serum RDW may associate with the severity of cardiac function in elderly CHF patients.The patients with increased RDW get higher incidence of cardiac events,with a unfavorable prognosis.

Key words Chronic heart failure;Aged;Red cell distribution width;Prognosis

Factors Impacting Self-management among Diabetes Patients in Communities

LIU Wei-wei,WANG Yuan-yuan,HAO Dong-hui,et al.The Second Clinic,Peking University Third Hospital,Beijing 100191,China

Abstract Objective To assess the influencing factors of self-management among diabetes patients in Beijing communities.

Methods The questionnaire survey was conducted among 240 patients with diabetes mellitus form three communities of Beijing from July to August 2012.SAS 8.0 software was used for statistical analysis of the collected data.

Results The average score of version of the Problem Areas in Diabetes(PAID) was(25.0±17.8),with the median of 21.5.The average score of summary of diabetes self-care activitiesSDSCA was(47.0±15.4),with the median of 48.0.The average score of self-management education was(10.3±4.7),with the median of 10.0.The difference in education background and average monthly income per capita of a family showed significant in the score of SDSCA (P0.10).The difference in sex and level of glycosylated hemoglobin showed significant in the score of self-management education(P0.10).The analysis model revealed that the worse a patients control of blood sugar was,the more education on self-management the community medical staff gave to the patient;and a patient with higher education had a higher capability in self-management.However,the more education on self-management also brought on more metal burden to the patient.The worse a patients control of blood sugar was,the lower a patients power in self-management was,and the younger a patients age was,the heavier burden the patient had mentally.Furthermore,the lower a patients power in self-management was,especially for a male patient,the worse the patients control of blood sugar.The average monthly income per capita of a family was also a negative factor.The higher a patients monthly average income per capita was,the lower a patients power in self-management was,and the worse a patients control of blood sugar was,the heavier burden the patient had mentally.

Conclusion The education background and average monthly income per capita of a family are the impacting factors for self-management power.And the sex and level of glycosylated hemoglobin are the impacting factors for self-management education.The education on self-management offered by the community medical staff not only has problems both quantitatively and qualitatively,but also enhance the patients metal burden.Therefore,"knowledge" itself is far from enough,and the absorbability and operability of knowledge are more important for a patient to really master the knowledge and apply it practically.Otherwise,"redundant knowledge" is not only non-effective,but may bring about negative effects to patients.

Key words Diabetes mellitus;Self-managementInfluencing factors

Clinical Features of Extrapulmonary Tuberculosis and Virus Infection in Patients with Fever of Unkown Origin

TIAN Geng WANG Huan-ling WANG Jing.Department of Infectious Diseases Xuanwu Hospital of Capital Medical University, Beijing 100053 China

Abstract Objective The clinical features of extrapulmonary tuberculosis and virus infection in patients with the fever of unkown originFUO were retrospectively analyzed,in order to benefit clinical diagnosis and treatment.

Methods From January 1 of 2009 to June 30 of 2011,35 patients finally diagnosed with extrapumonary tuberculosis(group A) and 25 with virus infection patients(group B),who were admitted because of FUO in our hospital,were enrolled.The patients general status including gender,age and the course of disease,laboratory measurements including periphery white blood cellsWBC,erythrocyte sedimentation rate ESR,C-reactive proteinCRP,adenosine deaminaseADA,lactic acid dehydrogenaseLDH,complementC3,and procalcitonin(PCT were between the two groups compared.The assay results of interferon gamma release and T cells subgroups were also compared.

Results No significant difference was found between the two groups about the proportion of gender and age P0.05.But the constituent ra


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