外文翻譯---社區(qū)健康中心的初級(jí)護(hù)理

1、<p>　　本科畢業(yè)設(shè)計(jì)（論文）</p><p>　　外 文 翻 譯</p><p><b>　　原文：</b></p><p>　　Teaching Primary Care in Community Health Centers</p><p>　　THE TEACHING HEALTH CENTER

2、: A DEFINITIVE APPROACH TO THESE KEY PROBLEMS</p><p>　　By expanding and integrating existing programs and resources, we propose to establish primary care resident ambulatory training programs in community he

3、alth 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 b

4、e required to be located in a community health center in a primary care health professional shortage area as designated by the H</p><p>　　Primary care residents would be the principal providers of primary ca

5、re 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

6、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 t</p>

7、;<p>　　IMPLEMENTATION AND PROJECTED OUTCOME</p><p>　　If health care reform legislation that includes the currently proposed community health center and primary care initiatives passes, our proposal is

8、 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 hospitalizations . In 2000, a

9、n estimated 5 million admissions to U.S. hospitals, with a resulting cost of more than $26.5 billion, may have been preventable with </p><p>　　Our proposal would also develop the capacity of teaching health

10、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 wi

11、th 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.</p>

12、;<p>　　Teaching health centers could be evaluated by using several readily quantifiable parameters. Affiliated academic institutions could obtain data regarding clinical productivity, trainee satisfaction, recruit

13、ment 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 exp

14、ansion.</p><p>　　DISCUSSION</p><p>　　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 c

15、are 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 physici

16、ans. Because of the similarity between the Massachusetts 2006 Health Reform plan and the types of national reform most like</p><p>　　Our proposal builds on more than 25 years of experience of family medicine

17、 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

18、-quality education for family physicians . More 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</p>&l

19、t;p>　　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

20、 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 fu

21、ture primary care residents and faculty. Teaching health centers also</p><p>　　Our proposal is directed toward aligning training for the primary care physician with the realities of 21stcentury practice. How

22、ever, 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 underse

23、rved. A proposal published in 1986 advocated expanding this role to the community ambulatory setting. However, the association of ambulatory graduate m</p><p>　　Teaching health centers provide an optimal tr

24、aining 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

25、 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

26、of underserved </p><p>　　Richard E. Teaching Primary Care in Community Health Centers[J].Ann Intern Med.(2010 ) vol. 152 no. 2 118-122 </p><p><b>　　譯文：</b></p><p>　　社區(qū)健康

27、中心的初級(jí)護(hù)理</p><p>　　醫(yī)療教學(xué)中心：關(guān)鍵問(wèn)題的最佳解決方案</p><p>　　通過(guò)擴(kuò)建和整合現(xiàn)有的項(xiàng)目和資源,提出在社區(qū)健康中心建立居民初級(jí)護(hù)理流動(dòng)培訓(xùn)。到2011年7月，這些項(xiàng)目就會(huì)開(kāi)始逐步輸送訓(xùn)練有素的初級(jí)護(hù)理醫(yī)師，他們有一些會(huì)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(gè)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、

28、小兒科方面的實(shí)習(xí)期項(xiàng)目并且能夠利用這些設(shè)置做居民初級(jí)護(hù)理流動(dòng)培訓(xùn)。成為一個(gè)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(duì)于以病人為中心的醫(yī)學(xué)家庭的全國(guó)委員會(huì)質(zhì)量管理要求。以病人為中心的醫(yī)學(xué)家庭是一個(gè)實(shí)踐模型，它能有效支持初級(jí)護(hù)理的核心功能，運(yùn)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(xiàng)目申請(qǐng)條件在其他各類(lèi)地方被仔細(xì)的描述過(guò)。</p><p&g

29、t;　　作為一個(gè)三年居民在為期十二個(gè)月的臨床培訓(xùn)中，初級(jí)護(hù)理居民是初級(jí)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(lái)說(shuō)，第一年和第二年居民會(huì)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(huì)在診所后勤上有基礎(chǔ)并且能夠成為一個(gè)有效的團(tuán)隊(duì)領(lǐng)導(dǎo)。第三年居民會(huì)在一個(gè)強(qiáng)調(diào)護(hù)理的持續(xù)性的診所工作，對(duì)于居民團(tuán)隊(duì)管理和流動(dòng)臨床用堅(jiān)定的技能支持。護(hù)理的持續(xù)性會(huì)通過(guò)在居民和監(jiān)管人員的密切工作關(guān)系來(lái)保證。由于以病人為中心的醫(yī)療

30、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(shí)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?yàn)檫@個(gè)模型會(huì)有可能偏離現(xiàn)有的訓(xùn)練指導(dǎo)方針，這就有必要對(duì)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(huì)批轉(zhuǎn)的免試。</p><p><b>　　貫徹執(zhí)行和預(yù)期結(jié)果</b></p><p>　　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

31、康中心和初級(jí)護(hù)理的主動(dòng)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(lái)預(yù)防效果、有效的慢性疾病治療的實(shí)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(guó)醫(yī)院的入座人數(shù)高達(dá)五百萬(wàn)，花費(fèi)了超過(guò)265億美元，這有可能通過(guò)高質(zhì)量的初級(jí)預(yù)防護(hù)理治療來(lái)避免。醫(yī)療教學(xué)中心通過(guò)擴(kuò)大提供初級(jí)護(hù)理的可接近性從而重建我們的健康防御系統(tǒng)。 初級(jí)護(hù)理醫(yī)師的核心是在一個(gè)環(huán)境中訓(xùn)練運(yùn)用電子醫(yī)療記錄和強(qiáng)調(diào)控制花費(fèi)和消除浪費(fèi)的能力。監(jiān)管人員會(huì)堅(jiān)持

32、建立在證據(jù)基礎(chǔ)上的想象運(yùn)用、實(shí)驗(yàn)室學(xué)習(xí)以及普通藥品的處方。</p><p>　　我們的提議也會(huì)發(fā)展醫(yī)療教學(xué)中心的可能性，作為為本科生流動(dòng)醫(yī)療教育的網(wǎng)點(diǎn)，并且促進(jìn)醫(yī)學(xué)專(zhuān)業(yè)的學(xué)生去選擇初級(jí)護(hù)理作為以后發(fā)展的事業(yè)。流動(dòng)的網(wǎng)點(diǎn)訓(xùn)練對(duì)于醫(yī)學(xué)專(zhuān)業(yè)的學(xué)生是非常必要的，尤其是在近來(lái)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(diǎn)對(duì)于訓(xùn)練護(hù)士臨床工作者、醫(yī)生助手、藥劑師、社會(huì)工作者和醫(yī)務(wù)助理。 醫(yī)療教學(xué)中心可以通過(guò)使用若干

33、便利的可量化的參數(shù)來(lái)評(píng)估。附屬的學(xué)術(shù)機(jī)構(gòu)可以獲得診所生產(chǎn)率、實(shí)習(xí)生滿(mǎn)意度、畢業(yè)生的招聘、護(hù)理的花費(fèi)、對(duì)于其他醫(yī)療專(zhuān)業(yè)人才逐漸上升的訓(xùn)練機(jī)會(huì)以及病人的滿(mǎn)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。</p><p><b>　　討論</b></p><p>　　我們的提議設(shè)計(jì)監(jiān)理一個(gè)初級(jí)護(hù)理職業(yè)者群體，他們可以在展開(kāi)的醫(yī)療護(hù)理環(huán)境中有效的運(yùn)轉(zhuǎn)，并且將改善美國(guó)人接近護(hù)

34、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(jí)護(hù)理醫(yī)師的臨床可能性。因?yàn)轳R薩諸塞州2006年醫(yī)療改革計(jì)劃和國(guó)家改革類(lèi)型之間的相似點(diǎn)很可能被執(zhí)行，關(guān)于近來(lái)馬薩諸塞州經(jīng)驗(yàn)的分析在建立公共政策方面是非常有價(jià)值的。 一個(gè)最近已經(jīng)被公布的來(lái)自于關(guān)于公共醫(yī)療補(bǔ)助制的凱澤委員會(huì)的報(bào)告強(qiáng)調(diào)社區(qū)健康中心在醫(yī)療保健改革的關(guān)鍵角色；在2007年的麻薩諸塞州，每十三位居民中就有一位享受服務(wù)。 醫(yī)療保險(xiǎn)的擴(kuò)大范圍使得

35、在基礎(chǔ)醫(yī)療上的要求激增，尤其是在沒(méi)有得到醫(yī)療服務(wù)、低收入的社區(qū)中。 適應(yīng)需求的增長(zhǎng)需要更多的能力。在這個(gè)方面，馬薩諸塞州遇到的一個(gè)主要問(wèn)題是能勝任的初級(jí)護(hù)理提供者的短缺，并且因醫(yī)療改革而惡化。馬薩諸塞州是第一個(gè)面臨這個(gè)問(wèn)題，即使它很快會(huì)為很多州所遭遇。</p><p>　　我們的提議建立在超過(guò)25年的擁有社區(qū)健康中心的家庭醫(yī)療實(shí)習(xí)期經(jīng)驗(yàn)的基礎(chǔ)上。在這些地點(diǎn)訓(xùn)練家庭醫(yī)師可以幫助增加為沒(méi)有享受醫(yī)療服務(wù)的人群提供醫(yī)療護(hù)

36、理的醫(yī)師數(shù)量。超過(guò)百分之四十二的社區(qū)健康中心已經(jīng)擔(dān)任初級(jí)護(hù)理實(shí)習(xí)期項(xiàng)目的訓(xùn)練網(wǎng)點(diǎn)，然而大多數(shù)沒(méi)有得到訓(xùn)練費(fèi)用的資金支持。</p><p>　　我們的提議為家庭醫(yī)療模型增加了若干獨(dú)一無(wú)二的特征。 它也包含以病人為中心的醫(yī)療家庭模式的護(hù)理，這對(duì)于為新健康護(hù)理環(huán)境的實(shí)習(xí)期訓(xùn)練是可取的。代表了初級(jí)護(hù)理特征的初級(jí)護(hù)理居民訓(xùn)練應(yīng)該在流動(dòng)環(huán)境下被引導(dǎo)，對(duì)于初級(jí)護(hù)理居民和監(jiān)管人員是有吸引力的。.醫(yī)療教育中心對(duì)于與高級(jí)的臨床醫(yī)師交

37、流的居民也提供一個(gè)理想的環(huán)境。 以病人為中心的醫(yī)療家庭環(huán)境提供了極好的機(jī)會(huì)在領(lǐng)導(dǎo)才能、團(tuán)隊(duì)合作、醫(yī)療教育和交流方面提高水準(zhǔn)。 最后，我們的提議介紹了一種新的主要的資源為社區(qū)健康中心的訓(xùn)練提供經(jīng)濟(jì)上的幫助。</p><p>　　我們的提議指向于矯正在21世紀(jì)實(shí)際情況中的初級(jí)護(hù)理醫(yī)師的訓(xùn)練。然而，致力于向未獲得醫(yī)療服務(wù)的人群做貢獻(xiàn)，但這并不是實(shí)習(xí)期訓(xùn)練的新特征。 在20世紀(jì)，居民在占主要優(yōu)勢(shì)的未得到醫(yī)療服務(wù)的人群提供

38、住院病人護(hù)理扮演了一個(gè)重要的角色。1986年，一個(gè)建議倡導(dǎo)擴(kuò)展這個(gè)角色加入到社區(qū)流動(dòng)環(huán)境中。. 然而，為這些沒(méi)有得到護(hù)理服務(wù)的人群提供護(hù)理的流動(dòng)畢業(yè)生醫(yī)療教育組織通過(guò)關(guān)于畢業(yè)生醫(yī)療教育基金的政策已經(jīng)被限制。 作為醫(yī)療改革的一部分，現(xiàn)代法律首創(chuàng)以醫(yī)療教學(xué)中心的方式提供一個(gè)方式去達(dá)到連接。</p><p>　　醫(yī)療教育中心提供一個(gè)絕佳的訓(xùn)練環(huán)境，為這些受到醫(yī)療教育的畢業(yè)生，給予他們密切的管理以及強(qiáng)調(diào)以病人為中心的護(hù)理

39、，代表了高質(zhì)量醫(yī)療實(shí)踐的未來(lái)。 初級(jí)護(hù)理居民在這種環(huán)境下訓(xùn)練可以立即增加社區(qū)健康中心的臨床可能性。另外，許多畢業(yè)生可以有接近為這些增加的未得到醫(yī)療服務(wù)的病人提供低收入初級(jí)護(hù)理服務(wù)的可能性。通過(guò)提供建立醫(yī)療教學(xué)中心的領(lǐng)導(dǎo)才能和生成多種多樣的可量化的參數(shù)去評(píng)估成功的專(zhuān)門(mén)知識(shí)，學(xué)術(shù)性的醫(yī)療教學(xué)中心和教學(xué)醫(yī)院也可以做出很大的貢獻(xiàn)對(duì)于醫(yī)療改革。 通過(guò)逐漸增長(zhǎng)的對(duì)于初級(jí)護(hù)理的接近性，醫(yī)療教學(xué)中心很有可能是在連接財(cái)政上可行的全民醫(yī)療保健制和醫(yī)療改革傳