Propensity Score Matching Analysis of the Influence of Waiting Time Satisfaction on Community Resident's Satisfaction With Medical Institutions: An Extensive Survey of Outpatient Population in Shantou City of Southern China.

OBJECTIVE: This study was designed to perform a nuanced analysis of the multifaceted association between community residents' satisfaction and their perceived satisfaction concerning the visit duration at medical facilities, that could be harnessed to enhance and streamline the process of hierarchical diagnosis and treatment, thereby augmenting healthcare outcomes and patient experiences. METHODS: Respondents who had utilized services from medical institutions were invited to fill out questionnaires by scanning QR codes. Additionally, surveys also distributed questionnaires through WeChat groups of community residents in densely populated areas of the community, as well as WeChat groups for patients who had previously visited local hospitals. To balance differences between groups, propensity score matching was applied to analyze the contrast between residents satisfied and dissatisfied with their medical visits. After eliminating the interference of confounding factors, a comparative analysis was conducted on the relationship between resident satisfaction and medical institution experience.After eliminating the interference of confounding factors, a comparative analysis was conducted to delve deeply into the relationship between residents' satisfaction and their experiences at medical facilities. RESULTS: The study incorporated a large dataset encompassing 2356 community residents. Upon successful propensity score matching, logistic regression analysis elucidated several determinants of overall resident satisfaction. Notably, the grade of the medical institution (χ2 = 8.226, P < .05), satisfaction with the time invested in the registration process (χ2 = 11.04, P < .05), satisfaction with the waiting duration for consultation (χ2 = 15.759, P < .05), and satisfaction with the travel time to the hospital (χ2 = 45.157, P < .05) each exerted significant influence on the holistic satisfaction of residents with their medical experience. CONCLUSION: Factors such as the grade of the medical institution, satisfaction related to registration and waiting durations, and travel time to the hospital emerged as crucial determinants shaping community residents' holistic satisfaction with their medical encounters. These findings underscore the exigency for strategic allocation and optimization of medical resources, refinement of the classification system, and enhancement of public health education on the graded diagnosis and treatment schema. The study also demonstrates the value of employing advanced propensity score matching and predictive modelling techniques in health services research.

Medical staff evaluation on 'the effect of medical alliance policy on hierarchical diagnosis and treatment'.

Introduction: Medical alliances are essential for constructing an hierarchical diagnosis and treatment (HDT) system; therefore, it is crucial to promote such alliances and evaluate their effectiveness in this regard from the medical staff perspective. This study thus investigated and analyzed the evaluations of medical staff in China concerning the effect of medical alliances on promoting HDT with the intention to encourage further establishment of medical alliances and HDT under China's new medical reform. Methods: A total of 616 medical staff personnel from 3 medical alliances in Fujian Province were surveyed, and data were analyzed using SPSS 20.0 software. Results: The level of medical institutions, posts and satisfaction with their medical alliances influenced the evaluation of medical alliance effectiveness in resolving the problem of expensive medical services. Primary medical institutions are more inclined toward policy formulation and related work; thus, the interests of primary hospitals can be guaranteed. However, tertiary hospitals must provide additional workforce, material, and financial resources to support primary hospitals. Discussion: Therefore, it is necessary to coordinate the interests of the medical staff at different levels of medical institutions. The study makes a significant contribution to the literature because it highlights the effect of medical alliances in promoting hierarchical diagnosis and treatment.

Design and implementation of informatization for unified management of stroke rehabilitation in urban multi-level hospitals.

Background: With the aging of the population, the prevalence and incidence of stroke in China are increasing every year. China advocates the establishment of a three-level medical service system for stroke rehabilitation, but it lacks uniform information management among all levels of medical institutions. Objective: To achieve unified management of stroke patient rehabilitation in multilevel hospitals in the region through informatization construction. Methods: The need for informatization of three-level stroke rehabilitation management was analyzed. Then, network connections were established, and a common rehabilitation information management system (RIMS) was developed for all levels of hospitals to enable daily stroke rehabilitation management, inter-hospitals referral, and remote video consultation. Finally, the impact on the efficiency of daily rehabilitation work, the functioning and satisfaction of stroke patients were investigated after implementing the three-level rehabilitation network. Results: One year after implementation, 338 two-way referrals and 56 remote consultations were completed using RIMS. The stroke RIMS improved the efficiency of doctors' orders, reduced therapists' time to write medical documents, simplified statistical analysis of data and made referrals and remote consultations more convenient compared to the traditional model. The curative effect of stroke patients managed by RIMS is better than that of traditional management. Patient satisfaction with rehabilitation services in the region has increased. Conclusion: The three-level stroke rehabilitation informatization has enabled the unified management of stroke rehabilitation in multilevel hospitals in the region. The developed RIMS improved the efficiency of daily work, improved the clinical outcomes of stroke patients, and increased patient satisfaction.

Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China.

The hierarchical diagnosis and treatment reform of China can guide residents to seek medical treatment in an orderly manner and improve access to medical treatment. Most existing studies on hierarchical diagnosis and treatment used accessibility as the evaluation index to determine the referral rate between hospitals. However, the blind pursuit of accessibility will cause the problem of uneven utilization efficiency of hospitals at different levels. In response to this, we constructed a bi-objective optimization model based on the perspective of residents and medical institutions. This model can give the optimal referral rate for each province considering the accessibility of residents and the utilization efficiency of hospitals, to improve the utilization efficiency and equality of access for hospitals. The results showed that the applicability of bi-objective optimization model is good, and the optimal referral rate based on the model can ensure the maximum benefit of the two optimization goals. In the optimal referral rate model, residents' medical accessibility is relatively balanced overall. In terms of obtaining high-grade medical resources, the accessibility is better in the eastern and central regions, but poorer in the western China. According to the current allocation of medical resources in China, the medical tasks undertaken by high-grade hospitals account for 60%-78%, which are still the main force of medical services. In this way, there is a big gap in realizing the "serious diseases do not leave the county" goal of hierarchical diagnosis and treatment reform.

Establishment and application of the performance appraisal system for hierarchical diagnosis and treatment in China: A case study in Fujian province.

Purpose: Hierarchical diagnosis and treatment, as an important measure and direction for China's medical reform, are conducive to improving the capacity of medical services and the national level of health. In this study, a hierarchical diagnosis and treatment performance evaluation index system is established to identify the effects of different influencing factors on developing hierarchical diagnosis and treatment. Methods: In this study, samples collected from 23 representative integrated medical institutions in nine Fujian cities from 2018 to 2020 are taken as subjects. A hierarchical diagnosis and treatment performance appraisal system is established based on the mechanism of research on the operation of hierarchical diagnosis and treatment. This is combined with the evaluation index system established by the Health Development Research Center, the National Health Commission of the People's Republic of China for the evaluation of hierarchical diagnosis and treatment and the construction of the medical treatment alliance, including studies carried out by related scholars. The weight of each evaluation index is determined with the CRITIC method, and the hierarchical diagnosis and treatment effects on 23 subjects are quantitatively evaluated by the Gray correlation method based on the weight of each index. Results: The hierarchical diagnosis and treatment performance evaluation index system is established from three aspects, namely allocation of hierarchical diagnosis and treatment resources, establishment of the hierarchical diagnosis and treatment management system, and hierarchical diagnosis and treatment implementation effect; 27 tertiary indexes are formed in total. The Gray correlation of each year in Fujian exceeds 0.5, but <0.53. Conclusion: Gray correlation of each year in Fujian has gradually increased. But there is still room for improvement. The government departments must improve the investment in medical resources with measures adjusted according to local conditions, promote a balanced allocation of resources for hierarchical diagnosis and treatment, increase communication and interaction between upper and lower medical institutions, and optimize the allocation of resources for hierarchical diagnosis and treatment. Then determine the types of disease to be treated, expand the coverage of chronic disease management, establish standardized chronic disease health management, and strengthen training of health management staff.

Patient allocation method in major epidemics under the situation of hierarchical diagnosis and treatment.

OBJECTIVES: Patients are classified according to the severity of their condition and graded according to the diagnosis and treatment capacity of medical institutions. This study aims to correctly assign patients to medical institutions for treatment and develop patient allocation and medical resource expansion schemes among hospitals in the medical network. METHODS: Illness severity, hospital level, allocation matching benefit, distance traveled, and emergency medical resource fairness were considered. A multi-objective planning method was used to construct a patient allocation model during major epidemics. A simulation study was carried out in two scenarios to test the proposed method. RESULTS: (1) The single-objective model obtains an unbalanced solution in contrast to the multi-objective model. The proposed model considers multi-objective problems and balances the degree of patient allocation matching, distance traveled, and fairness. (2) The non-hierarchical model has crowded resources, and the hierarchical model assigns patients to matched medical institutions. (3) In the "demand exceeds supply" situation, the patient allocation model identified additional resources needed by each hospital. CONCLUSION: Results verify the maneuverability and effectiveness of the proposed model. It can generate schemes for specific patient allocation and medical resource amplification and can serve as a quantitative decision-making tool in the context of major epidemics.

Application of continuous nursing care based on hierarchical diagnosis and treatment mode in Stage II cardiac rehabilitation of patients after percutaneous coronary intervention.

Objective: To explore the effect of applying continuous nursing care based on hierarchical diagnosis and treatment in Stage II cardiac rehabilitation of patients after percutaneous coronary intervention (PCI) and provide a theoretical basis for clinical nursing intervention. Methods: Patients in PCI postoperative II cardiac rehabilitation were selected and randomly divided into the experimental group (community group), the experimental group (rehabilitation group), and the control group. Patients in the control group received the routine cardiac rehabilitation management scheme, while those in the experimental groups received continuous nursing protocol based on the hierarchical diagnosis and treatment mode. All patients were compared for the cardiac rehabilitation evaluation indexes at discharge and 6 months after discharge. Results: Compared with the control group, the left ventricular ejection fraction, 6-minute walking distance test, medication compliance, and quality of life were all improved in the two experimental groups, and the differences were statistically significant (P < 0.05). The improvement in the rehabilitation group was more significant than in the community group. There were more patients with high cardiac rehabilitation compliance in the rehabilitation group than in the community group, with the difference being statistically significant (P < 0.05). Conclusion: Continuous nursing care rehabilitation based on the hierarchical diagnosis and treatment mode can improve the cardiac function of patients after PCI, enhance their quality of life, and improve their rehabilitation and medication compliance, facilitating their cardiac rehabilitation.

The impact of family doctor system on patients' utilisation of general practitioner in primary care facilities-Evidence from Hangzhou, China.

OBJECTIVE: This study aims to examine whether participating in the contracted family doctor system increases patients' utilisation of primary care general practitioner for multiple disease outcomes in China. METHODS: Binary logistic regression models were estimated using data collected from 372 community residents in nine selected districts of Hangzhou, China. RESULTS: Findings revealed that (1) for patients with influenza, diabetes, upper respiratory infection, and gingivitis, those who participated in the contracted family doctor system were approximately 4.3 times, 98.4%, 92.5%, and 52.8% more likely to choose primary care general practitioners (GP) for their initial diagnosis, respectively, as compared with their counterparts who did not have contracted family doctors; (2) For patients with stroke or cerebrovascular disease and cholecystitis or cholelithiasis, those who had contracted family doctors were 1.111 times and 80.6% more likely to choose primary care GP for their subsequent disease maintenance, respectively, as compared to their counterparts without contracted family doctors. CONCLUSION: Our findings indicate that the contracted family doctor system not only increases the utilisation of primary care GP for patients with many chronic conditions but also promotes the overall completion of China's hierarchical medical system in the long run. Policy implications were provided to help policymakers actively construct and develop the contracted family doctor system to promote the hierarchical medical system in China.

Supply-demand matching of medical services at a city level under the background of hierarchical diagnosis and treatment - based on Didi Chuxing Data in Haikou, China.

BACKGROUND: Implementation of the Healthy China Strategy and the hierarchical diagnosis and treatment system has injected new vitality into medical services. Given the insufficient supply of medical services and increasing demand for medical treatment, exploring the supply-demand pattern of medical services has become an urgent theoretical and practical problem to be solved. The equity of healthcare facilities has received widespread attention, but due to limited data, there is little research on the supply-demand pattern of medical services. This study focuses on evaluating the supply-demand matching pattern of medical services at different levels in Haikou City with big geographic data and promoting the realization of a balance between medical supply and demand. METHODS: This study utilizes spatial data of medical institutions, Didi Chuxing Data, and population density data. Firstly, use the two-step floating catchment area method and GIS spatial analysis to explore characteristics of the supply-demand patterns of medical services at different levels in Haikou. Secondly, we mine residents' demand for medical treatment based on Didi Chuxing Data. Then combined with population density data, divide supply-demand matching of medical institutions into four types. Finally, propose optimization strategies for the problems. RESULTS: The accessibility pattern of high-level medical institutions in Haikou presents high in the north and low in the south. The accessibility pattern of low-level medical institutions is the opposite. High-level medical institutions have a strong demand for medical treatment, which is less hampered by distance. The healthcare demand of low-level medical institutions is small, and they mainly are medium- and short-distance medical travel. The types of medical services at different levels are mainly "low supply - low demand" and "high supply - low demand" types. CONCLUSIONS: Medical services at different levels in Haikou are mainly in supply-demand imbalance. Therefore, we put forward optimization strategies to promote the equity of primary medical services, such as propelling the establishment and improvement of the hierarchical diagnosis and treatment system, building a new model of medical and health service supply, and strengthening balanced coverage of primary medical institutions. The mining of big geographic data is beneficial to alleviate the mismatch between medical supply and demand, although the data and methods need to be improved.

Implementation efficiency of the hierarchical diagnosis and treatment system in China: A case study of primary medical and health institutions in Fujian province.

The hierarchical diagnosis and treatment system is at the core of China's new round of medical reforms. We evaluated the operational efficiency of the hierarchical diagnosis and treatment system in primary medical and health institutions in Fujian Province. We used the data envelopment analysis algorithm to calculate 'input-output' data from 2016 to 2018 and established an index system. Regarding results for efficiency value, the implementation efficiency of Xiamen was 1.15, Fuzhou was 1.10, Zhangzhou was 1.09, Ningde was 1.06, Quanzhou was 0.98, Nanping was 0.96, Putian was 0.94, Longyan was 0.92, Sanming was 0.86, and Pingtan was 0.82. There were few and insufficient doctors providing services; in 2018, the number of practicing (assistant) doctors per 1000 permanent residents in primary medical institutions in Fujian was only 0.799. Outpatient and emergency service visits were increasing yearly; in Fujian, they increased by 8.39% from 2016 to 2018. From the incentive system of hierarchical diagnosis and treatment, the redundancy rate of each city was generally high, with only that of Nanping (3.28%) and Longyan (0.00%) being lower. In general, for the hierarchical medical system to succeed, we should start with innovative management policy and explore ways to adapt to local circumstances (such as population, economy, etc.).

How to promote the hierarchical diagnosis and treatment system: A tripartite evolutionary game theory perspective.

Due to the disorderly access to medical care and inefficient use of health resources, the advancement of the hierarchical diagnosis and treatment is more valued in promoting health system reform. Hence, this article integrates prospect theory into an evolutionary game model of the local government health departments, the medical institutions, and the patients in the system promotion of the hierarchical diagnosis and treatment. The simulation shows the specific influencing mechanism of the psychological perceived value of game subjects. Then by introducing the stochastic evolutionary game model, the system promotion under different medical cultures is also discussed in detail. The results indicate that for local government health departments, the amount and duration of financial subsidies are the key factors influencing the game system's evolution. For medical institutions, participating in the hierarchical diagnosis and treatment system is relatively beneficial. For patients, the recovery rate in primary hospitals matters more than the cost of treatment. Changes in the risk sensitivity coefficient will cause the equilibrium of the game system to change. However, changes in the loss avoidance factor do not change the equilibrium and only have an impact on the speed of convergence. With the health departments' intervention, patients in rural medical culture are more inclined to support the hierarchical diagnosis and treatment system than those in urban or town medical culture. Therefore, in order to promote the hierarchical diagnosis and treatment system, this article recommends that more attention should be paid to the regulatory role of health departments and the participation improvement of medical institutions and patients.

Analysis on the status quo of 0-14 years old children′s cross-provincial medical treatment in Shandong province / 中华医院管理杂志

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.

Construction and practice of medical alliance referral system based on blockchain / 中华医院管理杂志

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.

A comparative study on the difference coefficients of DRG payment in various cities in Zhejiang province / 中华医院管理杂志

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.

An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China.

Spatial accessibility to medical services (SAMS) is one of the most important indicators to examine the convenience for people to get access to medical services. In China, the difficulty in getting access to medical services is a commonly appreciated social problem. To mitigate this problem, Chinese government established the hierarchical diagnosis and treatment system (HDTS) in 2005. However, there is no existing study to examine the HDTS from the perspective of SAMS. This paper therefore introduces an integrative method to analyze SAMS in adopting HDTS. The introduced integrative method is developed by referring to the existing 2SFCA method, a commonly applied method for analyzing SAMS, and the characteristics of HDTS are taken into consideration. The application of the integrative method is demonstrated with reference to a Chongqing case. The research findings suggest that: 1) A new method to evaluate SAMS in the context of HDTS is needed; 2) The integrative method developed in this study is proven effective for analyzing SAMS in the context of HDTS through the case study; 3) The case results reveal that the implementation of HDTS can significantly improve the overall SAMS performance in Chongqing; 4) The desirable referral rate of HDTS is 1.24% in the case study by comparing the SAMS performance between different referral rates.

Practice and enlightenment of the construction of medical alliances in Guangzhou / 中华医院管理杂志

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.

Evaluation of the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area / 中华实用儿科临床杂志

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.

Exploration and practice of the two-way referral path of medical alliances based on telemedicine / 中华医院管理杂志

" 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.

Exploration on the construction of outpatient intra-hospital hierarchical diagnosis and treatment system / 中华医院管理杂志

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.

Survey on the management status of patients with type 2 diabetes mellitus in community health service centers in Beijing / 中华全科医师杂志

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.