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Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.
Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.
Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.
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Objetivo: analisar o empoderamento estrutural de enfermeiros em um hospital de alta complexidade. Métodos: estudo quantitativo, analítico e transversal, realizado com 93 enfermeiros, utilizando um questionário sociodemográfico e ocupacional e o Questionário de Condições de Eficácia no Trabalho II. Os dados foram coletados entre fevereiro e março de 2023. A análise dos dados deu-se por meio de estatística descritiva, teste de Kolgomorov-Smirnov, teste do qui-quadrado e regressão de Poisson. Resultados: os enfermeiros apresentaram nível moderado de empoderamento estrutural, com média de 20,67 (p<0,000). O componente mais pontuado foi a oportunidade (4,22 dp±0,80). Não foram encontradas diferenças significativas nos níveis de empoderamento estrutural relacionadas às unidades de trabalho (p-Valor 0,381), vínculo empregatício (p-Valor 0,352) e grau de instrução (p-Valor 0,839). O modelo de regressão de Poisson indica que tanto pode haver altos ou baixos níveis de empoderamento a depender do setor. Conclusão: os enfermeiros demonstraram possuir níveis moderados de empoderamento estrutural.
Objective: to analyze the structural empowerment of nurses in a high-complexity hospital. Methods: a quantitative, analytical, cross-sectional study was carried out with 93 nurses, using a sociodemographic and occupational questionnaire and the Questionnaire of Conditions of Effectiveness at Work II. The data was collected between February and March 2023. The data was analyzed using descriptive statistics, the Kolgomorov-Smirnov test, the chi-square test, and Poisson regression. Results: the nurses had a moderate structural empowerment level, with a mean of 20.67 (p<0.000). The highest scoring component was opportunity (4.22 sd±0.80). No significant differences were found in the structural empowerment levels related to work units (p-Value 0.381), employment relationship (p-Value 0.352) and education level (p-Value 0.839). The Poisson regression model indicates that there can be either high or low empowerment levels depending on the sector. Conclusion: nurses showed moderate structural empowerment levels.
Objetivo: analizar el empoderamiento estructural del enfermero en un hospital de alta complejidad. Métodos: estudio cuantitativo, analítico y transversal, realizado con 93 enfermeros, utilizando un cuestionario sociodemográfico y ocupacional y el Cuestionario de Condiciones de Efectividad en el Trabajo II. Los datos se recolectaron entre febrero y marzo de 2023. El análisis de los datos se realizó mediante estadística descriptiva, prueba de Kolgomorov-Smirnov, prueba de chi-cuadrado y regresión de Poisson. Resultados: los enfermeros presentaron un nivel moderado de empoderamiento estructural, la media fue de 20,67 (p<0,000). El componente con mayor puntaje fue oportunidad (4,22 DE±0,80). No se encontraron diferencias significativas en los niveles de empoderamiento estructural relacionados con las unidades de trabajo (valor p 0,381), la relación laboral (valor p 0,352) y el nivel de formación (valor p 0,839). El modelo de regresión de Poisson indica que pueden existir niveles altos o bajos de empoderamiento dependiendo del sector. Conclusión: los enfermeros demostraron niveles moderados de empoderamiento estructural.
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Introduction: Health Benefit Plan Administrators must manage the health risk of their members. Therefore, health characterization is performed from enrollment to support decision-making and timely intervention. Objective: To analyze the historical results of characterizing the adult population on admission to the insurance company in relation to the demand for all-cause and psychiatric hospitalization services. Materials and Methods: An observational cross-sectional study with members over 18 years of age, in which an analysis was made of the characterization of the adult population of the insurer and its association with the use of medical consultation services in primary care and all-cause and psychiatric hospitalizations. Bivariate and multivariate analysis was made, and odds ratios (OR) were calculated in logistic regression. Results: Variables significantly associated with having an all-cause hospitalization were identified: having referred history of heart disease OR=1.71(95%CI: 1.33; 2.20), respiratory disease OR= 1. 30(95%CI: 1.04; 1.61), chronic kidney disease OR=1.66(95%CI: 1.13; 2.45), cancer OR=1.65(95%CI: 1.14; 2.40), taking any medication permanently OR=1.35(95%CI: 1.174; 1.56) and smoking OR=1.44(95%CI: 1.12; 1.85). For psychiatric hospitalizations, a history of discouragement, depression, or little hope was relevant with OR=5.12(95%CI: 1.89; 13.87). Discussion: The characterization of patients during enrolment allowed the identification of predictor variables of hospitalization, guiding management from the primary care level minimizing costs and catastrophic health events. Conclusion: The timely identification of specific patient profiles allows timely actions to minimize health costs and catastrophic health events.
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Health Profile , Health Management , Insurance, HealthABSTRACT
Objective To analyze the health management situation of non-communicable chronic disease(NCD)in Chongqing City and Guizhou Province and its influencing factors.Methods A stratified random sampling method was used to select 16 representative primary medical and health institutions from Chongqing City and Guizhou Province as the research sites,and the data were collected through the combination method of qualitative and quantitative research.Results A total of 760 patients with NCD were surveyed,and the awareness rate,utilization rate and satisfaction rate of the NCD health management program all exceeded 84.2％,while the awareness rate,utilization rate and satisfaction rate of follow-up and categorical intervention were the lowest.The awareness rate of hypertension physical examination in the patients with＜60 years old was lower than that in the patients with 60-＜70 years old(OR=4.28,95％CI:1.43-12.81)and the pa-tients with ≥70 year sold(OR=3.16,95％CI:1.12-8.91);the utilization rate of diabetes screening in the patients with＜60 years-old was lower than that in the patients with ≥70 years old(OR=2.70,95％CI:1.08-6.76)and the awareness rate of hypertension physical examination was lower than that of the patients with 60-＜70 years old(OR=4.24,95％CI:1.01-17.75);the awareness rate of hypertension physical ex-amination in the patients in Chongqing City was higher than that in Guizhou Province(OR=0.15,95％CI:0.04-0.54)and the utilization situation was better than that in Guizhou Province(OR=0.13,95％CI:0.05-0.34).Conclusion The overall situation of NCD management services in Chongqing City and Guizhou Province is good,but the service quality of follow-up and classified intervention projects needs to be further improved.
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With the continuous deepening of aging in our country,the demand and importance of medical care and health management of the elderly are becoming more and more prominent,and the construction of discipline system of medical care and health management of the elderly provides powerful talent support for promoting the development of aging cause and the development of medical care and health industry.However,there are still many shortcomings in the professional construction and talent cultivation in the field of medical care and health management of the elderly in our country.Universities are still exploring and practicing in this area,and there is an urgent need to strengthen the construction of disciplinary systems and promote the development of the medical care and health industry.This paper introduces the construction of discipline system of medical care and health management of the elderly,analyzes the existing problems,looks forward to its future development direction,and elaborates the specific measures and characteristics in the construction of discipline system of medical care and health management of the elderly.
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Objective:To analyze the role of home medical and nursing care team in the service system of home disabled elderly.Methods:A total of 100 home disabled elderly managed by our hospital from Jan to Dec 2022 were enrolled,and the home medical and nursing care teams strengthened home rehabilitation nursing services and guidance,health risk guidance,psychological support,and nutrition guidance and intervention.The management results before and after intervention was compared.Results:After intervention,the mastery of health risk management,psychological support and nutritional intervention,and the compliance rate of rehabilitation exercise were higher than those before intervention(P＜0.05).The incidence of pressure injury was lower than that before intervention(P＜0.05).After intervention,the satisfaction rate of the elderly to the work of the home medical and nursing care team was 95%.Conclusion:Home medical and nursing care team plays an important role in the nursing service system of the disabled elderly,and play an important role in the construction of a three-level service health management system of institution-community-home.
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Objective To study the application effect of quality control circle(QCC)in reducing the dissatisfaction rate of physical examination clients in health management center.Methods To establish QCC,selected the health check-up popula-tion in our hospital in September-2019 and March-2020,through the questionnaire investigation and analysis,compare the dis-satisfaction of the clients before and after the quality control circle.Results After carrying out QCC activities,the dissatisfaction of physical examination clients was significantly lower than that before QCC,and the difference was statistically significant(P＜0.05).Conclusion The activities of QCC in the health management center can effectively improve the quality of the physical examination work and reduce the dissatisfaction of the customers in the physical examination.It is of great significance to the health management.
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Objective Summarize domestic and international community health management models and characteristics for elderly hypertensive patients,providing references for the development of community health management in China.Methods Employ literature research to retrieve relevant documents on community health management models for elderly hypertensive pa-tients,and analyze the characteristics and applicability of different models through summarization and comparative analysis.Results In China,community health management models for elderly hypertensive patients include family doctor contracting serv-ices,Hospital-Community-Home health management model,traditional Chinese medicine health management model,"Internet+"health management model,PDCA cycle model,PRECEDE-PROCEED model,and comprehensive community management model.Foreign studies can be categorized into self-management model,Health Rise model,Community Health2(CH2)model,and community pharmacy management model.Conclusion Conducting hypertension health management for elderly patients at the community level is effective,serving as a widely applicable strategy for chronic disease prevention and control.Continued ex-ploration of the scientific and effective aspects of different management models,improving the efficiency and effectiveness of com-munity health management,can contribute more evidence for the formulation of scientific and effective strategies for chronic dis-ease prevention and control.
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Objective:To study the clinical characteristics and management strategies of patients with chronic obstructive pulmonary disease (COPD) in high-altitude areas.Methods:An observational cross-sectional study was conducted in 79 stable COPD patients who visited the outpatient of Respiratory Medicine at Tibet Autonomous Region People′s Hospital and Peking University Third Hospital from August 3 rd 2020 to November 30 th 2020. Patients were divided into Lhasa group ( n=44) and Beijing group ( n=35). The differences of clinical characteristics including demographic characteristics, risk factors, respiratory symptoms, comorbidities, medications and spirometry were analyzed. Further comparative analysis was conducted on the clinical characteristics of smokers ( n=15) and non-smokers ( n=29) in Lhasa group. Results:The proportion of female patients and biofuel exposure in Lhasa group was significantly higher than Beijing group (56.8% vs 0, 86.4% vs 0, both P<0.001). The proportion of smokers in Lhasa group was significantly lower than Beijing group (34.1% vs 100%, P<0.001). The mean score of COPD assessment test (CAT) in Lhasa group was significantly higher than Beijing group (21.27 vs 9.17, P<0.001). The proportion of acute exacerbations ≥2 in the past year in Lhasa group was significantly higher than Beijing group (31.8% vs 11.4%, P=0.032). The median percentage of forced vital capacity in the first second of predicted value (FEV 1%pred) of patients in Lhasa group was significantly higher than Beijing group (63% vs 38%, P<0.001). The proportion of patients treated by inhaled corticosteroid/long-acting β 2-agonist (ICS/LABA) and inhaled long-acting muscarinic antagonists (LAMA) in Lhasa group was significantly lower than Beijing group (4.5% vs 60.0%, 0 vs 65.7%, both P<0.001). There were no significant differences in CAT score, number of acute exacerbations in the past year and lung function between smokers and non-smokers in Lhasa group. Conclusions:Compared with those patients in Beijing, the majority of patients with COPD living in Lhasa are female, with a low proportion of smokers and a high proportion of biofuel exposure. Although their lung function is better, their respiratory symptoms are more severe with more acute exacerbations in the past year, and most patients do not receive standardized medication.
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Objective:To construct the impact factor model of primary traditional Chinese medicine (TCM) health management service quality, and put forward corresponding policy suggestions.Methods:In this cross-sectional study, the typical sampling and random sampling method were used to select 39 insiders of primary TCM health management service from 15 communities in Zhejiang Province from August to October in 2022. Interviews on service projects, implementation effects and impact factors were conducted, the three-level coding of interview record was carried out using the grounded theory research method, a model of impact factor for health management service quality of basic TCM was constructed, and the corresponding policy recommendations were put forward.Results:Based on the open coding of 39 original interview data, a total of 516 reference points were obtained, and 53 initial concepts related to the topic were formed and summarized into 17 first-level categories. Through the summary of main axis coding, 6 main categories of “policy environment”，“health literacy”，“community orientation”，“capacity building”，“health preference” and “conflict of interest” were extracted. The logical correlation between the six main categories were analyzed with selective coding, an impact factor model was constructed in accordance with the story line of factors affecting service quality. The story line of this model was as follows: first, the policy environment was the external guarantee of community TCM service quality; second, as the demand-side of the services, the health literacy and requirement of residents was the regulatory factor for service quality; in addition, the community played the role of the supply-side of the services, the service ability construction was the key factor, and the community functions and target orientation was the internal driving factor, meanwhile, the internal/external conflicts of interest had a negative constraint on the service quality.Conclusions:The guarantee intensity of external policy environment is limited, the service demand side pays insufficient attention, and the service supply side functions are absent at the present stage. It is necessary to improve the external policy environment, deepen the connection between supply and demand sides in the field of TCM health service, promote the capacity building of TCM service at the grass-roots level, balance the interests of relevant departments of TCM service, in order to improve the quality of TCM health management service at the grass-roots level.
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Objective:To analyze the impact of individual and regional level socioeconomic characteristics on the mental health of middle-aged and older adults based on data from the China Health and Retirement Longitudinal Study.Methods:This study was a cohort study. Using the data from the China Health and Retirement Longitudinal Study, subjects without depression were screened in the baseline survey, the depression status of the selected subjects was tracked and observed for seven years. Descriptive statistical analysis, multivariate logistic analysis, joint analysis were used to analyze the influence of factors such as gender, personal annual income, education level, urban and rural areas, and eastern, central, and western regions on the risk of depression among middle-aged and elderly people.Results:The 7-year follow-up results showed that the prevalence of depression symptoms in the study subjects was 42.24%; compared with men, women′s risk of developing depression symptoms was significantly increased ( OR=1.782); compared with junior college education and above, middle school (including technical secondary school), primary and lower education levels had a significantly increased risk of developing depression symptoms ( OR=1.476, 2.134); compared with annual income of more than 10 000 yuan, subjects with an annual income of 10 000 yuan or below had significantly increased risk of developing depression symptoms ( OR=1.251). At the same time, compared with the urban area, the risk of developing depression symptoms was significantly increased in the rural areas ( OR=1.389). Compared with the eastern area, the risk of developing depression symptoms was significantly higher in the central and western areas ( OR=1.342, 1.730). The joint analysis results showed that compared with high-income and high-education men, low-income low-education women, high-income low-education women, low-income middle-education women, and high-income middle-education women were at the top four odd ratios for developing depression symptoms ( OR=5.050, 3.662, 3.047, 2.641); compared with men in eastern cities, rural women in the west, rural women in the middle, women in the western cities, and rural women in the east ranked the first four odd ratios for developing depression symptoms ( OR=4.286, 3.216, 2.642, 2.158). Conclusion:Socioeconomic factors at the individual and regional levels have a significant impact on the risk of developing depressive symptoms in middle-aged and older adults, and mental health management of middle-aged and older adults with low socioeconomic status should be strengthened.
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Objective:To investigate and analyze the current status of health management (physical examination) service capabilities of medical institutions in Tianjin in 2021.Methods:It was a cross-sectional study. Using the census method, a questionnaire survey was conducted to obtain the health management (physical examination) service capabilities of 86 medical institutions in Tianjin in 2021. The questionnaire covered the basic information of the institution, human resources and equipment, physical examination items carried out, the annual number of people receiving physical examination, the degree of informatization, and the completion of quality control indicators. In this survey, a total of 86 questionnaires were distributed and 86 valid questionnaires were collected (100%). Mann-Whitney U test and χ2 test were used to compare the differences of health management (physical examination) indicators between public and private medical institutions, and to analyze the current health management (physical examination) service capabilities of medical institutions in Tianjin. Results:Among the 86 medical institutions included in the analysis, 53 (61.6%) were public institutions and 33 (38.4%) were private medical institutions. In terms of basic information, the proportion of comprehensive hospitals and level-3 medical institutions belonging to public institutions, as well as the time of health management (physical examination) business development, were significantly higher than those of private medical institutions [62.3% vs 30.3%, 62.3% vs 0, 11 (7, 5) years vs 7 (5, 10) years], and the proportion of independent setup of the physical examination center and the business area of health management (physical examination) were significantly lower than those of private institutions[33.3% vs 98.1%, 1 011 (600, 1 000) m 2 vs 2 000 (1 395, 2 782) m 2] (all P<0.05). In terms of practitioners, there were 2 964 health management (physical examination) practitioners in Tianjin in 2021, aged 43 (35, 56) years. The proportion of male practitioners, part-time practitioners, nurses, practitioners with intermediate professional title, chief inspection physician, health management specialist in public institutions and the time engaged in health management work of employees were all significantly higher than those in private medical institutions [20.6% vs 17.5%, 20.7% vs 8.1%, 33.8% vs 23.4%, 40.7% vs 27.3%, 7.1% vs 3.9%, 13.8% vs 4.7%, 6 (3, 11) years vs 5 (3, 8) years] (all P<0.05). In terms of business development, the implementation rates of preventive medical management, mental health management, hypertension risk management, health management contract service, pulmonary nodule management, health management intervention plan, health risk assessment, and health education programs in public institutions were significantly higher than those in private medical institutions (24.5% vs 0, 28.3% vs 0, 35.8% vs 15.2%, 39.6% vs 15.2%, 41.5% vs 12.1%, 50.9% vs 18.2%, 66.0% vs 36.4%, 83.0% vs 42.4%), and the annual health physical examination person-times, group and individual physical examination person-times in public institutions were significantly lower than those in private institutions [18 625 (11 844, 27 998) to 38 384 (10 832, 46 927), 14 818 (8 803, 23 915) to 28 663 (4 982, 41 927), 2 179 (1 221, 3 588) to 5 784 (1 461, 12 156)] (all P<0.05). Among the six quality control indicators of health examination, the completion rates of waist-hip circumference measurement in both types of institutions were low (<40%). Conclusion:Compared with public institutions, the talent echelon construction and service capability of health management (physical examination) in private medical institutions in Tianjin still needs to be improved.
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Objective:To explore the influence of information-knowledge-attitude-practice (IKAP) health management model on nursing effect in elderly population with high cardiovascular risk in Baiyin city.Methods:In this non-randomized controlled trial, a total of 126 elderly population with high cardiovascular risk who received physical examination and nursing services from October 2021 to March 2022 in the Health Management Center of the First People′s Hospital of Baiyin were collected as the research subjects by cluster random sampling method. Using propensity score matching method to enroll patients in a 1∶1 ratio based on their preferred nursing methods, 63 patients receiving routine nursing were included in control group and were given routine health education and nursing (health education was given by explaining disease-related knowledge, diet and medication guidance, once a week), and 63 patients who received IKAP health management model were enrolled as IKAP group and were given IKAP health management on the basis of the control group once a week by collecting information, transmitting knowledge, changing ideas and behavior. Both groups were continuously intervened for 6 months. The psychological state [Chinese psychosomatic health scale (CPSHS)], self-efficacy [insight and treatment attitudes questionnaires (ITAQ)], quality of life [generic quality of life inventory-74 (GQOLI-74)], lifestyles (controlled diet, regular exercise, sleep difficulties, weight control) and physical health status [somatic self-rating scale (SSS)] were compared between groups before and after the intervention. The medication rate and compliance rates of blood pressure, blood glucose and blood lipid of the two groups were compared by chi-square test, and the influence of IKAP health management model on nursing effect in elderly population with high cardiovascular risk in Baiyin city was analyzed.Results:The CPSHS score, sleep difficulty rate and SSS score in both groups after intervention were all significantly lower than those before intervention [IKAP group, (19.29±4.96) vs (31.37±9.23) points, 31.75% vs 73.02%, (37.06±4.30) vs (60.16±79.83) points; control group, (22.93±7.39) vs (31.67±9.21) points, 52.38% vs 74.60%, (41.75±4.97) vs (60.04±9.95) points], and the above-mentioned indicators in IKAP group were all significantly lower than those in the control group (all P<0.05). The ITAQ score, GQOLI-74 score, diet control rate, regular exercise rate and weight control rate were all significantly higher in the two groups after intervention than those before [IKAP group, (17.65±3.65) vs (2.41±0.31) points, (83.91±6.04) vs (56.26±5.14) points, 76.19% vs 42.86%, 57.14% vs 30.16%, 71.43% vs 42.86%; control group, (14.35±3.36) vs (2.33±0.29) points, (75.25±5.78) vs (57.12±5.21) points, 57.14% vs 44.45%, 38.10% vs 28.57%, 53.97% vs 39.68%], and the above-mentioned indicators were all significantly higher in IKAP group when compared with those in the control group (all P<0.05). The compliance rates of blood pressure, blood glucose and blood lipid in IKAP group after intervention were all significantly higherthan those in the control group [(85.71% vs 68.25%, 90.48% vs 76.19%, 82.54% vs 66.67%)] (all P<0.05). Conclusion:IKAP health management model can effectively enhance the self-efficacy, correct the poor living habits, improve the psychological and physical states, help to control the blood pressure, glucose and lipid, and enhance the quality of life in elderly population with high cardiovascular risk.
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Under the backdrop of smart health management technology development, this article reviews research advances in smart monitoring, assessment and intervention technologies for older people with mild cognitive impairment, including the types, typical applications and results of monitoring, assessment and intervention technologies.In addition, from the perspective of community-dwelling older adults' cognitive health management, a model for innovative management of community-dwelling older adults' cognitive function taking advantage of smart health management technologies is proposed, aiming to enhance the acceptance of smart health technologies among older people with cognitive impairment and to provide policy advice on developing friendly communities for older people with cognitive impairment.
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The release of the Measures of Ethical Review of Life Sciences and Medical Research Involving Humans has brought new requirements to the field of ethical review in health management research. Based on the background of new regulations and combining the characteristics of the health management discipline， this paper explored the needs and necessity of ethical review in health management research. In the Measures， the ethical governance of health management research was updated， the concept of exemption from the ethical review was put forward， as well as the importance of protecting the rights and interests of research participants and the protection of personal information were emphasized. This paper also explored the ethical review framework for health management research， including the formulation of operational standards for exemption from ethical review， the refinement of standardized ethical review work systems and processes， and the clarification of information data source verification. These explorations aimed to provide an ethical guarantee for health management research， promote its healthy development， and ensure that the rights and interests of research participants are fully respected and protected. Through research， it is hoped that the ethical level of health management research can be further improved， promoting the development of the discipline and social progress.
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ObjectiveTo evaluate the efficacy of TCM health management based on tertiary management system for patients with myocardial infarction （MI）. MethodsA total of 277 patients with non-acute MI were enrolled and given comprehensive TCM health management strategies including health education， lifestyle adjustment， risk factors control， medication and TCM appropriate techniques management through a tertiary management system with "the patient as the core， village/community physicians as the main executive body， and tertiary TCM hospital specialists as the leading body"， for a period of 12 months by using a prospective single-arm cohort study. Through patient reporting and medical records surveys， various indicators before and after 12-month management were collected and compared. The primary efficacy indicators were readmission rate and recurrent exacerbation rate， and the secondary efficacy indicators included disease awareness-related indicators， lifestyle behavior-related indicators， cardiovascular risk factor-related indicators and Canadian cardiovascular society （CCS） cardiac function classification. ResultsA total of 255 patients completed the study and were included in the final analysis. The recurrent exacerbation and readmission rates of patients after management were 23.14% （59 cases） and 20.25% （49 cases）， respectively， significantly lower than 36.08% （92 cases） and 53.72% （130 cases） before management （P＜0.05）. Except for knowledge on diabetes diagnostic criteria with no significant difference before and after management （P＞0.05）， awareness of other knowledge with regard to the prevention and treatment of cardiovascular and cerebrovascular diseases were improved after management （P＜0.01）， as well as the total score （P＜0.01）. In terms of daily life behaviors， the rates of salty diet， sweet diet and greasy diet were significantly lower than baseline， while the rate of moderate exercise was significantly higher （P＜0.05 or P＜0.01）； the rates of ongoing smoking and vigorous exercise were not significantly changed （P＞0.05）. For cardiovascular risk factors， patients' total cholesterol， low-density lipoprotein （LDL） cholesterol， triglycerides， fasting glucose， total depression assessment scale score， and total anxiety assessment scale score were significantly reduced after management （P＜0.01）. Systolic blood pressure and body mass index （BMI） were both higher after management （P＜0.05 or P＜0.01）， and there was no statistically significant difference in diastolic blood pressure （P＞0.05）. In terms of the cardiovascular disease risk factors reaching the standard levels， the rate of LDL cholesterol ＜1.8 mmol/L significantly increased （P＜0.01）， while the rate of BMI ＜24 kg/m2 and the rate of systolic blood pressure ＜140 mmHg both decreased significantly （P＜0.05 or P＜0.01） from baseline； the diastolic blood pressure and rate of fasting glucose ＜7.0 mmol/L were not significantly changed （P＞0.05）. The patients' CCS cardiac function classification was significantly reduced （P＜0.05）. ConclusionTCM health management based on the tertiary management system can enhance MI patients' awareness of the disease， change poor lifestyle habits， reduce risk factors such as blood lipids and blood glucose， improve anxiety and depression， increase activity tolerance， and reduce their recurrence exacerbation and readmission rates， which is worthy of clinical promotion.
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In order to solve the problems in traditional health management experimental teaching, such as high cost, safety and difficult repeatability, a virtual simulation experimental teaching platform for health management combined with Traditional Chinese Medicine (TCM) characteristics has been constructed by using virtual simulation, multimedia, and human-computer interaction technologies, which comprises TCM constitution identification, TCM health management and health management service process. Through the combination of virtual simulation and reality situation, the platform has formed an online and offline model of experimental teaching, which has improved the innovation and practice ability of students and enhanced the teaching quality.
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The typical regions have established a coordinated chronic disease management organization system,promoted the coordinated management of health care,medical,and medicine systems,optimized the chronic disease service process,and empowered the grassroots through information technology construction.It has achieved different degrees of results in controlling the condition of patients,reducing the hospitalization rate and the level of medical expenses of patients with chronic diseases,and saving medical insurance funds.
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Based on the reality that the Health Management Alliance(HMA)has been initially established nationwide as an important component of the integrated health care service system,on the basis of summarizing the evolution process of transaction cost theory,discriminating the essential characteristics of HMA,deconstructing HMA transaction cost and putting forward a quantitative measurement model,the coping strategies of HMA transaction cost are summarized into three levels:"knowing","reducing"and"increasing".It aims to solve the high transaction cost effectively and explore the economic system supply path;correct the deviation of the field of vision which only focuses on the"output orientation"of HMA in the early stage,and arouse the attention and thinking of all parties on the transaction cost of HMA;provide a new position and a new idea for HMA policy research and reform practice in China.
ABSTRACT
The digital transformation of China's community health management is a key step in the high-quality development of medical and health services,and is of great significance in enhancing the health and well-being of all residents.Using literature analysis,logical analysis and other research methods,it analyzes the practical foundation and constraints of the digital transformation of China's community health management,and proposes optimization strategies.It concludes that national policy,infrastructure development and social demand provide a realistic foundation for the digital transformation of community health management in China,but it also faces the problems of insufficient transformation of thinking,the concept of digital management has not sufficiently replaced the traditional concepts;the technical foundation is weak,and the construction and operation of the digital application platform started late;the structural barriers are prominent,and the lack of sound system construction leads to insufficient cooperation among the main bodies;the lack of digital standards,and the lagging operation of digital standardization of community health management;and the lack of digital standards.Management digital standardized operation lagging behind the constraints.Accordingly,it is proposed to promote the identity of the digital transformation of community health management,to build an operational space for digital community health management,to improve the digital system to regulate the activation of synergistic governance of the main body,and to optimize the supervision and guarantee of technology in digital management.