The Delivery of Medical Care in China

Background: St. Petersburg is a city of federal importance with a large number of primary patients, identified annually. Objective: analysis of the main indicators characterizing medical care for children with cancer in St. Petersburg and the Leningrad region. Methods: The operative reports for 2013-2017 of the Health Committee of the Government of St. Petersburg and the Health Committee of the Leningrad Region were analyzed. Results. In 2013-2017 in the Russian Federation, 18 090 primary patients were identified, 927 (5.1%) of them in the analyzed subjects: in St. Petersburg - 697 (75,2%), in the Leningrad Region - 230 (24,8%). For 5 years, the number of primary patients increased in St. Petersburg - by 36%, in the Leningrad Region - by 2,5%. The incidence increased in St. Petersburg by 18,1% (from 14,9 in 2013 to 17,6 in 2017 per 100 000 of children aged 0-17). The incidence in the Leningrad Region fell by 4.9% (from 14.4 in 2013 to 13.7 in 2017). Mortality in 2016-2017 in St. Petersburg increased by 50% (from 2 to 3), in the Leningrad Region - by 12,5% (from 2,4 to 2,7). The one-year mortality rate in St. Petersburg increased by 3,9% (from 2,5 to 6,4%). In the Leningrad Region, the one-year mortality rate decreased from 6,5% in 2016 to 0 in 2017. The number of pediatric oncological beds did not change in St. Petersburg (0,9 per 10,000 children aged 0-17 years) and the Leningrad Region (0). In St. Petersburg patients were not identified actively in 2016-2017; in the Leningrad Region their percentage decreased from 8,7 to 0. The number of oncologists increased in St. Petersburg from 0,09 to 0.12 (+33,3%), in the Leningrad Region - from 0 to 0,03. Conclusion: Morbidity in St. Petersburg and the Leningrad region is significantly different, which indicates obvious defects in statistical data. Patients were not identified during routine preventive examinations which indicate a low oncologic alertness of district pediatric physicians. Delivery of medical care for children with cancer and the statistical data accumulation procedures should be improved.

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Editorial [How Health Services Researchers are Helping to Transform the Delivery of Medical Care in the United States]

The Open Health Services and Policy Journal ◽

10.2174/1874924000801010001 ◽

2008 ◽

Vol 1 (1) ◽

pp. 1-4

Author(s):

Steven S. Coughlin

Keyword(s):

United States ◽

Health Services ◽

Medical Care ◽

The United States ◽

Delivery Of Medical Care

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How Much does Improved Medical Service Affect Infant Mortality?

PEDIATRICS ◽

10.1542/peds.49.4.638 ◽

1972 ◽

Vol 49 (4) ◽

pp. 638-638

Author(s):

Arnold Gilbert

Keyword(s):

Infant Mortality ◽

Medical Care ◽

Community Health ◽

Medical Service ◽

Health Programs ◽

Community Health Programs ◽

Delivery Of Medical Care

The meaning of the article by Dr. Chabot in Pediatrics, June 1971 concerning improved infant mortality between 1964 and 1968 in Denver puzzled me. I wonder whether there is any relation between the improved community health programs described and the happy results presented. Surely, many factors other than medical care affect infant mortality. For example, I wonder whether the author would suggest that the startling (to me) rise in infant mortality noted in Table II for Boston, Buffalo, Phoenix, Pittsburgh and Seattle, resulted from poorer delivery of medical care.

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Rationing Medical Technology

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300000519 ◽

1987 ◽

Vol 3 (2) ◽

pp. 199-221 ◽

Cited By ~ 8

Author(s):

Ann Lennarson Greer

Keyword(s):

Decision Making ◽

Medical Care ◽

Medical Technology ◽

Consumer Preferences ◽

The United States ◽

Essential Elements ◽

Patient Trust ◽

American Hospital ◽

Delivery Of Medical Care ◽

English National Health

AbstractThis paper analyzes medical technology decision making in the United States and England in terms of the appropriateness of different decision-making models to the organization and delivery of medical care, and to the rationing of technology among and within hospitals. It examines the effect on the American hospital of prospective payment programs from the perspective of organizational structure and decision making. The strategies of central control and specification which characterize these programs are contrasted with decision-making procedures in the English National Health Service, which have emphasized decentralization, delegation, and consensus. The analysis suggests that decentralized models of decision making are more supportive of essential elements of medical care including doctor-patient trust and professional responsibility and are more able to achieve rationing decisions which are compatible with professional and consumer preferences.

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Estimation of biomarker distributions using laboratory data collected during routine delivery of medical care

Annals of Epidemiology ◽

10.1016/j.annepidem.2014.07.013 ◽

2014 ◽

Vol 24 (10) ◽

pp. 754-761 ◽

Cited By ~ 1

Author(s):

Maurice Alan Brookhart ◽

Jonathan V. Todd ◽

Xiaojuan Li ◽

B. Diane Reams ◽

Virginia Pate ◽

...

Keyword(s):

Medical Care ◽

Laboratory Data ◽

Delivery Of Medical Care

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Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle

Medical Care Research and Review ◽

10.1177/1077558718774905 ◽

2018 ◽

Vol 76 (4) ◽

pp. 359-385 ◽

Cited By ~ 2

Author(s):

L. Michele Issel

Keyword(s):

Health Care ◽

Medical Care ◽

Practice Guidelines ◽

Health Care Professionals ◽

Health Care Organizations ◽

Professional Expertise ◽

Work Processes ◽

Patient Centeredness ◽

Medical Practitioners ◽

Delivery Of Medical Care

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven’s (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners’ work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

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Liaison psychiatry or psychological medicine?

The British Journal of Psychiatry ◽

10.1192/bjp.183.1.5 ◽

2003 ◽

Vol 183 (1) ◽

pp. 5-7 ◽

Cited By ~ 11

Author(s):

Geoffrey G. Lloyd ◽

Richard A. Mayou

Keyword(s):

Health Care ◽

Medical Care ◽

Liaison Psychiatry ◽

Hospital Patients ◽

Psychological Medicine ◽

Substantial Progress ◽

Delivery Of Medical Care ◽

The Uk ◽

Psychiatric Profession ◽

Behavioural Aspects

Liaison psychiatry has been recognised in many countries as a special interest or sub-speciality of psychiatry concerned with the management of general hospital patients with psychological problems. However, despite increasing awareness of the emotional and behavioural aspects of illness, it has yet to achieve substantial influence within psychiatry and, more importantly, has had only modest effects on the delivery of medical care by physicians and other specialists. Recognition of its potential by planners and commissioners has been disappointing. Regrettably, in the UK and elsewhere, recent changes in the organisation of health care could hinder its development. This paper argues that in order to make substantial progress there is a compelling need to solve a fundamental obstacle – the separation between psychiatric and general medical care. This requires:(a) convincing the psychiatric profession that consultation-liaison is a distinct sub-speciality;(b) continuing efforts by liaison psychiatrists to define their special expertise and to demonstrate that their services are effective and acceptable to medical colleagues and to patients;(c) persuading those who organise health care that liaison psychiatry services need to be provided and administered as an integral component of comprehensive medical care.

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