Different Levels Of Medical Institutions Research Articles

Spatial Allocation Rationality Analysis of Medical Resources Based on Multi-Source Data: Case Study of Taiyuan, China.

Reasonably allocating medical resources can effsectively optimize the utilization efficiency of such resources. This paper took Taiyuan City as an example and established a model to evaluate the rationality of medical resource spatial allocation, incorporating two key dimensions: the spatial layout and the supply and demand of medical resources. In terms of the spatial layout, three indexes were included: Firstly, the service coverage rates of different levels of medical institutions, based on residents' medical orientations, were calculated using network analysis methods. Secondly, the Huff-2SFCA method was improved to calculate the accessibility of medical resources for four different modes of transportation. Then, the Health Resource Agglomeration Degree (HRAD) and Population Agglomeration Degree (PAD) were used to quantify the equity of medical resources. In terms of the supply and demand of medical resources, one index was included: the supply-demand ratio of medical resources during sudden public health events, which was calculated using the number of beds per thousand people as an indicator. These four indexes were weighted using the entropy weight method to obtain the rationality grade of medical resource spatial allocation in Taiyuan City. The study found that the rationality evaluation level of medical resource allocation in the central urban area of Taiyuan City followed a "concentrically decreasing" pattern. The rating ranged from "very reasonable" to "less reasonable", with the area of each level expanding gradually. The areas rated within the top two categories only accounted for 19.92% of the study area, while the area rated as "less reasonable" occupied 38.73% of the total area. These results indicate that the model accounted for residents' travel for various medical orientations and the availability of resources during public health emergencies. It considered both the spatial layout and supply and demand of medical resources, offering recommendations for the precise allocation of urban medical resources.

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

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. 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. 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. 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.

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

BackgroundThe construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called “Diagnostic Intervention Package” (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities.MethodsThis study takes Tai’an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels.ResultsThe results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity.ConclusionThe DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study.

Human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (MTB) co-infection has become a pressing global public health problem. Although tuberculosis (TB) is both treatable and curable, it has been exacerbated by the HIV/acquired immune deficiency syndrome (AIDS) epidemic. HIV-MTB co-infected patients have a variety of disease-specific, and treatment-related factors that can adversely affect their treatment outcomes. This study was conducted to assess the outcomes of TB treatment and its associated factors among HIV-MTB co-infected patients in Sichuan, Southwest China. A retrospective study was performed on HIV-MTB co-infected patients who were diagnosed and registered in TB designated hospitals in Sichuan from January 1, 2016, to December 31, 2020. Data were collected from patients' electronic medical records regarding their demographic, clinical, and social support information, and categorical data, such as sex, were reported using numbers and percentages. χ2 and t-tests were conducted to compare groups in relation to different levels of medical institutions. A binary logistic regression model was used to identify the factors associated with unsuccessful TB treatment outcomes. For logistic regression analysis performed using an α of 0.05, odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for various risk factors. A total of 3677 registered HIV-MTB co-infected patients were enrolled. After adjusting for other variables, male, advanced age, receiving TB treatment at the municipal medical institution, being diagnosed with external pulmonary TB, referral or tracing, being sputum smear positive, not initiating antiretroviral therapy (ART) and not using fixed-dose combinations were the main risk factors for treatment failure of HIV-MTB co-infected patients in Sichuan province. Sex, age, hospital level, patient source, other diagnostic factors (e.g., sputum smear results, anatomical site of TB), and factors of therapeutic schemes (e.g., antiretroviral therapy, fixed-dose combinations) may serve as risk factors to estimate the likely treatment outcome of HIV-TB co-infection.

Research on the Equity and Optimal Allocation of Basic Medical Services in Guangzhou in the Context of COVID-19.

Optimizing the allocation of basic medical services and ensuring their equity are necessary to improve the ability to respond to public health emergencies and promote health equity in the context of COVID-19. This study aims to analyze the equity of Guangzhou's basic medical service and identify areas where health resources are relatively scarce. The spatial distribution and patterns of basic medical services were analyzed using kernel density analysis and standard deviation ellipse. The equity was analyzed using the Gini coefficient and Lorenz curve in terms of population and geographical area, respectively. Considering the medical demand and supply sides, the Gaussian two-step floating catchment area method was used to analyze the accessibility to different levels of medical institutions. The kernel density analysis and standard deviation ellipse showed that the spatial distribution of medical and health resources in Guangzhou is unevenly distributed, and high-level hospitals and medical resources are mainly concentrated in the centrum. From the perspective of population, Guangzhou's medical equity is generally reasonable. The accessibility of medical institutions differs with different levels, and the tertiary medical institutions have the best accessibility, while the unclassified, primary, and secondary medical institutions generally have lower accessibility. The accessibility of districts in Guangzhou varies greatly. Areas in the center are most accessible to basic medical services, while accessibility in outskirt areas has gradually decreased. Conclusion: The quantity of per capita medical and health resources in Guangzhou, as evidenced by basic medical services, is sufficient, but the spatial distribution is unequal. The developed city center enjoys more adequate healthcare resources than the distant suburbs. Primary healthcare should be built, especially in distant suburbs, to strengthen basic medical service equity in Guangzhou.

The severity of adverse drug reactions and their influencing factors based on the ADR monitoring center of Henan Province

Adverse drug reactions (ADRs) may be a serious public health problem and have received widespread attention in recent years. This study has analyzed the factors leading to the occurrence of serious ADRs (SADRs), determined the factors affecting the prognosis of patients with severe adverse reactions at different levels of medical institutions, and finally made corresponding recommendations for the monitoring, prevention, and treatment of SADRs. We used descriptive analysis and chi-square test to analyze the year, age, gender, proportion of SADRs, and the results of the ADRs in the report. Use the logistic regression to analyze the factors affecting the prognosis of SADRs in different levels of medical institutions. A total of 387 642 people’s 394 037 ADRs were collected from the Henan Provincial Adverse Drug Reaction Monitoring Center from 2016 to 2020. Among them 35 742 cases of serious ADRs (9.1%), 96.1% were eventually relieved or cured, but 39 cases of SADRs caused death. The main causes of death included hemorrhages, organ failure, and allergies. Age, number of medication and illnesses, level of medical institution, history of adverse reactions, and type and method of medication were all factors that affected the severity of ADR. The prognosis of SADRs is worse than normal ADRs. The ADRs in autumn and winter and new adverse reactions are unique risk factors found in this study. The elderly and patients with multiple diseases or taking multiple drugs should pay attention to their adverse reactions. They should be closely observed within a week after taking the medicine. The supervision of patients with a history of allergies and new adverse reactions should be strengthened by primary medical institutions, and in nonprimary medical institutions should paid attention with past medical histories, and use imported drugs and biological agents with caution to ensure the safety and health of patients.

Options for Care of Elderly Inpatients With Chronic Diseases: Analysis of Distribution and Factors Influencing Use of Care in Shanghai, China.

Background: China's ability to provide sufficient healthcare for an elderly population with chronic diseases has become a challenge because of poor utilization of different levels of medical institutions. We aimed to explore the characteristics and factors influencing patient choices and the resulting utilization of different levels of public medical institutions among elderly inpatients with chronic diseases.Methods: Data were collected from the Information Center of the Health and Family Planning Commission of Pudong New Area in Shanghai from 2013 to 2016. A cross-sectional study using multinomial logistic regression analysis was performed to find the factors influencing use of care. Records of patients were identified from electronic health records from public medical institutions.Results: There were 95,445 elderly inpatients with chronic diseases in public medical institutions, 17.78% in community health centers, 68.44% in secondary hospitals, and 13.78% in tertiary hospitals. Compared with those over 80 years old, the 60–69 age group showed a preference for secondary hospitals (OR = 2.980, P < 0.001) and tertiary hospitals (OR = 4.497, P < 0.001), a trend also observed in the 70–79 age group (OR = 1.353, P < 0.001; OR = 1.673, P < 0.001). Compared with those using urban employee basic medical insurance, inpatients using urban resident basic medical insurance were less likely to visit secondary hospitals than community health centers (OR = 0.237, P < 0.001) or tertiary hospitals (OR = 0.293, P < 0.001). Compared with those inpatients who were married, inpatients who were widowed were less likely to go to secondary hospitals (OR = 0.391, P < 0.001) or tertiary hospitals (OR = 0.045, P < 0.001) than community health centers.Conclusions: The utilization of different levels of medical institutions by elderly people is not well-suited to the respective functions of these medical institutions. Most care services should be provided by community health centers, but our findings indicate that elderly people are more inclined to seek inpatient care at secondary hospitals and tertiary hospitals with some variation based on the patients' sex, age, medical insurance, expenses, and expected length of stay.

The effect of the integrated delivery system on managing hypertension in rural areas of China.

Since the implementation of the new medical reform in 2009, China has established and improved a series of medical security systems, established medical confederations based on four categories, and promoted the operation of the hierarchical diagnosis and treatment model. The purpose of this study is to analyze the effects of the matrix chronic diseases management platform developed from the integrated delivery system. To evaluate the effects of the matrix chronic diseases management platform developed from the integrated delivery system in China on expenses, medical seeking behaviors, compensation, and degree of satisfaction in hypertensive patients. A longitudinal and retrospective study was performed to investigate medical expenses, actual compensation ratios, medical behaviors, and the degree of satisfaction across different levels of medical institutions in hypertensive patients. A total of 7,037 patients with hypertension aged 36-99 from Zhili Town Health Center were selected based on the diagnostic criteria of the Guidelines for Prevention and Treatment of Hypertension in China. Data was collected from the hospital's database and systems, and questionnaires were distributed to patients who attended the Department of Cardiology. Outcomes included inspection and drug expenses in the outpatient and inpatient departments, actual reimbursement ratios, number of visits across different levels of hospitals, expenditure per visit, medical behaviors, complications of patients, and the degree of satisfaction of both patients and doctors in primary hospitals. The average cost for hypertensive patients was shown to be increasing year by year in the outpatient and inpatient departments. The number of patients in tertiary hospitals decreased significantly, while the number of patients in community hospitals (primary hospitals) increased, and the number of patients in secondary hospitals has remained almost unchanged. Furthermore, expenses per visit in hospitals across all levels also decreased during the study period. The primary complications of hypertension were cerebrovascular disease and coronary heart disease, which showed a slightly increasing trend. The degree of satisfaction of patients and doctors in primary hospitals was relatively high, and rose from 2014 to 2019. The matrix chronic diseases management platform developed from the integrated delivery system built in Huzhou No.1 Hospital had a positive effect on improving the reimbursement and satisfaction of patients with hypertension.

Tuberculosis infection and epidemiological characteristics in Haidian District, Beijing, 2005\u20132018

BackgroundThis study was aimed to investigate the epidemiological characteristic of pulmonary tuberculosis (PTB) in Haidian District, Beijing from 2005 to 2018 and to provide suggestions for controlling tuberculosis (TB) development.MethodsEpidemiological data about TB were obtained by the Infectious Disease Reporting System at different levels of medical institutions in Haidian District of Beijing from 2005 to 2018. The epidemiological methods combined with χ2 test were used to analyze the distribution of TB in population, time, region and TB diagnosis.ResultsIn total, 14,449 cases of TB patients were reported in Haidian District from 2005 to 2018 and the average annual morbidity was 31.67/10,000. Of the total cases, housework and unemployed people (20.73%; 2996/14,449) accounted for the highest proportion of occupational distribution, followed by students, accounting for 17.18% (2482/14,449). 2433 patients with the age of 65 years and over accounting for 16.83% (2433/14,449); Laboratory confirmed diagnosis of TB was 26.60% and the diagnostic delays accounted for 54.96%.ConclusionsFrom 2005 to 2018, TB incidence was falling gradually in Haidian District. However, particular attention should be paid to the elderly and student groups, and the policy publicity and education should be strengthened to reduce the diagnosis delay of TB.

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

BackgroundThe National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs.MethodsWe conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-for-performance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not.ResultsA total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78 ~ 4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.50 ~ 3.83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31 ~ 0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%).ConclusionsTo better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.

Spatial Equity of Multilevel Healthcare in the Metropolis of Chengdu, China: A New Assessment Approach.

The spatial equity of the healthcare system is an important factor in assessing how the different medical service demands of residents are met by different levels of medical institutions. However, previous studies have not paid sufficient attention to multilevel healthcare accessibility based on both the divergence of hierarchical healthcare supplies and variations in residents’ behavioral preferences for different types of healthcare. This study aims to propose a demand-driven “2R grid-to-level” (2R-GTL) method of analyzing the spatial equity in access to a multilevel healthcare system in Chengdu. Gridded populations, real-time travel distances and residents’ spatial behavioral preferences were used to generate a dynamic and accurate healthcare accessibility assessment. The results indicate that significant differences exist in the spatial accessibility to different levels of healthcare. Approximately 90% of the total population living in 57% of the total area in the city can access all three levels of healthcare within an acceptable travel distance, whereas multilevel healthcare shortage zones cover 42% of the total area and 12% of the population. A lack of primary healthcare is the most serious problem in these healthcare shortage zones. These results support the systematic monitoring of multilevel healthcare accessibility by decision-makers. The method proposed in this research could be improved by introducing nonspatial factors, private healthcare providers and other cultural contexts and time periods.

Analysis of current situation and influencing factor of medical disputes among different levels of medical institutions based on the game theory in Xiamen of China: A cross-sectional survey.

With continuous development of the Chinese health care system, the doctor–patient relationship is increasingly tense in recent years. China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This study aimed to help to theorize the doctor–patient relationship based on the game theory, and analyze the current situation and influencing factors for medical disputes among different hospitalsA total of 17 hospitals were randomly selected in Xiamen city, including 8 tertiary hospitals and 9 secondary hospitals. All medical dispute cases, between 2012 and 2014, were collected through questionnaires. Multiple logistic regression analyses were used to identify risk factors associated with medical disputes.In total, 896 medical dispute cases happened in 2012 to 2014, 733 (81.8%) of which occurred in tertiary hospitals. Medical disputes mainly were reported in the departments of obstetrics and gynecology (24.9%). The main causation of medical disputes was improper communication (24.0%) in tertiary hospitals and lower therapeutic skills (43.7%) in secondary hospitals, respectively. The negotiated rate (91.4%) in secondary hospitals was significantly higher than the tertiary hospitals (54.8%). The patients’ age, occupation and the doctor's medical location, professional title were the main risk factors for the occurrence of medical violence.Relationships between doctors and patients have become worse increasingly, whereas doctor–patient disputes or conflicts and their compensation have aggrandized year by year. The game relationship of doctor–patient is noncooperation, dynamic, and incomplete information game, and the advantages of cooperation are far greater than the competition between doctors and patients. Therefore, we need to take targeted measures to prevent and control the medical disputes by establishing a harmonious doctor–patient relationship in different levels of medical institutions.

Can Township-County Readmission (TCR) lower Costs of County Inpatient compared with Single County Inpatient?

Introduction: China has been trying to enhance service collaboration between different levels of medical institutions to lower patient flow and cut down medical expenditure. However, the outcome was poor. Township-County Readmission (TCR) means a patient is firstly admitted to a township hospital and then a county hospital within 30 days for the same disease. Our aim is to explore whether TCR can lower patients’ costs in county hospitals. Method: This study was carried out in Qianjiang District, China. Firstly, we selected out TCR patients from the database. Then, we picked out patients who was admitted to county hospitals less than 30 days before TCR (CTCR patients) or after TCR (TCRC patients) for respiratory system disease as our objects. Finally, we compare the former expenditure in county hospital with the latter for TCRC patients and CTCR patients by paired-t test. Result: 74 TCRC patients and 40 CTCR patients of respiratory system disease were screened out. The average of former expenditure in county hospital for TCRC patients was 651.6$, and the latter was 564.0$ (t=-0.467, P=0.643). The average of former expenditure in county hospital for CTCR patients was 594.4$, and the latter was 653.8$ (t=-0.963P=0.339). Discussion: The difference between costs of single county inpatient and costs of county inpatient in TCR is not significant, which means that service provided by township hospitals during TCR is ineffective. Conclusion: Service collaboration between township hospitals and county hospitals didn’t achieve the real continuity as wanted, which had enlarged waste and the inefficiency of supply system. Lessons learned: Cutting down the inefficiency during referral is a key task for service collaboration. At least, the patients should not pay for this. Limitation: The sample size was too small and disease severity was not included into the study. Suggestions for future research: More samples should be included. Disease severity needs to be better controlled.

Surgery in China.

It is an honor, through the<i>Archives of Surgery</i>, to introduce recent Chinese metamorphoses in surgery, covering personal resources and training, the latest achievements in surgery, and sources of scientific funds. Four trends in each of these categories will be discussed in this article. <h3>MEDICAL EDUCATION</h3> After 10 years of "Cultural Revolution" disasters, the rapid increase in the number of medical schools, colleges, and universities has been phenomenal. To date, three different levels of medical institutions compose a nationwide medical education network. <h3>Junior Medical Schools</h3> The principal responsibility of junior medical schools is to carry out a 3-year education to provide students for public health care at hospitals in townships, counties, and city districts. These students supplement the nurses, paramedics, technicians, and special technologists working in local provincial hospitals and research laboratories in medical universities and research institutions. Five hundred fifty junior medical schools cover whole counties and cities in