公立医院内部控制环境建设研究

良好的内部控制环境,是公立医院内部控制有效实行的前提条件。为保障内部控制制度充分发挥其规范财务管理、提高医院经营管理的重要作用,适应新医改的实践需要,建设稳定、高效的优质内部控制环境,已成为财会领域刻不容缓的重大课题。     

多级环境自动监测监控系统的设计与实现

为了对环境质量现状及变化趋势进行实时、准确地监测,对污染源及其治理进行监督监测,文章综合利用计算机自动控制技术、嵌入式数据采集与传输技术、无线与有线通讯技术、分布式计算与数据处理、面向服务的体系结构(SOA)、地理信息系统(GIS)、移动计算等技术,实现了对多级、多种类环境要素进行自动连续在线的实时监测与监控,并成功应用于山东1个省、17个地市、139个县的三级环保部门,为节能、降耗、减排、总量控制等环境管理工作提供科学的依据。     

Machine learning algorithms for the creation of clinical healthcare enterprise systems

Clinical recommender systems are increasingly becoming popular for improving modern healthcare systems. Enterprise systems are persuasively used for creating effective nurse care plans to provide nurse training, clinical recommendations and clinical quality control. A novel design of a reliable clinical recommender system based on multiple classifier system (MCS) is implemented. A hybrid machine learning (ML) ensemble based on random subspace method and random forest is presented. The performance accuracy and robustness of proposed enterprise architecture are quantitatively estimated to be above 99% and 97%, respectively (above 95% confidence interval). The study then extends to experimental analysis of the clinical recommender system with respect to the noisy data environment. The ranking of items in nurse care plan is demonstrated using machine learning algorithms (MLAs) to overcome the drawback of the traditional association rule method. The promising experimental results are compared against the sate-of-the-art approaches to highlight the advancement in recommendation technology. The proposed recommender system is experimentally validated using five benchmark clinical data to reinforce the research findings.     

集中式机房监控报警系统的设计与实现

随着信息技术的应用和发展,大型企业机房数目和机房设备愈来愈多,各类设备和系统相对独立,缺乏统一的监控报警系统进行管理,机房设备及系统的定期巡检给值班人员带来非常大的工作量,而且存在较大的安全生产隐患,为提高工作质量和效率,保障机房维护和管理的安全性,本文运用现代软件工程的思想,结合机房实际的硬件环境,在总结多个监测系统开发经验的基础上,设计并实现了机房环境、动力设备、保安报警、门禁、视频监控五位一体的集中式机房安全监测报警系统。     

A healthy bottom line and quality patient care: can they coexist?

In summary, it is the writer's opinion that a healthy bottom line and quality patient care can coexist. With today's economic pressures and with more and tighter controls and regulations being imposed by the government and regulatory agencies, providers (especially hospitals) need to be cost efficient and cost effective. Will the cost-containment measures necessary to maintain a healthy bottom line reduce the quality of patient care? They needn't. In point, such measures might actually increase the quality of care by avoiding wasteful clinical practices. Quality patient care comprises three basic elements: value, service, and compassion. To omit any one of these ingredients is to remove the quality from patient care. Should this happen, no cost-containment measure will be enough to sustain a hospital. Financial accountability is essential; quality care is imperative. Blended together thoroughly, they are the recipe to survival--for the hospital and for the patient.     

AFT regression-adjusted monitoring of reliability data in cascade processes

Today’s competitive market has witnessed a growing interest in improving the reliability of products in both service and industrial operations. A large number of monitoring schemes have been introduced to effectively control the reliability-related quality characteristics. These methods have focused on single-stage processes or considered quality variables which are independent. However, the main feature of multistage processes is the cascade property which needs to be justified for the sake of optimal process monitoring. The problem becomes complicated when the presence of censored observations is pronounced. Therefore, both the effects of influential covariates and censored data must be taken into account while presenting a monitoring scheme. In this paper, the accelerated failure time models are used and two regression-adjusted control schemes based on Cox-Snell residuals are devised. Two different scenarios with censored and non-censored data are considered respectively. The competing control charts are compared in terms of zero-state and steady-state average run length criteria using Markov chain approach. The comparison study reveals that the cumulative sum based monitoring procedure is superior and more effective. It should be noted that the application of the proposed monitoring schemes are not restricted to manufacturing processes and thus service operations such as healthcare systems can benefit from them.     

环境监测影响因素及改进措施

随着我国经济的发展,存在的环境问题也逐渐地显露出来,而且环境也对人的身体健康有着直接的影响。因此,我国为加强对环境的保护,制定了很多相应的政策和措施,在国家的管控下,我国环境的恶化程度降低。但是,环境问题仍然不容乐观,环境监测工作是对环境质量监测的关键手段。论文以环境监测的影响因素为主要内容,认识到只有提升环境监测的水平,才能确保环境监测质量得到进一步的提升。     

Hospital performance standards and medical pricing: The impact of information disclosure in cardiac care

A policy concern is that the initiation of Hospital Compare (HC) reporting in Medicare provided leverage to insurers in price negotiations for lowering private sector prices without regard to hospital performance. Using the sequential Nash bargaining framework we provide economic intuition to the contrary: while average hospital prices decline under quality disclosures, hospitals with above‐average quality are able to exert a stronger bargaining position, consequently capturing prices above the market rate. To explore this issue empirically we estimate variants of difference‐in‐difference models, examining the effects of the three main scores (heart attack, heart failure, and combined mortalities) on transaction prices of related hospital procedures. States which had similar mandated reporting systems in place before the initiation of HC form the control group. Analyzing claims data of privately insured patients, we find that HC exerted downward pressure on prices. However, hospitals rated “above‐average” captured higher prices, thereby offsetting the overall policy effect fully or partially. Leads and lags analysis lends further support for our difference‐in‐difference approach. We find that highly ranked hospitals received a quality premium of 8–14%, comparable to price effects found in other health care markets. We conclude that HC was effective at constraining prices without penalizing high performers.     

No excuses: forecasting can be managed

Originally written for manufacturers, the forecasting concepts presented in this article are easily applied to a hospital or health care facility with a supply function or central distribution center. Forecasting can offer a method of managing the control of medical supplies, pharmaceuticals, or maintenance items. A statistical based forecasting approach with seasonality testing could be useful in analyzing patient census data, calculating trends, and then recommending staffing levels. Cost containment and efficiency of operations are priorities in any industry. Forecasting the demand of medical supplies and services in today's hectic health care environment can have a significant effect on both customer service and financial results. The bottom line is happy patients and healthy profits.     

贯彻落实新医院会计制度,提高医院会计信息质量

随着市场经济体制的发展,我国卫生医疗市场也得到不断地完善,作为医院经济管理的重要部分会计管理工作的重要性也越来越突出,如果会计管理工作不到位,容易导致会计信息失真,使医院的经济管理工作受影响,进而影响整个医院工作的开展。2009年我国新医改方案的颁布与全面实施,对我国医院会计管理工作形成了较大的影响。为顺应新医改方案的相关规定与要求,医院内部会计管理工作也面临着重大改革。本文主要通过分析新医改环境下会计制度对会计信息质量的要求和当前影响医院会计信息的原因,提出相应的措施,目的为贯彻落实新医院会计制度,提高医院会计信息质量的问题进行简要的探讨。     

The Demand for Health Care Services in Rural Tanzania

This paper examines the pattern of health care demand in rural Tanzania. We distinguish between hospital and clinic‐based care, in both the public and private sector using a two‐level nested multinomial logit model. Own price elasticities of demand for all health care options are high, although less so for public clinics and dispensaries than other choices. However, there is a high degree of substitution between public and private care. Consequently, price increases or user fees will result in small percentage of people opting for self‐treatment. Another important contribution of this paper is that the quality of medical care has large effects on health demand. This applies to the quality and availability of doctors/nurses, drugs and the clinic environment.     

Technical and organisational aspects in enterprise resource planning systems implementation: lessons from a Spanish public hospital

Public resources should always be managed efficiently, more so in times of crisis. Due to the specific characteristics of the healthcare sector, there is a need for special attention, especially in regards to hospitals. Administrators need useful tools to be able to efficiently manage available resources, such as enterprise resource planning (ERP) systems. Therefore, an analysis of the effects of their implementation and use in hospitals is valuable. This study has two purposes. One is to analyse the role ERP systems play in aiding the integration of hospital data, with focus on user satisfaction as well as possible resistance to change. The other purpose is to analyse the effects of implanting and using ERP systems in the hospital environment and identifying how certain variables influence the process, especially the existence of different organisational cultures. Results indicate that clinical information has become notably more integrated, despite the lack of flow in the economic–financial area. The heterogeneous nature of the different groups, clinical (Medical, Nursing) and non-clinical (Economic–Financial, Accounting), had a negative influence on the implementation process, and limited the integration of information as well as the system's performance.     

钻孔灌注桩质量监控要点

钻孔灌注桩属于隐蔽工程,并且施工时受人、机、料、法、环诸多因素影响,为了确保钻孔灌注桩的质量,在施工过程中必须高度重视、严把质量关,详细考虑各种因素对每个环节的影响,稍有疏忽或者防护措施不到位,在灌注时就会发生质量事故。本文在监控钻孔灌注桩施工过程的同时,通过对人、材、法、机、环等方面进行质量监管,从而来确保钻孔灌注桩的质量符合设计的规范要求,为施工顺利进行提供参考依据。     

Social identification: linking high performance work systems,psychological empowerment and patient care

This paper examines the mediating effects of social identification on the relationship between high performance work systems (HPWS) and psychological empowerment and the direct relationship between psychological empowerment and clinician perceptions of quality of patient care. We use structural equation modelling on a sample of 254 health professionals from a large regional hospital in Australia. Results demonstrate, first, a strong effect of HPWS on social identification. Second, social identification mediates the relationship between HPWS and psychological empowerment and, third, psychological empowerment has a strong effect on clinician perceptions of quality of patient care. Implications are drawn for management theory and hospital managers.     

感染控制系统的设计与实现

医院感染控制是以医院感染监测的资料为依据,以医院感染管理为手段,目的是提高医疗质量,保证患者医疗安全。感染控制系统的设计开发使用面向对象的UML技术建模,MVC设计模式。主要实现了实时筛选病例,实时调阅患者病历、体温单、检验检查结果,从而协助感控人员实时监测医院感染的各个监测目标,及时汇总、分析监测结果,查找感染源、感染途径,及时上报相关部门,同时制定控制措施,并督导实施。     

小型水利工程质量存在的问题及对策浅析

水利工程的兴建,对于周围地区的环境将产生非常大的影响。因此,制定水利工程规划,必须要从流域或地区的全局出发,以期减少不利影响,才能收到经济、社会和环境的最佳效果。工程质检工作是工程质量监督管理的重要环节,也是保证工程质量的重要条件。如果要保证水利工程质量,就要必须坚持认真进行质量检测。     

全面预算管理条件下医院财务成本控制研究

全面预算管理是现代医院经营管理中的重要内容,也是实现医院财务成本控制的有效措施,对于医院核心竞争力的提升以及医院事业的稳定发展十分重要.随着新时期的到来,社会也在不断进步,同时医疗卫生体制也加入了改革的潮流中,医院需要积极做好财务成本控制工作,充分发挥出全面预算管理的价值,为医院财务成本控制工作提供重要保证,有效促进医...     

Healthcare information systems: data mining methods in the creation of a clinical recommender system

Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.     

A column generation-based approach to solve the preference scheduling problem for nurses with downgrading

The demand for nurses in virtually all western countries has been outpacing the supply for more than a decade. The situation is now at the point where the rules for good practice are being stretched to the limit and patient care is in jeopardy. The purpose of this paper is to present several ideas for maximizing the use of the available staff and to quantify the resultant benefits. Two approaches are investigated for substituting nurses with higher level skills for those with lower level skills when there is sufficient idle time to do so. Idle time is usually due to scheduling constraints and contractual agreements that prevent a hospital from arbitrarily assigning nurses to shifts over the week.When the substitution is skill-related, as it is here, it is often called downgrading. The models that we develop are for preference scheduling, which means that individual preferences are taken into account when constructing monthly rosters. There are several reasons for doing this in today's environment, the most important is the need to boost staff morale and increase retention. The problem is modeled as an integer program and solved with a column generation technique that relies on intelligent heuristics for identifying good candidate schedules. The computations show that high quality solutions, as measured by the reduction in the need for non-unit nurses as well as the degree to which preferences are satisfied, can usually be obtained in a matter of minutes.     

A causal model for the development of long-term facilities: a case in Taiwan

Elder care is an important issue in many developed countries such as U.S., Japan, and Taiwan. With the advent of population aging throughout the world, the development of long-term care facilities has become a very vital topic. In actuality, long-term care systems involve government oversight agencies as well as interaction between factors such as laws, social environment, culture, long-term care facilities, residents, and the families of residents, forming a complex and dynamic system. This paper uses system dynamics methodology to model the developmental structure of Taiwanese long-term care facilities to explore its system behaviors. The developmental structure of long-term care facilities in Taiwan is primarily composed of the four levels: overall satisfaction, overall service quality, the skill of administrative and medical care personnel and facility hardware resources. Time delay, complex, and dynamic relationships are present in the overall structure. The overall service quality of facilities is one of the most important factors in facilities’ development and that the skills of administrative and medical care personnel is the main critical factor in improving overall service quality. Finally, some suggestions are discussed relevant strategies for the government and the industry.