Medical Alliance Research Articles

Comprehensive evaluation of the implementation of close-type county medical alliance in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method

BackgroundTo improve the capacity of county medical and health services, China encourages all localities to pilot the close-type county medical alliance. In Shandong Province, medical alliances have been piloted in 47 counties, ranking first in the country. The objective of this study is to comprehensively evaluate the implementation of close-type county medical alliance in Shandong Province, identify the differences between different county regions, and analyze the reasons, so as to provide a reference for the construction of a new county medical and health service system with clear goals, powers and responsibilities, and division of labor.MethodsThe implementation of the close-type county medical alliance was comprehensively evaluated in 47 national pilot counties in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method. Variance analysis was used for comparison of the comprehensive evaluation results.ResultsThe weight coefficient of evaluation indicators was highest for information interconnection, at 18.06%, and lowest for orderly referral of patients, at 3.64%. There was no difference in results of the comprehensive evaluation of entropy weight TOPSIS method and non-integer rank sum ratio method. Comprehensively order the implementation status of each pilot county according to the relative paste progress, 13 counties Y5, Y11, Y14, Y16, Y20, Y25, Y26, Y27, Y28, Y32, Y33, Y40 and Y42 were ranked highest, whereas county Y37 was ranked lowest. Non-integer rank sum ratio method graded counties into three grades: excellent, good and average. Kruskal-Wallis nonparametric test showed that the difference between the grades was statistically significant (H\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\:=\\:$$\\end{document}37.099, p\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:<\\:$$\\end{document}0.001). Variance analysis based on comprehensive evaluation results showed that implementation status was not correlated with the county economic development level, the level of health resources input and the medical service ability of the lead hospital.ConclusionsOur findings indicated that the implementation of the close-type county medical alliance is significantly different between pilot counties, with a marked differentiation within the same urban area. Therefore, effective measures are recommended to reduce this gap, including promoting informatization empowerment of the county medical community, strengthening government responsibility and improving policy effectiveness.

A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China.

To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality. Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs. In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030). Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a "patient health-centered" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.

Effects of medical alliance health management model under the perspective of health ecology on mental health of patients with chronic heart failure

Effects of medical alliance health management model under the perspective of health ecology on mental health of patients with chronic heart failure

Multiple realization pathways of county-level medical alliances to improve service capacity:A fuzzy set qualitative comparative analysis

Multiple realization pathways of county-level medical alliances to improve service capacity:A fuzzy set qualitative comparative analysis

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.

Development and validation of an early diagnosis model for bone metastasis in non-small cell lung cancer based on serological characteristics of the bone metastasis mechanism

Bone metastasis significantly impact the prognosis of non-small cell lung cancer (NSCLC) patients, reducing their quality of life and shortening their survival. Currently, there are no effective tools for the diagnosis and risk assessment of early bone metastasis in NSCLC patients. This study employed machine learning to analyze serum indicators that are closely associated with bone metastasis, aiming to construct a model for the timely detection and prognostic evaluation of bone metastasis in NSCLC patients. The derivation cohort consisted of 664 individuals with stage IV NSCLC, diagnosed between 2015 and 2018. The variables considered in this study included age, sex, and 18 specific serum indicators that have been linked to the occurrence of bone metastasis in NSCLC. Variable selection used multivariate logistic regression analysis and Lasso regression analysis. Six machine learning methods were utilized to develop a bone metastasis diagnostic model, assessed with Area Under the Curve (AUC), Decision Curve Analysis (DCA), sensitivity, specificity, and validation cohorts. External validation used 113 NSCLC patients from the Medical Alliance (2019-2020). Furthermore, a prospective validation study was conducted on a cohort of 316 patients (2019-2020) who were devoid of bone metastasis, and followed-up for at least two years to assess the predictive capabilities of this model. The model's prognostic value was evaluated using Kaplan-Meier survival curves. Through variable selection, 11 serum indictors were identified as independent predictive factors for NSCLC bone metastasis. Six machine learning models were developed using age, sex, and these serum indicators. A random forest (RF) model demonstrated strong performance during the training and internal validation cohorts, achieving an AUC of 0.98 (95% CI 0.95-0.99) for internal validation. External validation further confirmed the RF model's effectiveness, yielding an AUC of 0.97 (95% CI 0.94-0.99). The calibration curves demonstrated a high level of concordance between the anticipated risk and the observed risk of the RF model. Prospective validation revealed that the RF model could predict the occurrence of bone metastasis approximately 10.27±3.58 months in advance, according to the results of the SPECT. An online computing platform (https://bonemetastasis.shinyapps.io/shiny_cls_1model/) for this RF model is publicly available and free-to-use by doctors and patients. This study innovatively employs age, gender, and 11 serological markers closely related to the mechanism of bone metastasis to construct an RF model, providing a reliable tool for the early screening and prognostic assessment of bone metastasis in NSCLC patients. However, as an exploratory study, the findings require further validation through large-scale, multicenter prospective studies. This work is supported by the National Natural Science Foundation of China (NO.81974315); Shanghai Municipal Science and Technology Commission Medical Innovation Research Project (NO.20Y11903300); Shanghai Municipal Health Commission Health Industry Clinical Research Youth Program (NO.20204Y034).

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

BackgroundChina initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models.MethodsData spanning April 2017 to March 2019 for Dangyang County’s MA and January 2018 to December 2019 for Qianjiang County’s MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform.ResultsAfter the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01).ConclusionsThis study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

Climate, diseases and medicine: the welfare of soldiers during the East Asian War of 1592-1598.

This article examines the care provided for the welfare of soldiers by the three combatant countries - China, Korea and Japan - during the East Asian War of 1592-8. Also known as the Imjin War, this large-scale military conflict can also be understood as an encounter between different state cultures and strategies of military medicine. This study focuses on cold-induced injuries, epidemic outbreaks and external wounds suffered during the war. I illuminate provision of prophylactic measures against cold by the Ming state, as well as attempts by the Sino-Chosŏn medical alliance to manage epidemics and treat wounded soldiers. I contrast these measures with the lack of similar centralised support for the Japanese forces, and examine the effect these differences had upon on military outcomes during the war. The difference in the amount of time, efforts and resources that the three combatant states devoted to sick and injured soldiers has implications not only for our understanding of the war but also for illuminating the early modern history of military medicine in East Asia. By exploring East Asian military medicine during and after the Imjin War, this article responds to recent calls for more detailed examination of histories of military medicine in premodern periods and non-European regions.

The Current Status and Promotional Strategies for Cloud Migration of Hospital Information Systems in China: Strengths, Weaknesses, Opportunities, and Threats Analysis.

In the 21st century, Chinese hospitals have witnessed innovative medical business models, such as online diagnosis and treatment, cross-regional multidepartment consultation, and real-time sharing of medical test results, that surpass traditional hospital information systems (HISs). The introduction of cloud computing provides an excellent opportunity for hospitals to address these challenges. However, there is currently no comprehensive research assessing the cloud migration of HISs in China. This lack may hinder the widespread adoption and secure implementation of cloud computing in hospitals. The objective of this study is to comprehensively assess external and internal factors influencing the cloud migration of HISs in China and propose promotional strategies. Academic articles from January 1, 2007, to February 21, 2023, on the topic were searched in PubMed and HuiyiMd databases, and relevant documents such as national policy documents, white papers, and survey reports were collected from authoritative sources for analysis. A systematic assessment of factors influencing cloud migration of HISs in China was conducted by combining a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and literature review methods. Then, various promotional strategies based on different combinations of external and internal factors were proposed. After conducting a thorough search and review, this study included 94 academic articles and 37 relevant documents. The analysis of these documents reveals the increasing application of and research on cloud computing in Chinese hospitals, and that it has expanded to 22 disciplinary domains. However, more than half (n=49, 52%) of the documents primarily focused on task-specific cloud-based systems in hospitals, while only 22% (n=21 articles) discussed integrated cloud platforms shared across the entire hospital, medical alliance, or region. The SWOT analysis showed that cloud computing adoption in Chinese hospitals benefits from policy support, capital investment, and social demand for new technology. However, it also faces threats like loss of digital sovereignty, supplier competition, cyber risks, and insufficient supervision. Factors driving cloud migration for HISs include medical big data analytics and use, interdisciplinary collaboration, health-centered medical service provision, and successful cases. Barriers include system complexity, security threats, lack of strategic planning and resource allocation, relevant personnel shortages, and inadequate investment. This study proposes 4 promotional strategies: encouraging more hospitals to migrate, enhancing hospitals' capabilities for migration, establishing a provincial-level unified medical hybrid multi-cloud platform, strengthening legal frameworks, and providing robust technical support. Cloud computing is an innovative technology that has gained significant attention from both the Chinese government and the global community. In order to effectively support the rapid growth of a novel, health-centered medical industry, it is imperative for Chinese health authorities and hospitals to seize this opportunity by implementing comprehensive strategies aimed at encouraging hospitals to migrate their HISs to the cloud.

Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties.

This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.

The evolutionary game of establishing a remote consultation system based on the downward allocation of medical resources in a medical alliance.

As a crucial component of hierarchical diagnosis and treatment systems, medical alliances in China are responsible for promoting the downward allocation of high-quality medical resources. Remote consultation, as an essential means to achieve this goal, is of practical importance in the realization of resource sharing between hospitals within medical alliances in China. The existing research on the construction of remote consultations within medical alliances has achieved fruitful results in both theory and practice. However, the establishment of remote consultation involves many factors, and the current research mainly focuses on the influence of traditional economic profit and loss on the construction of remote consultation. In view of the practical problems existing in the operation of medical and health services in China, such as the need to improve the capacity of primary medical and health services and the poor sinking effect of high-quality medical resources, it is of great importance to systematically study the promotion strategy of the construction of remote consultation within the medical alliance to build a reasonable order of medical treatment. Therefore, by determining the logical path formed by the remote consultation channel and on the basis of traditional profit and loss parameters, this paper fully considers the relevant influence of the resource sinking utility caused by the remote consultation channel. The stability of the evolutionary system is analyzed, and a numerical simulation is used to explore the impact of key parameters on system evolution. The research results indicate that the establishment of a remote consultation system between hospitals at different levels is primarily influenced by factors such as the initial proportion of the establishment strategy chosen by both parties, the establishment cost, the distribution proportion of the government subsidy, the distribution proportion of the economic benefit, and the effectiveness proportion in the utility derived from the downward allocation of resources and reputational damage. The findings suggest that moderate to high levels of reputation loss do not significantly influence the final decision-making process for either party. Government subsidies can have an impact on hospital decision-making in the early stages, and in the long term, the resource sinking utility is more appealing than the economic benefits. To a certain extent, this study enriches the related research on remote consultation and the sinking of high-quality medical resources, provides reliable theoretical and method support for the sinking of high-quality medical resources, promotes the construction of remote consultation in medical alliances in China, and provides a decision-making reference and basis for the government and health administrative departments to formulate relevant policies.

Risk factors for post-traumatic stress disorder in nurses from the regional medical alliance during the COVID-19 epidemic: A prospective cross-sectional study

Mental health issues among nursing professionals have been increasingly reported during the coronavirus disease (COVID-19) pandemic. However, there is a paucity of research on post-traumatic stress disorder (PTSD) among nurses working in Medical Alliances. In this study, we aimed to investigate the risk factors associated with PTSD in the Regional Medical Alliance (MA) in Shantou (China) during the COVID-19 pandemic. A total of 1286 nurses from four MA hospitals participated in the study from February to March 2020. Our findings revealed that the incidences of PTSD, depression, anxiety, and sleep disorders among nurses from MA were 15.6%, 35.5%, 18.3%, and 36.4%, respectively. Moreover, PTSD was positively correlated with depression, anxiety, and sleep disorders. In addition, the results of logistic regression analysis showed that working in a tertiary hospital, older age, more severe depression, more severe anxiety, and prevalent sleep disorders were independent risk factors for PTSD among nurses. Therefore, mental health interventions targeting high-risk nurses in MA with an incidence of PTSD are urgently needed.

Associations Among Organizational Capabilities, Organizational Performance and the Medical Alliance Implementation Effect in Community Health Centers in China: A Moderated Mediation Model.

Community health centers (CHCs) are an important part of the healthcare system worldwide. Based on the dual process model of organizational capabilities, this study explores the relationship between organizational capabilities and the organizational performance of CHCs, as well as the role played by the medical alliance implementation effect. In this study, whole-group sampling was used to extract CHCs. All 135 CHCs in 8 of 16 districts of Beijing were selected as subjects. The organizational capabilities of the CHCs and the medical alliance implementation effect were evaluated using a questionnaire survey of 1957 managers and 3622 medical staff, respectively. A pathway analysis of the mediating role of the organizational capabilities of CHCs and the moderating role of the medical alliance implementation effect was conducted using Mplus 8.0. The development capabilities had a positive impact on basic capabilities (β = 0.878, P < 0.001), and core capabilities (β = 0.952, P < 0.001), but had no direct impact on organizational performance. Basic capabilities positively affected organizational performance (β = 1.163, P < 0.001), and core capabilities negatively affected organizational performance (β =- 0.886, P = 0.004). Both basic capabilities (β =1.022, P < 0.001) and core capabilities (β =- 0.843, P = 0.005) played a mediating role in the relationship between development capabilities and organizational performance. The moderating role of the medical alliance implementation effect was not significant. This study found that strengthening the organizational capabilities of CHCs can effectively improve their performance, with the development of basic capabilities being a primary concern. The medical alliance implementation effect has not had a significant impact on organizational performance, and the cooperation between CHCs and high-level hospitals should be further promoted to give full play to the medical alliance's role and improve the organizational performance of CHCs.

Impact of perceived ease of use, organizational support mechanism, and industry competitive pressure on physicians' use of liver cancer screening technology in medical alliances.

Liver cancer is one of the malignant tumors worldwide, while the prevention and control situation is grim at present, and the diffusion of its early screening technology still faces some challenges. This study aims to investigate the influencing mechanism of perceived ease of use, organizational support mechanism, and industry competitive pressure on hepatic early screening technologies use by physicians, so as to promote the wider use of corresponding technologies. Under the theoretical guidance of technology-organization-environment framework and mindsponge theory, this study took hepatic contrast-enhanced ultrasound as an example, and conducted a cross-sectional questionnaire by randomly selecting physicians from Fujian and Jiangxi provinces in China with a high and low incidence of liver cancer, respectively. Structural equation modeling was used to determine the correlation among perceived ease of use, organizational support mechanism, and industry competitive pressure, as well as their impact on the physicians' behavior toward contrast-enhanced ultrasound use. The hypothesis model fits well with the data (χ2/df = 1.863, GFI = 0.937, AGFI = 0.908, RMSEA = 0.054, NFI = 0.959, IFI = 0.980, CFI = 0.980). Under technology-organization-environment framework, the perceived ease of use (β = 0.171, p < 0.05), organizational support mechanism (β = 0.423, p < 0.01), industry competitive pressure (β = 0.159, p < 0.05) significantly influenced physicians' use of hepatic contrast-enhanced ultrasound. Besides, perceived ease of use and organizational support mechanism (β = 0.216, p < 0.01), perceived ease of use and industry competitive pressure (β = 0.671, p < 0.01), organizational support mechanism and industry competitive pressure (β = 0.330, p < 0.01) were all associated significantly. From the lens of information processing (mindsponge theory) and technology-organization-environment framework, this study clarified the social and psychological influencing mechanism of perceived ease of use, organizational support mechanism, and industry competitive pressure on physicians' use of hepatic contrast-enhanced ultrasound. The results will directly propose recommendations for expanding hepatic contrast-enhanced ultrasound utilization and indirectly promoting other appropriate and effective health technologies diffusion within the integrated health system.

Factors underlying burnout among rural village physicians in Southwestern China

AbstractBackgroundPrimary healthcare doctors in China often experience problems with occupational burnout, a condition known to relate to high job stress and low wages. In China, many medical alliances have recently been established in rural areas, where village physicians work as healthcare gatekeepers. However, burnout in village physicians in the context of medical alliances remains underresearched.MethodsThis cross‐sectional survey was conducted among 100 village physicians practicing at village clinics in Qiandongnan prefecture, Guizhou province, China. An online questionnaire was distributed to assess physicians' demographic characteristics and work situations. Burnout was measured using the Oldenburg Burnout Inventory (validated Chinese version). A multivariate linear model with stepwise procedure was used to estimate the effects of factors of interest on burnout, focusing particularly on actions within the medical alliance that involved respondents' clinics, such as training and support for village physicians provided by higher‐level facilities.ResultsThe overall response rate was 79%. The mean burnout score was 38.09 (standard deviation, 4.55; range, 25–47). The multivariate analysis showed that fewer working years and too much farming work were significantly related to exacerbation of burnout. Greater medical services in the total workload and greater support from higher‐level facilities were associated with burnout alleviation.ConclusionClose connections and interactions across medical alliance member facilities could facilitate reduction in burnout for village physicians practicing as primary care gatekeepers.

Adaptive distributionally robust cluster-based healthcare network design problem under an uncertain environment

County medical alliances (CMAs) in China are considered to be effective in optimizing the layout of medical resources and improving primary healthcare services. To facilitate the implementation of CMAs in multiple geographical clusters, we examine a cluster-based healthcare network design (CHND) problem with patient referral in uncapacitated and capacitated cases. Considering the uncertainty of health demand and unit referral cost, we develop adaptive distributionally robust models for the CHND problem, where the location and allocation decisions anticipate the worst-case expected patient treatment and referral cost over an ambiguity set. In terms of tractability, we reformulate the adaptive distributionally robust models as tractable forms. Further, a hybrid genetic algorithm that combines a genetic algorithm with a commercial solver is designed to improve the computational efficiency for large-scale instances. Finally, we apply our models to a real-world case in Shenzhen, China, to verify the effectiveness of the proposed algorithm and assess the value of the adaptive distributionally robust models over the corresponding robust model. The results show that our algorithm has outstanding efficiency and accuracy when compared to the hybrid particle swarm algorithm and the commercial solver. Moreover, the adaptive distributionally robust model outperforms the robust model in terms of solution quality.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

Construction and Application of Enteral Nutrition Nursing Management System under Medical Alliance Mode.

We aimed to construct enteral nutrition nursing management system under medical alliance mode, and to explore the clinical application effect. Based on the training project of enteral nutrition nursing team of Chinese Association of Parenteral and Enteral Nutrition, the enteral nutrition nursing management system was constructed in June 2021. Using the convenient sampling method, 850 cases of enteral nutrition clinical practice were selected from medical alliance hospitals before and 6 months after the implementation of the system. The process indicators of enteral nutrition nursing quality were checked, and the reported outcome indicators were compared. After the implementation, the implementation rate of enteral nutrition risk screening, the implementation rate of nutritional status assessment, and the correct rate of nursing measures of nurses in medical alliance hospitals were significantly improved (P<0.001). The frequency of aspiration, diarrhea and unplanned extubation was notably decreased (P<0.05). The mastery rate of enteral nutrition knowledge and the satisfaction rate of nursing work of patients were significantly higher than before (P<0.001). The established enteral nutrition nursing management system under the medical alliance model was effective and feasible, which was helpful to improve the level of enteral nutrition nursing management and the quality of enteral nutrition nursing in the medical alliance hospitals.

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

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

How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect.

Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity. We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect. The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region. Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.