Hospital Alliances Research Articles

Inciting maintenance: Tiered institutional work during value-based payment reform in oncology

Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups’ institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned.

Coordination schemes for resource reallocation and patient transfer in hospital alliance models

AbstractIn many countries, healthcare systems encounter the issue of imbalance between supply and demand in a hierarchical structure. The comprehensive hospitals, which possess more high‐quality resources, are often overwhelmed, while their counterparts, community hospitals, are often idle. To address this imbalance issue, certain payment schemes are generally considered effective in motivating comprehensive hospitals to divert patients downstream via resource transfer. In addition to two particular payment schemes, namely, patient payment (PP) and fee‐for‐capacity (FFC), this study also considers two hospital alliance models, the government‐led (GL‐type) and the hospital‐forged (HF‐type) alliance, for effectively overcoming the imbalance issue. Compared to the HF‐type alliance, in which each community hospital determines the price paid to the comprehensive hospital for transferring resources, the GL‐type alliance requires the payment price to be set by the regulator. Methodologically, this study devises a three‐stage sequential game to characterize the dynamics among the various entities, such as the regulator, the comprehensive hospital, the community hospitals, and the patients. Equilibrium results, in terms of the capacity sinking rate and patient transfer rate, are derived, and scheme and alliance performances are evaluated using various measurements, such as patient utility, and hospital and social welfare. We find that a direct payment scheme (FFC) under a centralized alliance model (GL‐type alliance) is more effective for both making decisions (about the patient transfer rate, capacity sinking rate, and payment price) and the performances (of each hospital's welfare, patient welfare, the waiting time per patient, and social welfare). Furthermore, our study examines the impacts of the alliance scale and finds that social welfare is first decreasing and then increasing with alliance scale. Therefore, it is suggested to establish either a one‐to‐one hospital alliance (consisting of a comprehensive and a community hospital) or a large‐scale (e.g., a comprehensive and 10 community hospitals) hospital alliance.

The Policy Alliance Between Hospitals and Debt Collection Agencies: Content Analysis of Public Comments on Regulations on Billing and Collections.

Significant debate persists about the obligations of nonprofit hospitals toward low-income patients. Many issues pertaining to this subject were discussed during the rulemaking process following the passage of the Affordable Care Act of 2010, which set forth rules for hospital billing and collection. In public comments, hospitals, debt collectors, and patient advocates debated what constituted "reasonable efforts" to determine whether a patient qualified for hospital financial assistance before resorting to extraordinary collection actions including lawsuits, wage garnishments, and adverse credit reporting. This study analyzes public comments to the proposed Internal Revenue Service rule on section 501(r)(6). After an initial review of the data, 5 commonly mentioned issues were identified. Respondents were organized into commenter types, and the opinion of each respondent to each issue was coded by 2 separate reviewers. Discrepancies between reviewer determinations were resolved by consensus during follow-up discussions. This analysis revealed a set of common concerns: whether reporting delinquent medical debt to credit bureaus and selling debt to third party buyers should be considered extraordinary collection actions; whether hospitals should be able to use presumptive eligibility to rule patients either eligible or ineligible for financial assistance; and whether hospitals should be held legally liable for the actions of third-party debt collectors. Hospitals and debt collection agencies were allied on most issues, particularly in their shared belief that reporting debt to credit bureaus and selling debt to third parties should not be tightly regulated. Patient advocacy organizations and hospitals had divergent opinions on most issues. The alliance of hospitals and debt collectors in advocating for fewer regulations around collections is part of a history of hospital lobbying to maintain tax-exemption with fewer charity care mandates. This alignment helps explain why third-party debt collection agencies, and aggressive collection tactics, have become commonplace in hospital billing.

The Effects of the Multi-Hospital Global Budget Payment on Medical Expenditure and Service Volume: The Evidence from Dangyang County, China.

Global budget payment is currently the prevailing payment strategy internationally. In China, the concept of multi-hospital global budget payment has been proposed with the aims of achieving cost control effects while also encouraging hospital collaboration and optimising allocation of healthcare resources. This study seeks to analyse the impact of multi-hospital global budget payment in China on healthcare expenditure and service volume. A retrospective comparative study was carried out in Dangyang County, China. The exposure cases were migrants who were not locally registered in the residence registration system. The study period encompassed January 1, 2017, to December 31, 2019. Including 3,246,164 outpatient medical records and 242,685 inpatient medical records. The key variables are medical expenditure and service volume indicators. Continuous variables were reported as mean and tested by t-test. We used interrupted time series analysis models to estimate the changes in the level and trend of each outcome measure after the policy. After the outpatient global budget payment reform, the monthly medical expenditure of the hospital alliance has transitioned from a discernible upward trajectory to a deceleration in the rate of growth. The outpatient volume in public and private high-level hospitals decreased at a rate of -419.26 person/month and -137.04 person/month, respectively. In terms of inpatient service volume, only private high-level hospitals reported a decrease, with a reduction rate of -15.38 individuals per month. This study presents new evidence demonstrating that the multi-hospital global budget payment can effectively control costs and promote resource reallocation when implemented jointly with hospital alliance policies. However, overly lenient budget caps risk counterproductive effects.

Distributed surgical scheduling across collaborating hospitals considering stochastic duration and emergency demand

In this paper, we address the need for distributed surgical scheduling across multiple hospitals and multiple days. We develop an effective ex-ante distributed schedule to determine elective service operation and elective patient assignment plan in a hospital alliance with the goal of minimizing the total expected cost considering possible realizations of treatment durations and emergency demands. The problem is formulated into a two-stage stochastic integer programming where uncertainty is characterized by a scenario set. Cancellations of scheduled elective patients and inter-hospital transfers of materialized emergency patients are explicitly modeled as second-stage decisions. To solve the problem, we propose an integer decomposition algorithm that incorporates a novel logic-based optimality cut along with a validity proof. Additionally, we introduce several enhancements to improve the algorithm. Through numerical experiments, we demonstrate that our proposed algorithm outperforms both the commercial solver and the existing integer decomposition algorithm for the proposed problem. It provides effective solutions that closely approach the best upper bounds achieved by the solver in less time, or even surpass the solver’s best upper bounds. Furthermore, we provide operational insights into other commonly-used scheduling approaches through numerical comparisons, including the strengths and limitations of the most common way of scheduling elective patients and two strategies for handling emergencies within a hospital alliance.

Introduction to the Second Special Issue: Acute, Intensive, and Residential Services

ABSTRACT This second special issue of Evidence Based Practice in Child and Adolescent Mental Health will focus on Acute, Intensive, and Residential Services (AIRS) for youth. Despite recent increases in AIRS research, there remains a shortage of applying, evaluating, and developing evidence-based treatments (EBTs) in these settings. In addition, since the publication of our first special issue, the American Academy of Pediatrics (AAP), Children’s Hospital Alliance (CHA), and American Academy of Child and Adolescent Psychiatry (AACAP) have issued a joint statement declaring the state of youth mental illness to be a national crisis, worsened by the COVID-19 pandemic (American Academy of Pediatrics, Children’s Hospital Association, & American Academy of Child and Adolescent Psychiatrists [AAP, CHA, & AACAP], 2021). The introduction to the special issue will highlight work being done in AIRS settings for youth around the country.

Analysis of Blockchain in the Healthcare Sector: Application and Issues

The emergence of blockchain technology makes it possible to address disparate distributed system security concerns in formerly ridiculous practices. A key factor of this ability is the decentralization of the symmetrically distributed ledgers of blockchain. Such decentralization has replaced several security functionalities of centralized authority with the use of cryptographic systems. That is, public or asymmetric cryptography is the key part of what makes blockchain technology possible. Recently, the blockchain experience introduces the chance for the healthcare field to implement these knowhows in their electronic records. This adoption supports retaining and sharing the symmetrical patient records with the appropriate alliance of hospitals and healthcare providers in a secure decentralized system, using asymmetric cryptography like hashing, digitally signed transactions, and public key infrastructure. These include specialized applications for drug tracking, applications for observing patients, or Electronic Health Records (EHR). Therefore, it is essential to notice that the principled awareness of the healthcare professionals is the leading point of the right perception ethics. In this work, we provide a thorough review of the issues and applications of utilizing blockchain in the healthcare and medical fields emphasizing the particular challenges and aspects. The study adopted a systematic review of secondary literature in answering the research question. Specifically, this paper aims to investigate how blockchain technology can be applied to improve the overall performance of the healthcare sector and to explore the various challenges and concerns of the application of blockchain in the healthcare system.

Upsides and downsides of a telecounselling model of integrated asthma management between general practitioners and specialists.

BackgroundAsthma control, one of the most important goals in the management of asthmatic patients, requires good adherence to guidelines and support at a territorial level, in particular on the part of general practitioners (GPs). A territorial hospital alliance can become a strength in asthma management, where control by GPs can also be carried out through a spirometric examination.MethodsThe realisation of a telecounselling model management of asthma between GPs and specialists was the aim of this study, to understand how to obtain good asthma control. A specific digital platform, the PneumoApp platform, was used for the insertion of clinical data and flow volume (F‐V) curves, performed in asthmatic patients by GPs, and for the subsequent evaluation of these data by specialists.ResultsGPs have shown to be able to perform a check‐up of respiratory function well using a portable spirometer, but the analysis of the collected data showed that GP assessment of the severity level of asthma is incorrect in patients with moderate‐severe asthma.ConclusionsThe effectiveness of a telecounselling collaboration between hospital and territory in the management of asthma patients can be improved by greater diffusion of the use of Global Initiative for Asthma (GINA) guidelines at a local level.

The Roadmap for Implementing Value-Based Healthcare in European University Hospitals—Consensus Report and Recommendations

ObjectivesValue-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals’ resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. MethodsThe European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. ResultsThe blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. ConclusionThe blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC.

Learning from past respiratory failure patients to triage COVID-19 patient ventilator needs: A multi-institutional study

BackgroundUnlike well-established diseases that base clinical care on randomized trials, past experiences, and training, prognosis in COVID19 relies on a weaker foundation. Knowledge from other respiratory failure diseases may inform clinical decisions in this novel disease. The objective was to predict 48-hour invasive mechanical ventilation (IMV) within 48 h in patients hospitalized with COVID-19 using COVID-like diseases (CLD). MethodsThis retrospective multicenter study trained machine learning (ML) models on patients hospitalized with CLD to predict IMV within 48 h in COVID-19 patients. CLD patients were identified using diagnosis codes for bacterial pneumonia, viral pneumonia, influenza, unspecified pneumonia and acute respiratory distress syndrome (ARDS), 2008–2019. A total of 16 cohorts were constructed, including any combinations of the four diseases plus an exploratory ARDS cohort, to determine the most appropriate cohort to use. Candidate predictors included demographic and clinical parameters that were previously associated with poor COVID-19 outcomes. Model development included the implementation of logistic regression and three ensemble tree-based algorithms: decision tree, AdaBoost, and XGBoost. Models were validated in hospitalized COVID-19 patients at two healthcare systems, March 2020–July 2020. ML models were trained on CLD patients at Stanford Hospital Alliance (SHA). Models were validated on hospitalized COVID-19 patients at both SHA and Intermountain Healthcare. ResultsCLD training data were obtained from SHA (n = 14,030), and validation data included 444 adult COVID-19 hospitalized patients from SHA (n = 185) and Intermountain (n = 259). XGBoost was the top-performing ML model, and among the 16 CLD training cohorts, the best model achieved an area under curve (AUC) of 0.883 in the validation set. In COVID-19 patients, the prediction models exhibited moderate discrimination performance, with the best models achieving an AUC of 0.77 at SHA and 0.65 at Intermountain. The model trained on all pneumonia and influenza cohorts had the best overall performance (SHA: positive predictive value (PPV) 0.29, negative predictive value (NPV) 0.97, positive likelihood ratio (PLR) 10.7; Intermountain: PPV, 0.23, NPV 0.97, PLR 10.3). We identified important factors associated with IMV that are not traditionally considered for respiratory diseases. ConclusionsThe performance of prediction models derived from CLD for 48-hour IMV in patients hospitalized with COVID-19 demonstrate high specificity and can be used as a triage tool at point of care. Novel predictors of IMV identified in COVID-19 are often overlooked in clinical practice. Lessons learned from our approach may assist other research institutes seeking to build artificial intelligence technologies for novel or rare diseases with limited data for training and validation.

Coordination Control for Hospital Referral With Multitype Patients

Service coordination among hospitals is a crucial strategy to improving care outcomes and operational efficiency of healthcare delivery systems. This article proposes a referral cooperation system where patients can be referred from one upper-level hospital (ULH) to one lower-level hospital (LLH) for services provided in both types of hospitals with similar service qualities. For multitype patients with different disease conditions, a method for determining the types and quantities of patients that should be referred is explored based on ensuring the interests of the ULH and LLH simultaneously. This article proposes a threshold control method to address these issues along with the Pareto-based negotiation process to implement referral. The control decisions of both ULH and LLH can be achieved by the developed Pareto optimization based on particle swarm optimization-optimal computing budget allocation (POPSO-OCBA) simulation optimization method. To implement the threshold control easily, we further propose a simplified referral control method and conclude that when the flow variability is small, the method can approach similar effects as the previously proposed control while significantly reducing the administrative costs. The methodologies are studied using numerical investigation and a real case exploration in Shanghai. The results show that the methodologies are effective in helping to make the decisions in practice. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —Under the tide of the sharing economy, healthcare providers are more ready to coordinate on delivering integrated care to patients, especially on care transition operations. With the government’s promotion of hospital alliances, hospitals should pay increasing attention to dynamic care transition control at the operational level to ensure better quality of service. This article investigates an easily implementable threshold control policy for patient referral coordination, which is expected to aid hospitals in dealing with imbalanced resource utilization to share service requests based on their respective resource availability. More importantly, we expect that the derived Pareto frontier of control thresholds can help the hospitals with the presentation of quantitative evidence for facilitating the negotiation on the control agreement of patient referral coordination. At the same time, the control-based methodology proposed can help hospitals to make decisions on their implementation strategy. A case study on negotiating the control agreement between a representative urban-area comprehensive hospital and its partner is provided in this article. We emphasize the importance of applying system engineering and mathematical modeling to study the referral cooperation system and real-time patient control decisions through our analyses.

A Study on the International Strategic Alliance and Partner Selection Priority Factors of Chinese National and Public Hospitals

한국 병원 및 의료기관의 해외진출은 2000년대 일부 대기업 주도 및 중·소형 병원들을 기반으로 민간진출을 시작하였고, 2009년 1월 외국인 환자유치 지원법 시행과 2016년 의료수출지원법의 실행을 거쳐 현재까지 약 20년에 걸쳐 진행되어, 타 산업대비 해외진출 실행기간이 짧은 특성을 보유하고 있다. 따라서 선행연구 및 문헌 등 기반 자료들이 단순 설문조사 결과를 활용하였거나, 현지 시장 진출자 시각에서만 연구된 한계점을 보유하고 있다. 본 연구는 중국현지 국·공립병원업계 전문가들의 현지관점 기반에서 국제 전략적 제휴와 파트너 선정을 위한 주요 요인을 선별하고자 3차에 걸친 델파이 조사와 AHP기법을 적용하여 각 요인 간 상대적 중요도 및 전체 순위를 비교 산출하였다. 연구 결과로는 상위항목 11개중 1위 중국정부정책/제도, 2위 의료기술 및 서비스, 3위 중국 병원산업 및 시장 환경 등이 우선항목으로 도출되었으며, 하위요인 42개중 1위 중국 중앙정부 정책 부합성, 2위 신규 의료서비스 확장, 3위 중국현지 의료법숙지, 4위 시장 경쟁력 확보, 5위 신규 의료서비스 실시 등이 우선요인으로 나타났다. 본 연구 결과는 한국 병원 및 의료기관이 중국 병원 및 의료시장 진출을 준비할 때 진출병원의 입장과 현지병원의 시각 차이를 이해할 수 있는 실무 기반자료로 활용될 수 있을 것으로 보인다.

Strategic alliances’ effects over hospital efficiency and capacity utilization in México

PurposeThis paper aims to investigate the efficiency implications of belonging to a strategic hospital alliance (SHA) and measuring the effects over capacity utilization of such agreements in a Mexican healthcare context.Design/methodology/approachData Envelopment Analysis (DEA) is the nonparametric methodology used, which supports both objectives. Technological gaps ratios are calculated by using DEA-metafrontier approach to compare efficiency between SHA members and a hospital’s control group. Also, hospital capacity utilization ratios are used as the maximum rate of output possible from fixed inputs in a frontier setting using directional distance functions. Data were collected from an alliance called Consorcio Mexicano de Hospitales in México, which has 29 general private hospitals and a group of 47 hospitals with same characteristics from a database made by the Instituto Nacional de Estadística y Geografía for year 2014.FindingsThe results indicate that efficiency is better at hospitals that belong to an alliance; it also shows an improvement of installed capacity management for hospital alliances in México.Originality/valueThe results can be useful for both private health organization managers and regulators themselves to adopt management practices that may end up having a favorable impact on cost and prices containment. Additionally, there are no previous studies neither in Mexico nor in Latin America that analyze the impact of strategic hospitality alliances on the efficiency and utilization of the capacity of private hospitals.

Adapting a Nurse-Managed Mobile Simulation Program to Meet Rural Health Nursing Continuing Education Needs.

Rural nurses often practice in settings with limited access to continuing education resources. A hospital alliance in southeastern North Carolina developed a unique nurse-led mobile simulation program as a shared regional asset, for the purpose of meeting continuing education needs of rural nurses. The alliance used a hub-and-spoke model to deliver education to staff in rural, critical access hospitals in order to reduce costs associated with education travel, the resulting staffing shortages, and delays in critical training. Continuing education credit was awarded to nurses participating in the learning activity. Fully mobile simulation can be an effective delivery mode for continuing and just-in-time education for nurses practicing in rural settings. Establishing the program as a regional shared resource can make this a financially viable option for rural hospitals. Lessons learned during the mobile simulation program's evolution and the resulting financial sustainability are discussed. [J Contin Educ Nurs. 2020;51(2):82-86.].

Analysis of clinical effects of artificial dermis in functional reconstruction in the late stage of extremely severe burn

Objective: To explore the clinical effects of artificial dermis combined with autologous split-thickness skin transplantation in the treatment of functional reconstruction in the late stage of extremely severe burn. Methods: From May 2015 to May 2017, medical records of 40 patients with limited activity after scar hyperplasia and conforming to the study criteria, injured in August 2nd Kunshan factory aluminum dust explosion accident in 2014, and had surgeries in our hospital and rehabilitation treatment in our hospital's alliance rehabilitation hospital, Rehabilitation Hospital of Kunshan Zhou City, were retrospectively analyzed. According to the treatment methods, 20 patients (12 males and 8 females, aged 20 to 45 years) were enrolled in artificial dermis group. They were conducted with stage Ⅰ functional site scar loosening and artificial dermis (PELNAC) implanting+ stage Ⅱ transplantation of autologous split-thickness skin. Another 20 patients (14 males and 6 females, aged 20 to 45 years) were enrolled in conventional skin grafting group. They were conducted with stage Ⅰ functional site scar loosening and transplantation of autologous thin medium-thickness skin. After 5 days of autologous skin transplantation, the survival rates of autologous skin in patients of 2 groups were calculated. The autologous skin infection and complete healing time of skin grafting area in patients of 2 groups were recorded. In 3, 6, and 10 months after autologous skin transplantation, the Vancouver Scar Scale (VSS) was used to assess the scar condition of recipient site in patients of 2 groups. The complete healing time of donor site in patients of 2 groups was recorded. In 10 months after autologous skin transplantation, VSS was used to assess the scar condition of donor site in patients of 2 groups. In 12 months after autologous skin transplantation, the functional recovery of surgical function reconstruction site in patients of 2 groups was evaluated and rated. Data were processed with t test, analysis of variance for repeated measurement, Wilcoxon rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results: (1) After 5 days of autologous skin transplantation, the survival rate of autologous skin in patients of artificial dermis group was (95±3)%, similar to (93±3)% in conventional skin grafting group (t=1.262, P>0.05). The results of autologous skin infection of patients in the 2 groups were similar (P>0.05). (2) After autologous skin grafting, the complete healing time of skin grafting area in patients of artificial dermis group was (12.3±2.5) d, similar to (12.7±2.0) d of conventional skin grafting group (t=-0.139, P>0.05). In 3, 6, and 10 months after autologous skin transplantation, the VSS scores of scars in recipient site of patients in artificial dermis group were significantly lower than those of conventional skin grafting group (t=-4.428, -5.655, -6.839, P<0.01). (3) After autologous skin grafting, the complete healing time of donor site in patients of artificial dermis group was obviously shorter than that in conventional skin grafting group (t=-12.435, P<0.01). In 10 months after autologous skin transplantation, the VSS score in donor site of patients in artificial dermis group was significantly lower than that of conventional skin grafting group (t=-16.971, P<0.01). (4) After 12 months of autologous skin transplantation, the functional improvement levels of the functional site of patients in artificial dermis group were good in 4 patients, fair in 15 patients, and bad in 1 patient, while the functional improvement levels of the functional site of patients in conventional skin grafting group were good in 5 patients, fair in 8 patients, and bad in 7 patients. The functional improvement levels of the functional site of patients between the two groups were similar (Z=371.5, P>0.05). Conclusions: Compared with conventional stage Ⅰ functional site scar loosening and transplantation of autologous thin medium-thickness skin, stage Ⅰ functional site scar loosening and artificial dermis implanting+ stage Ⅱ transplantation of autologous split-thickness skin does not affect the survival of skin in the early stage and can effectively improve functional site function, reduce VSS scores of donor site and recipient site, and shorten complete healing time of donor site.

Smart Medical Information Technology for Healthcare (SMITH).

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on the German Medical Informatics Initiative. “Smart Medical Information Technology for Healthcare (SMITH)” is one of four consortia funded by the German Medical Informatics Initiative (MI-I) to create an alliance of universities, university hospitals, research institutions and IT companies. SMITH’s goals are to establish Data Integration Centers (DICs) at each SMITH partner hospital and to implement use cases which demonstrate the usefulness of the approach. Objectives: To give insight into architectural design issues underlying SMITH data integration and to introduce the use cases to be implemented. Governance and Policies: SMITH implements a federated approach as well for its governance structure as for its information system architecture. SMITH has designed a generic concept for its data integration centers. They share identical services and functionalities to take best advantage of the interoperability architectures and of the data use and access process planned. The DICs provide access to the local hospitals’ Electronic Medical Records (EMR). This is based on data trustee and privacy management services. DIC staff will curate and amend EMR data in the Health Data Storage. Methodology and Architectural Framework: To share medical and research data, SMITH’s information system is based on communication and storage standards. We use the Reference Model of the Open Archival Information System and will consistently implement profiles of Integrating the Health Care Enterprise (IHE) and Health Level Seven (HL7) standards. Standard terminologies will be applied. The SMITH Market Place will be used for devising agreements on data access and distribution. 3LGM 2 for enterprise architecture modeling supports a consistent development process. The DIC reference architecture determines the services, applications and the standards-based communication links needed for efficiently supporting the ingesting, data nourishing, trustee, privacy management and data transfer tasks of the SMITH DICs. The reference architecture is adopted at the local sites. Data sharing services and the market place enable interoperability. Use Cases: The methodological use case “Phenotype Pipeline” (PheP) constructs algorithms for annotations and analyses of patient-related phenotypes according to classification rules or statistical models based on structured data. Unstructured textual data will be subject to natural language processing to permit integration into the phenotyping algorithms. The clinical use case “Algorithmic Surveillance of ICU Patients” (ASIC) focusses on patients in Intensive Care Units (ICU) with the acute respiratory distress syndrome (ARDS). A model-based decision-support system will give advice for mechanical ventilation. The clinical use case HELP develops a “hospital-wide electronic medical record-based computerized decision support system to improve outcomes of patients with blood-stream infections” (HELP). ASIC and HELP use the PheP. The clinical benefit of the use cases ASIC and HELP will be demonstrated in a change of care clinical trial based on a step wedge design. Discussion: SMITH’s strength is the modular, reusable IT architecture based on interoperability standards, the integration of the hospitals’ information management departments and the public-private partnership. The project aims at sustainability beyond the first 4-year funding period.

Active pharmacovigilance in China: recent development and future perspectives.

The effectiveness of active pharmacovigilance depends on the specific methods adopted and the work patterns put into place. Over the past few years, much attention has been paid to the importance of implementing such systems in China. However, less has been done to evaluate the state of implementation and future needs of such systems. This paper reviews China's recent approaches to active pharmacovigilance by examining: (1) information collected from scientific articles and the websites of the China Food and Drug Administration and the China National Center for Adverse Drug Reaction Monitoring, (2) information available on China's spontaneous reporting systems (SRS) and active pharmacovigilance system, and (3) annual reports and internal reports on this subject. Areas that improved most meaningfully for China's active pharmacovigilance in recent years appear to include: (1) quicker reporting and more intelligent scanning methods for adverse drug reactions (ADRs), (2) the use of pharmacovigilance approaches to mine electronic hospital records, and (3) the development of integrated systems including the China Hospital Pharmacovigilance System and China Sentinel Hospital Alliance Program. Not only has the national online SRS system provided a platform for passive pharmacovigilance, it has also become an important platform for various explorations of active pharmacovigilance in China. Quick reporting and intelligent scanning of ADRs, facilitated by automated ADR detection based on electronic hospital records, have accelerated to capabilities for active pharmacovigilance. The outcomes of the programs, such as the China Hospital Pharmacovigilance System and China Sentinel Hospital Alliance Program, usher in a new era for China's active pharmacovigilance. These are particularly important to bridge the information system of sentinel hospitals and ADR research centers, but gaps remain. Thus, much work needs to be done before a high-level active pharmacovigilance system is sufficiently mature to ensure drug safety in the country.

Contributions of the medical alliance of northwest Guangxi hospitals in the health anti-poverty campaign

To implement the task of health anti-poverty campaign, the medical alliance of northwest Guangxi hospitals made full use of its synergy strengths to achieve remarkable progress in constructing a telemedicine cooperation network, nurturing medical discipline of primary hospitals in the alliance, promoting regional medical resources sharing, and improving the humanities connection mechanism. To further develop health anti-poverty via medical alliances, relevant institutions are recommended to probe into such problems as telemedicine compensation mechanism, precision-based disciplinary support, breakdown of resource sharing barriers and profit distribution mechanisms. Key words: Health resources; Medical alliance; Telemedicine; Health anti-poverty campaign; Hierarchical medical system

A Resource-Based Perspective on China Hospital Alliance

Recently in China, Hospital Alliance is considered to be the most effective solution of healthcare system. The purpose of research is to illustrate the concept of hospital alliance in China, use empirical research methodology of case study based on resource-based view. The main results get from the empirical analysis is to apply the modern theory of resource allocation and reallocation to redesign the model of hospital alliance, thus improve the quality of medical service and effectiveness. The final conclusion is to show a model of health delivery in China using pre-paid medical insurance.

Perceptions of the Performance, Goals and Characteristics of Hospital Alliances: A Multi-national Study

A mixed methodology study of inter-hospital alliances in Germany, Canada and Switzerland was conducted to describe the goals and performance of inter-hospital alliances and to identify which alliance features best predict performance. Alliance features and performance were studied through a series of 59 interviews conducted within 12 hospitals involved in such partnerships. Respondents included administrative, medical and nursing staff. A standardized interview schedule was used to document the perceived as well as factual attributes and performance of the inter-hospital alliances they were included in. Results indicated that financial goals were not rated as being as important as improvements regarding service access and quality. A path analysis generated a seven component model of features linked to the perceived success of alliances: environmental, human and structural components of the alliances had an indirect relationship with overall success which was mediated through adaptability. Inter-hospital alliances have similar goals with regards to service quality and access, .notwithstanding the country, the type of health care system and the respondents.