Practice of multi-campus homogeneous management of outpatient services at a large public hospital / 中华医院管理杂志

The homogeneous management of outpatient services at public hospitals with multi-campus is the foundation for promoting high-quality development of hospitals. Since 2013, a large general hospital had implemented a practice of multi-campus homogeneous management of outpatient services based on the hospital′s integrated organizational structure and management system, addressing such issues as weak outpatient service capabilities in the early stages of new campus construction, lack of homogenization in management system implementation, and poor communication between cross hospital services and information. An integrated post management mode was established with multi-post service integration, cross-post personnel flow and unified job standard. An integrated outpatient quality management system was created by the strategy of " one standard" system management, " one platform" service handling, integrated quality monitoring and management, and multi-aspect service experience improvement. The integration of vertical management and flat management were promoted through the committee system, three-level management system, and functional groups. At the same time, this management practice actively leveraged the advantages of the hospital to innovate services, and promoted the interconnection of outpatient service information across hospital areas, to integrate outpatient service positions, work, services, and management across multi campuses. The satisfaction rate of outpatient patients, the pass rate of outpatient medical records, and the on-time visit rate of outpatient physicians had increased from 91.96分, 95.38%, and 91.62% in 2019 to 93.75分, 98.47%, and 93.68% in 2022, as well as the stopping rate of expert outpatient services had decreased from 5.26% to 1.86%. This practice of homogeneous management had achieved good results, so as to provide references for other hospitals to carry out homogeneous management of outpatient services in their campuses.

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study

Physical rehabilitation interventions address functional deficits caused by impairments that affect someone's performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).Objectives: This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method: Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organizations or faith-based organizations. Results: Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities' catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion: Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution: Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda

Analyzing the Impact of the NRCMS Polices on the Utilization of Outpatient Services in Rural Resident Based on the Balanced Panel Data / 中国卫生统计

Objective To analyze the influence of NRCMS polices evolutionon residents’utilizationof outpatient serv-ices.Methods Based on the same individual balance panel data in two years of three counties in Ji＇nan city,we build panel dat-amodel and conductrandom effects of binary choice panel data model,random effects Poisson regression model,difference in differences(DID)model to analyze the influence.Results Our study shows that the four-week consultation rate in 2011 in-creased by 4. 1% compared to 2008.Age,self-ratedhealthstatus,suffering from chronic diseases or not,the distance to the nearest medical institution have an influence on outpatient service utilization.The new rural cooperative medical outpatient reimburse-ment policy has an effect on thefour-week consultation rate of middle-income residents and high-income residents.The NCMS policy tends to benefit middle and high-income groups.Conclusion we should increase NCMS outpatient compensation level of low-income residents appropriately.

A Study on methods of risk-adjusted capitation fee of risk pooling for outpatient services in basic medical insurance:A case study of Shenzhen City / 中国卫生政策研究

Objective: The main objective of the present study is to develop the risk-adjusted capitation pay-ment standards to compensate health service providers. Methods:Descriptive statistical analysis was conducted to an-alyze the insured's enrollment and visit conditions, and the two-part model was conducted to obtain the appropriate compensation standard using data retrieved from information system of social health insurance for the period of 2014 to 2015 in Shenzhen City. Results:The estimated value of total expenditure per insured person per month is 6. 17 yuan. Age,sex,insurance level and with or without chronic disease or catastrophic disease were elicited as risk adjustors. The whole number insured people were divided into 52 groups by this four risk-adjustment factors whereby the rele-vant payment standards for each group was calculated. Conclusions:By adjusting capitation fee on the grounds of risk of disease and expected expense of medical services of the insured, the capitation payment standards can be calculat-ed virtually. This method will promote the process of capitation payment system reform and also lay a solid foundation for further research.

Analysis on status and determinants of outpatient service utilization of rural floating population in Beijing at different residence time / 北京大学学报(医学版)

Objective: To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time.Methods: The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object.Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables.Logistic regression model was used to analyze the influencing factors.Results: The average age of the research object was 36.7 years, with mostly secondary education.The average accumulated residence time in Beijing was 8.4 years.The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%.The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization.Conclusion: The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower.It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization.This is because people with longer residence time have lower age-adjusted two-week prevalence rate.This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice.It does not mean people with longer residence time have lower utilization of medical service.The residence time variable plays the role of proxy variable.It can solve the problem of variables' endoge-neity.At the same time, it can reflect the influence to outpatient services utilization of some determinants,which are not included in the model but varies with residence time.

Evaluation of the outpatients risk pooling of capitation payment under basic medical insurance in China / 中华医院管理杂志

An analysis is made according to policy documents of localities on capitation payment, and by means of literature review and the analysis framework of the World Bank,this paper reviewed studied the following:definition of service package,per capita rate,designated institutions,design of financial regulations,and service supervision.Given the attempts made at localities,most of the schemes are incomplete in design,and defective in capitation measurement methods and dynamic adjustment mechanisms.The authors recommend a systematic design of the capitation payment scheme for better outcomes.

An empirical analysis on the substitution effect of outpatient services on inpatient services / 北京大学学报(医学版)

Objective:To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods:The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study em-ployed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and re-imbursements on inpatient services. Results: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient re-imbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/coun-ty levels, and no significant impacts on the outpatient services at the city levels. Conclusion:There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design out-patient and inpatient reimbursement policies.

Research and exploration on how to increase the outpatient information system processing power / 中国医学装备

Objective: To discuss the urgent need to improve the handling capacity of the outpatient information system in our hospital under the context that the patient registration is not available after the daily outpatient exceeding about 4,500 people times and that the outpatient demand is rapidly growing. Methods: To analyze all factors which constraint outpatient demands, develop relevant solutions, and update the outpatient information system in phases so as to ensure the normal medical work. Results:After the initial updating, the handling capacity of the system is up to from 4,500 to 13,000 people times, meeting the patient’s need; in the future, the complete updating will lead to a handling capacity to 19,000 people times. Conclusion: The comprehensive consideration shall be given to the building of the hospital information system, including the scalability of the system during its design.