社区健康中心的初级护理外文翻译.doc

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1、社区健康中心的初级护理外文翻译 本科毕业设计(论文)外 文 翻 译原文:Teaching Primary Care in Community Health CentersTHE TEACHING HEALTH CENTER: A DEFINITIVE APPROACH TO THESE KEY PROBLEMS By expanding and integrating existing programs and resources, we propose to establish primary care resident ambulatory training programs in com

2、munity health centers. These programs could begin increasing the output of well-trained primary care physicians, many of whom would be committed to caring for the underserved, as soon as July 2011. Teaching health centers would be required to be located in a community health center in a primary care

3、 health professional shortage area as designated by the Health Resources and Services Administration; be affiliated with a residency program in family medicine, internal medicine, or pediatrics and capable of using this setting for primary care resident ambulatory training; be part of an established

4、 community health center with the capability to expand and staff the center, as well as be part of a community governance board committed to supporting both the educational and service missions; and have implemented or intend to implement National Committee for Quality Assurance tier-2 requirements

5、for a patient-centered medical homeThe patient-centered medical home is a practice model that effectively supports the core functions of primary care, uses electronic medical records, and emphasizes prevention and the management of chronic diseaseQualification criteria for these programs have been d

6、escribed in detail elsewhere Primary care residents would be the principal providers of primary care services, in close partnership with appropriate faculty, during a 12-month block of clinic training as a third-year resident. Ideally, first- and second-year residents would be assigned to the teachi

7、ng health centers for their continuity clinics. Then, as third-year residents, they would be well grounded in clinic logistics and capable of performing as an effective team leader. Third-year residents would work in a practice that emphasized continuity of care, with robust faculty support for the

8、development of resident team management and ambulatory clinical skills. Continuity of care would be ensured through the close working relationship between the resident and the supervising faculty member. This arrangement would provide the capacity to deliver coordinated, high-quality, and accessible

9、 care?with a substantially increased patient volume?because of the efficiencies of the patient-centered medical home and the physician multiplier effect of senior residents. Because this model would deviate from current training guidelines, it would be necessary for sponsoring institutions to obtain

10、 waivers from the family medicine, internal medicine, and pediatrics residency review committees.IMPLEMENTATION AND PROJECTED OUTCOME If health care reform legislation that includes the currently proposed community health center and primary care initiatives passes, our proposal is clearly attainable

11、. If successful, it could result in substantial savings from the effects of prevention, effective chronic disease management, and decreases in emergency department use and hospitalizationsIn 2000, an estimated 5 million admissions to U.S. hospitals, with a resulting cost of more than $26.5 billion,

12、may have been preventable with high-quality primary and preventive care treatmentTeaching health centers would contribute to the restructuring of our health care system by expanding access to the value provided by primary careThis new cadre of primary care physicians would be trained in an environme

13、nt that used electronic medical records and emphasized cost control and the elimination of wasteSupervising faculty would insist on evidence-based use of imaging and laboratory studies, as well as the prescription of generic drugs. Our proposal would also develop the capacity of teaching health cent

14、ers as sites for undergraduate ambulatory medical education and serve to stimulate medical students to choose primary care as a career. Ambulatory training sites for medical students are greatly needed, especially with the recent expansion of medical school class size. In addition, these clinics wou

15、ld be excellent sites for training nurse clinicians, physician assistants, pharmacists, social workers, and medical assistants. Teaching health centers could be evaluated by using several readily quantifiable parameters. Affiliated academic institutions could obtain data regarding clinical productiv

16、ity, trainee satisfaction, recruitment of graduates to underserved areas, cost of care, increased training opportunities for other health professionals, and patient satisfaction. These outcomes could then be used to support legislation for subsequent expansion.DISCUSSION Our proposal is designed to

17、build a primary care workforce that can function effectively in our evolving health care environment and will improve access to care for many Americans. It is based on the development of teaching health centers that will immediately expand the clinical capacity of selected community health centers a

18、nd replenish the pipeline of primary care physicians. Because of the similarity between the Massachusetts 2006 Health Reform plan and the types of national reform most likely to be implemented, analysis of the recent Massachusetts experience is of great value in establishing national policy. A recen

19、tly published report from the Kaiser Commission on Medicaid and the Uninsuredemphasizes the critical role of community health centers in health care reform; in Massachusetts in 2007, they served 1 out of every 13 residents. Health insurance expansion led to a great increase in the demand for primary

20、 health care, especially in medically underserved, low-income communities. Accommodating this increase in demand requires increased capacity. In that respect, a major problem encountered in Massachusetts was the shortage of qualified primary care providers, which was exacerbated by health care refor

21、m. Massachusetts was the first to experience this problem, although it could soon confront many states Our proposal builds on more than 25 years of experience of family medicine residencies with community health centers. Training family physicians in these sites helps increase the number of physicia

22、ns caring for the underserved, enhances their recruitment of family physicians, and provides high-quality education for family physiciansMore than 42% of community health centers already serve as training sites for primary care residency programs, yet most receive no funding to cover the cost of tra

23、ining Our proposal adds several unique features to the family medicine model. First, it expands training to other primary care disciplines. It also incorporates the patientcentered medical home model of care, which is highly desirable for residency training for the new health care environment. Prima

24、ry care resident training should be conducted in an ambulatory setting that represents the future of primary care and is attractive to future primary care residents and faculty. Teaching health centers also provide an ideal setting for residents to interact with advanced practice clinicians. The pat

25、ient-centered medical home environment provides an excellent opportunity to improve skills in leadership, teamwork, patient education, and communication? all important components of resident education. Finally, our proposal introduces a new major source of financial support for training in community

26、 health centers Our proposal is directed toward aligning training for the primary care physician with the realities of 21stcentury practice. However, the contribution of residency training to the care of the underserved is not a new feature. For most of the 20th century, residents served an importan

27、t role in providing predominately inpatient care for the underserved. A proposal published in 1986 advocated expanding this role to the community ambulatory setting. However, the association of ambulatory graduate medical education with care for the underserved has been constrained by policy on grad

28、uate medical education funding. Current legislative initiatives that are part of health care reform provide a way to achieve this linkage by means of teaching health centers Teaching health centers provide an optimal training environment for graduate medical education, given their close faculty supe

29、rvision and the emphasis on patientcentered care, and represent the future of high-quality medical practice. Primary care residents trained in this setting could immediately increase the clinical capacity of community health centers. In addition, many of the graduates would provide access to low-cos

30、t primary care services for the projected increased number of underserved patients. By providing both the leadership to establish teaching health centers?in affiliation and partnership with community health centers?and the expertise to generate data for evaluating multiple parameters to measure succ

31、ess, academic health centers and teaching hospitals can make a major contribution to health care reform. By increasing access to primary care, teaching health centers would be a major step in forging a link between achieving fiscally feasible universal coverage and reforming the health care delivery

32、 system; improved primary care access is required to achieve the goals of the medical practice transformation necessary for health care reform. Skeptics will judge health care reform by how it works from day 1?without this missing link, the promising initiatives for reform may not achieve the expect

33、ed timely resolution to this major public policy problem that affects our nations future.Richard E. Teaching Primary Care in Community Health CentersJ.Ann Intern Med.2010 vol. 152 no. 2 118-122 译文: 社区健康中心的初级护理医疗教学中心:关键问题的最佳解决方案 通过扩建和整合现有的项目和资源,提出在社区健康中心建立居民初级护理流动培训。到2011年7月,这些项目就会开始逐步输送训练有素的初级护理医师,他

34、们有一些会致力于照顾一些未得到服务的人群。医疗教学中心被要求在一个被医疗资源服务机构指定的缺乏卫生医疗资源的地区建立社区健康中心,附属于在家庭医学、内科、小儿科方面的实习期项目并且能够利用这些设置做居民初级护理流动培训。成为一个已经建立的有足够能力去扩建和配备职员的社区健康中心的一部分,在社区管理上致力于支持教育和服务任务,执行或者有意愿执行对于以病人为中心的医学家庭的全国委员会质量管理要求。以病人为中心的医学家庭是一个实践模型,它能有效支持初级护理的核心功能,运用电子医疗记录,强调预防和治疗慢性疾病。 这些项目申请条件在其他各类地方被仔细的描述过。 作为一个三年居民在为期十二个月的临床培训中

35、,初级护理居民是初级护理服务最主要的提供者,与恰当的能力有着密切的合作关系。理想地来说,第一年和第二年居民会被指定去医疗教学中心继续他们的临床培训。而作为第三年居民,他们会在诊所后勤上有基础并且能够成为一个有效的团队领导。第三年居民会在一个强调护理的持续性的诊所工作,对于居民团队管理和流动临床用坚定的技能支持。护理的持续性会通过在居民和监管人员的密切工作关系来保证。由于以病人为中心的医疗家庭的有效性和医师成倍扩大资深居民的影响,这种安排以实质上大大提升的病人的声音提供传递协调的高质量的可操作的护理的可能性。因为这个模型会有可能偏离现有的训练指导方针,这就有必要对于倡办的组织去得到从家庭医疗、内

36、科医疗和儿科医疗检查委员会批转的免试。贯彻执行和预期结果 如果医疗护理改革法律包括现有的被推荐的社区健康中心和初级护理的主动通行证,我们的提议是很明显能够实现的。 如果成功了,它将带来预防效果、有效的慢性疾病治疗的实质性的节约以及急诊科和住院治疗上的消耗减少。在2000年,美国医院的入座人数高达五百万,花费了超过265亿美元,这有可能通过高质量的初级预防护理治疗来避免。医疗教学中心通过扩大提供初级护理的可接近性从而重建我们的健康防御系统。 初级护理医师的核心是在一个环境中训练运用电子医疗记录和强调控制花费和消除浪费的能力。监管人员会坚持建立在证据基础上的想象运用、实验室学习以及普通药品的处方。

37、 我们的提议也会发展医疗教学中心的可能性,作为为本科生流动医疗教育的网点,并且促进医学专业的学生去选择初级护理作为以后发展的事业。流动的网点训练对于医学专业的学生是非常必要的,尤其是在近来医学院数量激增的大背景下。 另外,这些诊所是非常好的地点对于训练护士临床工作者、医生助手、药剂师、社会工作者和医务助理。 医疗教学中心可以通过使用若干便利的可量化的参数来评估。附属的学术机构可以获得诊所生产率、实习生满意度、毕业生的招聘、护理的花费、对于其他医疗专业人才逐渐上升的训练机会以及病人的满意度的数据。这些成果可以被用作支持随后扩展的法律。讨论 我们的提议设计监理一个初级护理职业者群体,他们可以在展开

38、的医疗护理环境中有效的运转,并且将改善美国人接近护理的程度。 这立足于医疗教学中心的发展,其将立即增加被挑选的社区健康中心以及补充考虑中的初级护理医师的临床可能性。因为马萨诸塞州2006年医疗改革计划和国家改革类型之间的相似点很可能被执行,关于近来马萨诸塞州经验的分析在建立公共政策方面是非常有价值的。 一个最近已经被公布的来自于关于公共医疗补助制的凯泽委员会的报告强调社区健康中心在医疗保健改革的关键角色;在2007年的麻萨诸塞州,每十三位居民中就有一位享受服务。 医疗保险的扩大范围使得在基础医疗上的要求激增,尤其是在没有得到医疗服务、低收入的社区中。 适应需求的增长需要更多的能力。在这个方面,

39、马萨诸塞州遇到的一个主要问题是能胜任的初级护理提供者的短缺,并且因医疗改革而恶化。马萨诸塞州是第一个面临这个问题,即使它很快会为很多州所遭遇。 我们的提议建立在超过25年的拥有社区健康中心的家庭医疗实习期经验的基础上。在这些地点训练家庭医师可以帮助增加为没有享受医疗服务的人群提供医疗护理的医师数量。超过百分之四十二的社区健康中心已经担任初级护理实习期项目的训练网点,然而大多数没有得到训练费用的资金支持。 我们的提议为家庭医疗模型增加了若干独一无二的特征。 它也包含以病人为中心的医疗家庭模式的护理,这对于为新健康护理环境的实习期训练是可取的。代表了初级护理特征的初级护理居民训练应该在流动环境下被

40、引导,对于初级护理居民和监管人员是有吸引力的。.医疗教育中心对于与高级的临床医师交流的居民也提供一个理想的环境。 以病人为中心的医疗家庭环境提供了极好的机会在领导才能、团队合作、医疗教育和交流方面提高水准。 最后,我们的提议介绍了一种新的主要的资源为社区健康中心的训练提供经济上的帮助。 我们的提议指向于矫正在21世纪实际情况中的初级护理医师的训练。然而,致力于向未获得医疗服务的人群做贡献,但这并不是实习期训练的新特征。 在20世纪,居民在占主要优势的未得到医疗服务的人群提供住院病人护理扮演了一个重要的角色。1986年,一个建议倡导扩展这个角色加入到社区流动环境中。. 然而,为这些没有得到护理服

41、务的人群提供护理的流动毕业生医疗教育组织通过关于毕业生医疗教育基金的政策已经被限制。 作为医疗改革的一部分,现代法律首创以医疗教学中心的方式提供一个方式去达到连接。 医疗教育中心提供一个绝佳的训练环境,为这些受到医疗教育的毕业生,给予他们密切的管理以及强调以病人为中心的护理,代表了高质量医疗实践的未来。 初级护理居民在这种环境下训练可以立即增加社区健康中心的临床可能性。另外,许多毕业生可以有接近为这些增加的未得到医疗服务的病人提供低收入初级护理服务的可能性。通过提供建立医疗教学中心的领导才能和生成多种多样的可量化的参数去评估成功的专门知识,学术性的医疗教学中心和教学医院也可以做出很大的贡献对于医疗改革。 通过逐渐增长的对于初级护理的接近性,医疗教学中心很有可能是在连接财政上可行的全民医疗保健制和医疗改革传递系统之间很大的一步;改善的初级护理被要求达到医疗改革中医疗实践转变的目标。怀疑主义者将根据它如何运转DAY1?without这条断链来评价医疗改革,这些前景光明的对于改革的首创很有可能达不到及时解答影响我们国家的未来的主要公共政策问题的期望。 出处:理查德.E;社区健康中心的初级护理J.安实习医师杂志.2010.第2号 P118-122