社區(qū)健康中心的初級護(hù)理外文翻譯 本科畢業(yè)設(shè)計(論文)外 文 翻 譯原文: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 community 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 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 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 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 described 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 teaching 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 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 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 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. 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, 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 environment 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 centers 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 would 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 productivity, 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 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 and 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 recently 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 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 reform. 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 physicians 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 training 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. primary 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 patient-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 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 important 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 graduate 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 supervision 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-cost 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 success, 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 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 expected 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 譯文: 社區(qū)健康中心的初級護(hù)理醫(yī)療教學(xué)中心:關(guān)鍵問題的最佳解決方案 通過擴(kuò)建和整合現(xiàn)有的項目和資源,提出在社區(qū)健康中心建立居民初級護(hù)理流動培訓(xùn)。到2011年7月,這些項目就會開始逐步輸送訓(xùn)練有素的初級護(hù)理醫(yī)師,他們有一些會致力于照顧一些未得到服務(wù)的人群。醫(yī)療教學(xué)中心被要求在一個被醫(yī)療資源服務(wù)機(jī)構(gòu)指定的缺乏衛(wèi)生醫(yī)療資源的地區(qū)建立社區(qū)健康中心,附屬于在家庭醫(yī)學(xué)、內(nèi)科、小兒科方面的實習(xí)期項目并且能夠利用這些設(shè)置做居民初級護(hù)理流動培訓(xùn)。成為一個已經(jīng)建立的有足夠能力去擴(kuò)建和配備職員的社區(qū)健康中心的一部分,在社區(qū)管理上致力于支持教育和服務(wù)任務(wù),執(zhí)行或者有意愿執(zhí)行對于以病人為中心的醫(yī)學(xué)家庭的全國委員會質(zhì)量管理要求。以病人為中心的醫(yī)學(xué)家庭是一個實踐模型,它能有效支持初級護(hù)理的核心功能,運用電子醫(yī)療記錄,強(qiáng)調(diào)預(yù)防和治療慢性疾病。 這些項目申請條件在其他各類地方被仔細(xì)的描述過。 作為一個三年居民在為期十二個月的臨床培訓(xùn)中,初級護(hù)理居民是初級護(hù)理服務(wù)最主要的提供者,與恰當(dāng)?shù)哪芰τ兄芮械暮献麝P(guān)系。理想地來說,第一年和第二年居民會被指定去醫(yī)療教學(xué)中心繼續(xù)他們的臨床培訓(xùn)。而作為第三年居民,他們會在診所后勤上有基礎(chǔ)并且能夠成為一個有效的團(tuán)隊領(lǐng)導(dǎo)。第三年居民會在一個強(qiáng)調(diào)護(hù)理的持續(xù)性的診所工作,對于居民團(tuán)隊管理和流動臨床用堅定的技能支持。護(hù)理的持續(xù)性會通過在居民和監(jiān)管人員的密切工作關(guān)系來保證。由于以病人為中心的醫(yī)療家庭的有效性和醫(yī)師成倍擴(kuò)大資深居民的影響,這種安排以實質(zhì)上大大提升的病人的聲音提供傳遞協(xié)調(diào)的高質(zhì)量的可操作的護(hù)理的可能性。因為這個模型會有可能偏離現(xiàn)有的訓(xùn)練指導(dǎo)方針,這就有必要對于倡辦的組織去得到從家庭醫(yī)療、內(nèi)科醫(yī)療和兒科醫(yī)療檢查委員會批轉(zhuǎn)的免試。貫徹執(zhí)行和預(yù)期結(jié)果 如果醫(yī)療護(hù)理改革法律包括現(xiàn)有的被推薦的社區(qū)健康中心和初級護(hù)理的主動通行證,我們的提議是很明顯能夠?qū)崿F(xiàn)的。 如果成功了,它將帶來預(yù)防效果、有效的慢性疾病治療的實質(zhì)性的節(jié)約以及急診科和住院治療上的消耗減少。在2000年,美國醫(yī)院的入座人數(shù)高達(dá)五百萬,花費了超過265億美元,這有可能通過高質(zhì)量的初級預(yù)防護(hù)理治療來避免。醫(yī)療教學(xué)中心通過擴(kuò)大提供初級護(hù)理的可接近性從而重建我們的健康防御系統(tǒng)。 初級護(hù)理醫(yī)師的核心是在一個環(huán)境中訓(xùn)練運用電子醫(yī)療記錄和強(qiáng)調(diào)控制花費和消除浪費的能力。監(jiān)管人員會堅持建立在證據(jù)基礎(chǔ)上的想象運用、實驗室學(xué)習(xí)以及普通藥品的處方。 我們的提議也會發(fā)展醫(yī)療教學(xué)中心的可能性,作為為本科生流動醫(yī)療教育的網(wǎng)點,并且促進(jìn)醫(yī)學(xué)專業(yè)的學(xué)生去選擇初級護(hù)理作為以后發(fā)展的事業(yè)。流動的網(wǎng)點訓(xùn)練對于醫(yī)學(xué)專業(yè)的學(xué)生是非常必要的,尤其是在近來醫(yī)學(xué)院數(shù)量激增的大背景下。 另外,這些診所是非常好的地點對于訓(xùn)練護(hù)士臨床工作者、醫(yī)生助手、藥劑師、社會工作者和醫(yī)務(wù)助理。 醫(yī)療教學(xué)中心可以通過使用若干便利的可量化的參數(shù)來評估。附屬的學(xué)術(shù)機(jī)構(gòu)可以獲得診所生產(chǎn)率、實習(xí)生滿意度、畢業(yè)生的招聘、護(hù)理的花費、對于其他醫(yī)療專業(yè)人才逐漸上升的訓(xùn)練機(jī)會以及病人的滿意度的數(shù)據(jù)。這些成果可以被用作支持隨后擴(kuò)展的法律。討論 我們的提議設(shè)計監(jiān)理一個初級護(hù)理職業(yè)者群體,他們可以在展開的醫(yī)療護(hù)理環(huán)境中有效的運轉(zhuǎn),并且將改善美國人接近護(hù)理的程度。 這立足于醫(yī)療教學(xué)中心的發(fā)展,其將立即增加被挑選的社區(qū)健康中心以及補(bǔ)充考慮中的初級護(hù)理醫(yī)師的臨床可能性。因為馬薩諸塞州2006年醫(yī)療改革計劃和國家改革類型之間的相似點很可能被執(zhí)行,關(guān)于近來馬薩諸塞州經(jīng)驗的分析在建立公共政策方面是非常有價值的。 一個最近已經(jīng)被公布的來自于關(guān)于公共醫(yī)療補(bǔ)助制的