Medical Alliance Research Articles

Practice and exploration of the model of general practice alliance in general hospital

The article introduces the implementation of the general practice alliance model in the First Affiliated Hospital of Zhejiang University School of Medicine. Based on the high-quality resources of a tertiary university hospital the general practice alliance has upgraded the clinical, research and teaching abilities of primary care and promoted two-way referral system. Our experience shows that the alliance would improve the effectiveness of health care system and facilitate to form a rational medical service ecosystem. Key words: General medical alliance; Practice; Exploration

Building the tiered system of disease diagnosis and treatment from 2015 to 2017 in Jiangsu: achievements and challenges

BackgroundJiangsu, China, launched a comprehensive provincial medical reform in 2015, and the implementation of a tiered system of disease diagnosis and treatment is the core strategy. Focusing on improving the service capacity of primary care facilities and building the contract system of family doctors and medical alliance, which is an cooperative mode of medical institutions of different levels in the same region, aiming to promote medical resources integration, Jiangsu established a new tiered system of disease diagnosis and treatment. We aimed to explore the achievements and challenges in the construction of the system. MethodsIn January, 2019, a compilation of health statistics of all cities in Jiangsu Province during 2013–17 were drawn from the Health Statistics Information System provided by the Statistical Information Centre of Jiangsu Health Commission. An autoregressive integrated moving average (ARIMA) model and descriptive analysis was done to assess the trends in patient visits and referrals in Jiangsu province. FindingsResults from the ARIMA model showed that the primary health facilities were predicted to contribute 52·38% of total outpatient visits in the province, which was lower than the actual proportion of 52·73%. In 11 cities, the consultation rate in counties was over 90%, which reaches the national standard (82·5%). More than 60% of key groups have signed up to the family doctors. Also, the proportion of referrals from hospitals to primary care facilities barely changed, from 0·02% in 2013, to 0·03% in 2017, and the proportion of referrals from primary care facilities to hospitals increased from 0·22 to 0·38, by 0·16 percentage points. InterpretationThe construction of the medical alliance has effectively contributed to the sinking of medical resources from tertiary hospitals to primary care facilities, the establishment of the contract system of family doctors, and the improvement of the capacity of primary care facilities. However, grassroots services were still far from meeting residents' needs of basic medical services. Family doctor services primarily serviced key groups, and the first diagnosis provided by family doctors was not mandatory. Because of the insufficient coordination between hospitals and communities, the referral system within the medical alliance has not been effectively implemented. Because Jiangsu is one of the first pilot provinces in China undergoing a comprehensive health-care reform, our findings are informative to national policy rollout. FundingNational Natural Science Foundation of China.

A universal artificial intelligence platform for collaborative management of cataracts

BackgroundCommon diseases are not satisfactorily managed under the current health-care system because of inadequate medical resources and limited accessibility. We aimed to establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios, and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. MethodsThe training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel health-care facilities and capture modes. The datasets were labeled using a three-step strategy: capture mode recognition (modes: mydriatic-diffuse, mydriatic-slit lamp, non-mydriatic-diffuse, and nonmydriatic-slit lamp); cataract diagnosis as a normal lens, cataract, or a postoperative eye; and detection of referable cataracts with respect to cause and severity. Area under curve [AUC] was measured at each stage. We also integrated the above cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary health care, and specialised hospital services. The diagnostic accuracy, treatment referral, and ophthalmologist-to-population service ratio were used to evaluate the performance and efficacy of the system. FindingsThe universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: capture mode recognition (AUC 99·28–99·71% for the four different capture modes), cataract diagnosis (AUC for mydriatic-slit lamp mode 99·82% [95%CI 98·93–100] for normal lens vs 99·96% [99·90–100] for cataract vs 99·93% [99·78–100] for postoperative eye, and AUCs >99% for other capture modes), and detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30·3% of people be referred to treatment, substantially increasing the ophthalmologist-to-population service ratio by 10·2-times compared with the traditional pattern. InterpretationThe universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations. FundingNational Key Research and Development Program, National Natural Science Foundation of China, Science Foundation of China for Excellent Young Scientists, Guangdong Provincial Natural Science Foundation, Guangdong Province Universities and Colleges Youth Pearl River Scholar Funding Scheme, Science and Technology Planning Projects of Guangdong Province, Clinical Research and Translational Medical Center of Pediatric Cataract in Guangzhou City, Outstanding Young Teacher Cultivation Projects in Guangdong Province, Fundamental Research Funds for the Central Universities.

Universal artificial intelligence platform for collaborative management of cataracts

PurposeTo establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency...

Practical exploration of developing medical alliances in various models in Fujian Provincial Hospital

Development of medical alliances is an important step and institutional innovation to deepen the healthcare reform.The authors analyzed the practice and experience in Fujian Provincial Hospital in this regard, and discussed the confusion and difficulties faced in the process.On such basis, they raised such proposals as transforming conception of the people, forming a multi-departmental coordination mechanism and policy superposition effect, building a sound medical alliance assessment system, and clarifying information construction standards, hence developing a new era of hierarchical medical system by means of developing medical alliances. Key words: Hierarchical medical system; Medical alliance; Types; Fujian province

Development and practice of medical alliances for respiratory diseases in China

Respiratory disease is currently one of the main causes of human deaths.Due to the shortage, fragmentation, imbalance and heterogeneity of health resources and medical resources in China, it is urgent to strengthen the prevention and control system and capacity construction for respiratory science and innovate the prevention and treatment mode.The authors expounded the necessity of constructing a medical alliance for respiratory diseases, and held that such an alliance can achieve the purpose of patient care and discipline development, by means of integration of resources and system building, from such aspects as healthcare, teaching, research and department construction. Key words: Respiratory disease; Hospital, specialist; Disease management; Medical alliance

Introducing the System for Observing Medical Alliances (SOMA): A Tool for Studying Concordance in Patient-Physician Relationships.

We developed the System for Observing Medical Alliances (SOMA) to study relationships between medical providers and patients with medically unexplained symptoms (MUS). Based on literature in health psychology, medicine, and the psychotherapeutic alliance, the SOMA operationalizes three medical alliance dimensions: Engagement in the Consultation Process, Trust in the Provider, and Concordance of Illness Beliefs and Treatment Recommendations. Specific behavioral indicators, tallied as observed by trained judges, are used as the basis for rating each dimension. In a sample of 33 medical consultations with veterans who had MUS, interrater reliabilities ranged from .79 to .94. Notably, the other dimension ratings accounted for 40% of the variability in Concordance, with Trust in the Provider contributing unique variance. In addition to research, psychologists in integrated health settings can use the SOMA to consult and train medical providers on communication skills that enhance concordance.

Discussion on the regional medical scientific research alliance

Objective Through analyzing and summarizing the experiences and reflections during the construction of regional medical scientific research alliance, to explore the ultimate goal and ideal model of such work. Methods Literature review, as well as working experience summary and analysis. Results The purpose of setting up regional medical scientific research alliance lies in shared regional medical scientific research data information, using the two-way transformation model of laboratory and clinical research to support the medical service of primary health care in local hospitals, at the same time, promoting the construction and development of regional medical alliance. The ideal model is to make good use of the regional clinical scientific research data sharing platform and related information sharing platform to promote the collaborative development of regional medical scientific research. Conclusions The ultimate goal of collaborative development of scientific research is to establish an information map of regional scientific research resources , the map can be used for scientific research project cooperation, resource allocation, integration of scientific research forces and training of talent echelon, thereby comprehensively improve the regional research capacity. Key words: Medical alliance; Regional medical scientific research alliance; Collaborative development of scientific research

The willingness of patients to make the first visit to primary care institutions and its influencing factors in Beijing medical alliances: a comparative study of Beijing\u2019s medical resource-rich and scarce regions

BackgroundTo improve the efficiency of the use of medical resources, China has implemented medical alliances (MAs) to implement a hierarchical diagnosis and treatment system. The willingness to undertake a first visit to primary care institutions (PCIs) is an important indicator of the effect of this system. Beijing has also built MAs since 2013, but to date, there have been few studies on the first visit to PCIs in Beijing. The purpose of this study is to analyze patients’ willingness to make their first visit to PCIs and its influencing factors to provide references for the realization of a hierarchical diagnosis and treatment system.MethodsTwo relatively different districts with large differences in resources in Beijing, D and F, were selected, and a self-reported questionnaire and convenience sampling method were applied. A cross-sectional survey was administered to 1221 patients of MAs. The chi-square test and binary logistic regression were used to analyze the influencing factors of patients’ willingness to undertake a first visit to a PCI.ResultsFewer patients in District D received medical alliance services (44.42%) than those in District F (59.25%), but patients in District D had a higher degree of satisfaction with the services they received (72.04%) than those in District F (28.96%). Patients in District D had a higher willingness to undertake a first visit (64.00%) than those in District F (58.18%). Patients of an older age, low medical expenses, participation in urban employees’ basic medical insurance, a high understanding of MAs and high satisfaction with medical services were indicators of being more willing to choose primary care institutions for their first visit.ConclusionsThe different medical resources and MA constructions in the two districts have resulted in a difference between the two districts in terms of the willingness of individuals to make their first visit to PCIs. Strengthening the service capabilities of PCIs remains a priority. The government should propose solutions to solve the problems encountered in practice and actively promote the realization of MAs and hierarchical diagnosis and treatment.

Experience and enlightenment of countywide medical alliances construction in Hangzhou

Based on a sufficient analysis of the theoretical framework of transformation learning (TLC) and people-centered and integrated health care (PCIC) mode, this article introduced the main practices and achievements of Hangzhou characteristics countywide medical alliances, centering on TLC mode.Hangzhou takes the countywide medical alliance construction as a pilot, refers to the TLC model, and takes growth-oriented collaboration as the guidance, to promote responsibility sharing, benefit sharing, service integration and management collaboration.Guided by the PCIC model proposed by the World Health Organization, the city has established an integrated service model of hierarchical medical system-prevention-rehabilitation-aging care.The countywide medical alliance system framework features 5 fields, unified leadership, unified culture, 6 supports, 3 tasks and TLC teams , which may provide references for the coordinated and integrated development of such alliances. Key words: Countywide medical alliance; Transition learning collaboration; People-centered and integrated health care; Hierarchical medical system; Family doctor

Discussion on the training program for general practitioners as led by medical alliances

The fourth affiliated hospital of Zhejiang university is responsible for training general practitioners in view of the basics of local general practitioners and the characteristics of chronic and frequently-occurring diseases in Yiwu city. This program is carried out relying on the high-quality faculty of medical alliances within Zhejiang university, and funded by the municipal government of Yiwu. The 4+ 6 training program is designed to elevate the competence of primary general practitioners. Such training fit the overall medical level of general practitioners, enhances people′s trust of general practitioners and the rate of diagnosis at primary level. Key words: Clinical competence; Medical alliance; General practitioner; Yiwu characteristic; Training program

Effect of an Integrated Payment System on the Direct Economic Burden and Readmission of Rural Cerebral Infarction Inpatients: Evidence from Anhui, China.

Rural China is piloting an integrated payment system, which prepays a budget to a medical alliance rather than a single hospital. This study aims to evaluate the effect of this reform on the direct economic burden and readmission rates of cerebral infarction inpatients. The settlement records of 78,494 cerebral infarction inpatients were obtained from the New Rural Cooperative Medical Scheme (NRCMS) database in Dingyuan and Funan Counties in the Anhui Province. The direct economic burden was estimated by total costs, out-of-pocket expenditures, the out-of-pocket ratio, and the compensation ratio of the NRCMS. Generalized additive models and multivariable linear/logistic regression were applied to measure the changes of the dependent variables along with the year. Within the county, the total costs positively correlated to the year (β = 313.10 in 2015; 163.06 in 2016). The out-of-pocket expenditures, out-of-pocket ratios, and the length-of-stay positively correlated to the year in 2015 (β = 105.10, 0.01, and 0.18 respectively), and negatively correlated to the year in 2016 (β = −58.40, −0.03, and −0.30, respectively). The odds ratios of the readmission rates were less than one within the county (0.70 in 2015; 0.53 in 2016). The integrated payment system in the Anhui Province has considerably reduced the direct economic burden for the rural cerebral infarction inpatients, and the readmission rate has decreased within the county. Inpatients’ health outcomes should be given further attention, and the long-term effect of this reform model awaits further evaluation.

Practice and exploration of a new model of extended nursing care based on regional informationization platform within a medical alliance

The rapidly aging society gives rise to sizable demands for chronic disease nursing care.With IT development as backup, the hospital has developed a platform for regional collaborative nursing informationization within a medical alliance and a health management platform for home care of the elderlies.This practice can build an extended nursing care model, featuring the three main service lines of hospital-family, hospital-medical alliance and hospital-community hospital-family . The model provides diversified, personalized, disease specific, informationization and multi-disciplinary coverage for nursing care, providing the primary level with high quality nursing resources.Medical alliances and corresponding communities share information, for a full-range, full region and full timeframe coverage of nursing health supervision and scientific guidance, thus effectively minimizing the rate of revisit to upper-level hospitals by patients and implementing the hierarchical medical system. Key words: Informationization services; Social needs; Extended nursing care; Medical alliances

Practice of mobile App-based chronic care management for discharged patients by pharmacists within a medical alliance

Regional medical alliances help distribute high-quality medical resources to primary healthcare institutions.Under the guidance of Internet-plus Healthcare and Hierarchical Medical System policies, pharmacists are also exploring new management approaches for discharged patients with chronic diseases.The authors developed a Chronic Care Management(CCM)platform based on mobile App Yi Xing, and carried out full-range CCM for discharged patients in cooperation with pharmacists within the alliance.This CCM practice can contribute to an innovative transformation of pharmaceutical care, deliver high-quality pharmaceutical care to primary institutions, improve patients adherences and efficacy of medication, reduce adverse reactions, and save costs. Key words: Information services; Medical alliance; Pharmacist; Chronic care management; Discharged patients

Extended care for chronic wound ostomy by specialist nurses in a medical alliance

Development of medical alliances can provide patients of wound ostomy with cost-effective, safe and effective continuing specialized care at their community, gradually homogenizing hospital-community specialized care.By means of establishing a nurse advice referral and specialist nurses consultation mechanism, Shenzhen Luohu Hospital Group has achieved to share specialist nursing resources between hospitals and social health centers.This practice can reduce re-hospitalization rate of these patients, reduced their economic burden, save medical resources and improve patient satisfaction as well. Key words: Specialist nurse; Chronic wounds; Extended care; Medical alliances; Community

Case analysis of further high-quality nursing services by medical institutions

Objective To learn the efforts made by China′s medical institutions in furthering high-quality nursing services. Methods From June to October 2018, 582 cases were collected regarding Furthering high-quality medical , which ranks one of the ten innovative medical services under China Healthcare Improvement Initiative(2018-2010). By means of statistics on the frequency of the subject words in the cases, the authors identified hotspots of these hospitals in this regard, and used descriptive analysis to study the data. Results These keywords were categorized into six aspects, namely, strengthening the construction and management of nursing teams, creating special nursing service programs, creating innovative nursing models, innovating models of continuing care/home care/healthcare plus aging care, improving primary healthcare capabilities relying on medical alliances, and internet plus nursing . Conclusions Diversified measures should be taken to make up for the shortage of nursing manpower, strengthen the understanding of the connotation of quality nursing, and improve the nursing management mechanism. Key words: High-quality nursing service; Medical institutions; Case; Innovation

Analysis of the present medical service of China′s public hospitals as guided by China Healthcare Improvement Initiative

Objective To objectively study the current progress of China Healthcare Improvement Initiative, and its effectiveness and shortcomings for further improvement. Methods Questionnaires were customized by expert consultation and pre-investigation, and distributed by the National Health Commission in April 2018 to the hospitals.Data of 5 469 hospitals were recovered and analyzed with a statistics software for descriptive analysis. Results Implementation progress of the five working systems varied with regions, and rooms of improvement were found in such aspects as outpatient appointment, clinical pathway management and social work system.In 2017, the proportion of outpatient appointments of 5 469 hospitals averaged 19.1%.Progress of the ten major service models also varied, as defects were found in such service models as continuous medical service, intelligent service, and interconnection service.In 2017, only 6.7% of the 5 469 hospitals had put in place hierarchical integrated clinical pathways within their medical alliances. Conclusions Improvement of the medical services calls for not only the efforts of medical institutions themselves, but also top-level design by the local health authorities.In particular, an online information platform should be established for the whole region, to unify the information standards and processes, and corresponding mechanisms and system support are needed. Key words: Health services administration; China Healthcare Improvement Initiative; Outpatient appointment; Clinical pathway; Intelligent hospital

Design and Preliminary Experience of a Tele-Radiotherapy System for a Medical Alliance in China.

Background: The medical alliance and telemedicine are considered to be important means to solve the imbalance between regions and shortage of professionals and promote the homogenization of medical services. Sichuan Provincial People's Hospital Group (SPPHG) is a network of hospitals with different levels of expertise, and all the members with radiotherapy form a radiotherapy network (RTN). Addressing the inadequacy and imbalance of radiotherapy services of Sichuan Province, China, a tele-radiotherapy system for RTN-SPPHG is designed, which includes the business model and corresponding technical implementation of an information system. Materials and Methods: In the RTN-SPPHG, a distributed remote collaboration business model is explored and a tele-radiotherapy information system is customized for this telemedicine model. Both the business model and tailored information system were evaluated in actual use. Results: Based on the tele-radiotherapy system of RTN-SPPHG, multitype hospitals are linked together and serve as a whole. Through the internet, the experience of experts of Sichuan Provincial People's Hospital is effectively deployed to member hospitals at the grassroot level. Conclusions: A close-knit medical alliance based on a tele-radiotherapy system should be a way to rapidly improve radiotherapy services and promote the homogenization of service in a region.

Information analysis of patients with allopatry direct settlement of medical insurance at an oncology hospital

Objective To propose on and improve direct settlements by medical insurance offices and hospital systems in their processing of medical treatment in allopatry (MTA), by analyzing such data as the homepages of medical records of such inpatients at a tertiary cancer hospital with their medical expenses settled directly. Methods Data of 6 379 MTA inpatients with direct settlements of in-hospital fees from April 2017 to March 2018 were included in this study. Such data were used to identify the change trend of their case counts and their regional distribution, and analyzed with hierarchical clustering to calculate the settlement counts of various provinces. Results Analyses found that the total cases of such patients remained stable at the hospital, yet the cases of direct settlement rose from five to 1 263, and the proportion of direct settlement among all MTA inpatients rose month by month from 0.14% to 29.26%. Most of MTA inpatients come from Hebei, Shandong, Inner Mongolia and Shanxi provinces in turn, yet the direct settlement counts and hospitalization case trends appear different. Clustering results indicate Hebei as the type-1 province with the highest proportion of direct settlement inpatients, accounting for 30.41%; Shandong, Inner Mongolia and Shanxi as the type-2 provinces, accounting for 15.05%, 13.45% and 11.00% respectively; Liaoning, Henan and Heilongjiang as the type-3 provinces, accounting for 6.79%, 4.81% and 4.42% respectively; while the rest provinces as the type-4, accounting for less than 3%. Conclusions Regional distribution varies distinctively among such inpatients, and the number of these inpatients keeps rising stably. In such circumstances, hospitals are recommended to enhance their management in strengthening medical insurance audit systems, speeding up settlement, and building regional medical alliances. Key words: Insurance, hospitalization; Allopatry medical treatment; Direct settlement; Regional distribution

Analysis of reciprocal sharing of large medical devices at the medical alliance headed by the Third People′s Hospital of Wuxi

Reciprocal sharing of medical devices plays a breakthrough point for strengthening medical alliances, while promoting efficiency building is the core work of medical devices sharing as well. Taking this medical alliance as an example, this paper discussed the effective strategies of large medical devices sharing within the medical alliance. The measures taken include basic information research and expert interview, high-level planning, and information platform, as well as incentive protection, effectiveness evaluation and atmosphere construction. These efforts can enhance the service support, satisfaction, inspection income, full usage, work ability, new function extension, and equipment management. Furthermore, it can promote the service ability, telemedicine and hierarchical medical of the medical alliance. Key words: Medical alliance; Medical devices; Reciprocal sharing; Wuxi