Medical Consortium Research Articles

A cross domain access control model for medical consortium based on DBSCAN and penalty function

BackgroundGraded diagnosis and treatment, referral, and expert consultations between medical institutions all require cross domain access to patient medical information to support doctors’ treatment decisions, leading to an increase in cross domain access among various medical institutions within the medical consortium. However, patient medical information is sensitive and private, and it is essential to control doctors’ cross domain access to reduce the risk of leakage. Access control is a continuous and long-term process, and it first requires verification of the legitimacy of user identities, while utilizing control policies for selection and management. After verifying user identity and access permissions, it is also necessary to monitor unauthorized operations. Therefore, the content of access control includes authentication, implementation of control policies, and security auditing. Unlike the existing focus on authentication and control strategy implementation in access control, this article focuses on the control based on access log security auditing for doctors who have obtained authorization to access medical resources. This paper designs a blockchain based doctor intelligent cross domain access log recording system, which is used to record, query and analyze the cross domain access behavior of doctors after authorization. Through DBSCAN clustering analysis of doctors’ cross domain access logs, we find the abnormal phenomenon of cross domain access, and build a penalty function to dynamically control doctors’ cross domain access process, so as to reduce the risk of Data breach. Finally, through comparative analysis and experiments, it is shown that the proposed cross domain access control model for medical consortia based on DBSCAN and penalty function has good control effect on the cross domain access behavior of doctors in various medical institutions of the medical consortia, and has certain feasibility for the cross domain access control of doctors.

Data‐sharing strategies in medical consortium based on master‐slave multichain and federated learning

Data‐sharing strategies in medical consortium based on master‐slave multichain and federated learning

Telemedicine-Enhanced Lung Cancer Screening Using Mobile Computed Tomography Unit with Remote Artificial Intelligence Assistance in Underserved Communities: Initial Results of a Population Cohort Study in Western China.

Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623.

Does integrated health management within a county medical consortium improve rural type 2 diabetic patients’ self-management behavior and quality of life? An empirical analysis from Eastern China

BackgroundLevels of self-management behaviors (SMB) and quality of life (QoL) are suboptimal in Chinese adults with type 2 diabetes (T2D), especially in rural China. Integrated health management within a county medical consortium, featuring multi-level teams of doctors, nurses, and other professionals offering follow-up services such as check-ups, assessments, treatment, and health education, is promising in improving this. This study aimed to assess the effect of integrated health management within a county medical consortium on the SMB and QoL of rural T2D patients in China.MethodsBased on a survey conducted on the county medical consortium in Eastern China, this study initially employed propensity score matching (PSM), a nonparametric technique, to precisely estimate the average treatment effect on the treated (ATT) of integrated health management on SMB and QoL in rural T2D patients. Subsequently, quantile regression was also performed to estimate the relationship between the implementation of integrated health management, sociodemographic factors, follow-up services (offered during integrated health management) and both SMB and QoL.ResultsThe ATT values for SMB and QoL, representing the net effect of integrated health management within a county medical consortium on SMB and QoL, were significantly positive. They ranged from 4.34 to 4.67 for SMB and from 0.89 to 1.06 for QoL, respectively, based on the four different PSM modalities. The results of quantile regression also revealed a statistically significant positive association between the implementation of integrated health management and both SMB (coef. = 4.15) and QoL (coef. = 1.54). These findings suggest that integrated health management within a county medical consortium can effectively improve SMB and QoL in rural T2D patients. Furthermore, frequency of follow-up service and health behavior guidance were positively associated with SMB and QoL. Conversely, on-call follow-up services, medication guidance and follow-up services at medical institutions were negatively correlated with SMB or QoL.ConclusionsThe study highlights the effectiveness of integrated health management within a county medical consortium in improving SMB and QoL among individuals with T2D in rural China. The findings offer invaluable insights for the advancement of chronic disease management in rural areas of developing countries.

Exploration and contemplation of homogenized education of specialists in pulmonary and critical care medicine at member hospitals of a hospital consortium

Talent construction is the cornerstone to the establishment of a high-quality, homogeneous healthcare system in a healthcare consortium. Pulmonary and critical care medicine (PCCM) as the first pilot specialty, the standardized training of PCCM specialists has started and achieved remarkable results. The consortium member hospitals' physician specialist education is an important complement to PCCM training. The establishment of the consortium provides a new form of the education of physicians in PCCM, with the advantages of high quality teaching, wide coverage of staff and throughout the career development process. This article summarized the current status of physician specialty education in the member hospitals of the consortium, and further proposes the goal of homogenized specialty education for physicians in the member hospitals. And it analyzed in depth the problems that existed in the practice of training for hospital consortium member hospitals specialists, such as non-uniform level of instruction, non-systematic content of training, limited sources of teaching cases, and lack of teaching materials and equipment. For the medical consortium member hospital physician specialty education of in-depth thinking, we put forward the corresponding countermeasures. The aim of this study is to explore the homogenization of the specialty education system of pulmonary and critical care medicine in the member hospitals, in order to comprehensively improve the medical level of respiratory specialists in the member hospitals of the medical consortium.

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review.

The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

Differences in influencing mechanism of clinicians’ adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums

BackgroundMedical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians’ adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians’ hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems.MethodsA self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization.ResultsIt revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01).ConclusionTo effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.

Untraceable blockchain-assisted authentication and key exchange in medical consortiums

Medical consortium provides tamper-proof data sharing of patient medical records. Since the communications of patients’ devices with hospital servers are accomplished through insecure mediums, scholars have suggested secure authentication protocols to protect the communication links. Yet careful analysis of cutting-edge blockchain-assisted schemes reveals they are susceptible to flooding, ephemeral secret leakage, and tracing/tracking attacks. Besides, they cannot provide a proper balance between security and resource efficiency. This paper introduces a blockchain-assisted authentication protocol that not only defends against potential attacks, but also significantly improves efficiency in computation, communication, and storage usage on the blockchain. Besides, patients are able to receive continuous services from multiple hospitals after just one registration on a cloud server, with the blockchain ensuring the authenticity and traceability of authentication records. We present both formal and informal proof of the proposed protocol and conduct experimental evaluations using ARM and Hyperledger Fabric to provide realistic security and performance insights.

5 P consortium “Children’s Medicine”

Medical consortia help solve current healthcare problems. Four scientific medical institutions (GBUZ of the Moscow region “Research Institute of Childhood of the Ministry of Health of the Moscow Region”, Scientific Research Clinical Institute of Pediatrics and Pediatric Surgery named after Academician Yu. E. Veltishchev Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N. I. Pirogov” of the Ministry of Health Russia, the Federal State Budgetary Institution “Medical Genetic Research Center named after Academician N. P. Bochkov”, the Federal Budgetary Institution “Moscow Research Institute of Epidemiology and Microbiology named after G. N. Gabrichevsky” of Rospotrebnadzor) and one higher educational institution (the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation) united into the 5P “Children’s Medicine” consortium to solve pressing problems of children’s healthcare in accordance with the basic principles of personalized medicine. Organizing large congresses with international participation dedicated to the problems of children’s healthcare is an opportunity for doctors in the Russian Federation and other countries to share knowledge and best practices on saving a child’s life and treating diseases from an early age of the patient through direct communication. A systematic approach can be considered the most effective for solving problems in all areas, including children’s healthcare, and the 5 P “Children’s Medicine” congress helps doctors go beyond the boundaries of the familiar and familiar, learn new things, and get ideas for further professional growth.

The UK Divide: Does Having a Pembrolizumab–Chemotherapy Option in Head and Neck Cancer Matter? Real-world Experience of First-line Palliative Pembrolizumab Monotherapy and Pembrolizumab–Chemotherapy Combination in Scotland

AimsThe Scottish Medical Consortium recently approved first-line pembrolizumab monotherapy or in combination with chemotherapy for head and neck squamous cell carcinoma in the palliative setting, contrasting with the decision made by the National Institute for Health and Care Excellence, who approved monotherapy alone in England and Wales. The aim of this study was to provide real-world performance data for first-line pembrolizumab-containing treatments for head and neck squamous cell carcinoma in the palliative setting in Scotland. Materials and methodsWe analysed the electronic records of patients who started pembrolizumab-containing treatment between 1 March 2020 and 30 September 2021. Outcomes included overall survival, progression-free survival (PFS), the duration of response and the disease control rate. Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival. ResultsOur cohort included 91 patients (median follow-up 10.8 months). Patient characteristics were similar to those in the KEYNOTE-048 study, although our cohort had a higher proportion of patients with newly diagnosed, non-metastatic disease. For patients receiving monotherapy (n = 76), 12- and 24-month overall survival were 45% and 27%, respectively. For patients receiving pembrolizumab–chemotherapy (n = 15), 12-month overall survival was 60% (24-month overall survival had not yet been reached). Experiencing one or more immune-related adverse event (irAE; versus no irAEs), of any grade, was associated with favourable overall survival and PFS for patients receiving monotherapy in both univariable Log-rank analysis (median overall survival 17.4 months versus 8.6 months, respectively, P = 0.0033; median PFS 10.9 months versus 3.0 months, respectively, P < 0.0001) and multivariable analysis (Cox proportional hazards regression: overall survival hazard ratio 0.31, P = 0.0009; PFS hazard ratio 0.17, P < 0.0001). ConclusionOur real-world data support the KEYNOTE-048 study findings and the value of combination treatment options. Additionally, our data show that irAEs of any grade, as reported in routine clinical records, are associated with better outcomes in this patient group, adding to the growing body of evidence showing that irAEs are generally a positive marker of programmed death-ligand 1 (PD-L1) inhibitor response.

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.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China.

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China. An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform. After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09). The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

The Effect of an Empowerment-Based Health Management Program within a Medical Consortium Framework on Secondary Prevention of Stroke

The Effect of an Empowerment-Based Health Management Program within a Medical Consortium Framework on Secondary Prevention of Stroke

Incentive mechanism for sharing and using EHR in medical consortiums based on performance evaluation.

The construction of medical consortiums not only promotes active cooperation among hospitals, but also further intensifies active competition among them. The shared use of electronic health records (EHR) breaks the original pattern of benefit distribution among hospitals. The purpose of this paper is to establish an incentive mechanism for the shared use EHR, and to reveal the incentive effect and mechanism of key factors, and to put forward management suggestions for solving the real conflicts. We constructed a basic incentive model and an incentive model that introduces performance evaluation as a supervisory signal, based on analyzing the hospital cost function, the hospital benefit function, and the incentive contract function. Finally, the incentive effects of key factors before and after the introduction of performance evaluation were verified and compared using MATLAB simulation method. The profit level and incentive coefficient of hospitals sharing EHR are independent of the amount of one-time government subsidies. Regardless of whether a performance evaluation supervisory signal is introduced or not, the incentive coefficients are increasing functions with respect to ρ, τ, but decreasing functions with respect to β, δ, γ. After the inclusion of supervisory signal of performance evaluation in the model, the ability of hospitals to use EHR has a higher impact effectiveness on improving both incentive effects and benefit levels. The impact of the value-added coefficient on the level of earnings is consistently greater than it would have been without the inclusion of the performance evaluation supervisory signal. Enhancing the capacity of hospitals to use EHR and tapping and expanding the value-added space of EHR are 2 key paths to promote sustainable shared use of EHR. Substantive performance evaluation plays an important role in stabilizing incentive effects.

Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors.

This study aims to assess the efficiency and productivity of the Luohu Hospital Group after the reform and to identify factors influencing the efficiency to support the future development of medical consortia. Data on health resources from Shenzhen and the Luohu Hospital Group for the years 2015 to 2021 were analyzed using the super-efficiency slack-based measure data envelopment analysis (SE-SBM-DEA) model, Malmquist productivity index (MPI), and Tobit regression to evaluate changes in efficiency and productivity and to identify determinants of efficiency post-reform. After the reform, the efficiency of health resource allocation within the Luohu Hospital Group improved by 33.87%. Community health centers (CHCs) within the group had an average efficiency score of 1.046. Moreover, the Luohu Hospital Group's average total factor productivity change (TFPCH) increased by 2.5%, primarily due to gains in technical efficiency change (EFFCH), which offset declines in technical progress change (TECHCH). The efficiency scores of CHCs were notably affected by the ratio of general practitioners (GPs) to health technicians and the availability of home hospital beds. The reform in the Luohu healthcare system has shown preliminary success, but continuous monitoring is necessary. Future strategies should focus on strengthening technological innovation, training GPs, and implementing the home hospital bed policy. These efforts will optimize the efficiency of health resource allocation and support the integration and development of resources within the medical consortium.

MC-DSC: A Dynamic Secure Resource Configuration Scheme Based on Medical Consortium Blockchain

MC-DSC: A Dynamic Secure Resource Configuration Scheme Based on Medical Consortium Blockchain

Barriers and facilitators to offering post-intensive care follow-up services from the perspective of critical care professionals: A qualitative study.

Various programmes and models for post-intensive care unit (ICU) follow-up services have been developed worldwide. In China, post-ICU follow-up remains in the exploratory stage and little is known regarding the appropriate form and challenges of implementation, which need to be further explored. This study aimed to explore and describe the barriers to and facilitators of post-ICU follow-up services from the perspective of critical care professionals. This was a descriptive qualitative study. Semi-structured interviews were conducted with 21 health care workers whose units had offered ICU survivors different forms of follow-up services; the data were analysed by qualitative content analysis during August 2022 and December 2022. The study was conducted at 14 ICUs in 11 tertiary hospitals in Shanghai, China. Seventeen subthemes were extracted as barriers and facilitators in the follow-up of ICU survivors. In the initiating process, the barriers included the restriction of decision-making rights and scope of practice, indifferent attitude towards survivors and repeated work. The facilitators included admitted significance, the needs of ICU survivors, the conscientiousness of professionals and the pioneers and leadership support. In the implementation process, lack of confidence, lack of cooperation in medical consortium, distrusted relationships, restrictions of medical insurance, ageing problems and insufficient human resources acted as barriers, whereas lessons learned, positive feedback and digital support served as facilitators. Furthermore, recommendations and tips were identified for offering follow-up services. Medical personnel can better utilize available resources and develop strategies to overcome constraints by gaining insights into the abovementioned barriers and facilitators. The findings of this study can provide a useful reference for structured and systematic follow-ups to ameliorate post-intensive care syndrome in low- and middle-income countries. Publicity and educational measures play a crucial role in enhancing the awareness of survivors and the consensus of health care professionals from medical consortium regarding impairments after critical care. Leadership and policy support can address numerous obstacles to guiding follow-up services.

Perceived knowledge, attitudes and practices regarding the medical consortium among medical staff in Sichuan, China: a cross-sectional survey

BackgroundIn China, fragmented and inefficient health care systems are common while quality resources are limited. To promote an organized, efficient system, the government launched a medical consortium policy to vertically integrate health care through the collaboration of different levels of medical care. Logically, medical staff’s knowledge, attitudes and practices (KAP) regarding the consortium are critical for its development. The objective of this study was to explore the KAP regarding the medical consortium among medical staff in a medical consortium in Sichuan Province, China.MethodsA cross-sectional survey was conducted. In total, 690 medical staff members in 3 cities of Sichuan Province, China, were interviewed from November 2018 to December 2018. The questionnaire consisted of 18 items, including 4 items related to perceived knowledge, 4 items related to attitudes and 2 items related to practices, and was rated on a 5-point Likert scale (one = strongly disagree/do not know, five = strongly agree/know).ResultsThe effective response sample was 640 copies of the questionnaire, and most medical staff members (92.50%) knew about the cooperation with other hospitals in the medical consortium. Medical staff scored differently on each item in the questionnaire, with the highest score being the item ‘agreeing with the ward rounds and clinical teaching and training organized by the leading hospital’ (4.54 ± 0.76), and the lowest score being the item ‘frequency in participating in ward rounds and clinical teaching organized by the leading hospital’ (2.83 ± 1.36). In addition, the effect of demographic characteristics on KAP was evaluated by stepwise multiple regression analysis, and a significant positive correlation was found between all the studied variables by Spearman’s correlation (p < 0.05).ConclusionsThis study showed that the attitudes toward and knowledge of the medical consortium significantly contribute to practices, satisfaction with the support work performed by the leading hospital and agreement of improvement after joining the medical consortium. Thus, to improve medical staff’s KAP and satisfaction, publicity and educational programs in medical consortia are necessary, and the leading hospital should attach importance to the informatization construction and demand of different medical staff members.Clinical trial registrationThere are no clinical trials in this study.

Predictors of referral behaviour and intention amongst physicians in a medical consortium based on the theory of planned behaviour: a cross-sectional study in China.

To promote patients' referral across healthcare institutions and integrated care delivery, we identified predictors of physicians' behaviour and intention to refer patients in a county medical consortium in China on the basis of the theory of planned behaviour (TPB). This census-based cross-sectional study was conducted in Yangxi Hospital Group (YHG). All physicians in county hospitals and township health centres were invited to participate. Structural equation modelling was employed to analyse the relationships between referral intention and behaviour and other TPB variables in the group of whole participants and in sub-groups. In total, 330 physicians participated in this study. One-third of participants were general practitioners, and half of them were from county hospitals. Referral behaviour of females (χ2 = 20.372, p < 0.001), who had lower education levels (χ2 = 17.859, p = 0.001), lower professional title (χ2 = 14.963, p = 0.005), and lower monthly salary (χ2 = 33.753, p < 0.001) were less frequent than the others. Among them, 116 (35.2%), 108 (32.7%), and 106 (32.1%) respondents reported that they had never referred patients, had referred patients 1-9 times, and had referred patients over 10 times during the past 3 months, respectively. The mean score of referral intention was 4.23/5 (SD = 0.71). In the model with all participants, a stronger referral intention (β = 0.218, 95% CI = 0.080-0.356) was associated with more frequent referral behaviour. The subjective norm (β = 0.703, 95% CI = 0.590-0.817) was the strongest predictor of physicians' referral intention, followed by perceived behavioural control (β = 0.234, 95% CI = 0.090-0.378). Mediated by referral intention, subjective norms (β = 0.153, p < 0.01) and perceived behavioural control (β = 0.190, p < 0.01) had significant indirect effects on physicians' referral behaviour. The model with participants in county hospitals showed similar results to the model with all participants. Meanwhile, in the model with participants in township health centres, there were no significant associations between referral behaviour and other TPB constructs. Physicians' referral behaviour was influenced by intention, subjective norms, and perceived behavioural control in Chinese county hospitals.

Patient referral strategy and cost sharing for a medical consortium

Patient referral strategy and cost sharing for a medical consortium