在臨床醫(yī)學(xué)中課件

在臨床醫(yī)學(xué)中2HealthCareDeliverySystemsHistoryofMedicineandHealthcareDeliveryContinuumofCareHealthCareFacilityOwnershipHealthCareFacilityOrganizationalStructureLicensure,Regulation,andAccreditation3IntroductionHealthcaredeliveryhasbeengreatlyimpactedbyescalatingcosts,resultinginmedicalnecessityrequirements,reviewofappropriatenessofadmissions,andrequirementforadministrationofqualityandeffectivetreatments.4MRXO在臨床醫(yī)學(xué)中，進(jìn)行手術(shù)時(shí)同時(shí)使用磁振造影並整合各種影像技術(shù)是目前最熱門的醫(yī)療概念。新式的「未來手術(shù)室」中，安裝有全球首套MRXO解決方案，即完全整合磁振造影(MR)、Ｘ光及電腦斷層掃描(CT)系統(tǒng)，大幅減少病患危險(xiǎn)並簡化醫(yī)師的手續(xù)，可望提高手術(shù)成功率。這項(xiàng)由日本東海大學(xué)、飛利浦醫(yī)療系統(tǒng)事業(yè)部合力推動(dòng)的「未來手術(shù)室」，已經(jīng)由日本東海大學(xué)的松前教授、津具醫(yī)師、山本醫(yī)師共同在手術(shù)室同時(shí)使用MR(磁振造影)和X光影像技術(shù)，來進(jìn)行神經(jīng)外科手術(shù)。5MRXO在「未來手術(shù)室」中執(zhí)行手術(shù)，可依執(zhí)刀醫(yī)師與病患狀況，在數(shù)分鐘內(nèi)將病患從手術(shù)臺(tái)搬移到磁振造影、電腦斷層掃描或Ｘ光診斷系統(tǒng)，增加手術(shù)精密度與成功率。在磁振造影和電腦斷層掃描區(qū)域有拉門。6HistoryofMedicine&HealthCareDeliveryHistoryofmedicineEvolutionofhealthcaredeliveryintheUnitedStates7HistoryofmedicineIn1994,scientistsdiscoveredthegenesresponsibleformanycasesofhereditarycoloncancer,inheritedbreastcancer,andthemostcommontypeofkidneycancer.8EvolutionofhealthcaredeliveryintheUnitedStates1991TheWorkgrouponElectronicDataInterchange(WEDI)wascreatedtoreducehealthcareadministrativecoststhroughimplementationoftheelectronicdatainterchange(EDI),whichusesnationalstandardstotransmitdataforreimbursementpurposes.9EvolutionofhealthcaredeliveryintheUnitedStates1996TheHealthInsurancePortabilityandAccountabilityAct(HIPAA)waspassed.Itmandatesadministrativesimplificationregulationsthatgovernprivacy,security,andelectronictransactionstandardsforhealthcareinformation.10EvolutionofhealthcaredeliveryintheUnitedStates1996TheHealthcareIntegrityandProtectionDataBank(HIPDB)wascreatedwhichcombatsfraudandabuseinhealthinsuranceandhealthcaredeliverybyalertinguserstoconductacomprehensivereviewofapractitioner’s,provider’s,orsupplier’spastactions.11HealthcareIntegrityandProtectionDataBankAccesstoinformationintheHIPDBisavailabletoentitiesthatmeettheeligibilityrequirementsdefinedinSection1128EoftheSocialSecurityActandtheHIPDBregulations.Inordertoaccessinformation,eligibleentitiesmustfirstregisterwiththeDataBank.HIPDBinformationisnotavailabletothegeneralpublic.However,informationinaformthatdoesnotidentifyanyparticularentityorpractitionerisavailable.12HealthcareIntegrityandProtectionDataBank/Estimatesofannuallossesduetohealthcarefraudrangefrom3to10

percentofallhealthcareexpenditures--between$30

billionand$100

billionbasedonestimated1997expendituresofover$1trillionand2.5trillionfor2009.13ContinuumofCareAcompleterangeofprogramsandservicesiscalledacontinuumofcare,withthetypeofhealthcareindicatingthehealthcareservicesprovided.PrimarycareSecondarycareTertiarycare14PrimarycareservicesIncludepreventiveandacutecare,arereferredtoasthepointoffirstcare,andareprovidedbyageneralpractitionerorotherhealthprofessionalwhohasthefirstcontactwithapatientseekingmedicaltreatment,includinggeneraldental,ophthalmic眼科的,andpharmaceuticalservices.15PrimarycareservicesAnnualphysicalexaminationsEarlydetectionofdiseaseFamilyplanningHealtheducationImmunizationsTreatmentofminorillnessesandinjuriesVisionandhearingscreening16SecondarycareservicesProvidedbymedicalspecialistsorhospitalstaffmemberstoapatientwhoseprimarycarewasprovidedbyageneralpractitionerwhofirstdiagnosedortreatedthepatient.17TertiarycareservicesProvidedbyspecializedhospitalsequippedwithdiagnosticandtreatmentfacilitiesnotgenerallyavailableathospitalsotherthanprimaryteachinghospitalorLevelI,II,IIIorIVtraumacenters.18TraumacentersLevelI:providesthehighestlevelofcomprehensivecareforseverelyinjuredadultandpediatricpatientswithcomplex,multi-systemtrauma.LevelII:broadrangeofsub-specialistsareon-callandpromptlyavailabletoprovideconsultationorcare.19TraumacentersLevelIII:physiciansareadvancedtraumalifesupport(ATLS)trainedandexperiencedincaringfortraumaticallyinjuredpatients;nursesandancillarystaffarein-houseandimmediatelyavailabletoinitiateresuscitativemeasures.20TraumacentersLevelIV:criticallyinjuredpatientswhorequirespecialtycarearetransferredtoahigherleveltraumasystemhospitalinaccordancewithpre-establishedcriteria.1、病毒性肝炎：由病毒造成的肝炎按照其病毒系列不同分為甲、乙、丙、丁、戊和庚共六種類型病毒性肝炎。能引起肝臟細(xì)胞腫脹，是世界上流傳廣泛，危害很大的傳染病之一。

1908年，才發(fā)現(xiàn)病毒也是肝炎的致病因素之一。1947年，將原來的傳染性肝炎（infectioushepatitis）稱為甲型肝炎（HepatitisA,HA）；血清性肝炎（serumhepatitis）稱為乙型肝炎（HepatitisB,HB）。1965年人類首次檢測(cè)到乙型肝炎的表面抗原。我國經(jīng)濟(jì)和科學(xué)技術(shù)日益發(fā)展，學(xué)術(shù)文化領(lǐng)域百家爭鳴，（df高血壓958心臟病983u6糖尿病87fr）特別是思想家的革新精神，為中醫(yī)學(xué)理論的創(chuàng)新和突破性進(jìn)展，提供了有利的文化背景。宋代陳無擇著《三因極一病證方論》一書，（45傳染病q566丙肝964jo乙肝28jgsx甲肝gh）提出三因?qū)W說；并產(chǎn)生了最具盛名四大學(xué)派，劉完素倡導(dǎo)火熱論；張從正力倡“攻邪論”；李杲提出“內(nèi)傷脾胃，百病由生”的理論；朱震亨創(chuàng)造性地闡明了相火的演變規(guī)律。編輯本段明清時(shí)期（df肺25s血液f369血小板t5172紅血球gdf55m白血球fd2）是中醫(yī)學(xué)理論綜合匯編、深化發(fā)展，臨床各科辨證體系豐富、提高階段。如明代樓英的《醫(yī)學(xué)綱目》和王肯堂的《證治準(zhǔn)繩》，清代吳謙等編著的《醫(yī)宗金鑒》和陳夢(mèng)雷主編的《古今圖書集成·醫(yī)部全錄》等。王清任著《醫(yī)林改錯(cuò)》，注重實(shí)證研究，（df高血壓958心臟病983u6糖尿病87fr）糾正了古醫(yī)籍中關(guān)于解剖知識(shí)的某些錯(cuò)誤，肯定了“腦主思維”，發(fā)展了瘀血理論。溫病學(xué)說的形成和發(fā)展，標(biāo)志著中醫(yī)理論的創(chuàng)新與突破，吳有性著《溫疫論》，葉天士著《溫?zé)岵∑罚瑓蔷贤ㄖ稖夭l辨》等，在藥物學(xué)研究方面，（45傳染病q566丙肝964jo乙肝28jgsx甲肝gh）李時(shí)珍著的《本草綱目》，總結(jié)了16世紀(jì)以前我國藥物學(xué)研究的成就。醫(yī)的診察疾病能參考現(xiàn)代醫(yī)學(xué)的微觀分析，將辨證與辨病相結(jié)合，實(shí)現(xiàn)宏觀與微觀的統(tǒng)一，使中醫(yī)診斷客觀化，即把分析與綜合相結(jié)合的方法引入中醫(yī)理、法、方、藥的研究，使二者有機(jī)結(jié)合，互相借鑒、補(bǔ)充，避免各自的片面性、局限性，這將有利于中西醫(yī)學(xué)的優(yōu)勢(shì)互補(bǔ)，“和而不同”，多元發(fā)展。近年來，中醫(yī)藥在防治非典、禽流感和艾滋病方面發(fā)揮的獨(dú)特作用也證實(shí)了二者的有機(jī)結(jié)合，具有肯定的臨床療效。編輯本段東西方醫(yī)學(xué)交融不管是中醫(yī)學(xué)還是西醫(yī)學(xué)，從二者現(xiàn)有的思維方式的發(fā)展趨勢(shì)來看，均是走向現(xiàn)代系統(tǒng)論思維，中醫(yī)藥學(xué)理論與現(xiàn)代科學(xué)體系之間具有系統(tǒng)同型性，屬于本質(zhì)相同而描述表達(dá)方式不同的兩種科學(xué)形式。可望在現(xiàn)代系統(tǒng)論思維上實(shí)現(xiàn)交融或統(tǒng)一，成為中西醫(yī)在新的發(fā)展水平上實(shí)現(xiàn)交融或統(tǒng)一的支撐點(diǎn)，希冀籍此能給中醫(yī)學(xué)以至生命科學(xué)帶來良好的發(fā)展機(jī)遇，進(jìn)而對(duì)醫(yī)學(xué)理論帶來新的革命。編輯本段現(xiàn)代中醫(yī)史上個(gè)世紀(jì)末,本世紀(jì)初，1996年,清華學(xué)界對(duì)中醫(yī)氣本質(zhì)，經(jīng)絡(luò)實(shí)質(zhì)，陰陽，五行，藏象，中醫(yī)哲學(xué)觀等都有了新的全面整體創(chuàng)造性的認(rèn)識(shí)和解說。如，鄧宇等發(fā)現(xiàn)的:氣是流動(dòng)著的‘信息－能量－物質(zhì)’的混合統(tǒng)一體；分形分維的經(jīng)絡(luò)解剖結(jié)構(gòu)；數(shù)理陰陽；中醫(yī)分形集：分形陰陽集－陰陽集的分形分維數(shù)，五行分形集－五行集的分維數(shù)；分形藏象五系統(tǒng)－暨心系統(tǒng)、肝系統(tǒng)、脾系統(tǒng)、肺系統(tǒng)、腎系統(tǒng)；中醫(yī)三個(gè)哲學(xué)觀－新提出的第三哲學(xué)觀：相似觀－分形論等。還包括近代針灸經(jīng)絡(luò)的發(fā)展史,近代中醫(yī)氣的進(jìn)展簡史,中西醫(yī)結(jié)合史,中醫(yī)中藥史等.六種類型的病毒性肝炎遺傳因子不同，除乙型肝炎遺傳因子是DNA外，其余幾型肝炎遺傳因子均為RNA。其中甲型肝炎的傳播途徑是糞口傳播，乙型肝炎的傳播途徑是血液傳播、性傳播和母嬰傳播。疫苗。

2、酒精性肝炎：酒精性肝炎早期可無明顯癥狀，但肝臟已有病理改變，發(fā)病前往往有短期內(nèi)大量飲酒史，有明顯體重減輕，食欲不振，惡心，嘔吐，全身倦怠乏力，發(fā)熱，腹痛及腹瀉，上消化道出血及精神癥狀。體征有黃疸，肝腫大和壓痛，同時(shí)有脾腫大，面色發(fā)灰，腹水浮腫及蜘蛛痣，食管靜脈曲張。從實(shí)驗(yàn)室檢查看，有貧血和中性白細(xì)胞增多，紅細(xì)胞容積測(cè)定（MCV）大于95FL,血清膽紅素增高，可達(dá)17.1μmoL/L或以上，轉(zhuǎn)氨酶中度升高，常大于2.0，測(cè)定線粒體AST（mAST）及其與總AST（tAST）的比值，其升高可達(dá)12.5+5.2%。并有γ-GT，谷氨酸脫氫酶和堿性磷酸酶活力增高，凝血酶原時(shí)間延長。此外，病毒性肝炎還有丙型肝炎、丁型肝炎、戊型肝炎和庚型肝炎。過去被定為己型肝炎病毒的病毒現(xiàn)在被確定為乙型肝炎病毒的一個(gè)屬型，因此己型肝炎不存在。在病毒肝炎的疫苗，A型、B型、D型的疫苗已研發(fā)成功；C型、E型、F型的目前無編輯本段宋金元時(shí)期精品課件文檔，歡迎下載，下載后可以復(fù)制編輯。更多精品文檔，歡迎瀏覽。22TertiarycareBurncentertreatmentCardiothoracicandvascularsurgeryInpatientcareforAIDSpatientsMagneticresonanceimaging(MRI)NeonatologylevelIIIunitservicesNeurosurgeryOrgantransplant23TertiarycarePediatricsurgeryPositronemissionstomography(PET)RadiationoncologyServicesprovidedtoapersonwithahigh-riskpregnancyServicesprovidedtoapersonwithcancerState-designatedtraumacentersTraumasurgery24Positronemissionstomography(PET)buildsimagesbydetectingenergygivenoffbydecayingradioactiveisotopes.Isotopesareatomsofanelementwiththesamenumberofprotons(positivelychargedparticles)inthenucleus,butadifferentnumberofneutrons(neutralparticles).Becauseradioactiveisotopesareunstable,astheydecay,theythrowoffpositronsthatcollidewithelectronsandproducegammaraysthatshootoffinnearlyoppositedirections.25PETPETsystemsusethepathsofthetwodetectedgammaraystodeterminetheoriginatingcollisionpoint,aprocesscalledelectroniccollimation(瞄準(zhǔn)).Thescannersuseacircularseriesofgammaray-detectorstoenvelopethepatientsobothgammascanbedetectedsotheinstrumentcanuseelectroniccollimationtopredictwheretheenergysignaloriginated.Thissignalisthenconvertedintoathree-dimensionalimageslice.26臺(tái)灣醫(yī)院分類診所地區(qū)醫(yī)院(497/2005)區(qū)域醫(yī)院(80/2005,65/2006,64/2007)醫(yī)學(xué)中心(23/2005,18/2006,19/2007,14/2009)27醫(yī)學(xué)中心在衛(wèi)生局登記開放的急性一般病床與急性精神病床合計(jì)須達(dá)五百床以上至少應(yīng)能提供家庭醫(yī)學(xué)、內(nèi)、外、婦產(chǎn)、兒、骨、神經(jīng)外、泌尿、耳鼻喉、眼、皮膚、神經(jīng)、精神、復(fù)健、麻醉、放射線、病理、核醫(yī)、牙等十九科之診療服務(wù)。28醫(yī)學(xué)中心專任主治醫(yī)師人數(shù)(包括主任在內(nèi))每八床應(yīng)有一名。專任護(hù)理人員每2床至少1名。加護(hù)病房：每床2.5名。手術(shù)室：每班每臺(tái)2.5名。手術(shù)恢復(fù)室：每班每床0.5名。產(chǎn)房及待產(chǎn)室：每床2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教學(xué)、研究及其他護(hù)理人員(如院內(nèi)感染控制、公衛(wèi)、供應(yīng)中心等護(hù)理人員)另計(jì)，應(yīng)佔(zhàn)總?cè)藬?shù)百分之六。應(yīng)有受過感染控制訓(xùn)練之專任護(hù)理人員，每300床應(yīng)設(shè)1名。29醫(yī)學(xué)中心藥事人員每40床至少1名。每60張門診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數(shù)至少四分之三為藥師。藥事人員至少有4名負(fù)責(zé)藥品管理諮詢及臨床等工作。30區(qū)域醫(yī)院應(yīng)設(shè)置250床位以上急性病病床數(shù)每床所擁有的樓地板面積應(yīng)在50平方公尺以上每9床至少應(yīng)擁有一名主治醫(yī)師每2.5床至少應(yīng)擁有一名護(hù)理人員等。至少應(yīng)能提供家庭醫(yī)學(xué)、內(nèi)、外、婦產(chǎn)、兒、骨、耳鼻喉、眼、精神、復(fù)健、麻醉、放射線、病理、牙等十四科之診療服務(wù)。31區(qū)域醫(yī)院Nurse加護(hù)病房：每床2名。手術(shù)室：每班每臺(tái)2名。手術(shù)恢復(fù)室：每班每床0.5名。產(chǎn)房及待產(chǎn)室：每床1.2名。嬰兒室：每床0.4名。急診室：觀察室每床0.5名；診療室每12人次1名。門診：每班每診療室0.5名。血液透析室：每4人次1名。行政、教學(xué)、研究及其他護(hù)理人員(如院內(nèi)感染控制、公衛(wèi)、供應(yīng)中心等護(hù)理人員)另計(jì)，應(yīng)佔(zhàn)總?cè)藬?shù)百分之四。應(yīng)有受過感染控制訓(xùn)練之專任護(hù)理人員，每300床應(yīng)設(shè)1名。32區(qū)域醫(yī)院藥事人員每50床至少1名。每70張門診處方至少1名。特殊藥品處方每15張至少1名。藥事人員總數(shù)至少四分之三為藥師。藥事人員中，至少有2名負(fù)責(zé)藥品管理諮詢及臨床等工作。33地區(qū)醫(yī)院在衛(wèi)生局登記開放的急性一般病床需20床以上，急性一般病床及急性精神病床合計(jì)249床（含）以下。34地區(qū)醫(yī)院專任員工總?cè)藬?shù)每床應(yīng)有1名。專任主治醫(yī)師人數(shù)以及專任護(hù)理人員應(yīng)符合醫(yī)療機(jī)構(gòu)設(shè)置標(biāo)準(zhǔn)。藥事人員每50床至少1名。每80張門診處方至少1名。每增加100張?zhí)幏綉?yīng)增加1名。應(yīng)有藥師1人以上。35評(píng)鑑分級(jí)設(shè)施總樓地板面積病房設(shè)施安全設(shè)備及一般設(shè)備保險(xiǎn)病床比率36評(píng)鑑分級(jí)人員員工總?cè)藬?shù)醫(yī)師總數(shù)麻醉科醫(yī)師放射線科醫(yī)師核醫(yī)科醫(yī)師病理科醫(yī)師復(fù)健科醫(yī)師精神科醫(yī)師護(hù)理藥事醫(yī)事檢驗(yàn)醫(yī)用放射線技術(shù)復(fù)健技術(shù)精神科社會(huì)工作營養(yǎng)師病歷管理37評(píng)鑑分級(jí)醫(yī)療業(yè)務(wù)及設(shè)備醫(yī)療業(yè)務(wù)急性病床數(shù)診療科別急診業(yè)務(wù)手術(shù)及麻醉作業(yè)產(chǎn)房嬰兒室加護(hù)病房藥事作業(yè)檢驗(yàn)作業(yè)輸血作業(yè)放射線診療作業(yè)病理作業(yè)復(fù)健醫(yī)療作業(yè)精神科核子醫(yī)學(xué)牙科特殊醫(yī)療服務(wù)醫(yī)務(wù)社會(huì)服務(wù)工作營養(yǎng)部門病歷部門社區(qū)衛(wèi)生服務(wù)員工健康檢查38評(píng)鑑分級(jí)品質(zhì)保證醫(yī)療品質(zhì)審查感染控制人體試驗(yàn)藥事作業(yè)品質(zhì)護(hù)理服務(wù)品質(zhì)檢驗(yàn)作業(yè)品質(zhì)管制輸血作業(yè)品質(zhì)管制病理作業(yè)品質(zhì)管制放射線診療品質(zhì)管制核子醫(yī)學(xué)品質(zhì)管制病歷管理醫(yī)院管理業(yè)務(wù)醫(yī)病關(guān)係之促進(jìn)39評(píng)鑑分級(jí)指定項(xiàng)目評(píng)估住院診斷處置用藥手術(shù)病歷寫作40評(píng)鑑分級(jí)教學(xué)訓(xùn)練教學(xué)師資教學(xué)訓(xùn)練與研究設(shè)備教學(xué)訓(xùn)練活動(dòng)與其他醫(yī)院(醫(yī)學(xué)院)交流合作情形研究情形及論文發(fā)表教學(xué)進(jìn)修研究經(jīng)費(fèi)41新制教學(xué)醫(yī)院評(píng)鑑基準(zhǔn)教學(xué)資源教學(xué)訓(xùn)練計(jì)畫與成果研究執(zhí)行與成果臨床師資培育及繼續(xù)教育學(xué)術(shù)交流與社區(qū)功能及角色管理行政42財(cái)團(tuán)法人醫(yī)院評(píng)鑑暨醫(yī)療品質(zhì)策進(jìn)會(huì).tw/Identify.asp?catid=2343HealthCareFacilityOwnershipGovernment(not-for-profit)25%Proprietary(for-profit)15%Voluntary(not-for-profit)60%44MedicalStaffIntern:aphysicianinthefirstyearofgraduatemedicaleducation,whichordinarilyimmediatelyfollowscompletionofthefour-yearmedicalcurriculum.Resident:aphysicianwhohascompletedaninternshipandisengagedinaprogramoftrainingdesignedtoincreasehisorherknowledgeoftheclinicaldisciplinesofmedicine,surgery,oranyoftheotherspecialfieldsthatprovideadvancedtraininginpreparationforthepracticeofaspecialty.45MedicalStaffChiefresident:aphysicianwhoisinhisfinalyearofresidencyorintheyearaftertheresidencyhasbeencompleted.VisitingStaff(VS):主治醫(yī)師46HealthCareFacilityOrganizationalStructureGoverningboardAdministrationMedicalstaffDepartments,services,andcommitteesContractedservices47GoverningboardThegoverningboard(boardoftrustees,boardofgovernors,boardofdirectors)serveswithoutpay,anditsmembershipisrepresentedbyprofessionalsfromthebusinesscommunity.48AdministrationServesasliaisonbetweenthemedicalstaffandgoverningboardandisresponsiblefordevelopingastrategicplanforsupportingthemissionandgoalsoftheorganization.CEO:chiefexecutiveofficeCFO:chieffinancialofficerCIO:chiefinformationofficerCOO:chiefoperatingofficer49MedicalstaffConsistsoflicensedphysiciansandotherlicensedprovidersaspermittedbylaw(e.g.,nursepractitionersandphysicianassistants)whoaregrantedclinicalprivileges.50physicianassistantsExamine,diagnose,andtreatpatientsunderthedirectsupervisionofaphysician.51MedicalstaffmembershipcategoriesActive:deliversmosthospitalmedicalservices,performssignificantorganizationalandadministrativemedicalstaffdutiesAssociate:advancementtoactivecategoryisbeingconsideredConsultingCourtesy:admitsanoccasionalpatienttothehospitalHonorary5253Hospitaldepartments,Services,andCommittees54HealthInformationDepartmentDepartmentadministrationCancerregistryCodingandabstractingImageprocessingIncompleterecordprocessingMedicaltranscriptionRecordcirculationReleaseofinformationprocessing5556CodingInvolvesassigningnumericandalphanumericcodestodiagnoses,procedures,andservices;thisfunctionisusuallyperformedbycredentialedindividuals.CodersassignICD-9-CMcodestoinpatientcasesandCurrentProceduralTerminology(CPT),HealthCareProcedureCodingSystem(HCPCS)LevelII(National),andICD-9-CMcodestooutpatient,emergencydepartment,andphysicianofficecases.57CancerregistryPerformedbyindividualswhoarecredentialedascertifiedtumorregistrarsandincludeusingcomputerizedregistrysoftwaretoconductlifetimefollow-uponeachcancerpatient,electronicallytransmitdatatostateandnationalagenciesforuseatlocal,regional,state,andnationallevels,andgeneratereportsandinformationforrequestingentities.58CurrentProceduralTerminology(CPT)PublishedannuallybytheAmericanMedicalAssociationandcodesare5-digitnumbersassignedtoambulatoryproceduresandservices.E.g.90663Influenzavirusvaccine,pandemicformulation59ICD-9-CMTheInternationalClassificationofDiseases,Ninthrevision,ClinicalModificationisusedintheUnitedStatestocollectinformationaboutdiseasesandinjuriesandtoclassifydiagnosesandprocedures.NationalCenterforHealthStatistics(NCHS).60/1.INFECTIOUSANDPARASITICDISEASES(001-139)TUBERCULOSIS(010-018)Includes:infectionbyMycobacterium分枝桿菌tuberculosis(human)(bovine牛)Excludes:congenitaltuberculosis(771.2)lateeffectsoftuberculosis(137.0-137.4)Thefollowingfifth-digitsubclassificationisforusewithcategories010-018:0unspecified1bacteriologicalorhistological組織學(xué)的examinationnotdone2bacteriologicalorhistologicalexaminationunknown(atpresent)3tuberclebacilli結(jié)核桿菌found(insputum)bymicroscopy4tuberclebacillinotfound(insputum)bymicroscopy,butfoundbybacterialculture5tuberclebacillinotfoundbybacteriologicalexamination,buttuberculosisconfirmedhistologically6tuberclebacillinotfoundbybacteriologicalorhistologicalexamination,buttuberculosisconfirmedbyothermethods[inoculation預(yù)防接種ofanimals]61/010PrimarytuberculousinfectionRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.011PulmonarytuberculosisRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Useadditionalcodetoidentifyanyassociatedsilicosis矽肺病(502)012OtherrespiratorytuberculosisRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Excludes:respiratorytuberculosis,unspecified(011.9)013Tuberculosisofmeninges

腦脊膜andcentralnervoussystemRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.62/014Tuberculosisofintestines

腸,peritoneum

腹膜,andmesentericglands

腸系膜腺Requiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.015TuberculosisofbonesandjointsRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.Useadditionalcodetoidentifymanifestation,as:tuberculous:Arthropathy關(guān)節(jié)病(711.4)Necrosis壞死ofbone(730.8)Osteitis骨炎(730.8)Osteomyelitis骨髓炎(730.8)Synovitis滑膜炎(727.01)Tenosynovitis腱鞘炎(727.01)63/016Tuberculosisofgenitourinary

泌尿生殖器的systemRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.017TuberculosisofotherorgansRequiresfifthdigit.Seebeginningofsection010-018forcodesanddefinitions.018Miliary

粟粒狀的tuberculosis

Includes:tuberculosis:Disseminated彌散性Generalized全身性的miliary,whetherofasinglespecifiedsite,multiplesites,orunspecifiedsitePolyserositis漿膜炎ICD-10TheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems10thRevisionisacodingofdiseasesandsigns,symptoms,abnormalfindings,complaints,socialcircumstancesandexternalcausesofinjuryordiseases,asclassifiedbytheWHO.Thecodesetallowsmorethan14,400differentcodesandpermitsthetrackingofmanynewdiagnoses.Usingoptionalsubclassifications,thecodescanbeexpandedtoover16,000codes.64USICD-10CMTheInternationalversionofICDshouldnotbeconfusedwithnationalClinicalModificationsofICDthatincludefrequentlymuchmoredetail,andsometimeshaveseparatesectionsforprocedures,sothenewUSICD-10CMhassome155,000codes.6566HCPCSTheHealthCareProcedureCodingSystemiscomprisedofLevelI(CPT)andLevelII(National)codes.LevelIIHCPCScodesaredevelopedbytheCentersforMedicare&MedicaidServices(CMS)andusedtoclassifyreportproceduresandservices.67CPT(CurrentProceduralTerminology)anumericcodingsystemmaintainedbytheAmericanMedicalAssociation(AMA).TheCPTisauniformcodingsystemconsistingofdescriptivetermsandidentifyingcodesthatareusedprimarilytoidentifymedicalservicesandproceduresfurnishedbyphysiciansandotherhealthcareprofessionals.68LevelIoftheHCPCS,theCPTcodes,doesnotincludecodesneededtoseparatelyreportmedicalitemsorservicesthatareregularlybilledbysuppliersotherthanphysicians.69LevelIIHCPCSCodesarereportedtothird-partypayers(e.g.,insurancecompanies)forreimbursementpurposes.70LevelIIHCPCSLevelIIoftheHCPCSisastandardizedcodingsystemthatisusedprimarilytoidentifyproducts,supplies,andservicesnotincludedintheCPTcodes,suchasambulanceservicesanddurablemedicalequipment,prosthetics假體,orthotics矯形器,andsupplies(DMEPOS)whenusedoutsideaphysician'soffice71LevelIIHCPCSLevelIIalphanumericHCPCSprocedureandmodifiercodes,theirlongandshortdescriptions,andapplicableMedicareadministrative,coverage,andpricingdata.TheLevelIIHCPCScodes,whichareestablishedbyCMS'sAlpha-NumericEditorialPanel,primarilyrepresentitemsandsuppliesandnon-physicianservicesnotcoveredbytheAmericanMedicalAssociation'sCurrentProceduralTerminology-4(CPT-4)codes;Medicare,Medicaid,andprivatehealthinsurersuseHCPCSprocedureandmodifiercodesforclaimsprocessing.72/MedHCPCSGenInfo/A1001007DRESSINGFORONEWOUNDDressingforonewoundC2002070120020701N

A2001007DRESSINGFORTWOWOUNDSDressingfortwowoundsC02002070120020701NA3001007DRESSINGFORTHREEWOUNDSDressingforthreewoundsC02002070120020701N73AbstractingPerformedtoentercodesandotherpertinentinformationutilizingcomputersoftware.Togeneratestatisticalreportsanddisease/procedureindexes,whichareusedforadministrativedecision-makingandquality-managementpurposes.74IncompleterecordprocessingIncludestheassemblyandanalysisofdischargedpatientrecords.Afterapatientisdischargedfromanursingunit,therecordisretrievedandreportsareassembledaccordingtoahospital-andmedicalstaff-approvedorderofassembly.75MedicaltranscriptionInvolvestheaccurateandtimelytranscriptionofdictatedreports.76RecordcirculationIncludestheretrievalofpatientrecords,forthepurposeof:InpatientreadmissionScheduledandunscheduledoutpatientclinicvisitsAuthorizedquality-managementstudiesEducationandresearch77Licensure,RegulationandAccreditationCodeofFederalRegulations(CFR)FederalRegisterAlegalnewspaperpublishedeverybusinessdaybytheNationalArchivesandRecordsAdministration(NARA)inpaperform,microfiche,andonline.AccreditationStandardsandSurveys78RegulationAregulationisaninterpretationofalawthatiswrittenbytheresponsibleregulatoryagency.E.g.theConditionsofParticipation(CoP)areregulationswrittenbytheCentersforMedicare&MedicaidServices(CMS).Congresswritesandpassesanact,thePresidentsignstheactintolaw,andCMSinterpretsthelawcreatingaregulation.79AccreditationAvoluntaryprocessthatahealthcarefacilityororganizationundergoestodemonstratethatithasmetstandardsbeyondthoserequiredbylaw.80StandardsAccreditationorganizationsdevelopstandards,whicharemeasurementsofahealthcareorganization’slevelofperformanceinspecificareasandareusuallymorerigorousthanregulations.81SurveyAsurvey(evaluation)processisconductedbothoff-siteandon-sitetodeterminewhetherthefacilitycomplieswithstandards.82AccreditingOrganizationsAccreditationAssociationforAmbulatoryHealthCare(AAAHC)CommissiononAccreditationofRehabilitationFacilities(CARF)CommunityHealthAccreditationProgram(CHAP)83AccreditingOrganizationsJointCommissiononAccreditationofHealthCareOrganizations(JCAHO)NationalCommitteeforQualityAssurance(NCQA)NationalCommissiononCorrectionalHealthCare(NCCHC)84Bringinganewdrugtomarket5000compoundsevaluated5compoundsenterclinicaltrials1compoundapproved2345678910111213141516yearsDiscoveryandpreclinicaltesting:Compoundsareidentifiedandevaluatedinlaboratoryandanimalstudiesforsafety,biologicalactivity,andformulation.ReviewandapprovalbyFood&DrugAdministrationPhaseIII:Confirmseffectivenessandmon