ABSTRACT
Background: Digital health technologies are progressively assuming significant roles in aspects encompassing in-hospital management, patient-centered design, and tiered referral systems. Nevertheless, current studies do not involve exploration into the potential value and mechanisms of digital health in a patient-centered context. This study aimed to explore the development of a framework of comprehensive, evidence-based digital health technologies for the construction of welfare-oriented healthcare. Methods: From March to June 2023, a cross-sectional online study was performed, involving 335 respondents with prior referral experiences hailing from the Central China region. Data on welfare-oriented healthcare factors (clinical pathway management, medical structure configuration, healthcare service accessibility, two-way referrals) underwent factor analysis in advance, and correlation between these factors and their association with two-way referrals was evaluated by testing for direct and indirect (mediating) effects. Results: Firstly, there existed a significant positive correlation between integrative medical indicators and welfare-centered healthcare (ß = 0.02-0.16, p < 0.05). Furthermore, two-way referral had an direct association with integrative medical parameters and the welfare healthcare service system (ß = 0.15-0.31, p < 0.05), but exerted a partial mediatory function in the welfare healthcare service system (ß = 0.005-0.021, α < 0.05). Two-way referrals partially mediate the integrated medical indicators, mainly through direct effects, while also providing complementary support. Clinical pathways, medical structure, and accessibility are closely linked to welfare healthcare and significantly influence healthcare quality. Thus, improving these factors should be prioritized. Conclusion: This study proposes a method combining integrated evaluation indicators with pathway mechanism design. This pathway mechanism design includes key steps such as patient registration, information extraction, hospital allocation or referral, diagnosis and treatment, rehabilitation plan monitoring, service feedback, and demand resolution. This design aims to change patients' intentions in seeking healthcare, thereby increasing their acceptance of bidirectional referrals, and ultimately enhancing the effectiveness and realization of welfare healthcare.
ABSTRACT
BACKGROUND: Compared to early enteral feeds, delayed introduction and slow enteral feeding advancement to reduce necrotizing enterocolitis (NEC) is not well studied in micropremies (<750g birth weight). METHODS: Pre-post case control study. Micropremies who followed a standardized slow enteral feeding (SSEF) protocol (September 2009 to March 2015) were compared with a similar group of historical controls (PreSSEF, January 2003 to July 2009). Enteral feeding withheld for first 10-14 days and advanced at <10âml/kg/day in the SSEF group. RESULTS: Ninety-two infants in the SSEF group were compared with 129 PreSSEF group. Birth weight and gestational age in SSEF and PreSSEF were similar. Breast milk initiation rate was higher in SSEF (87.0 vs. 72.0%, pâ=â0.01) compared to PreSSEF, but were similar at full enteral feeds. Compared with PreSSEF, feeding initiation day, full enteral feeding day, parenteral nutrition days, and total central line days were longer in SSEF. There was significant reduction in NEC (1.1 vs. 16.2%, pâ<â0.01), surgical NEC (0.0 vs. 7.8%, pâ<â0.01) and NEC/death (7.6 vs. 29.5%, pâ<â0.01), in SSEF compared to PreSSEF. SSEF, compared to PreSSEF, had more cholestasis (41.8 vs 28.8%, pâ=â0.04), higher peak serum alkaline phosphatase (638 vs. 534 IU/dL, pâ<â0.01), but similar rates of late-onset sepsis (39.1 vs 43.4%, pâ=â0.53). In infants who survived to discharge, SSEF had higher discharge weight, lower extra-uterine growth restriction, and similar length of stay, compared to PreSSEF. CONCLUSIONS: A SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in micropremies.
