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As one of notable works of HUANG Yuanyu， a renowned physician from the Qing Dynasty， The Indications of Classics by Four Medical Sage emphasize the theoretical paradigm of “one qi circulation” with a particular focus on the middle qi. Building upon disease differentiation and treatment， HUANG Yuanyu attaches great importance to understanding the underlying cause of the disease. It is believed that the imbalance of the six climatic factors is the fundamental cause of diseases. The concept of mutual interaction between the physiological and pathological aspects of the six climatic factors is proposed to grasp the basic pathogenesis. Based on the individual's specific condition of six climatic factors， excess or deficiency， specific prescriptions are formulated. The diagnosis and treatment system can be summarized as a “differentiation of diseases → disease etiology → differentiation of the condition of six climatic factors → individualized pathogenesis of traditional Chinese medicine （TCM） → prescription of TCM” model based on the holistic view. HUANG Yuanyu' s diagnosis and treatment system is highly practical and can provide reference for clinical diagnosis and treatment of diseases in TCM.
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Objective:To explore the driving mechanisms of doctors′ collaborative willingness and behavior in the tiered diagnosis and treatment system, in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods:Based on the harmonious management theory, a theoretical framework for the driving mechanisms of doctors′ collaborative behavior in the tiered diagnosis and treatment system was developed. Through random sampling, a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022. The t-test, variance analysis, and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics. The structural equation model and stratified linear regression were used to assess the impact of collaborative factors (professional environment and work expectations) and harmonious factors (perception of policy support and perception of management mechanism) on doctors′ collaboration willingness and behavior. Results:A total of 1 959 doctors participated in the survey. Doctors′ collaborative behavior scored 2.13±1.12, indicating a slightly below-average level, whereas their willingness to collaborate scored 3.88±0.79, falling between neutral and somewhat willing. Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking, age, years of experience, monthly average income, and professional titles ( P<0.05). Both collaborative and harmonious factors directly influenced the doctors′ willingness to collaborate, with standardized path coefficients of 0.428 and 0.139, respectively. Similarly, these factors directly impacted their collaborative behavior, with standardized path coefficients of 0.104 and 0.366. The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′ collaborative willingness and behavior, with effect values of 0.047 and 0.043 respectively ( P<0.05). Conclusions:The collaborative and harmonious elements serve as positive drivers for collaboration among doctors in the tiered diagnosis and treatment system at both the cognitive and behavioral levels. Enhancing and optimizing policy support and management mechanisms can facilitate the transition from intention to actual collaborative actions among doctors from different levels of medical institutions.
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Objective:To analyze the cost-effectiveness of a relatively mature artificial intelligence (AI)-assisted diagnosis and treatment system (ENDOANGEL) for gastrointestinal endoscopy in China, and to provide objective and effective data support for hospital acquisition decision.Methods:The number of gastrointestinal endoscopy procedures at the Endoscopy Center of Renmin Hospital of Wuhan University from January 2017 to December 2019 were collected to predict the procedures of gastrointestinal endoscopy during the service life (10 years) of ENDOANGEL. The net present value, payback period and average rate of return were used to analyze the cost-effectiveness of ENDOANGEL.Results:The net present value of an ENDOANGEL in the expected service life (10 years) was 6 724 100 yuan, the payback period was 1.10 years, and the average rate of return reached 147.84%.Conclusion:ENDOANGEL shows significant economic benefits, and it is reasonable for hospitals to acquire mature AI-assisted diagnosis and treatment system for gastrointestinal endoscopy.
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Pulmonary nodule is a key window for moving ahead the diagnosis and treatment of lung cancer. Traditional Chinese medicine （TCM） can delay the transformation of lung nodules into lung cancer， improve the prognosis of patients， effectively fill the treatment gap during the follow-up period of pulmonary nodules， and has been applied it in the whole cycle and multi-dimensional management of pulmonary nodules. This paper discussed the construction ideas and feasible paths of the whole process management diagnosis and treatment system of pulmonary nodules in TCM， proposed the diagnosis and treatment database of TCM for pulmonary nodules based on the social module of “family-community-hospital”. Through artificial intelligence， we can develop， improve and promote the multi-level and multi-modal “disease-symptom combination” risk prediction model and effectiveness evaluation system of pulmonary nodules. At the same time， the biological connotation of the prevention and treatment of pulmonary nodules by TCM is excavated， which provided empirical evidence for the construction of TCM diagnosis and treatment system， in order to further improve the quality and diagnosis and treatment level of the whole course management of pulmonary nodules.
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Shanghai is a super-large metropolis with a highly developed globalization. Since the 21st century， Shanghai has experienced several threats of emerging and imported infectious diseases. Infectious disease surveillance has been established and developed from single-disease surveillances to a comprehensive surveillance network. Integration of clinical and preventive medicine has been gradually extended， which facilitates the improvement in the monitoring and early warning system. In 2020， when the COVID-19 epidemic spread， Shanghai quickly established a prevention and control expert team and a clinical medical expert team to effectively and shortly control local COVID-19 epidemic. In order to improve Shanghai’s capacity to respond to major epidemics of infectious diseases and public health emergencies， the metropolis will build and improve a three-level diagnosis and treatment system for emerging， imported， rare， and unknown infectious diseases in the next five years. Based on the big data monitoring platform of medical institutions， Shanghai will achieve the intelligence-supported diagnosis and treatment of infectious diseases， and consolidate the cooperation to implement the integration of clinical and preventive medicine.
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Reasonable intra-hospital hierarchical diagnosis and treatment system will effectively guide the patients to see a doctor on demand and improve the efficiency of medical services. Beijing Tongren Hospital, Capital Medical University, has explored the intra-hospital hierarchical diagnosis and treatment system depending on different situatioins such as for new patients, subsequent visit patient, and the same patients with different clinical stage. Through establishing a series of intra-hospital hierarchical diagnosis and treatment modes, such as the well-known expert team, the outpatient service for specialized diseases, the multidisciplinary outpatient service for complex diseases, the nursing service, and the pharmaceutical care service, the outpatients could be oriented by specialties and disciplines and graded by the complexity in diagnosis and treatment of diseases. Relying on the appointment methods such as referral and revisit to open up the information channel, it can optimize the time cost and economic cost of patients, reflect the functional positioning of the tertiary hospitals, and improve patients′ sense of medical access and happiness.
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The combination of mobile medical technology and the grading diagnosis and treatment system (GDTS) can stimulate the allocation of medical resources, reduce medical cost and improve public health significantly. Firstly we summarize development features of mobile medical technology in foreign and domestic market, then we study the application model of mobile medical application in GDTS with field research data and analyzes its advantage and shortage. Finally, we propose four measures for further developing mobile medical application in the GDTS:the government departments should formulate policies and industry standards of products as soon as possible to meet requirement of market; service providers should take the hospitals as core role to achieve mutual benefit and win-win situation; take the daily monitoring of chronic diseases as an entry point to build profitable business model; enhance publicity to promote public health awareness.
Subject(s)
Diagnosis , Mobile Applications , Public Health , TechnologyABSTRACT
[Objective] Summary of Ming and Qing Dynasties and traditional Chinese medicine before tumor disease, to clarify the concept and to separate the tumor, and the tumor gall. [Method] Carefully read the documents of ancient Chinese medicine literature, combined with the relevant theoretical research methods of TCM, analyze the etiology and pathogenesis of neoplasia and its diagnosis and treatment system, summarize the theoretical system of the disease. [Results] The tumor is between blood stasis and phlegm stagnation. In time, the flesh skin membrane, between flesh and skin, because of its clinical and gall disease shows the organism body mass, so the ancient medical books of the two are collectively referred to as the gall disease. It is equivalent to the surface soft tissue tumor of modern medicine. [Conclusion] Before and after Ming and Qing Dynasties, Chinese medicine has formed a complete system of diagnosis and treatment of tumor, which has a good guiding effect on modern clinic.
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In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.
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The experience of various countries proves that the hierarchical diagnosis and treatment model can lead to reasonable resources allocation and utilization, however, the waste of China''s disordered treatment model has not been estimated.Nowadays, it is very important to establish a hierarchical diagnosis and treatment system during China''s healthcare system reform.Therefore, it is necessary to estimate the benefit the reform may bring.We take Zhejiang Province as an example, and adopted the system dynamics model to build the health delivery system, to emulate the hierarchical diagnosis and treatment model and the disordered model, and to evaluate the benefit.Results showed that if first option at the primary health institutions increased 10%, it could save 0.251 billion yuan, and if increased 15%, it could save 0.39 billion yuan.If the first option at the primary health institution reached 72.35% and the treatment in county reached 90%, the outpatient in tertiary hospital could reduce by 13 million, and those in primary healthcare institutions could increase by 74 million yuan.The direct healthcare cost could reduce 3.016 billion Yuan.