Objective To understand the situation and technical level of aeromedical rescue in medical institutions in Qinling-Daba mountainous area. Methods A questionnaire survey was conducted on the staff of medical institutions of the medical consortium of Renmin Hospital of Hubei University of Medicine, located in Qinling-Daba mountainous area between June and September 2023. The basic information and development, demand, and knowledge mastery of aeromedical rescue were investigated. Results A total of 45 medical institutions participated in the research, 500 questionnaires were sent out, and 479 valid questionnaires were recovered, with an effective rate of 95.8%. Among them, there were 7 tertiary hospitals, 23 secondary hospitals, and 15 township health institutions; 11 medical institutions had participated in aeromedical rescue, and 17 hospitals had participated in aerial rescue drills. The survey subjects were mainly from emergency departments and intensive care medicine departments, women, aged>30 and ≤40 years old, undergraduate students, intermediate professional titles, and doctors. Twenty-one medical workers had received formal training in aeromedical rescue skills, 77 had received short-term theoretical and practical training, 123 had participated in short-term simulation exercises, and 93 had participated in aeromedical rescue activities. There was a statistically significant difference among the scores of first aid knowledge, aviation flight knowledge, and aeromedical rescue knowledge (9.34±0.35 vs. 4.65±2.91 vs. 3.28±3.44; F=15.048, P=0.001). There were statistically significant differences between first aid knowledge and aviation flight knowledge, as well as between first aid knowledge and aeromedical rescue knowledge (P<0.05). There was no statistically significant difference between aviation flight knowledge and aeromedical medical rescue knowledge (P>0.05). Conclusion There is an urgent demand for aviation rescue in medical institutions in Qinling-Daba mountainous area, and there is a shortage of professionals, so it is necessary to strengthen the training, rehearsal and practice of aeromedical rescue.
The Technical Specifications for Evaluation of Age-friendly Medical Institutions is a set of evaluation standard for admittance of age-friendly medical institutions. The standard was prepared by Beijing Geriatric Hospital, organized by Beijing Municipal Health Commission and issued by Beijing Municipal Bureau of Market Supervision and Administration in 2021. The standard evaluates the construction of age-friendly medical institutions in four profiles, involving age-friendly culture, age-friendly management, age-friendly service, and age-friendly environment, and standardizes the specific links in the medical institutions evaluation and acceptance, displaying important guiding value for construction activities of national age-friendly medical institutions.
Objective To explore the impact of Diagnosis-Intervention Packet (DIP) reform on the operation of pilot county-level hospital, analyze the challenges that hospitals may face in DIP reform, and propose strategies to adapt to the reform. Methods The settlement list data of inpatients insured by medical insurance for 2022 from a county-level tertiary public hospital in Jiuquan City, Gansu Province were collected, where DIP was planned to operate. The DIP payment was simulated, and the operational status of the hospital and departments after implementing DIP reform was analyzed based on enrollment status, cost deviation, length of stay, hospitalization expenses, and DIP payment as relevant indicators. Results Under the implementation of DIP payment, the overall enrollment rate of the hospital was 98.1%, including 85.4% in the core group, 7.0% in the comprehensive group, and 7.6% in the grassroots group. Normal costs accounted for 88.9%, deviation costs accounted for 11.1%, with high magnification cases accounting for 1.9% and low magnification cases accounting for 9.2%. The payment standard for all cases included in the hospital according to DIP was 15.464 million yuan, the total amount paid by the pooling fund was 19.986 million yuan, and the difference between DIP payment and payment by project was –4.522 million yuan. Conclusion There is a significant difference in the medical insurance payments received by county-level hospitals after implementing DIP payment, and there is an urgent need to adapt to the DIP payment reform as soon as possible.
ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
Objective To explore the generalizability and implementation effectiveness of standardized clinical pathways of food for special medical purpose (FSMP). Methods From November 10, 2023 to November 30, 2023, a pilot study for the standardized clinical pathway of FSMP in medical institutions was conducted at Nanjing Drum Tower Hospital (the Affiliated Hospital of Nanjing University Medical School), Chenzhou First People’s Hospital, and the Second People’s Hospital of Yibin. The hospitalized patients using FSMP in these three hospitals were continuously included to analyze the feasibility and effectiveness of the pathway. Results A total of 99 patients were included. The overall effect evaluation of the pathway showed that the proportion of convenient medical order (96.9%), timely delivery (100.0%), and easy storage (96.9%) were relatively high. The proportion of patients with good compliance was 88.9%, the proportion of patients who achieved treatment goals was 51.5%, and the proportion of patients who suspended the use of FSMP in advance was 19.2%. The incidence of gastrointestinal complications, metabolic complications, and infectious complications in patients were relatively low (<30%), and the median (lower quartile, upper quartile) satisfaction scores for patients, family members, and nurses were all 9.0 (8.0, 10.0) points. There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different prescribing personnel (P>0.05). There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different nutritional support methods (P>0.05). Conclusions The FSMP clinical pathway pilot has performed well in terms of convenience, compliance, satisfaction, with a low incidence of complications. The pathway is effective and safe, and can be widely applied.
Objective To describe the range of Public-private partnerships (PPP) in the provision of healthcare services, and how the authors have assessed these partnerships. Methods We searched 19 international electronic databases and 3 grey literature databases up to September 2008. Nine websites of relevant organizations and Google were searched for any missing information. Search terms were determined by both health policy experts and search specialists after repeated discussion and pilot searching. Our inclusion criteria were research papers that reported describing or evaluating any public-private partnerships in provision of healthcare services. Two reviewers independently screened, appraised and extracted the data, and disagreements were resolved by discussion or by consulting a third researcher. The studies that scored A or B in terms of quality assessment were analyzed. Results Of the 38 studies included in the analysis, 22 studies aimed to describe strategies, while 16 ones were to evaluate the effectiveness of strategies. The targeted populations were tuberculosis patients, AIDS patients, psychiatric patients, community residents and children. Six partnership mechanisms were categorized: ① formal/ informal contract; ② working group committee; ③ supervision, training and regulation; ④ support and subsidizing; ⑤ integration of health care organizations; and ⑥ co-location. Most of the studies evaluating effectiveness were observational studies. Only three studies were comparative studies, pre- and post- intervention. The results of the most evaluation studies showed that PPP had positive impact on service provision, while it also had some problems and challenges. Conclusion Current studies show that PPP could improve health service provisions to some extent. There are limitations in the range of health services and the depth of the studies, especially evaluation studies that lack rigorous design. However, people should be cautious when they try to learn from the experience from internationally successful PPPs and consider the Chinese context, as the effect of PPP is closely associated with the relevant implementation context.
Objective To construct an index system for the rational use of foods for special medical purposes (FSMP) by medical institutions. Methods Based on the literature review and the survey of 300 medical institutions, we developed a questionnaire for expert consultation and conducted two rounds of expert consultation using Delphi method and consensus meeting method to determine the final index system for the rational use of FSMP in medical institutions. Results After two rounds of expert consultation and expert consensus conference meetings, it was finally determined that medical institutions should reasonably use the FSMP comprehensive evaluation index system, including 3 first-level catalog indicators, 17 second-level catalog indicators, and 13 third-level catalog indicators. Conclusion This index system can help promote the rationalization and standardization of FSMP clinical application in medical institutions in China and improve the quality of clinical nutrition care.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.
Objective To provide some theoretical reference and practical guidance for the medical risk management and early warning of private medical institutions, and to improve the service level and social reputation of private medical institutions. Methods China National Knowledge Infrastructure, Wanfang, VIP, and Web of Science database were searched for literature on medical risk management of private medical institutions published from the dates of establishment of databases to July 31, 2023. CiteSpace software was used for analysis. The aspects of literature number, literature source, author-institution cooperation, keyword co-occurrence, keyword clustering and burst were analyzed. Results A total of 2 635 literature were detected. Among them, there were 1446 articles in Chinese and 1189 articles in English. Although domestic research started late, it covered a wide range of disciplines and research fields. The Chinese literature showed a growth trend in the medium term, but the growth trend was slower than that of foreign literature. At the same time, the cooperation network of foreign authors and institutions was closer than that of domestic ones, and the overall development was relatively insufficient. There were differences between domestic and foreign research hotspots in terms of disciplines and research contents. Conclusions It is necessary to strengthen the theoretical and practical research on medical risk management of private medical institutions, and accelerate the construction of risk management and early warning models suitable for the characteristics of private medical institutions in China. In the future, the emerging research fields such as moral hazard, emergency and internal control need to be deepened and expanded.