Health Care In Shanghai Research Articles

Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study

ObjectivesTo develop person-centered integrated care quality indicators for home health agencies in Shanghai, China. DesignThe study combined the Delphi method and the analytic hierarchy process (AHP). Material and methodsThe Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care. ResultsThe authority coefficient (Cr) in this study was 0.835. The coordination degree of experts’ opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators. ConclusionsA person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.

Non-emergency medical transportation practice in Shanghai

Background: To describe the current landscape of non-emergency medical transportation (NEMT) services in China’s mainland, and analyze information obtained from a private NEMT company in Shanghai. Methods: With regards to the NEMT environment in China’s mainland, we collected relevant NEMT policies from the websites of local Health Commissions, and collected business operating data from a Chinese enterprise information query tool, Qichacha. With regards to NEMT service in Shanghai, we analyzed operating data from 3426 trips by a professional NEMT company. Descriptive statistics were used to explain the characteristics of NEMT trips, and log-linear analyses were performed to compare the trips inside Shanghai with trips to/from other areas. Results: Of the 3426 trips in this study, there were 2962 trips inside Shanghai (86.5%) and 464 trips to/from other areas (13.5%), and the number of trips to/from each province was related to the distance to Shanghai. When comparing transportation types between trips inside Shanghai and to/from other areas, there was a significant difference (χ2=144.87, p&lt;0.001), with a significantly larger proportion of trips for discharge to/from other areas, and a significantly larger proportion of referrals in trips inside Shanghai. Over 50% of trips were to orthopedics-featured class A tertiary hospitals. Discussion and Conclusion: To lower the NEMT service costs and bring benefit to patients with a broader spectrum of diseases, medical insurance could completely or partially cover NEMT services, and companies could initiate rideshare services. Shanghai is an attractive place for patients, with the highest level of healthcare resources. Transportation combining high-speed trains and NEMT vehicles ensures patients who live further away can access health care in Shanghai.

Non-emergency medical transportation practice in Shanghai

Background: To describe the current landscape of non-emergency medical transportation (NEMT) services in China’s mainland, and analyze information obtained from a private NEMT company in Shanghai. Methods: With regards to the NEMT environment in China’s mainland, we collected relevant NEMT policies from the websites of local Health Commissions, and collected business operating data from a Chinese enterprise information query tool, Qichacha. With regards to NEMT service in Shanghai, we analyzed operating data from 3426 trips by a professional NEMT company. Descriptive statistics were used to explain the characteristics of NEMT trips, and log-linear analyses were performed to compare the trips inside Shanghai with trips to/from other areas. Results: Of the 3426 trips in this study, there were 2962 trips inside Shanghai (86.5%) and 464 trips to/from other areas (13.5%), and the number of trips to/from each province was related to the distance to Shanghai. When comparing transportation types between trips inside Shanghai and to/from other areas, there was a significant difference (χ2=144.87, p&lt;0.001), with a significantly larger proportion of trips for discharge to/from other areas, and a significantly larger proportion of referrals in trips inside Shanghai. Over 50% of trips were to orthopedics-featured class A tertiary hospitals. Discussion and Conclusion: To lower the NEMT service costs and bring benefit to patients with a broader spectrum of diseases, medical insurance could completely or partially cover NEMT services, and companies could initiate rideshare services. Shanghai is an attractive place for patients, with the highest level of healthcare resources. Transportation combining high-speed trains and NEMT vehicles ensures patients who live further away can access health care in Shanghai.

The ecology of medical care in Shanghai

BackgroundTo better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai.MethodsThe data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence.ResultsThis paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery.ConclusionsAge is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.

Medical Education Reform in China: The Shanghai Medical Training Model.

Medical Education Reform in China: The Shanghai Medical Training Model.

Improved gray neural network model for healthcare waste recycling forecasting

This paper addresses the problem of predicting multiple factors of health care waste recycling for promoting the construction of ecological civilization against the background of a comprehensive implementation of the “healthy China” strategy. In this paper, an improved gray neural network model is developed for recovery prediction. The one order single variable gray model and triple exponential smoothing are used for predicting the factors affecting recovery. A particle swarm optimization optimized back propagation (BP) neural network is trained by selecting higher-prediction results by precision comparison, and the trained BP neural network is used to predict the recovery of health care waste. Taking Shanghai as an example, this paper uses the actual data about Shanghai health care waste during 2013–2017, and the historical data of 11 factors affecting the recovery amount; these are used for empirical analysis. The results of this research show that the gray neural network performs better than other benchmark models and traditional predictive models. An accurate prediction of the amount of health care waste recovered can help decision-makers to implement recycling, and can serve as a reference for governmental departments, helping them to formulate relevant laws and regulations, develop a variety of tasks, and rationally allocate resources.

Demands for perimenopausal health care in women aged 40 to 60 years-a hospital-based cross-sectional study in Shanghai, China.

The aim of the study was to describe the major complaints of menopausal symptoms among middle-aged women who initiated healthcare seeking for menopausal symptoms and to understand the factors influencing women's decisions to seek perimenopausal health care in Shanghai, China. A cross-sectional study was performed in five hospitals in Shanghai. Women aged 40 to 60 years at their first visit to the perimenopausal outpatient departments/clinics were investigated in person over a 3-month period. Information on sociodemographics, menopausal symptoms, and experiences in seeking perimenopausal health care was collected using a structured questionnaire. Menopausal symptoms were assessed with the modified Kupperman Menopausal Index (mKMI). A total of 316 women were enrolled in the study, with an average age of 50.5 years (SD: 5.1 y). The prevalence of menopausal syndrome (mKMI >6 points) was 80%, with 7% of the cases being severe. The top five reported symptoms were hot flushes/sweating (62%), fatigue (54%), sleep disturbance (51%), mood swings (40%), and joint/muscle pain (40%). The median interval between symptom occurrence and seeking perimenopausal health care was 5.0 months (IQR: 2.0-23.3 mo). Cox regression analysis revealed that older age, no health insurance, employment, multiple symptoms, sleep disturbance, urinary incontinence, and visits to nonspecialized departments were significantly associated with a longer delay in seeking perimenopausal health services (P < 0.05). The prevalence of menopausal syndrome was relatively high among 40- to 60-year-old women who initiated healthcare seeking in Shanghai. Months of delay occurred before they sought perimenopausal health services. The delay was related to age, the nature and number of symptoms, working status, and health insurance. Improvement of the menopausal health knowledge in Chinese middle-aged women may lead to more timely healthcare seeking. Professional and accessible perimenopausal health services are in high demand in Shanghai.

Location Planning Problem of Service Centers for Sustainable Home Healthcare: Evidence from the Empirical Analysis of Shanghai

It is of theoretical and practical significance to understand what factors influence the sustainable development of home healthcare services in China. Based on a face-to-face survey, we find that the location planning, which is decisive for the improvement of patient satisfaction, can effectively reduce the risks, as well as the costs of redundant construction and re-construction of service centers for home healthcare and, thus, helps ensure the sustainability of health and the environment. The purposes of this paper are to investigate the existing problem of home healthcare in Shanghai and to find the optimum location planning scheme under several realistic constraints. By considering differentiated services provided by the medical staff at different levels and the degrees of patient satisfaction, a mixed integer programming model is built to minimize the total medical cost. The IBM ILOGCPLEX is used to solve the above model. Finally, a case study of Putuo district in Shanghai is conducted to validate the proposed model and methodology. Results indicate that the model used in this paper can effectively reduce the total medical cost and enhance the medical sustainability, and therefore, the results of the model can be used as a reference for decision makers on the location planning problem of home healthcare services in China.

Fecal calprotectin concentrations in healthy children aged 1-18 months.

ObjectiveFecal calprotectin (FC) is an established biomarker of gut inflammation. The aim of this study was to evaluate FC concentrations in healthy children between 1 and 18 months of age.MethodsHealthy children aged 1-18 months were enrolled in this study at the Department of Children's Health Care in Shanghai, China. Children’s stool samples were collected and analyzed, and FC concentration was determined using a commercially available enzyme-linked immunosorbent assay (ELISA). The children's weights and lengths were measured. Parents were asked to complete a brief questionnaire regarding several clinical and sociodemographic factors.ResultsThe FC concentrations were unevenly distributed; the median FC concentration was 174.3 μg/g (range: 6.0-1097.7 μg/g) or 2.241 log10 μg/g (range: 0.775-3.041 log10 μg/g) for all 288 children. The children were divided into several age groups: 1-3 months, 3-6 months, 6-9 months, 9-12 months and 12-18 months. The median FC concentrations for these age groups were 375.2 μg/g (2.574 log10 μg/g), 217.9 μg/g (2.338 log10 μg/g), 127.7 μg/g (2.106 log10 μg/g), 96.1 μg/g (1.983 log10 μg/g) and 104.2 μg/g (2.016 log10 μg/g), respectively. A significant correlation between age and FC concentration was found (r=-0.490, p<0.001). A simple correlation analysis of weight-for-length Z-scores or weight-for-age Z-scores vs. FC concentrations showed that these variables were negatively correlated (Spearman’s rho=-0.287, p<0.001; Spearman’s rho=-0.243, p<0.001, respectively).ConclusionsThe FC levels of children aged 1-18 months exhibit a downward trend with increasing age and are greater than the normal levels observed in healthy adults. In healthy children aged <6 months, FC levels are high. In children aged 6-18 months, FC concentrations are relatively low but are still higher than those of children aged >4 years.

Shanghai rising: health improvements as measured by avoidable mortality since 2000.

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai's healthcare system by analyzing "Avoidable Mortality" (AM) - deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000-10 and compare Shanghai's experience to other mega-city regions - New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai's population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai's establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities - both in China and worldwide - can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.

Successes and challenges of Shanghai's healthcare reforms

Successes and challenges of Shanghai's healthcare reforms

What should the government do regarding health policy-making to develop community health care in Shanghai?

What should the government do regarding health policy-making to develop community health care in Shanghai?

The overall progress and challenges of Shanghai health care for the last 30 years since reform and opening up

Marked by the Third Plenary Session of the Eleventh Central Committee of the CPC, Shanghai health care started a journey of reform and opening up as with other sectors. This essay reviews various stages Shanghai health care experienced and the achievements for the last 30 years since reform and opening up, and analyzes the challenges Shanghai health care faces currently. On this basis, the essay summaries the experiences and lessons learned from Shanghai health care reform and development. Key words: 30 years since reform and opening up; Shanghai; Health care; Achievements; Challenges

Grid-based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai

Due to the rapid growth of Shanghai city to 20 million residents, the balance between healthcare supply and demand has become an important issue. The local government hopes to ameliorate this problem by developing an image-enabled electronic healthcare record (EHR) sharing mechanism between certain hospitals. This system is designed to enable healthcare collaboration and reduce healthcare costs by allowing review of prior examination data obtained at other hospitals. Here, we present a design method and implementation solution of image-enabled EHRs (i-EHRs) and describe the implementation of i-EHRs in four hospitals and one regional healthcare information center, as well as their preliminary operating results. We designed the i-EHRs with service-oriented architecture (SOA) and combined the grid-based image management and distribution capability, which are compliant with IHE XDS-I integration profile. There are seven major components and common services included in the i-EHRs. In order to achieve quick response for image retrieving in low-bandwidth network environments, we use a JPEG2000 interactive protocol and progressive display technique to transmit images from a Grid Agent as Imaging Source Actor to the PACS workstation as Imaging Consumer Actor. The first phase of pilot testing of our image-enabled EHR was implemented in the Zhabei district of Shanghai for imaging document sharing and collaborative diagnostic purposes. The pilot testing began in October 2009; there have been more than 50 examinations daily transferred between the City North Hospital and the three community hospitals for collaborative diagnosis. The feedback from users at all hospitals is very positive, with respondents stating the system to be easy to use and reporting no interference with their normal radiology diagnostic operation. The i-EHR system can provide event-driven automatic image delivery for collaborative imaging diagnosis across multiple hospitals based on work flow requirements. This project demonstrated that the grid-based implementation of IHE XDS-I for image-enabled EHR could scale effectively to serve a regional healthcare solution with collaborative imaging services. The feedback from users of community hospitals and large hospital is very positive.

COST CONTAINMENT AND ACCESS TO CARE: THE SHANGHAI HEALTH CARE FINANCING MODEL

The medical savings account (MSA) model of health care financing is viewed as a health care cost containment strategy. Yet, health care expenditure in Shanghai has increased sharply since the adoption of the MSA system. This paper looks into the health care reforms in Shanghai, especially since the introduction of the MSA scheme. From the Labor Insurance Scheme and Government Insurance Scheme to the Medical Savings Account scheme, ordinary Shanghai residents have not benefited from the most recent health care reforms. They have found medical care much less affordable. Disparity in access to health care access has become more evident than ever. Meanwhile, health care cost has increased sharply. China has benefited from an emphasis on prevention and primary care, but the government's recent policies give a high priority to catastrophic disease. This is not a cost-effective approach. Shanghai's health care system needs to break socioeconomic class boundaries if it is to construct a harmonious society. Shanghai's decision makers and various stakeholders have the resources and wisdom to face the challenge.

The Shanghai case: a qualitative evaluation of community health reform in response to the challenge of population ageing

Shanghai's health care system is facing a serious challenge of an ageing population, as 14% of its 17 million residents are 65 or older. In 2000, a community health reform was implemented to provide comprehensive and continuous primary care to community residents with a focus on seniors. The study employed the theoretical framework of examining primary care in terms of the constellation of its four unique elements (first contact, comprehensiveness, longitudinality and coordination) and three healthcare components (structure, process and outcome). The study aimed to evaluate the extent to which the reform has achieved its process goals and how the organizational context influenced the level of implementation. In-depth interviews with 25 health providers, 15 seniors and four community leaders were carried out. The study found that the Shanghai community health reform has improved the structure and process of primary care regarding first contact, comprehensiveness and longitunality. However, the reform is constrained by structural barriers on seniors' financial access to resources and the capacity of primary care providers. The previous organization system also constrains the reform in CHCs financing and administration. The Shanghai case illustrates that a broad societal view has to be taken when analysing health reforms, which requires the involvement of multiple sectors including the government, health providers and health consumers.