摘要:目的:探討臨床教學的全程制度化管理及其效果。方法:通過健全組織,完善制度,加強教學、臨床及實習生管理、建立激勵機制等措施,進行全程制度化的規范管理。結果:教學質量顯著提高,不良事件鮮見,無惡性事件發生。近來醫院已有6篇教學論文公開發表,4個先進集體和8名先進個人受到醫院表彰,5名優秀帶教教師和8名實習生受到各學院獎勵。結論:臨床教學全程制度化管理是提高教學質量的切實有效途徑。Abstract: Objective: To investigate system management during the entire clinical teaching process and its effect. Methods: To robust organization, perfect rules, strengthen management of clinical teaching and intern student, and establish encouragement mechanism,and other measures, so as to conduct standard system management during the entire process. Results: Quality of teaching improved notably, bad event was scarce, no malignant event occurred. There were six teaching articles issued publicly, four advanced collectives and eight advanced individuals had been praised by hospital, and five excellent teachers,eight intern students had been rewarded by each college. Conclusion: System management during the entire clinical teaching process is an effective way to improve teaching quality.
Objective To compare the newest essential medicine lists (EMLs) of China and the World Health Organization (WHO) in 2009, so as to provide the evidence for the selection, adjustment and implementation of the newest national EML of China. Methods Differences in the procedures of selection, implementation and the categories as well as the number of medicines in 2009 EMLs of the WHO and China were compared by descriptive analysis. Result Principles and procedures of selecting and updating EML of China were based on those of the WHO EML. However, the transparency of procedures, methods of selection, and evidence of efficacy, safety, cost-effectiveness and suitability were not enough. Essential medicines of the WHO were categorized by the Anatomical-Therapeutic-Chemical (ATC) classification system, while those of China were classified by clinical pharmacology. Twenty-one identical categories of the first class were found in the two lists. There were 8 and 3 unique categories in the WHO EML and China EML, respectively. A total of 358 and 255 medicines (including medicines in its explanation) were included in the EMLs of the WHO and China, respectively, with 133 identical medicines as well as 206 and 108 unique medicines. There were 51 antiinfective medicines in China EML, accounting for half of the WHO EML. Forty medicines were the same in both lists, and 11 and 60 anti-infective medicines were unique in EMLs of China and the WHO, except for 40 identical medicines. Among them, 22 and 31 antibacterials were included in the lists of the WHO and China with 17 identical medicines. Antifungal, antituberculosis and antiviral medicines in China EML were fewer than those in the WHO EML. The numbers of the identical medicines acting on the respiratory, digestive, and nervous systems and hormones in the both lists were 1, 7, 9, and 17, respectively, while the unique ones in China EML were 6, 12, 7, and 14, respectively. However, most of them were selected without adequate evidence in efficacy and safety. The medicines acting on cardiovascular system were 19 and 29 in both lists with 14 identical medicines. Some antihypertensive and antiarrhythmic medicines were included in China EML with similar mechanism, whereas some of them were excluded by the EML. Conclusion The total numbers of both EMLs are close to each other with half of the identical medicines. The selection of China EML mostly meets the needs of disease burden in China. However, the transparency of selection and evidence are not enough. We suggest that health authorities should cooperate with other stakeholders to promote the transparency of selection, to enhance the capacity of producing high-quality evidence, to develop related technical documents and guidelines, and to disseminate and monitor the implementation of EML.
ObjectiveTo access the current study status and the existing problems of studies on National Essential Medicines System (NEMS) in China based on systematic review methods, and provide the evidence-based evidence and references to the studies of this field. MethodsThe following databases such as PubMed, EMbase, The Cochrane Library (Issue 3, March 2014), CNKI, WanFang Data, VIP and CBM were electronically searched to collect studies related to the policy analysis, implementation background, implementation strategies, implementation situation, implementation problem and implementation effects about NEMS in China. The retrieval time was from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and finally conducted analysis on study types, study time, source journals, authors' units, study themes, etc. of the included studies. ResultsA total of 1 607 articles were finally included, encompassing 56.38% qualitative studies and 43.62% quantitative studies. The number of published studies per year, the number of quantitative studies as well as the number of financiallysupported studies out of the total studies published per year had increased by year since 2009. The study topics focused on every parts during the implementation of NEMS in different proportions. The proportion of the national studies in the quantitative studies was lower than that of others. The regional distribution involved in the quantitative studies was unbalanced, and the ratio of which located on the East, the Central and the West of China was 2 to 1 to 1. ConclusionThe implementation of NEMS and related studies are mutually promoted. More studies are needed to be carried out on remote areas as well as West China. Although the studies related to these areas tend to be standardized and evidence-based, but more in-depth studies should be well advanced. Most of the topics of the studies are widely covered, and the topics of further studies should be enforced in the detail of implementation links. Most of the studies focus on primary medical institutions, and more studies are also needed for supporting and expanding the implementation of NEMS in second and three degree medical institutions.
From the perspective of the new institutional economics, the institutional change of hospital accreditation & evaluation in China was summarized and the experiences of hospital accreditation & evaluation from international organizations and other countries were refined to put forward the counter-measures for institutional innovations of accreditation & evaluation in China. First, it’s urgent for the government to issue the standards of hospital accreditation and discriminating hospital evaluation; second, these standards should pass the certification by the International Society for Quality in Health Care External Evaluation Association; finally, China should construct the commission on certification and accreditation administration for healthcare to supervise the social or third part organizations.
Objectives Through a systematic review, to summarize and describe various health security mechanisms of protecting financial risk from illness in low and middle income countries (LMICs), and to analyze causes that lead to different effects in financial risk protecting. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. Twenty-four electronic databases, websites of 11 health institutions, and the search engine Google were searched. Any original study to evaluate the role of financial protection of health security mechanism in LMICs was included. Pre-designed data extraction form was used for collecting strategies and study method of included studies, and extracted information was analyzed and described. Results Fifty-two studies were included, and 56 specific health security mechanisms were categorized into 6: community-based health insurance, social health insurance, health sector reform, subsidy, user fee, and new rural cooperative medical scheme (NRCMS) in China. Forty-two mechanisms had positive effect in financial protection, 6 were negative, 5 had no effect and the effect of the other 2 was unclear. Conclusion Mechanisms that produced positive effect can be summarized as: setting up of co-payment rate, design of benefit packages, providing free care for vulnerable population, delivering primary health care directly in remote area, and Chinese NRCMS. Mechanisms to protect the poor from financial risk of illness include: government provides health insurance, providing free care and setting up different co-payment rate according to income. The failure of health security mechanisms can be ascribed the deviation from its original goal of health security mechanism design, due to various inner or external causes.
In the context of deepening healthcare reform and advancing the high-quality development of public hospitals, constructing a supervision system aligned with the modern hospital management system has become essential for ensuring strategic implementation and improving governance effectiveness. This paper systematically examines the three foundational pillars of such a system: the theoretical foundation grounded in scientific management principles, the historical foundation rooted in China’s governance traditions and the Communist Party’s experience in policy execution, and the practical foundation driven by the persistent challenge of “policy implementation gaps.” It further elucidates the internal logic of the supervision system as an integrated framework comprising four interrelated dimensions: core conceptual constructs, multi-dimensional value orientations, foundational coordination mechanisms, and innovative operational practices. Furthermore, the study proposes a strategic pathway centered on “renewing institutional momentum, optimizing structural design, empowering through digital technologies, and advancing systemic reforms”, thereby providing theoretical insights and practical guidance for the standardized development and refined enhancement of supervision mechanisms in modern hospitals.
ObjectiveTo explore the implementation of standardized training of general practitioners system in China. MethodsA total of 25 bases of training general practitioners and its collaborative community service centers, which were located in the east and western region of China, met the inclusion criteria; qualitative interviews and questionnaires were done between November 2012 and November 2013, including 456 teachers, 281 students, and 166 teaching management staff. Survey content involved implementation of standardized training system, teaching method and so on. ResultsSatisfaction rate of training general practitioners training system with teachers, students, and administrators was 76.2%, 71.3%, and 86.3%, respectively (χ2=92.372, P<0.001). The average satisfaction rate of training model, teaching programme, teaching materials, teaching arrangements, the examination system, the quality of training, and supporting policies was 95.7%, 92.1%, 73.8%, 65.7%, 72.5%, 86.8%, and 48.9%, respectively (χ2=813.196, P<0.001). Satisfaction rate of teaching method with teachers, students, and administrators was 81.1%, 74.4%, and 67.7%, respectively (χ2=40.159, P<0.001). ConclusionSatisfaction rates of training general practitioners training system and teaching method with teachers, students, and administrators are low. The main impact factors are:the syllabus and textbooks are not practical, qualified teachers are short, teaching arrangements is unreasonable, teaching content is specialization, government support is inadequate and so on.