Medical Consortium Research Articles

Exploring disease interrelationships in older inpatients: a single-centre, retrospective study.

Comorbidity is a common phenomenon in the older population; it causes a heavy burden on societies and individuals. However, the relevant evidence, especially in the southwestern region of China, is insufficient. We aimed to examine current comorbidity characteristics as well as correlations among diseases in individuals aged >60 years. Retrospective study. We included records of 2,995 inpatients treated at the Gerontological Department of Sichuan Geriatric Hospital from January 2018 to February 2022. The patients were divided into groups according to sex and age. Diseases were categorised based on the International Classification of Diseases and their Chinese names. We calculated the age-adjusted Charlson Comorbidity Index (ACCI), categorised diseases using the China Health and Retirement Longitudinal Study questionnaire, and visualised comorbidity using web graphs and the Apriori algorithm. The ACCI was generally high, and it increased with age. There were significant differences in the frequency of all diseases across age groups, especially in individuals aged ≥90 years. The most common comorbid diseases were liver diseases, stomach or other digestive diseases, and hypertension. Strong correlations between the most common digestive diseases and hypertension were observed. Our findings provide insights into the current situation regarding comorbidity and the correlations among diseases in the older population. We expect our findings to inform future research directions as well as policies regarding general clinical practice and public health, especially for medical consortiums.

Evaluation of the star family doctors training program: an observational cohort study of a novel continuing medical education program for general practitioners within a compact medical consortium: a quantitative analysis

IntroductionTo determine the effectiveness of the Star Family Doctors Training Program, a comprehensive Continuing professional development (CPD) program for general practitioners (GPs) in a compact medical consortium.Patients and MethodsObservational cohort study with a quantitative analyses in primary health care institutions in Sichuan Province. The interventions were as following: (1) The Star Family Doctors Training Program is a full-time, local government allocation program certified by the Health Department of Sichuan Province, emphasizing small group learning and practice, and using standard patients and medical patient simulators; 30 participants were selected by their institutions. (2) The control group underwent a self-financed after-work CPD program using conventional lectures; 50 participants were self-selected. Short-term effectiveness assessed using immediate post-training tests and self-evaluations; long-term (1 year) effectiveness evaluated using self-reported surveys.ResultsThe study involved 80 GPs (28.75% men; mean age: 38.2 ± 9.2 years). The average post-training total score was higher in the STAR group than in the control group (72.83 ± 5.73 vs. 68.18 ± 7.64; p = 0.005). Compared to the controls, STAR participants reported seeing more patients (all p < 0.05), and had more patients who signed family-doctor contracts (p = 0.001) as well as increased patient satisfaction (p = 0.03), respectively. STAR-group trainees appraised the program higher and were more willing to recommend it to colleagues (90% vs. 64%, p = 0.011).ConclusionThe Star Family Doctors Training Program achieved good responses and provides a reference for future CPD programs.

Vertical Integration of Electronic Health Records in Medical Consortiums: Dynamic Modeling Approach Based on the Evolutionary Game Theory.

China has continuously issued policies to speed up the interconnection, mutual recognition, sharing of medical information systems, and data integration management across regions and institutions. However, the vertical integration of electronic health records (EHRs) within the medical consortium is hampered by "poor mechanism and insufficient motivation" and the phenomenon of "free riding" among participating medical institutions, which makes the integration less effective. We hope to clarify the game mechanism of stakeholders in the vertical integration of EHRs, and put forward targeted policy suggestions for improvement. We constructed the "government-hospital-patient" tripartite evolutionary game model based on the detailed analysis of the research problems and their assumptions. We then simulated the game strategies and outcomes of each participant using the system dynamics approach to reveal the long-term strategy evolution mechanism of the core participants in the vertical integration of EHRs in the medical consortium, as well as the influencing factors and action mechanisms of each party's strategy evolution to provide references for improving relevant policies. The evolutionary game system could eventually reach an optimal equilibrium, but in areas where the government was required to be in a dominant position, patient supervision was necessary to have a positive role, while a reasonable reward and punishment mechanism can promote active participation of hospitals. The effective way to achieve the goal of vertical integration of EHRs in the medical consortium is to build a multiagent coordination mechanism under the guidance of the government. Meanwhile, it is necessary to establish a scientific integration performance evaluation mechanism, a reward and punishment mechanism, and a benefit distribution mechanism to promote the healthy development of vertical integration of EHRs in medical consortiums.

Current status and influencing factors for physicians in different departments prescribing novel hypoglycemic agent with cardiovascular benefits

Objective: To investigate the knowledge, use and barriers when prescribing GLP-1RA and SGLT2i among cardiologists, endocrinologists and general practitioners, and explore the influencing factors that hinder the use of these medications. Methods: A questionnaire was conducted among physicians in the above departments in Peking University Third Hospital and health service institutions at all levels in its medical consortium. A total of 342 physicians were involved. Among them, 40.6% (139) were cardiologists, 28.9% (99) were endocrinologists and 30.4% (104) were general practitioners; 66.7% (270) came from Beijing while 33.3% (72) from other provinces. The survey included clinicians' knowledge and current use of GLP-1RA and SGLT2i, and the possible reasons that influenced the prescription of these medications. Medical therapies of physicians were investigated by simulating different clinical scenarios. The difference of measures among physicians in different departments was compared. Results: A total of 342 physicians were involved, with the average age of 40 (35, 46) years old and the average working time of 13 (7, 20) years. Among them, 40.6% (139) were male. 77.5% (265) physicians had comprehensive knowledge of SGLT2i and prescribed it, which was higher than that for GLP-1RA (70.5%, 241) (P<0.001). 21.1% (72) physicians prescribed SGLT2i more than 20 times per month, which was higher than that for GLP-1RA (8.2%, 28) (P<0.001). Endocrinologists had more knowledge and prescribed more GLP-1RA and SGLT2i compared with other physicians (both P values<0.001). 38.1% (53) cardiologists, 22.2% (22) endocrinologists, and 30.8% (32) general practitioners believed patients needed an endocrinologist to evaluate and adjust GLP-1RA, which was the primary barrier for the use of medications (P=0.042). 27.4% (38) cardiologists, 14.1% (14) endocrinologists, and 30.8% (32) general practitioners believed patients needed an endocrinologist to evaluate and adjust SGLT2i, which was the primary barrier for the use of medications (P=0.018). 21.6% (30) cardiologists, 45.5% (45) endocrinologists, and 31.7% (33) general practitioners believed side effects of SGLT2i was the primary barrier for the use of medications (P<0.001). For patients with unqualified glycemic control and cardiovascular complications, 65.4% (75) cardiologists, 69.7% (69) endocrinologists, and 43.3% (45) general practitioners chose the above medications (P<0.001). For patients with qualified glycemic control, combined with cardiovascular complications and diabetic organ damage, 35.3% (49) cardiologists, 52.5% (52) endocrinologists, and 25.0% (26) general practitioners chose the above medications (P<0.001). Conclusions: Physicians had more knowledge and prescription of SGLT2i than that of GLP-1RA. Endocrinologists had more knowledge and prescription of the above medications than other physicians. The side effect of medications was potential primary barrier for the use of the novel hypoglycemic agent with cardiovascular benefits. In clinical practice, most of physicians considered that high-risk patients with cardiovascular comorbidities need to be referred to cardiologist or endocrinologist to adjust clinical therapies.

Study on the evolutionary strategy of upward patient transfer in the loose medical consortia.

Medical institutions in loose medical consortia tend to have poor cooperation due to fragmented interests. We aim to explore any issues associated with patient upward transfer in a loose medical consortium system consisting of two tertiary hospitals with both cooperative and competitive relationships. A two-sided evolutionary game model was constructed to assess the stability of equilibrium strategy combinations in the process of interaction between game players under different cost-sharing scenarios and different degrees of penalties when running patient upward transfer between super triple-A hospitals (STH) and general triple-A hospitals (GTH). We found that a hospital's stabilization strategy was related to its revenue status. When a hospital has high/low revenues, it will treat patients negatively/positively, regardless of the strategy chosen by the other hospital. When the hospital has a medium revenue, the strategy choice will be related to the delay cost, delay cost sharing coefficient, government penalty and the strategic choice of the other hospital. Delay cost-sharing coefficient is an important internal factor affecting the cooperation in a medical consortium for patient upward transfer. External interventions, such as government penalty mechanisms, can improve the cooperation between hospitals when hospitals have moderate revenue.

A Review of Research on Regional Medical Consortia

China's healthcare resources have long suffered from an imbalance between regional allocations, and there are obvious differences in the provision of healthcare services between urban and rural areas, and between the east and west. In order to promote the continuous improvement and reform of the medical system and to explore the construction of a medical and health system suitable for the current situation in China, in the context of regional medical integration, the medical consortium model has attracted much attention and become a hot spot for research in the academic field. The main situation of the existing research results is as follows: there is a lack of systematic theoretical foundation research at home and abroad, and the pilot case studies of regional medical consortia are the main ones in China, while there is a lack of overall high-level research in the country, compared with domestic and foreign countries, the quantity of research on regional medical consortia is far less than the relevant research in foreign countries, and the overall quality of research is not high, and it is at a fledgling stage. Therefore, in future research, we should pursue diversification in methodology, cross-application of multiple disciplines, condensation of theoretical studies on the basis of case studies, in-depth research on research content and strengthening of localization of foreign experience.

Study on the effectiveness evaluation of medical consortia based on AHP

Objective: To effectively evaluate the timeliness of China's medical union policy, and to help the medical management department provide a reference basis for the implementation of the medical union policy, this paper, by combing the relevant research on the medical union policy at home and abroad, constructs a comprehensive evaluation index system of the timeliness of the medical union in four dimensions: the construction of basic medical services, the sharing of regional information, the two-way referral within the medical union, and the level of medical service. The weights of different indicators are calculated by using the analytic hierarchy process, and the results of different indicators are compared and analyzed. The results show that the level of medical service and regional information sharing are the most important indicators for evaluating the effectiveness of the medical consortium.

Key influencing factors of vertical integration of electronic health records in medical consortiums

BackgroundSimilar to other countries around the world, China has incorporated the recording of electronic health data into its national strategy. After the completion of the decentralized construction phase, the construction of electronic health records in China has reached the stages of integration, sharing, and utilization. “Vertical integration” is the premise and foundation of “shared utilization” of electronic health records within the medical consortium, but it is also a bottleneck in realizing this goal. ObjectiveThe main purpose of this paper is to find out the key factors affecting the vertical integration of electronic health records in the medical consortiums, and to clarify the impact mechanism of these key factors, so as to provide reference for improving relevant policies. MethodsIn this study, an index system of influencing factors is established for cross-institutional vertical integration of electronic health records within a medical consortium, identifying key influencing factors using the combined fuzzy-DEMATEL-ASIM method and revealing the influence relationship and action mechanism among the key influencing factors using a multi-layer hierarchical influence structure model. ResultsThere are 32 factors influencing the vertical integration of electronic health records in the medical consortium, 17 of which are key factors. According to the hierarchical structure of key influencing factors, they can be divided into three categories: surface-level factors, middle-level factors and deep-level factors. ConclusionsIn practice, these key factors should be prioritized for improvement and optimization to promote integration projects. In the future, we should focus on key influencing factors to precisely implement policies, such as introducing special promotion policies, unifying development planning, changing health insurance payment methods, establishing sharing standards, and raising public awareness.

U.S. medical organizations and climate change advocacy: a review of public facing websites

BackgroundClimate change poses a risk of health catastrophes and must be expeditiously addressed across the health care sector. Physicians are considered trustworthy and are well positioned to discuss climate change with patients. A unified strategy by all U.S. medical societies is essential to effectively mitigate their carbon footprint and address health concerns.MethodsWe conducted a review of the public facing websites of member organizations of the AMA House of Delegates and the AMA, which were scored based on inclusion of content related to climate change in position statements or policies, task forces or committees, patient education materials, practice recommendations and any official society publications. Membership in the Medical Society Consortium on Climate and Health or participation in the organization My Green Doctor were recorded as indicators of a commitment to providing educational resources about mitigation and adaptation to climate change. The availability of a virtual option for annual meetings, as a potential means to reduce the carbon footprint of attendees, was trended from 2021 to 2022.ResultsFifty out of 111 U.S. medical organizations (45%) had at least one metric with a reference to climate change and sixty-one organizations (55%) had no evidence of such website content. Out of 111 websites, only 20% (N = 22) had position statements or policies pertaining to climate change, 11% (N = 12) had committees or task forces dealing with climate change, 8% (N = 9) provided patient education resources on climate change, 21% (N = 23) included green practice recommendations and 45% (N = 50) had an article in an official society publication addressing climate change. Only 14% (N = 15) were listed as member societies of the Medical Consortium on Climate Change and 2% (N = 2) were participating organizations with My Green Doctor.ConclusionsViewed through the lens of medical society websites, there was a wide variation in efforts to address climate change. The high performing organizations can serve as a guide for other societies to help mitigate and adapt to the climate emergency.

The Pathway of China's Integrated Delivery System: Based on the Analysis of the Medical Consortium Policies.

With the deepening of China’s health-care reform, an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system. For China’s integrated delivery system, a medical consortium plays an important role in integrating public hospitals and primary care facilities. The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system. This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process, changes of the series of policies, and characteristics of the policy issued in 2020. We considered that a fully integrated medical consortium would be a major phenomenon in China’s medical industry, which would lead to the formation of a dualistic care pattern in China.

A Cross-Domain Authentication Scheme Based on Cooperative Blockchains Functioning With Revocation for Medical Consortiums

Regional medical consortium systems facilitates medical information sharing. However, many security issues exposed by the dominant centralized architectures, such as single points of failure, unauthorized operations and illegal access, are increasingly apparent constraints on the security and efficiency of data sharing across domains. Even more, any malicious operation detected, effective measures should be executed promptly for identity tracing. In this paper, we propose a secure and efficient cross-domain authentication scheme based on two cooperative blockchains (BCs) for medical consortium systems. Specifically, an intra-domain BC records any legal users’ registration and authentication information while an inter-domain BC is responsible for writing users’ cross-domain authentication information. In each domain, the general hospital acts as a trusted third service provider to achieve cross-chain interactions. For the entire cross-domain authentication procedure, anonymity mechanism is utilized to enhance security, and to trace malicious users, the improved chameleon hash is used in the intra-domain BC to redact the state of the user, and blacklist merkle tree is extended in the inter-domain BC to protect different domains’ services from illegal accessing. In addition, security analysis and performance evaluation are completely given to prove the superior security features and performance compared with other schemes.

Effect of Tiaoshen Patting Therapy Combined with Zhichan Granule on Patients with Parkinson's Disease

<bold>Objective</bold> To observe the clinical effect of Tiaoshen patting therapy combine with Zhichan granule on tremor, stiffness and postural instability on patients with Parkinson's disease. <bold>Methods</bold> A total of 228 patients with Parkinson's disease who were treated in the Shanghai Municipal Hospital of Traditional Chinese Medicine and it's medical consortium, which were randomly divided into Western medicine treatment group, traditional Chinese and Western medicine treatment group and combined treatment group,with 76 cases in each group. The Western medicine treatment group received health education about PD and Dobasazide tablets, three times a day, seven days a week, continuous treatment for 12 weeks; the traditional Chinese and Western medicine treatment group received Zhichan granule on the basis of the Western medicine treatment group, two times a day, seven days a week, continuous treatment for 12 weeks; the combined treatment group received Tiaoshen patting therapy on the basis of the traditional Chinese and Western medicine treatment group, 30 minutes a time, one time a day, three days a week, continuous treatment for 12 weeks. Before treatment, after treatment for eight weeks and after treatment for 12 weeks, Unified Parkinson Disease Rating Scale (UPDRS) and UPDRS-Ⅲ were used to evaluate PD severity and motor symptoms; Parkinson's disease non-motor symptoms questionnaire (NMS Quest) was used to evaluate the non motor symptoms of patients; 39 item Parkinson's disease quality of life questionnaire (PDQ-39) was used to evaluate the quality of life of patients; the differences of adverse reactions in the three groups were evaluated. <bold>Results</bold> Compared with before treatment, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for eight weeks decreased significantly (<italic>P</italic>&lt;0.05), and the total score of UPDRS and UPDRS-Ⅲ in the three groups after treatment for 12 weeks decreased significantly (<italic>P</italic>&lt;0.05); the scores of NMS Quest and PDQ-39 in the traditional Chinese and Western medicine treatment group after treatment for 12 weeks decreased significantly, the scores of NMS Quest and PDQ-39 in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the Western medicine treatment group at the same time, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for 8,12 weeks decreased significantly (<italic>P</italic>&lt;0.05), the NMS Quest score in the traditional Chinese and Western medicine treatment group after treatment for 8 weeks decreased significantly, the PDQ-39 score in the traditional Chinese and Western medicine treatment after treatment for 12 weeks decreased significantly, and the NMS Quest and PDQ-39 scores in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the traditional Chinese and Western medicine treatment group at the same time, the total UPDRS score, UPDRS-Ⅲ score, NMS Quest score and PDQ-39 score of the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). There was no significant difference in the incidence of adverse reactions in the three groups (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Tiaoshen patting therapy combined with Zhizhan granule can improve the motor symptoms, non motor symptoms and quality of life of PD patients, which is safe and worthy of clinical application.

Advanced glycation end products and diabetes and other metabolic indicators

BackgroundDiabetes is a global concern among adults. Previous studies have suggested an association between different screening methods and diabetes; however, increasing evidence has suggested the importance of early screening for diabetes mellitus (DM) and its influencing factors. In this study, we aimed to explore whether the non-invasive detection of advanced glycation end products (AGEs) in the early screening of DM in the Chinese community and whether body mass index (BMI) and metabolic indexes could moderate this relationship.MethodsThree community health service centers in Hefei that signed the medical consortium agreement with the First Affiliated Hospital of Anhui Medical University were selected to screen the population aged 30–90 years in each community using a multi-stage cluster sampling method from January 2018 to January 2019. Univariate analysis of variance was used to compare the differences in general data, biochemical indexes, skin AGEs levels, and blood glucose among groups. In addition, a multivariable logistic regression analysis was performed.ResultsA total of 912 patients with a community health physical examination and no history of diabetes were selected, excluding those with missing values > 5%. Finally, 906 samples were included in the study with an effective rate of 99.3%. The prevalence in the normal, impaired glucose tolerance, and DM groups were 79.8%, 10.0%, and 10.2%, respectively. By dividing AGE by quartile, AGE accumulation was classified as ≤ P25, P25–P50, P50–P75, and > P75. Higher AGE accumulation (χ2 = 37.95), BMI (χ2 = 12.20), systolic blood pressure (SBP) (χ2 = 8.46), triglyceride (TG) (χ2 = 6.23), and older age (χ2 = 20.11) were more likely to have a higher prevalence of fasting blood glucose (FBG). The analyses revealed significant correlations between AGE accumulation, BMI, TG, total cholesterol (TC), and FBG (P < 0.05).ConclusionAs the findings indicate, priority should be given to the quality of metabolic-related indicators, such as BMI, TG, and TC, employed to effectively reduce the FBG of Chinese participants with high AGE accumulation. Skin autofluorescence may prove to be a rapid and non-invasive method for assessing the metabolic progression of all glucose level layers.

Intensive Intervention Improves Outcomes for Chronic Obstructive Pulmonary Disease Patients: A Medical Consortium-Based Management.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Strategies involving multidimensional approaches for the treatment of COPD are needed. This study aimed to evaluate the efficiency of medical consortium-based management for COPD. Patients were grouped in accordance with whether the hospitals they went to were under the medical consortium. We enrolled 141 COPD patients in the management group and 147 COPD patients in the control group. There was no predetermined sex and disease severity inclusion or exclusion criteria. Patients in the control group were managed by standard care, while patients in the management group were managed with intensive medical intervention jointly by specialists in the hospital and general practitioners and healthcare workers in community health centers. There was no difference in the basal demographics between the two groups. The basal condition of the management group was worse than that of the control group, demonstrated by a higher CAT score and a lower pulmonary function index. Half-year intensive intervention decreased CAT score from 17.28 to 15.62 and the Barthel ADL index from 73 to 60 in the management group, which was associated with better pulmonary rehabilitation, pursed-lip breathing, oxygen usage, and medicine regularity. The benefits became more obvious after one-year intensive intervention in the management group. There was a difference in mMRC grades and smoking cessation between the two groups. This study shows that a one-year intensive intervention improves the patients' health status and pulmonary function, suggesting that our medical consortium-based management is effective in the treatment of COPD.

Treatment patterns and outcomes in ALK or ROS1 altered NSCLC: An ATOMIC Registry Study.

9077 Background: New tyrosine kinase inhibitors (TKIs) targeting ALK and ROS1 alterations in non-small cell lung cancer (NSCLC) have emerged over the last decade. Given the rarity of these genetic changes in NSCLC, data on long term outcomes with sequential therapies are limited. Methods: We conducted a multicenter retrospective cohort study of patients with metastatic NSCLC and ALK or ROS1 alterations across 12 Academic Thoracic Oncology Medical Investigators Consortium (ATOMIC) sites between 1/29/2007 and 3/31/2021. Data were abstracted from the electronic medical record. Median time to treatment discontinuation (TTD) of 1st TKI, overall survival (OS), and time to brain metastases were estimated using Kaplan-Meier methodology from start date of 1st TKI. Results: 566 patients with ALK (n = 464) or ROS1 (n = 102) were included. The majority (ALK: 426/464, 92%; ROS1: 88/102, 86%) received a TKI at some point during therapy (1st line TKI n = 262 ALK, 48 ROS1). Crizotinib was the most common 1st TKI (ALK: 57%; ROS1: 88%). Following crizotinib, alectinib (64%) and lorlatinib (41%) were the most common subsequent TKIs for ALK and ROS1, respectively. Alectinib (38%) and entrectinib (10.2%) were the 2nd most common initial TKIs used in ALK and ROS1, respectively. Additional treatment patterns presented in table. With a median follow up time of 31.1 (ALK, 95% CI, 27.6-35.0) and 32.6 (ROS1, 95% CI, 25.7-39.6) months, median OS from start of 1st TKI was 53.3 (ALK, 95% CI, 40.0-68.9) and 42.0 (ROS1, 95% CI, 31.8-NA) months. Out of the 321 patients with brain imaging prior to 1st line therapy, 40% (105/262, ALK) and 39% (23/59, ROS1) had CNS disease. Median time to development of brain metastases from start of 1st TKI in those without previous CNS disease (ALK: 278; ROS1: 58) was 30.0 (ALK, 95% CI, 25.3-39.1) and 27.0 (ROS1, 95% CI, 18.2-NA) months. Median TTD of 1st TKI was 11.2 (ALK) and 10.8 (ROS1) months. Conclusions: This is the largest retrospective cohort of NSCLC patients with ALK or ROS1 rearrangements treated in the real world setting. CNS metastases are common and subset analyses by agent and by year of diagnosis will be presented. Median time to CNS metastasis of &gt; 2 years supports revision of the NCCN guidelines to include regular surveillance brain MRIs in this population. [Table: see text]

Diagnosed with advanced prostate cancer: A population-based cohort from national oncology practices.

5087 Background: Clinical trials can provide access to novel systemic agents and possible improved survival for men diagnosed with regional and metastatic prostate cancer. Although clinical trials should be accessible to all patient populations, racial disparities to enrollment of clinical trials and its outcomes remain an important unknown outcome. Herein, we sought to elucidate the racial disparities in clinical trial enrollment and survival amongst advanced prostate cancer patients from a large community-based medical oncology consortium. Methods: Using CancerLinQ, we identified all patients who were diagnosed with regional (N1+) and/or metastatic (M1) prostate cancer from 2011 – 2021. Enrollment into a clinical trial and overall survival constituted the primary outcomes in this study. Multivariable logistic regression and Cox proportional hazard regression were used to identify covariates associated with each outcome. Results: Amongst the 160,888 patients with regional/metastatic prostate cancer, only 1.5% patients were enrolled in a clinical trial (n = 2,368). On multivariable analysis, patients with worse ECOG performance status were associated with lowers odds of clinical trial enrollment (p &lt; 0.001). Relative to white patients, African-American men (AAM) also had lower odds of clinical trial enrollment (OR: 0.67; p &lt; 0.001). For the entire cohort, clinical trial enrollment correlated with higher survival (HR: 1.19; p &lt; 001) and lower survival for AAM men (HR: 0.85; p &lt; 0.001) compared to white men after adjusting for other covariates. In the subgroup analysis of patients enrolled in clinical trials, AAM demonstrated similar survival to white patients (HR: 0.96, p = 0.95). Conclusions: Although African-American men with regional/metastatic prostate cancer face barriers to clinical trial enrollment, racial disparities in survival appear to resolve for patients who enroll in clinical trials. Increased attention is needed to address barriers to communication and access to clinical trials.

New enhanced clustering algorithms for patient referrals in medical consortia

Medical consortia is a form of healthcare capacity sharing and an effective means to maximizing healthcare resource utilization. To fully satiate patient demand and derive maximum efficiency for the medical consortium, patient referrals among the consortium members is a key mechanism. Patient referrals require two main steps: allocating patients to hospitals (i.e., patient assignment) and assigning patients to each time slot (i.e., patient scheduling). Patient treatment cost and tardiness are two concerns for the patients and are treated simultaneously. A clustering algorithm based on Fuzzy-C Means (FCM) is proposed to solve the problem, with patients clustered for each hospital based on their characteristics and preferences. Solution-enhancing strategies are developed to improve the schedule quality, including a virtual patient moving strategy (VPMS) and local search algorithms (LSA). Three spatial distributions of patients, central clumped, random and uniform distributions, are used to validate the performance of the algorithms. From the experimental results, the FCM-VPMS algorithm yields patient referral solutions at the lowest treatment cost, while the FCM-LSA performs better on minimizing total patient tardiness. On the cost efficiency of the algorithms, VPMS performs well with a central clumped distribution, while the LSAs show higher efficiency with the random and uniform distributions respectively.

Application of Smartphone Otoscope in Telemedicine in Rural Medical Consortium in Eastern China in the COVID-19 Era.

PurposeThis study aimed to evaluate the effectiveness of smartphone otoscope telemedicine in the rural medical consortium in East China in the COVID-19 era.MethodsThis prospective study was conducted within a rural medical consortium that provides health care services by integrating medical resources in the same area. When a patient visited primary health care (PHC) for ear diseases, the PHC provider used a smartphone otoscope to examine the patient's external ear canal and eardrum, and then sent photos or videos of the patient's ear to the otolaryngologist at the lead hospital via WeChat group. The otolaryngologist provided remote diagnosis and management recommendations to the PHC provider. The following data were recorded: age and gender, outpatient diagnosis, disease duration, sides, duration of treatment, telemedicine visits, treatment outcomes, patient satisfaction, and PHC providers' self-evaluation score.ResultsA total of 83 patients were included in the study, including 43 males and 40 females, with a mean age of 44.6 ± 19.7 years (range 3–83 years). The duration of treatment for these patients was 14.0 (7,14) days. PHC visits were 2.2 ± 1.1 times (range: 1–7 times). Telemedicine visits ranged from 1 to 5, with a mean of 1.8 ± 0.9. Among of patients, 62 (74.7%) were cured, 21 (25.3%) improved, and 0 (0%) were ineffective. Sixty-five patients (78.3%) were very satisfied, 16 (19.3%) patients were somewhat satisfied, and two patients (2.4%) were dissatisfied. Based on the self-reported helpfulness, the primary health care providers assessed telemedicine as very helpful (n = 63, 75.9%), helpful (n = 20, 24.1%), and unhelpful (n = 0, 0%).ConclusionsSmartphone otoscope telemedicine in the medical consortium can effectively improve the ability of rural PHC providers to diagnose and treat ear diseases, save time and costs for patients, and improve patient satisfaction.

A fine‐grained and secure health data sharing scheme based on blockchain

AbstractElectronic health record (EHR) allows patients to use an open channel (ie, Internet) to control, share and manage their health records among family members, healthcare providers and other third party data users. Thus, in such an environment, privacy, confidentiality, and data consistency are the major challenges. Although cloud‐based EHR addresses the aforementioned discussions, these are prone to various malicious attacks, trust management and non‐repudiation among servers. Recently, due to the property of immutability, blockchain technology has been introduced to be as an auspicious solution for achieving EHR sharing with privacy and security preservation. Motivated by the above debates, we present BFHS, a blockchain‐based fine‐grained secure EHR sharing mechanism. On BFHS, we encrypt the EHR using ciphertext‐policy attribute‐based encryption (CP‐ABE) and upload it to the interplanetary file system (IPFS) for storage, while the matching index is encrypted via proxy re‐encryption and kept in a medical consortium blockchain. In addition, we created a credit assessment mechanism and incorporated it into the smart contract. Smart contracts, proxy re‐encryption, a credit evaluation mechanism, and IPFS all work together to give patients with a trustworthy EHR sharing environment and a dynamic access control interface. The thorough comparison and experimental analysis show that the proposed BFHS has more comprehensive security features and is more practicable.

Application Research of Artificial Intelligence Screening System for Diabetic Retinopathy.

According to the latest data from the Bureau of Disease Control and Prevention of the National Health and Family Planning Commission, China currently has 199.6 million diabetic patients and has become the world's largest country with diabetes. The prevalence rate is as high as 14.3%, which is much higher than the world average of 5.8%. The primary-level ophthalmic screening service is one of the important tasks to improve primary-level medical services, and the corresponding ophthalmic imaging diagnosis technology is an important support for primary-level medical and health services. Therefore, it is very necessary for us to study the application of artificial intelligence image recognition technology for diabetic retinopathy under the medical consortium mode and to study the precise initial diagnosis, precise referral, and precise follow-up of diabetic retina under the medical conjoined mode, so as to better promote the transformation of the ophthalmology primary service model. Based on this background, in this article, we have proposed and carried out the following solution: (1) diabetes data collation. Based on medical artificial intelligence technology, this paper collected 2,265 electronic medical records from an eye hospital in Ningbo and selected 2,000 qualified medical records for data integration and preprocessing. The contents of electronic medical records mainly include age, gender, and examination records. (2) Establish diabetic retinopathy diagnosis model based on neural network algorithm. This article first uses the classic algorithm of BP neural network for modeling, chooses the Levenberg–Marquardt method as the training function, and selects 10 hidden layer units through comparison experiments. After that, ophthalmologists assessed 80 sets of test results and determined the right diagnosis rate. Finally, this article compares and analyzes the accuracy of the two routes in 80 tests.