Routine Medical Services Research Articles

Association of Gaps in Medical Insurance Coverage with Vision Care Benefits Among US Adults

ABSTRACT Background In the US, routine vision care and medical services are often covered by separate insurance plans. Unmet needs for vision care are more common among adults with gaps in medical coverage, but it is unclear how gaps in medical coverage correlate with lack of vision benefits among currently insured adults. We hypothesized that gaps in medical coverage in the past 12 months would be associated with lack of coverage for vision care among US adults currently covered by commercial medical insurance. Methods We included adults age 18–65 with private insurance who participated in the 2019–2022 National Health Interview Survey. The primary outcome was any coverage for vision care services, and the secondary outcome was a source of vision coverage (primary health insurance policy as compared to single-service plans only). Results Based on a sample of 50,000 participants, we estimated 4% of commercially insured adults recently experienced coverage gaps, and 75% had coverage for vision care services. On multivariable analysis, commercially insured adults with recent gaps in medical coverage were more likely to lack coverage for vision care at the time of the survey, compared to adults with continuous medical coverage (odds ratio [OR], 0.77; 95% CI: 0.68, 0.86). However, medical coverage gaps were not associated with source of vision care coverage. Conclusions Gaps in medical insurance coverage were associated with lower likelihood of vision care coverage compared to continuous medical coverage. Protecting continuity of health insurance may support access to vision benefits and reduce gaps in routine vision care.

Impact of COVID-19 on asthma and COPD patients’ hospital care: a lesson for future pandemics

Abstract Objectives Preventive measure for COVID-19 spread have dramatically affected patients with chronic diseases worldwide, including asthma/chronic obstructive pulmonary disease (COPD) patients. This study aimed to examine the impact of the COVID-19 outbreak and the associated lockdown on the medical care provision of asthma/COPD patients in Jordan. The healthcare behaviours and perceptions of these patients regarding the outbreak were also investigated. Methods A population-based cohort study was conducted on asthma/COPD patients seeking medical care during 2019–2021 at a tertiary hospital in Jordan. Patients were interviewed by phone call, their medical files were also accessed. Demographics, clinical information, and those related to healthcare access (clinic visits, hospital admissions, and emergency room [ER] visits), exacerbation management and medication adherence were all collected. Key findings A total of 371 cases were identified, the majority (65.2%) were asthmatics. The most (76.3%) were not vaccinated (influenza or pneumococcal), none had a written action plan. The study findings showed reduced healthcare utilization (hospital admission and ER visits) during the study period (P < 0.05). Clinic visits also decreased over 2019–2020 (P < 0.05). Accordingly, the pattern of acute exacerbation treatment also changed with fewer antibiotics and inhaled corticosteroids administered during the pandemic (P < 0.05). Medication adherence was relatively low (14.6%–17.25%). Telemedicine was not provided during the study period. Conclusions The study demonstrated disruption in healthcare utilization. There is need for better preparedness for future pandemics to maintain the routine medical care services. Telemedicine should be introduced as part of healthcare systems. Efforts are still needed to optimize medication adherence in Jordan. Future research is needed to better address COVID-19 impact on chronic patients.

Telemedicine and COVID-19 Pandemic: Experiences of Western China Hospital.

COVID-19 has brought unprecedented challenges to the healthcare system. In response to COVID-19, hospitals can replace some routine medical services with telemedicine. At the beginning of the pandemic, West China Hospital developed a new model of telemedicine platform against COVID-19. The telemedicine platform played a critical role in fighting the pandemic in Sichuan Province and significantly improved healthcare outcomes.

Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia.

Diabetes mellitus is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of death and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in Makkah province, Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2018 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah City, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and other vital events like marital status, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p = 003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26-1.03) and if the deceased was > = 80 years compared to 34-59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02-4.42). Exploring community perception of causes of death is crucial as it provides valuable insights into the community's understanding, beliefs, and concerns regarding mortality. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.

SWALLOWAPP: IMPLEMENTATION OF THE QUALITY OF CARE AND FOLLOW-UP FOR THE ONCOLOGICAL DYSPHAGIA PATIENT

The COVID-19 pandemic has dramatically altered the provision of routine medical services and has imposed unprecedented challenges on the healthcare system. This contingency inevitably also had repercussions on the management of patients with dysphagia resulting from head and neck tumors. Technology has provided many useful tools to stem this discomfort and among them, the creation of an app seemed to us an advantageous way to go. The theoretical conceptualization underlying the birth of this project is represented, on the first step, by the observation that mobile apps for smartphones provide an ideal platform for providing educational support to patients; second step, the patients need to have these informations. A need that has certainly increased during the health emergency, as patients were unable to have easy access to the hospitals where they were followed up during the follow-up. It is important to emphasize that this tool is not a substitute for the direct relationship with the speech therapist, nor is it presented to patients as an alternative to it; however, it can be considered as a constant and continuous support to the patient and his family, as it represents one of the useful tools to best combine the existing professionalism and the needs of patients with swallowing disorders and those who care for them, exploiting the progress of technology. We tried to quantify the benefit received by the patient to assess how much SwallowAPP (the name we gave to the aforementioned App) can impact on the perception of care received at a time unfavorable to face-to-face relationships. In the same way, we evaluated the ease of use of the system, a fundamental requirement for its acceptance by the user. From the careful analysis of the work carried out, SwallowAPP has shown that implementing the quality of care provided to the swallowing disorders during the early stages of subsequent follow-up to surgery, it had a strong impact especially on the patient's quality of life.

Artificial intelligence-driven biomedical genomics

As genomic research becomes more complex and data-rich, artificial intelligence (AI) has emerged as a crucial tool for processing and analyzing high-dimensional genomic data, accelerating biomarker discovery, and enhancing genomic sequence annotations. Despite the increasing application of AI in genomic research, challenges persist, particularly regarding the integration of biomedical knowledge into algorithm development. We reviewed high-quality, AI-driven biomedical genomic studies from the past five years, covering applications in disease prediction, detection, diagnosis, and treatment. Each category highlights how different AI techniques are applied in biomedical contexts. Furthermore, we identify current challenges and potential solutions in AI-assisted biomedical genomics. This comprehensive review is designed to encourage collaboration among computer scientists, healthcare professionals, and interested communities, propelling the development of AI applications that can be smoothly integrated into routine medical services.

The National Israeli Field Hospital in Ukraine - Innovative Adaptation to a Unique Scenario

Introduction:Following the outbreak of hostilities in Ukraine and the resultant humanitarian crisis, the State of Israel deployed a field hospital inside Ukraine. Challenges included a large refugee population, disruption of routine medical services to the local population, first-time deployment of a civilian field hospital, and deployment to a country at war.Method:The activity of the field hospital during a deployment in Ukraine is described along with lessons learned for future deployments.Results:A Rapid Assessment Team (RAT) performed needs assessment and coordination with local authorities. The main necessity encountered was delivery of primary care to both the refugee and local population. During the 6 weeks of deployment, 6,161 patients were treated in the hospital. 65 patients were hospitalized and 59 underwent surgery. The hospital was completely digitalized. 103 remote consultations were performed using telemedicine techniques. Capacity building of local teams was given high priority and 796 Ukrainian health professionals underwent training.Conclusion:Deployment of a national civilian field hospital in a country of war is possible through coordination with local authorities while undertaking the necessary security measures.The change in caseload from expected war trauma to predominantly primary care necessitated agility in planning and operation with subsequent adaptation of hospital and staff structure.The use of telemedicine enhanced capabilities, allowing access to consultation with the most experienced specialists in Israel.Capacity building of local teams should be given a high priority. This was implemented by combining clinical training and the inclusion of a medical simulation unit in the hospital.Dispatching a team delivering medical care and extending a helping hand in time of need, especially when done by a national entity, contributes greatly to building the people's faith, hope, and resilience during the crisis, and has a critical role in the recovery effort.

JS-HOPE ASIA-4: TELEMEDICINE IN HYPERTENSION

The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.

Impact of COVID-19 pandemic on reproductive, maternal, newborn, and child health care services in Phuentsholing General Hospital: A retrospective descriptive study.

COVID-19 pandemic has derailed health care services. The health resources and manpower were prioritized and diverted to curb the COVID-19 infections at the cost of routine medical services to the people. The impact of the COVID-19 pandemic on maternal and child health is unknown. This study aimed to assess the impact of the Covid-19 pandemic on maternal and child health care services in Phuentsholing General Hospital. A descriptive retrospective study was conducted at Phuentsholing General Hospital from January1toJune30, 2022. The patient medical records were reviewed for the prepandemic years 2018, and 2019, and the pandemic years 2020, and 2021. The medical records of all the female patients and newborns who came to the Maternal and Child Health Unit (MCH), those who were admitted to the gynecology ward, and who underwent obstetrical and gynecological surgeries were reviewed. The data were analyzed using SPSS version 23. Descriptive statistics such as frequencies and percentages were used to describe the study variables. The line graph and bar graph were used to determine the trends and to compare the impact of COVID-19 on MCH services between the pre-pandemic and pandemic years. During the COVID-19 pandemic, the total admission dropped by 10% to 14.4%; the total deliveries dropped by 16.1%; Cesarean section rate dropped to 12.9%; and fewer gynecological surgeries were performed (13.9% from 20.6%). There was a significant drop in antenatal and postnatal follow-up visits (31.5% and 24.51%) respectively; Pap smear dropped by 93% and colposcopy by 52%. The overall immunization coverage has dropped drastically during the pandemic period. The pregnant mothers and newborn babies missed antenatal and postnatal follow-up visits, missed immunization, and women were not able to be screened for cervical cancers during the pandemic. These negative impacts of the COVID-19 pandemic on maternal and child health care were profound.

The National Israeli Field Hospital in Ukraine: Innovative adaptation to a unique scenario.

BACKGROUND On February 24, 2022 hostilities broke out in Ukraine resulting in a full-scale humanitarian crisis with thousands of civilians injured, twelve million persons displaced – seven million internally displaced and five million refugees fleeing the country. The crisis led to a severe disruption of routine medical services. These circumstances, combining warfare and refugees, pose […]

The facilitated sensemaking model as a framework for nursing intervention on family members of mechanically ventilated patients in the intensive care unit.

Adverse psychological outcomes are prevalent among family members of intensive care unit (ICU) patients. The facilitated sensemaking model (FSM) provides a framework for understanding how intensive care nurses can help these family members overcome situations in which a loved one is critically ill, and reduce adverse psychological outcomes through the facilitated sensemaking process. This study aimed to implement FSM-based research performed by ICU nurses and patients' family members to investigate the impact of the facilitated sensemaking intervention on the psychological status of ICU families. The intervention was performed by nurses on 80 family members of mechanically ventilated patients, 40 in the control group and 40 in the experimental group. The control group only received routine medical services, while the experimental group received the nursing intervention based on FSM in addition to routine medical services. Anxiety, depression, and post-traumatic stress disorder (PTSD) were measured with the Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Post-Traumatic Stress Disorder Check-List-Civilian Version (PCL-C), respectively. SPSS version 25.0 was applied to analyze the data; what is more, some statistical methods, including descriptive statistical analysis, chi-square test and t-test were further adopted. Before the intervention, there were no significant differences in anxiety, depression, and PTSD of family members of ICU mechanical ventilation patients between the two groups (p > .05). After the intervention, the score of anxiety, depression, and PTSD of family members in the control group and the experimental group were 41.50 ± 5.738 versus 36.50 ± 4.385, p < .001; 45.28 ± 8.089 versus 42.13 ± 5.725, p < .05; and 30.55 ± 7.595 versus 27.55 ± 4.696, p < .05, respectively. The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients' family members. The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients' family members. However, there was only a statistically significant difference in the avoidance and numbness symptom cluster of PTSD via the PCL-C. Therefore, the observation time after the implementation of the FSM intervention needs to be extended in the future to clarify the effect of the intervention. Further efforts by advanced practice nurses and the cooperation of patients' families are required to incorporate this intervention into ICU practice.

Potential impact of COVID-19 pandemic on endometriosis.

The impact of coronavirus disease 2019 (COVID-19) on endometriosis (EM) is currently unclear. Here, we aimed to describe the potential influence of COVID-19 on the pathogenesis, clinical symptoms, and treatment of EM. The cytokine storm caused by COVID-19 may induce the occurrence and progression of EM, and immunosuppression of COVID-19 may help the ectopic endometrium escape from immune clearance. Consequently, the forced social isolation and the cancelation of non-emergency medical treatment during the COVID-19 pandemic aggravate anxiety and psychological pressure, which can aggravate the symptoms related to EM and delay routine medical services.

Health Care Logistics Network Design and Analysis on Pandemic Outbreaks: Insights From COVID-19.

Health care systems throughout the world are under pressure as a result of COVID-19. It is over two years since the first case was announced in China and health care providers are continuing to struggle with this fatal infectious disease in intensive care units and inpatient wards. Meanwhile, the burden of postponed routine medical procedures has become greater as the pandemic has progressed. We believe that establishing separate health care institutions for infected and non-infected patients would provide safer and better quality health care services. The aim of this study is to find the appropriate number and location of dedicated health care institutions which would only treat individuals infected by a pandemic during an outbreak. For this purpose, a decision-making framework including two multi-objective mixed-integer programming models is developed. At the strategic level, the locations of designated pandemic hospitals are optimized. At the tactical level, we determine the locations and operation durations of temporary isolation centers which treat mildly and moderately symptomatic patients. The developed framework provides assessments of the distance that infected patients travel, the routine medical services expected to be disrupted, two-way distances between new facilities (designated pandemic hospitals and isolation centers), and the infection risk in the population. To demonstrate the applicability of the suggested models, we perform a case study for the European side of Istanbul. In the base case, seven designated pandemic hospitals and four isolation centers are established. In sensitivity analyses, 23 cases are analyzed and compared to provide support to decision makers.

267-OR: Diabetes, COVID-19, and All-Cause Mortality among People with Diabetes during the COVID-Pandemic in Minnesota: Population-Based Study

People with diabetes have been profoundly impacted by the COVID-pandemic. Diabetes and its comorbidities are strong risk factors for severe, including fatal, COVID-disease. People with diabetes may also have limited or delayed routine and non-emergent medical services, potentially increasing their risk of death from causes unrelated to COVID-19. Granular population-level data on rates, causes, and places (i.e. home vs. hospital) of death among people with diabetes during the COVID-pandemic is scarce. We examined Minnesota death certificates from 2020 (COVID-year) and 2018-20 (comparator years) among people with diabetes to compare changes in population-adjusted rates of diabetes-specific mortality (diabetes as a primary cause of death) , and all-cause and other disease-specific mortality (other primary causes with diabetes as a contributing cause of death) . We also assessed COVID-mortality (COVID-as a primary cause and diabetes as a contributing cause) . Analyses were adjusted for multiple comparisons using the false discovery rate correction. COVID-accounted for 246 deaths per 100,000 people with diabetes. There was no significant change in diabetes-specific mortality from 2018-20to 2020 (328 to 353 per 100,000; 2020 vs. 2018-20IRR 1.[95% CI 1.01-1.15]; p=0.08) . All-cause mortality among people with diabetes increased from 1,484 to 1,922 per 100,000 (IRR 1.30 [95% CI 1.26-1.33]; p&amp;lt;0.001) , while non-COVID mortality among increased from 1,484 to 1,675 per 100,000 (IRR 1.13 [95% CI 1.10-1.16]; p&amp;lt;0.001) . Deaths for cardiovascular diseases, cancers, and infectious diseases (not including COVID-19) also increased significantly, suggesting that people may have deferred care for these conditions with deadly consequences. Our findings underscore the need for uninterrupted comprehensive care for people living with diabetes to ensure that access for acute and chronic health concerns remains prioritized. Disclosure R.G.Mccoy: Consultant; Emmi. A.F.Mullan: None. M.M.Jeffery: Stock/Shareholder; Goodness Growth Holdings. C.M.Bucks: None. C.M.Clements: Consultant; Vail Scientific LLC. R.Campbell: Consultant; Bryn Pharma. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

Resurgence of mucormycosis during COVID-19 pandemic

ObjectiveTo explore the literature on corona-associated mucormycosis and explain its relevance to dentists and oral surgeons. MethodsA literature search was carried out to identify reported cases on corona-associated mucormycosis since the start of COVID-19 pandemic. ResultsA review of literature identified 265 published papers on CAM between March 2020 and September 2021. Careful screening of abstracts and full texts revealed 29 studies reporting case series of CAM and, 27 case reports on CAM. ConclusionsA multitude of factors may be responsible for the alarming rise in the incidence of corona-associated mycosis including reduced access to routine medical services during the pandemic, injudicious use of antibiotics, steroids and nutritional supplements. Risk factors contributing to corona-associated mucormycosis need to be recognized. Dentists and oral surgeons can contribute to early recognition of corona-associated mucormycosis involving the maxilla, and palate. Prioritizing research focus on optimal management of mucormycosis may reduce the morbidity and mortality associated with this debilitating infection.

Commercial Off-the-Shelf Components (COTS) in Realizing Miniature Implantable Wireless Medical Devices: A Review.

Over the past decade, there has been exponential growth in the per capita rate of medical patients around the world, and this is significantly straining the resources of healthcare institutes. Therefore, the reliance on smart commercial off-the-shelf (COTS) implantable wireless medical devices (IWMDs) is increasing among healthcare institutions to provide routine medical services, such as monitoring patients’ physiological signals and the remote delivery of therapeutic drugs. These smart COTS IWMDs reduce the necessity of recurring visits of patients to healthcare institutions and also mitigate physical contact, which can minimize the possibility of any potential spread of contagious diseases. Furthermore, the devices provide patients with the benefit of recuperating in familiar surroundings. As such, low-cost, ubiquitous COTS IWMDs have engendered the proliferation of telemedicine in healthcare to provide routine medical services. In this paper, a review work on COTS IWMDs is presented at a macro level to discuss the history of IWMDs, different networked COTS IWMDs, health and safety regulations of COTS IWMDs and the importance of organized procurement. Furthermore, we discuss the basic building blocks of IWMDs and how COTS components can contribute to build these blocks over widely researched custom-built application-specific integrated circuits.

Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh

BackgroundCOVID-19 has seriously disrupted health services in many countries including Bangladesh. This research aimed to explore whether Rohingya (forcefully displaced Myanmar nationals) older adults in Bangladesh faced difficulties accessing medicines...

Impact of the COVID-19 Epidemic on the Routine Emergency Services in a Tertiary Hospital, China: A Retrospective Cohort Study.

The sudden outbreak of the COVID-19 pandemic has caused tremendous challenges to the medical system. The government and hospitals have taken robust measures to curb the spread of the deadly virus. Its impact on routine medical services is gradually being taken seriously. To identify the impact of the novel Coronavirus pandemic on emergency department (ED) patient flow and the performance of the routine ED service. This retrospective cohort study was undertaken in a tertiary public teaching hospital ED in Chengdu, China. ED data of patients were routinely collected to compare demographic, clinical characteristics and outcomes during an 8-week period from January 1, 2019 to February 25, 2020. Data were analyzed with the chi-square statistical test. Over the study periods, there were 31855 and 25244 patients presented to the ED in 2019 and 2020 respectively. During the pandemic period in 2020, the daily number of average ED visits was lower than that in 2019 (430 ± 134.9 versus 572 ± 38.6, P = 0.00), with fewer triage 1&2 cases (145 ± 33.3 versus 178 ± 15.0, P = 0.00). Nevertheless, the mortality increased remarkably during the pandemic period in 2020 (0.2% versus 0.1%, P = 0.009), with higher APACHE II scores (28 versus 19, P = 0.022) and shorter ED elapsed time (0.2 versus 1.4 days, P = 0.016) among these death cases. The COVID-19 pandemic had an evident impact on the patient's behavioral patterns and routine emergency services, which caused higher ED mortality.

Expanding the concept of safety in antenatal care provision

Antenatal care is one of the most commonly accessed routine medical services in the world. Although considerable progress has been made to improve outcomes for pregnant women (eg, according to UNICEF the global maternal mortality rate declined by 38% between 2000 and 2017), complications of pregnancy and childbirth remain the leading cause of morbidity and mortality in women of reproductive age globally.1 In line with the UN Sustainable Development Goals, provision of high quality antenatal care is therefore essential for ensuring the safety of pregnant women and their offspring.

Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol

BackgroundCost control and usage regulation of medical materials (MMs) are the practical issues that the government pays close attention to. Although it is well established that there is great potential to mobilize doctors and patients in participating MMs-related clinical decisions, few interventions adopt effective measures against specific behavioral deficiencies. This study aims at developing and validating an independent consultation and feedback system (ICFS) for optimizing clinical decisions on the use of MMs for inpatients needing joint replacement surgeries.MethodsDevelopment of the research protocol is based on a problem or deficiency list derived on a trans-theoretical framework which incorporates including mainly soft systems-thinking, information asymmetry, crisis-coping, dual delegation and planned behavior. The intervention consists of two main components targeting at patients and doctors respectively. Each of the intervention ingredients is designed to tackle the doctor and patient-side problems with MMs using in joint replacement surgeries. The intervention arm receives 18 months' ICFS intervention program on the basis of the routine medical services; while the control arm, only the routine medical services. Implementation of the intervention is supported by an online platform established and maintained by the Quality Assurance Center for Medical Care in Anhui Province, a smartphone-based application program (APP) and a web-based clinical support system.DiscussionThe implementation of this study is expected to significantly reduce the deficiencies and moral hazards in decision-making of MMs using through the output of economic, efficient, sustainable and easy-to-promote cooperative intervention programs, thus greatly reducing medical costs and standardizing medical behaviors.Trial registration numberISRCTN10152297.