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Hotz HG. [Role of social medicine within the German Federal Employment Agency]. Dermatologie (Heidelb) 2024; 75:357-365. [PMID: 38530422 DOI: 10.1007/s00105-024-05330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
Social medicine deals with the interrelationships between health and society-as a cross-sectional subject within medicine and a bridging subject at the interfaces to other specialist disciplines. In the public and within the health system, social medicine still does not receive the attention it should be given, despite to its medical and socioeconomic importance. A significant proportion of social medicine specialists in Germany work as experts for social security providers. Using the example of the Medical Specialist Service ("Ärztlichen Dienstes", ÄD) of the German Federal Employment Agency ("Bundesagentur für Arbeit", BA), the medical tasks in social medicine are outlined. About 350 full-time medical employees nationwide as well as other contracted physicians support the specialists of the employment agencies and job centers to integrate those seeking training, jobs and employees with health restrictions into the labor market or maintaining an existing integration. In each individual case, they assess the extent of the health restrictions, the performance/earning ability, the suitability for training and professions as well as the requirement and type of vocational rehabilitation services. The ÄD's approximately 500,000 expert opinions each year are not only of far-reaching importance for the BA's affected customers, but also contribute to the responsible, effective, and accurate use of social system resources.
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Affiliation(s)
- Hubert G Hotz
- Ärztlicher Dienst der Bundesagentur für Arbeit, M5, 2-3, 68161, Mannheim, Deutschland.
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Lin Y, Li L, Liu B. Assessing the price levels of medical service and influential factors: evidence from China. BMC Public Health 2024; 24:119. [PMID: 38191342 PMCID: PMC10775578 DOI: 10.1186/s12889-024-17639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Medical service prices play a crucial role in cost containment in China. This study aimed to assess the change in medical service price levels at the macro level and the relationship with relevant macroeconomic factors. METHODS Data from the 2022 China Statistics Yearbook, the 2022 China Health Statistics Yearbook, and the 2020 China National Health Accounts Report were used. Time trends of health price levels, utilization, and health expenditure were examined. A time-series regression model was employed to measure the impact of service utilization and medical service prices on total medical service expenditure growth from 2000 to 2021. The Johansen cointegration test was conducted to test the cointegrating relationship between medical service price levels and total medical service expenditure, average wage of employees and CPI. The Granger causality test was performed to observe the direction of causality. RESULTS Descriptive analyses showed consistent growth in utilization and medical service price levels from 2000 to 2021. The time-series model indicated that medical service expenditure was influenced by the rise in inpatient admissions and price levels of medical service and medicine. The Johansen cointegration test identified a long-term equilibrium relationship between medical service price levels and total medical service expenditure, average wage and CPI. The change in medical service price levels was the Granger cause of the change in medical service expenditure, but it had no impact on average wage and CPI. However, the change in medical service price levels was influenced by these three macroeconomic factors. CONCLUSIONS The growth of medical service expenditure in China was driven by inpatient use and price level. There was a long-term equilibrium relationship between medical service price levels and relevant macroeconomic factors. However, medical service price levels only affected medical service expenditure and have no impact on average wage and CPI. It is necessary to improve the value transmission mechanism of medical service prices.
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Affiliation(s)
- Yanxian Lin
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Luo Li
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Bao Liu
- Department of Health Economics, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, China.
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China.
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Shin JW, Choi BR. Effect of patient-related factors on hospitalization service satisfaction and recommendation intention of medical institutions in Korea. BMC Health Serv Res 2023; 23:716. [PMID: 37391768 DOI: 10.1186/s12913-023-09754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE This study examined the factors that influence the 'Overall Satisfaction' and 'Intention to Recommend' of medical institutions used using the Korea Medical Service Experience Survey (2019-2021). DATA SOURCES This study used the data of Medical Service Experience Survey in Korea. The data collected for data analysis were from 2019 to 2021 (Medical service period: 2018.07.01. ~ 2021.06.30). STUDY DESIGN The 2019 Medical Service Experience Survey was conducted from July 8 to September 20, 2019, and a total of 12,507 people (Medical service period: 2018.07.01. ~ 2019.06.30) were collected. The 2020 survey was conducted from July 13 to October 9, 2020, and a total of 12,133 people (Medical service period: 2019.07.01 ~ 2020.06.30.) were collected. The 2021 survey was conducted from July 19 to September 17, 2021), and a total of 13,547 people were collected (Medical service period: 2020.07.01. ~ 2021.06.30). Overall satisfaction and recommendation intentions for medical institutions consist of a Likert 5-point scale. At this time, the Top-box rating model used in the United States was applied. DATA COLLECTIONS/EXTRACTION METHODS In this study, only those who used inpatient services (15 years of age or older) were included because they spent a long time in a medical institution and had an intensive experience, and a total of 1,105 subjects were included in the analysis. PRINCIPAL FINDINGS Self-rated health and the type of bed influenced overall satisfaction with medical institutions. In addition, the type of economic activity, living area, self-rated health, the type of bed, and the type of nursing service affected the intention to recommend. And it was confirmed that overall satisfaction with medical institutions and intention to recommend them were higher in the 2021 survey than in 2019. CONCLUSIONS These results suggest that government policy on resources and systems is important. Through the case of Korea, it was found that the policy of reducing multi-person beds and expansion of integrated nursing service had a significant impact on patients' experience of using medical institutions and improving the quality of care.
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Affiliation(s)
- Jeong Woo Shin
- Korea Institute for Health and Social Affairs, 370 Sicheong-Daero, Sejong, South Korea
| | - Bo Ram Choi
- Department of Health Administration, Hanyang Cyber University, 220 Wangsimni-Ro, Seongdong-Gu, Seoul, South Korea.
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Zhang Z, Fu D, Wang J. How containment policy and medical service impact COVID-19 transmission: A cross-national comparison among China, the USA, and Sweden. Int J Disaster Risk Reduct 2023; 91:103685. [PMID: 37069850 PMCID: PMC10088288 DOI: 10.1016/j.ijdrr.2023.103685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
As COVID-19 shows a heterogeneous spreading process globally, investigating factors associated with COVID-19 spreading among different countries will provide information for containment strategy and medical service decisions. A significant challenge for analyzing how these factors impact COVID-19 transmission is assessing key epidemiological parameters and how they change under different containment strategies across different nations. This paper builds a COVID-19 spread simulation model to estimate the core COVID-19 epidemiological parameters. Then, the correlation between these core COVID-19 epidemiological parameters and the times of publicly announced interventions is analyzed, including three typical countries, China (strictly containment), the USA (moderately control), and Sweden (loose control). Results show that the recovery rate leads to a distinct COVID-19 transmission process in the three countries, as all three countries finally have similar and close to zero spreading rates in the third period of COVID-19 transmission. Then, an epidemic fundamental diagram between COVID-19 "active infections" and "current patients" is discovered, which could plan a country's COVID-19 medical capacity and containment strategies when combined with the COVID-19 spreading simulation model. Based on that, the hypothetical policies are proved effectively, which will give support for future infectious diseases.
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Affiliation(s)
- Zhao Zhang
- School of Transportation Science and Engineering, Beihang University, Beijing, 100191, China
| | - Daocheng Fu
- School of Transportation Science and Engineering, Beihang University, Beijing, 100191, China
| | - Jinghua Wang
- School of Transportation Science and Engineering, Beihang University, Beijing, 100191, China
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Liu P, Gong X, Yao Q, Liu Q. Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013. Cost Eff Resour Alloc 2022; 20:73. [PMID: 36567370 PMCID: PMC9791778 DOI: 10.1186/s12962-022-00407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. METHODS This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis. RESULTS The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. CONCLUSION The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.
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Affiliation(s)
- Paicheng Liu
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Xue Gong
- grid.10420.370000 0001 2286 1424Department of East Asian Studies, University of Vienna, Vienna, Austria
| | - Qianhui Yao
- grid.443347.30000 0004 1761 2353School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Qiong Liu
- grid.459584.10000 0001 2196 0260School of Politics and Public Administration, Guangxi Normal University, No.15, Yucai Road, Qixing District, Guilin, Guangxi People’s Republic of China
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6
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Khosravizadeh O, Maleki A, Ahadinezhad B, Shahsavari S, Amerzadeh M, Tazekand NM. Developing decision model for the outsourcing of medical service delivery in the public hospitals. BMC Health Serv Res 2022; 22:135. [PMID: 35101040 PMCID: PMC8805371 DOI: 10.1186/s12913-022-07509-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decision to outsource an activity is one of the most complex organizational decisions. This decision is also influenced by several factors and components. In order to facilitate and optimize it, for the first time in this study, a decision model for outsourcing medical service delivery in public hospitals has been developed. METHODS We conducted this cross-sectional study in 3 stages: 1) We identified the factors affecting the outsourcing decisions, 2) an expert panel identified the influential factors. After standardization, we distributed 220 questionnaires among university staff managers and heads, nursing managers, and managers of the research units, and 3) Structural Equation Model applied to evaluate the relationship between the variables on AMOS22, at 0.05 significant level. RESULTS Findings indicated the optimal level of all fit indices. The path coefficient between all identified factors with the outsourcing decision was positive (t > 1.96). Factors ranging from the most effective to least effective included monitoring and control, service type, human resource, economic and financial, executive capability, external environment, and terms and conditions. CONCLUSION The proposed model provides unit evaluation to make the appropriate decision on outsourcing or non-outsourcing. Control and monitoring were the most determining factors. We recommend performing monitoring continuously as a guide and deterrent to error. We also recommend continuous monitoring and control over the quality of outsourced units and stakeholder satisfaction.
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Affiliation(s)
- Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aisa Maleki
- Health products safety research center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Saeed Shahsavari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Instructor of Biostatistics, Health Products Safety Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Lutz J, Grundmann Y, Böger A, Nilges P, Benecke A, Sabatowski R. [The judgment of the Federal Social Court on the involvement of psychological psychotherapists in interdisciplinary multimodal pain therapy : A critical comment]. Schmerz 2021; 36:121-127. [PMID: 34591177 PMCID: PMC8482739 DOI: 10.1007/s00482-021-00593-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
In the context of their offer of interdisciplinary multimodal pain therapy (day-patient and inpatient), hospitals repeatedly have to contend with strict detailed checks of the procedure codes (OPS 8-918.xx; 8-91c) by health insurers and the medical service. The necessity of day-patient or inpatient treatment in the respective sector, documented therapy components, and the qualifications of the therapists are regularly reviewed. On 27 October 2020, the Federal Social Court ruled on the specific qualification of psychological psychotherapists (BSG, 27 October 2020, Ref.: B 1 KR 25/19 R). The ruling and its potential impact are explained and discussed in this overview.
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Affiliation(s)
- J Lutz
- Zentrum für Interdisziplinäre Schmerztherapie, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland.
| | - Y Grundmann
- Seufert Rechtsanwälte Leipzig, Leipzig, Deutschland
| | - A Böger
- Vitos Schmerzzentrum Kassel, Kassel, Deutschland
| | - P Nilges
- Klinische Psychologie Weiterbildungsstudiengang Psychotherapie, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - R Sabatowski
- UniversitätsSchmerzCentrum, Universitätsklinik "Carl Gustav Carus", Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik "Carl Gustav Carus", Dresden, Deutschland
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8
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Li B, Peng Y, He H, Wang M, Feng T. Built environment and early infection of COVID-19 in urban districts: A case study of Huangzhou. Sustain Cities Soc 2021; 66:102685. [PMID: 33520609 PMCID: PMC7836794 DOI: 10.1016/j.scs.2020.102685] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 05/05/2023]
Abstract
Since COVID-19 spread rapidly worldwide, many countries have experienced significant growth in the number of confirmed cases and deaths. Earlier studies have examined various factors that may contribute to the contagion rate of COVID-19, such as air pollution, smoking, humidity, and temperature. As there is a lack of studies at the neighborhood-level detailing the spatial settings of built environment attributes, this study explored the variations in the size of the COVID-19 confirmed case clusters across the urban district Huangzhou in the city of Huanggang. Clusters of infectious cases in the initial outbreak of COVID-19 were identified geographically through GIS methods. The hypothetic relationships between built environment attributes and clusters of COVID-19 cases have been investigated with the structural equation model. The results show the statistically significant direct and indirect influences of commercial vitality and transportation infrastructure on the number of confirmed cases in an infectious cluster. The clues ch inducing a high risk of contagions have been evidenced and provided for the decision-making practice responding to the initial stage of possible severe epidemics, indicating that the local public health authorities should implement sufficient measures and adopt effective interventions in the areas and places with a high probability of crowded residents.
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Affiliation(s)
- Bo Li
- School of Architecture and Art, Central South University, 410083, Changsha, China
| | - You Peng
- Urban Planning and Transportation Group, Department of the Built Environment, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, the Netherlands
| | - He He
- School of Architecture and Art, Central South University, 410083, Changsha, China
| | - Mingshu Wang
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, PO Box 217, 7500 AE Enschede, the Netherlands
| | - Tao Feng
- Urban Planning and Transportation Group, Department of the Built Environment, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, the Netherlands
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Liu S, Liu Y, Zhang T, Wang L, Huang J, Liang H, Chen G, Liu C, Zhang Y. The developing family doctor system: evidence from the progress of the family doctor signing service from a longitudinal survey (2013-2016) in Pudong New Area, Shanghai. BMC Fam Pract 2021; 22:11. [PMID: 33419410 PMCID: PMC7792058 DOI: 10.1186/s12875-020-01353-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/13/2020] [Indexed: 12/03/2022]
Abstract
Background The family doctor system is a vital part of China’s national medical and health system reform. Evidence of the degree of implementation of the family doctor system is required to assist managers and policy makers in Pudong with resource allocation planning. This study analyzed changes in indicators (family doctor team construction, contracted medical services, health management services and so on) over time to evaluate the progress of the family doctor system in Pudong. Methods We used a cross-sectional design with an online questionnaire survey to collect 3-year (2013–2016) consecutive data. The online questionnaires were completed by the doctors responsible for information reporting in each community health service center of Pudong. The data were sorted, and the indices calculated and analyzed using descriptive statistics and statistical tests. Results The proportion of registered general practitioners increased each year, from 50.8% in 2013 to 66.5% in 2016; this difference was statistically significant (P = 0.000). The number of family doctors per 10,000 permanent residents rose each year, from 1.7 in 2013 to 2.1 in 2016. The rate of contracted household residents was 55.7% in 2013 and increased to 71.7% in 2016, with the difference being significant in different years (P = 0.012). Analysis of referral services showed the people times of contracted residents transferring to higher-level hospitals from family doctors increased each year, from 172,734 in 2013 to 341,615 in 2016; differences among different regions were statistically significant for 2013–2016. The rate of health screening for contracted residents also increased each year, with statistically significant differences in different years (P = 0.000). The rate of health assessment interventions for contracted residents rose each year, with statistically significant differences in different years (P = 0.003). Conclusions The family doctor signing service in Pudong made headway in general practitioner availability, contract service rate of household residents, and providing health management services. However, problems included family doctor shortages and limited supporting policies, especially in rural and suburban areas compared with urban divisions. Increasing the enrollment rate of family doctors and speeding up the implementation of “contract service fees” are key tasks for the sustainable development of the family doctor system in Pudong. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01353-0.
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Affiliation(s)
- Shanshan Liu
- Pudong Institute for Health Development, Shanghai, China
| | - Yan Liu
- School of Public Health, Fudan University, Shanghai, China.,Health Inspection Agency of Shanghai Pudong New Area Health Commission, Shanghai, China
| | - Tao Zhang
- Jinyang Community Health Service Center of Pudong New Area, Shanghai, China
| | - Luan Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiaoling Huang
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Liang
- Pudong Institute for Health Development, Shanghai, China.,School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai, China.
| | - Chengjun Liu
- School of Social Development and Public Policy, Fudan University, Shanghai, China. .,Eye and dental diseases prevention & treatment of Pudong new area, Shanghai, China.
| | - Yimin Zhang
- Pudong Institute for Health Development, Shanghai, China.
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Jeong J, Choi JK, Nam JS, Shin HA, Chang JH, Choi HS. The effect of tonsillectomy with adenoidectomy on medical services used in association with otitis media based on Korean national sample cohort data. Cost Eff Resour Alloc 2020; 18:48. [PMID: 33117086 PMCID: PMC7590674 DOI: 10.1186/s12962-020-00243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background The effect of tonsillectomy with adenoidectomy (T&A) on otitis media has been investigated, but there have been no reports of the relationship between T&A and medical services used in association with otitis media. We investigated the effect of T&A on otitis media with regard to the number and cost of medical services used. Methods From the National Health Insurance Service National Sample Cohort data in Korea, we selected patients 7 years old or younger in 2002 who had T&A in 2005 while between the ages of three and ten. A control group was established matching the patient group with similar propensities of demographic characteristics. The number and cost of medical services used in association with otitis media were analyzed for 3 years before T&A through 8 years after T&A. Results The total number of patients was 1,338, with 227 in the T&A group and 1,111 in the non-T&A group. The number of medical services used was not significantly different between the T&A and non-T&A groups before and after surgery. The cost of medical services used was significantly higher in the T&A group than in the non-T&A group one year before surgery. The cost of medical services used was not significantly different between the two groups after surgery. Conclusions There were no significant differences between the T&A and non-T&A groups in the number and cost of medical services used in association with otitis media after surgery.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444 Korea
| | - Jung Kyu Choi
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Sung Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Ae Shin
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444 Korea
| | - Jung Hyun Chang
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444 Korea
| | - Hyun Seung Choi
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444 Korea
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11
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Che G. [Proper Selection of Enhanced Recovery after Surgery Programs between the Medical Service and Medical Intervence - Is It Time to Do?]. Zhongguo Fei Ai Za Zhi 2020; 22:681-686. [PMID: 31771736 PMCID: PMC6885415 DOI: 10.3779/j.issn.1009-3419.2019.11.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科(enhanced recovery after surgery, ERAS)理念诞生与微创外科技术进步密切相关。ERAS发展过程中利用技术,又融入人文因素,使其高于技术,而丰富ERAS的内涵和外延。结合近年ERAS在外科各领域的进展,总结ERAS临床应用的现状与策略:一是微创技术进步使ERAS理念的临床应用成为必然;二是外科学理论与技术的发展,深入与扩大了ERAS的内涵与外延;三是ERAS临床应用需要我们更新观念;四是ERAS的临床实践需要在医疗服务和医疗干预之间合理选择;五是ERAS临床应用加减之间应用的现实问题与策略。从而深入理解ERAS的真正临床意义,更好地指导临床实践。
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Affiliation(s)
- Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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12
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Ding R, Zhu D, He P, Ma Y, Chen Z, Shi X. Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China. BMC Cancer 2020; 20:250. [PMID: 32209058 PMCID: PMC7092481 DOI: 10.1186/s12885-020-06759-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background It is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China. Methods We used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively. Results Among 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions. Conclusion Comorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.
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Affiliation(s)
- Ruoxi Ding
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ping He
- China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Yong Ma
- China Health Insurance Research Association, Beijing, 100013, China
| | - Zhishui Chen
- Department of Medical Insurance, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
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13
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KIM KL, SEO BR. Developmental Strategies of the Promotion Policies in Medical Tourism Industry in South Korea: A 10-Year Study (2009-2018). Iran J Public Health 2019; 48:1607-1616. [PMID: 31700816 PMCID: PMC6825657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After the revision of the Medical Service Act, Article 27-2, in 2009, Korea has been actively involved in the medical tourism industry. The number of foreign patients visiting Korea has consistently increased coming from various countries around the world. Currently, the industry is striving to achieve qualitative growth in medical tourism. Accordingly, there is a necessity to analyze and review policies for the development of medical tourism to create a sustainable market. METHODS We analyzed the information of foreign patients visiting Korea over a period of last 10 years. Statistical data were obtained from the Korea Health Industry Development Institute (KHIDI) and Korea Tourism Organization (KTO). RESULTS The number of foreign patients visiting Korea had increased from 60,201 in 2009 to 321,574 in 2017. Since 2017, the number of patients from the U.S., Russia and Middle East has been on an upward trend while the number of Chinese patients has decreased. This result clearly shows that international affairs and cultural aspects have a significant impact on the selection of medical tourism. CONCLUSION It is suggested to i) establish the medical tourism information system and brand the Korean medical tourism offering a joint treatment of western and oriental medicine, ii) prepare the expansion of the industry to the medical wellness tourism industry by training global healthcare experts and iii) organize tailored medical services with consideration of various backgrounds and culture of foreign patients.
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Affiliation(s)
- Kyoung-Lee KIM
- Asia Contents Institute, Konkuk University, Seoul, Korea
| | - Byung-Ro SEO
- Korea Department of Global MICE, Konkuk University, Seoul, Korea,Corresponding Author:
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14
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Chen Y, Ding S, Xu Z, Zheng H, Yang S. Blockchain-Based Medical Records Secure Storage and Medical Service Framework. J Med Syst 2018; 43:5. [PMID: 30467604 DOI: 10.1007/s10916-018-1121-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
Accurate and complete medical data are one valuable asset for patients. Privacy protection and the secure storage of medical data are crucial issues during medical services. Secure storage and making full use of personal medical records has always been a concern for the general population. The emergence of blockchain technology brings a new idea to solve this problem. As a hash chain with the characteristics of decentralization, verifiability and immutability, blockchain technology can be used to securely store personal medical data. In this paper, we design a storage scheme to manage personal medical data based on blockchain and cloud storage. Furthermore, a service framework for sharing medical records is described. In addition, the characteristics of the medical blockchain are presented and analyzed through a comparison with traditional systems. The proposed storage and sharing scheme does not depend on any third-party and no single party has absolute power to affect the processing.
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Affiliation(s)
- Yi Chen
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
| | - Shuai Ding
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China. .,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China.
| | - Zheng Xu
- The Third Research Institute of the Ministry of Public Security, Shanghai, 201142, China.
| | - Handong Zheng
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
| | - Shanlin Yang
- School of Management, Hefei University of Technology, Hefei, 23009, Anhui, China.,Key Laboratory of Process Optimization and Intelligent Decision-Making (Ministry of Education), Hefei University of Technology, Hefei, 23009, Anhui, China
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15
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Gur S, Weizman S, Stubbs B, Matalon A, Meyerovitch J, Hermesh H, Krivoy A. Mortality, morbidity and medical resources utilization of patients with schizophrenia: A case-control community-based study. Psychiatry Res 2018; 260:177-181. [PMID: 29202380 DOI: 10.1016/j.psychres.2017.11.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/05/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
Patients with schizophrenia have higher level of mortality and physical comorbidity compared to control population. However the association to primary-, secondary- and tertiary-medical resources utilization is not clear. We used a retrospective community-based cohort of patients with schizophrenia (n=1389; age 37.53 years, 64.3% males) and, age-, gender-, and socioeconomic status-matched controls (n=4095; age 37.34 years; 64.3% males) who were followed-up for nine years. Mortality rate of patients was almost twice as high as that of matched controls (7% versus 3.8%). Diagnoses of ischemic heart disease and hypertension were more prevalent among controls than patients (8.2% versus 5%, and 21.6% versus 15.8%, respectively). Tertiary medical resources utilization was higher among patients with schizophrenia than control population (mean hospital admissions per year: 0.2 versus 0.12, emergency department visits: 0.48 versus 0.36). Patients that died were more likely to have cardiovascular disease, to be admitted to general hospital and to spend more days in hospital than patients that did not die. There is a discrepancy between lower rates of cardiovascular disease diagnoses but higher rates of mortality and tertiary medical resources utilization among patients with schizophrenia when compared to control population. This may stem from an under-diagnosis and, eventually, under-treatment of these patients.
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Affiliation(s)
- Shay Gur
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Weizman
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom
| | - Andre Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Medicine Wings, community division, Clalit Health Services, Tel Aviv, Israel
| | - Haggai Hermesh
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom.
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16
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Back DA, Waldmann K, Hauer T, Huschitt N, Bowyer MW, Wesemann U, Lieber A, Willy C. Concept and evaluation of the German War Surgery Course - Einsatzchirurgie-Kurs der Bundeswehr. J ROY ARMY MED CORPS 2016; 163:206-210. [PMID: 27909067 DOI: 10.1136/jramc-2016-000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. METHODS Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaver-based Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their self-rated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. RESULTS Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. CONCLUSIONS The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.
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Affiliation(s)
- David A Back
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Waldmann
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - T Hauer
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - N Huschitt
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - M W Bowyer
- Division of Trauma and Combat Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - A Lieber
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - C Willy
- Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
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17
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Maio G. ["I do the right thing only against payment": A critique of pay for performance in psychiatry]. Nervenarzt 2015; 86:1349-1357. [PMID: 26429196 DOI: 10.1007/s00115-015-4330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper takes a critical look at pay for performance (P4P) as a model for introducing new incentives in psychiatry. This model is to be seen as a tool of commercialism, and such a restructuring of psychiatry represents a wide-reaching political maneuver which actively introduces economical parameters into the field and will have a great impact on psychiatry. P4P starts with the false premise that medicine has to be structured like industry. This premise is false because psychiatry has to do with relationships to patients, and not with the production of a product. Therefore, it is essential to reflect critically upon the premises and consequences of P4P for psychiatry. Only this critical reflection can help psychiatry to keep its identity as a humane service for suffering people.
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Affiliation(s)
- G Maio
- Lehrstuhl für Medizinethik, Institut für Ethik und Geschichte der Medizin, Albert-Ludwigs-Universität Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg i.Br., Deutschland.
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18
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Schmocker RK, Vang X, Cherney Stafford LM, Leverson GE, Winslow ER. Involvement of a surgical service improves patient satisfaction in patients admitted with small bowel obstruction. Am J Surg 2015; 210:252-7. [PMID: 25886702 DOI: 10.1016/j.amjsurg.2014.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/16/2014] [Accepted: 11/02/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however, it remains unknown how it impacts satisfaction. METHODS Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. RESULTS Forty-seven patients were included; 74% (n = 35) were admitted to a surgical service. Twenty-six percent of the patients (n = 12) were admitted to medicine, and 50% of those (n = 6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (MED) (80% SURG, 33% MED, P = .015). SURG patients also had higher satisfaction with physicians (74% SURG, 44% MED, P = .015). CONCLUSION Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons.
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Affiliation(s)
- Ryan K Schmocker
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Xia Vang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Linda M Cherney Stafford
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Glen E Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Emily R Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Zhang P, Tao Z, Sun H. Improving the Management of Appointment Registration and Exploring an Innovative Medical Service. Cell Biochem Biophys 2014; 72:339-42. [PMID: 25548003 DOI: 10.1007/s12013-014-0460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improving levels of healthcare service to enhance patient care are not only what patients' demands of medical staff, but also what the medical staff demands of the hospital managers. The practical experiences of Xuzhou Central Hospital have proved that a carefully designed hospital culture helps to mobilize the enthusiasm of medical staff, improve patient satisfaction, and lead to an increase in the pace of a hospital's integrated development.
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Affiliation(s)
- Peiying Zhang
- Xuzhou Central Hospital, No. 199 Jiefang South Street, Xuzhou, 221009, Jiangsu Province, China.
| | - Ziqi Tao
- Xuzhou Central Hospital, No. 199 Jiefang South Street, Xuzhou, 221009, Jiangsu Province, China
| | - Haiqin Sun
- Xuzhou Central Hospital, No. 199 Jiefang South Street, Xuzhou, 221009, Jiangsu Province, China
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20
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Takaki O, Takeuti I, Takahashi K, Izumi N, Murata K, Ikeda M, Hasida K. Graphical representation of quality indicators based on medical service ontology. Springerplus 2013; 2:274. [PMID: 23888265 DOI: 10.1186/2193-1801-2-274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 05/17/2013] [Indexed: 11/19/2022]
Abstract
For recent years, it has grown importance to evaluate medical service qualities of medical staffs and/or hospitals by using quality indicators. This paper introduces a representation system QI-RS of quality indicators. By using QI-RS, one can define quality indicators that satisfy understandability and formality, where “understandability” means that one can understand the calculation formula of a quality indicator easily and correctly, while “formality” means that the formula can be calculated to obtain the values of the indicator based on databases in a coherent manner.
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