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Objective:To analyze the current situation and problems of cross-provincial medical treatment for children in Shandong province, and put forward corresponding countermeasures.Methods:The FUTang Updating medical REcords(FUTURE)database established by Futang Children′s Medical Development Research Center was selected to extract the data of 0-14 years old children who were discharged outside Shandong province from January 1, 2019 to December 31, 2020 and whose current address was in Shandong province, and the data of hospitalized children in a children′s hospital in Shandong province during the same period were selected for comparison. The SPSS 22.0 software was used to establish the database, and statistics and analysis were made on the number of cases, main flow direction, departments, types of diseases and hospitalization cost of children.Results:A total of 13 071 cases accepted cross-provincial medical treatment were included, and the main flow of medical treatment was Beijing Children′s Hospital. The data of 87 742 children admitted to a children′s hospital in Shandong province at the same time were included. The proportion of female and school-age children in children accepted cross-provincial medical treatment was higher than that of local patients, and the hospitalization cost was higher than that of local patients. The main diseases for children seeking medical treatment outside the province were tumors, immune diseases and other serious diseases or chronic diseases, while the main diseases for children seeking medical treatment in the province were respiratory diseases such as pneumonia.Conclusions:The proportion of tumors and immune diseases among children aged 0-14 years accepted cross-provincial medical treatment is relatively high. Hospitals in Shandong province should pay attention to the construction of key specialties, actively develop new technologies and new businesses, and enhance the core competitiveness of hospitals. At the same time, we should improve the medical service system and guide patients to seek medical care reasonably through policies.
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Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.
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In order to compare the setting of difference coefficients in DRG point payment in different cities in Zhejiang province, the implementation rules of DRG point payment issued by 11 cities in Zhejiang province were comprehensively analyzed. It was found that the difference coefficients in different cities could be divided into three categories, including hospital coefficients alone, hospital coefficients and grade coefficients weighted, and weighted by hospital coefficients, grade coefficients, personal burden levels, case mix indexes, and head-to-time ratio. Its setting differences included four aspects: connotation composition, weight distribution, threshold value, and classification of medical institutions. The authors suggested that the adjustment cycle should be set scientifically to dynamically adjust the difference coefficient, and the scientific setting of the difference coefficient should be promoted through provincial coordination.
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" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.
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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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Construction of medical alliances could help structural adjustment of medical resources, promote the shift of medical and health investment to primary level, improve the overall effectiveness of the medical service system, and better meet the health needs of the people. Guangzhou has established a multi-form and multi-level medical alliance system in accordance with local conditions. According to the distribution characteristics of medical resources in the districts under the jurisdiction of Guangzhou, these districts were divided into areas of controlled development, those of stable development and those of encouraged development. Different strategies were taken for various medical alliances. Advantages of traditional Chinese medicine were given full play in community health management and elderly care services, alliance of traditional Chinese medicine specialists was established to provide residents with continuous medical and health services. An appropriate medical insurance payment system was established to promote the implementation of the hierarchical diagnosis and treatment system. However, there were still such problems as unbalanced distribution of medical resources, insufficient leverage role played by medical insurances, and rooms of improvement in the ability of primary medical services.
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Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.
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Intra-abdominal infections(IAIs)is common in the clinic which includes a variety of pathological conditions,ranging from uncomplicated appendicitis to fecal peritonitis.IAIs can be classified as healthcare-associated IAIs and community-acquired IAIs according to the circumstance of origin.IAIs can be also classified as uncomplicated IAIs and complicated IAIs according to the extent of infection.However,the circumstance of origin and extent of infection can't predict the therapy difficulty and clinical outcome.So,the authors first propose the new concept of "pan-complicated IAIs" and elaborate its clinical significance which may evoke the interest of clinicians to pay close attention to the diagnosis and treatment of IAIs.
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From January 2016 to June 2017, 1 002 outpatients with T2DM were recruited in Chuiyangliu Hospital (core hospital) and eleven community health service centers in Chaoyang district in Beijing. A questionnaire survey was conducted, the survey items included demographic information, complications of T2DM, comorbidities and status of treatments. Among 1 002 patients, there were 525 cases from the Southern Medical Consortium core hospital and 477 from the Southern Medical Consortium community health centers. The control rates of glycosylated hemoglobin, fasting blood glucose, 2 h postprandial glucose were 54.1%, 49.5% and 54.6%, respectively. The blood glucose control rates in lifestyle intervention, single OAD and multiple OAD groups of core hospital were all higher than those in corresponding groups of community health centers (P<0.05). There were 115 patients managed with lifestyle interventions only and 887 patients with medications, in whom 533 were treated with oral antidiabetic drugs (OAD) and 354 cases were treated with insulin+OAD. The use rates of metformin in the core hospital and in community health service centers were 58.3% and 35.4%, the use rates of insulin were 48.4% and 24.2%, respectively. The blood sugar control of patients in community health centers is less satisfactory than that in core hospital of Chaoyang District South Medical Consortium in Beijing. The communication and cooperation between core hospitals and community health service centers should be further strengthened for better management of T2DM patients.
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From January 2016 to June 2017, 1002 outpatients with T2DM were recruited in Chuiyangliu Hospital (core hospital) and eleven community health service centers in Chaoyang district in Beijing. A questionnaire survey was conducted, the survey items included demographic information, complications of T2DM, comorbidities and status of treatments. Among 1002 patients,there were 525 cases from the Southern Medical Consortium core hospital and 477 from the Southern Medical Consortium community health centers. The control rates of glycosylated hemoglobin, fasting blood glucose, 2 h postprandial glucose were 54.1％, 49.5％ and 54.6％, respectively. The blood glucose control rates in lifestyle intervention, single OAD and multiple OAD groups of core hospital were all higher than those in corresponding groups of community health centers (P<0.05). There were 115 patients managed with lifestyle interventions only and 887 patients with medications, in whom 533 were treated with oral antidiabetic drugs (OAD) and 354 cases were treated with insulin+OAD. The use rates of metformin in the core hospital and in community health service centers were 58.3％and 35.4％, the use rates of insulin were 48.4％and 24.2％, respectively. The blood sugar control of patients in community health centers is less satisfactory than that in core hospital of Chaoyang District South Medical Consortium in Beijing. The communication and cooperation between core hospitals and community health service centers should be further strengthened for better management of T2DM patients.
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An information system for "Internet+" hierarchical diagnosis and treatment was constructed with pa-tients as its center,with clinical information system as its basis,and with solution of difficulties in implementation of "Internet+" hierarchical diagnosis and treatment as its guidance. Its three key modules, namely online service module,data center module and off-line management module,were designed and analyzed,which helps the preci-sion match of resources and demands for the"Internet+" hierarchical diagnosis and treatment,promotes the vertical flow of good medical resources and improves the grass-root service level and efficiency.
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The medical alliance is an important carrier for the construction of hierarchical medical treatment system.In the study,the medical alliance under public and private partnership is explored and analyzed,the necessity of private medical institutions participating in the medical alliance construction is expounded.The feasibility of the construction of medical alliance under public and private partnership is illustrated from three aspects,such as policy,theory and practice.Based on the policy background and market environment of China,challenges of the construction of public and private partnership is analyzed,and the corresponding suggestions are proposed to provide ideas for the long-term development of medical alliance in China.
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As the medical and health service model China currently vigorously promotes,the medical alliance is of great significance for implementing the five basic medical and health systems and perfecting the medical and health service system.At the same time,the construction of medical alliance can't be separated from the medical treatment,medical insurance and medicine linkage.Clarifying the relationship between the medical alliance and synergy among hospitals is conducive to solving many problems in the construction of medical alliance,and to promoting the healthy and sustainable development of medical alliance.
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Improving and accelerating the implementation of the hierarchical medical services can't be separated from the support of information technology.The paper elaborates the concept and current situation of hierarchical medical services in China;and from the perspective of family doctor,basic initial diagnosis and dual referral,hierarchical diagnosis and treatment process is analyzed.And the application of information technology in the hierarchical medical services process is discussed.
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Objective To discuss the dilemma of establishing the hierarchical diagnosis and treatment system in China and the relevant policy recommendations.Method Game theory and Pareto improvement theory can be used to analyze and promote the implementation of the hierarchical diagnosis and treatment system.Results The difficulty of grading diagnosis and treatment lies in the failure to achieve Pareto improvement,that is,patients and the government can save costs in the grading system,but doctors have not been given corresponding incentives,therefore,they are lack of enthusiasm for subsidence.Conclusion The hierarchical diagnosis and treatment system can save the government subsidies for health insurance and medical costs.If the doctor can get part of the costs,they will sink to the grassroots medical institutions,which can realize the Pareto improvement.The order of medical treatment and classification will be formed.
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Since the release of On the Promotion of Hierarchical Diagnosis and Treatment System Construction Guidance in 2015,the relevant supporting policies have been introduced.That whether the classification system can continue to implement effectively,still needs the adjustment and protection of legal level.Therefore,in view of the current problems in the construction of the classification and treatment system,the paper conducts an in-depth investigation and analysis,and puts forward the ideas and suggestions for legislation to promote the construction of the classification and treatment system.
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In the view of the obstetrics and gynecology hospital,and through setting up a cooperative hierarchical diagnosis and treatment of ambulatory surgery in Department of Obstetrics and Gynecology in the secondary hospital,the feasible model of hierarchical diagnosis and treatment of specialty diseases is explored,and suggestions are put forward.Hierarchical diagnosis and treatment mode of ambulatory surgery can increase patients' efficiency and satisfaction of seeing doctors,and medical resource can be fully used.
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Through screening of the literature,published time,published journals,research sites,research objects,research perspectives,influencing factors and countermeasures were listed by multi angle analysis of the bibliometrics method.The results show that the research on influencing factors of patients' selection of institutions in China has reached a certain level,but there are still some deficiencies.Follow-up studies need to define the following points which include the research heat is strongly related with the policy,the research of the patient's referral influencing factors should be strengthened,the depth of research needs to be improved,and the patients is the foundation of the countermeasures.
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Hierarchical diagnosis and treatment is an effective way to "optimize and reconstruct medical and health service system" and solve the problems of "difficulty and expensiveness of getting medical treatment". At present, the hierarchical diagnosis and treatment still exists many problems in the process of practice, and the solu-tion of these problems not only requires government departments to do the top-level supporting policies, but also needs the medical institutions at all levels to change their thinking mode and innovate the appropriate hierarchical diagnosis and treatment system. This paper analyzed the dilemma of hierarchical diagnosis and treatment in China from the aspects of medical alliance operation mechanism, medical insurance system, physician multi-point occu-pation, medical resource allocation and medical information sharing and so on, and put forward corresponding countermeasures.
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The paper focuses on the (Primary Diagnosis at Grassroots Level,PDGL),and the current pilot situation and consequence of PDGL,analyzes the problems during the progresses,and dissects the conflicts of interest among the relative stakeholders.At last,the paper provides the corresponding countermeasures to the future development of PDGL.