TCM Hospitals Research Articles

A Decision Tree Model-based Study on the Grouping of Hospitalization Expenses of Type 2 Diabetes Patients in a Traditional Chinese Medicine Hospital

Objective To discover the case-mix approach for TCM treatment of dominant disease type 2 diabetes patients and to analyze the hospitalization expense standards for different combinations of patients to provide theoretical references for better participation of TCM hospitals in the DRG payment method as well as reasonable regulation of hospitalization expenses for TCM type 2 diabetes patients in the future. Methods Case data were collected from 1,171 patients discharged with a principal diagnosis of type 2 diabetes from September 2021 to April 2023 from a tertiary care Chinese medicine hospital in Tianjin. Univariate and multivariate stepwise regression analyses determined categorical node variables. The decision tree model was used to perform case combinations and to analyze the expense standards and weights of different groups of disease types. Results The number of days of hospitalization, conditions in admission, and whether complicated cardiovascular and cerebrovascular diseases are the main factors affecting the hospitalization expense of type 2 diabetes patients in Chinese medicine hospitals, and the decision tree model was used to group the patients to form nine groups of patient case combinations. The standard of hospitalization expense for each combination was set reasonably. Conclusion The grouping results are more satisfactory, and the grouping scheme and hospitalization expense standards can provide a scientific basis for DRG grouping, adopting differentiated expense management, and improving the medical resource efficiency in TCM hospitals.

Analysis of hospital infection knowledge, beliefs, behavior, and influencing factors among healthcare workers in Chinese medicine hospitals in Hunan Province

ObjectivesThis study investigated the knowledge, attitude, and behavior of healthcare workers related to hospital infection in Chinese medicine hospitals in Hunan Province. We analyzed the influencing factors and made rational suggestions to improve the healthcare workers’ ability for hospital infection prevention and control in Chinese medicine hospitals based on knowledge, beliefs, and action models. MethodsThe survey participants were selected using multi-stage stratified cluster random sampling. In the first stage, 14 tertiary-level hospitals and 42 tertiary-level hospitals in Hunan Province were selected, and 56 TCM hospitals at provincial, municipal, and county levels were finally covered. In the second stage, 2253 Medical personnel were selected as survey participants from January 2022 to January 2023. The network questionnaire was used to investigate the current knowledge, attitude, and behavior of hospital infection prevention and control by self-compiled questionnaire. ResultsAccording to the self-prepared questionnaire, the survey results show that 2253 Medical personnel scored 35.88 ± 8.96, 98.12 ± 24.61, and 112.27 ± 6.31 on knowledge, attitude, and behavior regarding hospital infection prevention and control, respectively. There was a linear relationship between knowledge and sex, age, working years, education level, job title, and position, with working experience having the greatest influence. There was a linear relationship between attitudes and working years, education level, job title, position, and hospital level, with working experience having the greatest influence. There was a linear relationship between attitudes and sex, age, working years, education level, job title, and hospital level, with education level having the greatest influence. ConclusionsThe knowledge reserve of medical staff in TCM hospitals should be improved. The level of awareness of nosocomial infection prevention when using traditional Chinese medicine techniques is low. Therefore, training is required to strengthen and enhance awareness regarding hospital infection prevention and control among healthcare workers in traditional Chinese medicine hospitals. Moreover, there is a need to adopt stratified management training for healthcare workers of different ages and educational levels, especially to regulate the behavior of junior healthcare workers.

Research on the equity of health resource allocation in TCM hospitals in China based on the Gini coefficient and agglomeration degree: 2009–2018

BackgroundThe demographical and geographical distributions of health resources are important aspects of healthcare access. Few studies have been published on health resource allocation in TCM hospitals in China despite public equity concerns.MethodsThis article uses the Gini coefficient and agglomeration degree to analyze the health resources of TCM hospitals in China according to demographic and geographic configuration conditions in order to study the equity of the health resources of TCM from 2009 to 2018.ResultsFrom 2009 to 2018, all regions of the TCM health resources per ten thousand people and per ten thousand square kilometers showed overall upward trends. The overall equity of the health resource allocations of TCM hospitals in China tended to improve year by year. However, there were still great differences among regions. Generally, the equity of physical resource allocation was better than the equity of human resource allocation. Additionally, the equity of health resources in TCM hospitals allocated by population was better than it was by geographic region.ConclusionsIt is necessary to further optimize the structure of TCM resource allocation, and enhance the equity of resource allocation among different regions.

The Efficiency Evaluation of Municipal-Level Traditional Chinese Medicine Hospitals Using Data Envelopment Analysis After the Implementation of Hierarchical Medical Treatment Policy in Gansu Province, China.

Background: Efficiency evaluation is an integral part of new medical reform and is necessary to solve the problem of limited and unbalanced medical resources. This study evaluated the efficiency of municipal-level Traditional Chinese Medicine hospitals by Data Envelopment Analysis application after a hierarchical medical treatment policy was implemented. We propose solutions to the problems existing in hospital operations and promote the utilization efficiency of medical resources in those hospitals. Methods: The sample included all municipal-level TCM hospitals in Gansu province from 2017 to 2019. The DEA-BCC model was employed to evaluate the relative efficiency of hospital operations, and the Manny-Whitney test was used to compare the input and output variables of technical efficiency efficient and inefficient hospitals. Results: From 2017 to 2019, the growth in the number of staff in secondary hospitals (25.88%) was lower than that in tertiary hospitals (31.98%). However, the increase in the number of beds (16.52%) in secondary hospitals was higher than that in tertiary hospitals (−0.30%). 5 (38.46%) achieved DEA efficient in secondary hospitals and 2 (40.00%) in tertiary hospitals. The means of technical efficiency, pure technical efficiency, and scale efficiency in secondary hospitals were 0.812, 0.887, and 0.908, respectively. The means in tertiary hospitals were 0.868, 0.926, and 0.935, respectively. The hospital areas were statistically different between the TE efficient and inefficient hospitals (P<0.05) in secondary hospitals. However, the number of outpatients between the two groups was statistically different (P<0.05) in tertiary hospitals. Conclusion: In this study, the medical and health services of municipal TCM hospitals in Gansu Province have made great progress. Due to the backward economy of Gansu Province, the classification of diagnosis and treatment of diseases was still based on Western medicine, resulting in the slow medical development of some municipal TCM hospitals. TCM hospitals should improve management efficiency, optimize hospital operation scale, improve the utilization efficiency of medical resources and promote efficient hospital development.

Analysis and reflection on the current situation of informatization construction in tertiary TCM hospitals in China

In order to understand and master the current situation of the informatization construction in tertiary TCM hospitals in China, measures to develop the informatization of TCM hospitals were studied and put forward. An online survey on the informatization construction of TCM hospitals in 2018 was carried out through the information system, and effective data of 487 tertiary TCM hospitals for descriptive statistical analysis were collected. The results show that the information infrastructure construction in China’s tertiary TCM hospitals is different, with the eastern part being better. The business application information system is based on clinical service. The connectivity of information platforms and the application of new technologies need to be strengthened. The conclusion is that the tertiary TCM hospitals should pay attention to construction of infrastructure and improve awareness of information security, build TCM characteristic system, strengthen system operation and maintenance; as well as attaching importance to application of standards and norms and improve the connectivity of the platform; and importance to the introduction of new technology to facilitate the construction of smart TCM hospitals.

Comprehensive evaluation on bed utilization efficiency of public TCM hospitals in 17 cities of Hubei province

To evaluate the bed utilization efficiency of public TCM hospitals in 17 cities of Hubei Province, the date of the bed utilization of public TCM hospitals in 17 cities of Hubei Province in 2017 was collected. Then, the entropy weight method was used to determine the weight of evaluation indicators, and the method of TOPSIS and RSR were used to evaluate bed utilization efficiency. The bed utilization efficiency of public TCM hospitals in 17 cities of Hubei Province can be divided into three levels. Ezhou, Yichang were in lower range, Huanggang, Enshi, Jingmen, Huangshi, Tianmen, Wuhan, Qianjiang, Xiangyang, Xianning, Shiyan, Shenlongjia, Xiantao were in midrange and Jingzhou, Suizhou, Xiaogan were in higher range. The method of entropy weight TOPSIS and RSR can reflect the bed utilization efficiency of public TCM hospitals in different cities objectively and comprehensively, and the results are scientific and reliable. There is a big gap in the bed utilization efficiency of public TCM hospitals in cities of Hubei Province. It is suggested that cities with low bed utilization efficiency should give full play to the characteristics and advantages of TCM to improve the core competitiveness of hospitals and to enhance the attractiveness of hospitals to patients. At the same time, public TCM hospitals should deepen the integration of TCM and Internet, and optimize the medical service process of TCM to improve the bed utilization efficiency.

Perceptions of traditional Chinese medicine for chronic disease care and prevention: a cross-sectional study of Chinese hospital-based health care professionals

BackgroundIn China, demands for disease prevention and health care and the prevalence of chronic non-communicable diseases have increased. TCM and general hospitals are increasingly utilizing TCM strategies for chronic non-communicable disease care and prevention. This study aimed to investigate health care professionals’ (HCPs’) perceptions of TCM for prevention, their TCM knowledge, and their abilities to provide such services in TCM and general hospitals.MethodsThis cross-sectional study investigated Chinese medicine hospitals and Chinese medicine departments in general hospitals in five Chinese cities. A self-designed questionnaire used to study 400 HCPs focused on basic demographic data, the demand for and effects of TCM for prevention and treatment, and their perceptions of such service implementation. The data analysis included chi-squared tests and descriptive and multi-factor analyses.ResultsThe 335 HCP respondents comprised 230 (68.7%) females and 105 (31.3%) males, 75.5% of whom overall had knowledge of TCM preventive and health care services. Respondents older than 40 years (28.6%) had greater knowledge of and satisfaction with TCM for preventive and health care services than younger respondents. Moreover, 97.7% of the older respondents were clearly willing to provide TCM preventive services for chronic diseases, 67.8% of whom indicated that their hospitals already provided TCM for prevention and treatment. According to the chi-squared test results, the TCM service characteristics in hospitals, hospital outlooks regarding TCM and TCM development in hospitals were the primary factors affecting the respondents’ perceptions of TCM for chronic disease care and prevention. The multivariate analysis showed high satisfaction as significantly associated with older providers and those with lengthier work experience, particularly among those who worked in hospitals that provided typical TCM services and had positive attitudes towards TCM.ConclusionThe study HCPs had relatively satisfactory knowledge of and positive attitudes towards TCM for chronic disease care and prevention and would use it in practice. Their perceptions and satisfaction levels correlated closely with the successful application of TCM for preventive care and treatment in hospitals. While the use of TCM for prevention and treatment was well developed in some hospitals, further improvements are warranted.

Analyze of development strategy of Dongfang hospital the clinical medical college of Beijing university of Chinese medicine and the management mode about multi-hospital district

Up to 2015, almost all of the Third-grade class-A TCM hospitals in Beijing set up sub-hospitals, under the regional integrating of Beijing-Tianjin-Hebei region, in order to meet regional homogenization of medical and health care demand, to provide high-quality medical service for the patients, and to improve the hospital development in a certain stage. Taking Beijing university of traditional Chinese medicine affiliated Dongfang hospital for example, it creates two sub-hospitals a court layout of mode of one hospital with branches. This article analyzed the sub-hospitals organization structure reform, cost budget control, performance management & personnel training, information system construction, to draw lessons from practical manage experience, and explored the multiple sub-hospitals superior management mode for our hospital. Key words: Third-grade class-A TCM hospital; Scale development strategy; Multiple sub-hospitals; Management mode of hospital

Suggestions on Transformation of the Traditional Chinese Medicine Doctors Management Based on the Competency Model

Suitable management mode of TCM doctors will improve the medical quality and have positive effects on the development of TCM hospitals, and promote the whole development of TCM. In this paper, through a comparative analysis of traditional management mode of TCM doctors and management mode based on competency model, it is suggested that the reform of the management mode based on competency model of TCM doctors should be carried out, including the aspects of selection, training and performance evaluation of TCM doctors, paying more attention to knowledge, skills of diagnosis and treatment on TCM, and also the professional ethics and values of TCM doctors.

Bibliometric analysis of the acupoint sticking application in clinical practice

Objective To explore the application of acupoint sticking in clinical practice by bibliometric analysis. Methods Based on CNKI and Wanfang databases, searching the literature related to the clinical nursing application of acupoint sticking published from 2000 to 2014. Analysing the annual amount of published papers, journal distribution, places and units of the author, the cooperation rate, citation frequency, fund situation, and disease distribution. Results A total of 906 pieces of work were included in our study. The amount of the literature had a significant growth since 2006. The first author was from 30 regions of China. The top 4 productive provinces included Guangdong, Jiangsu, Zhejiang, and Hubei, where contributed to 46.8% (424/906) published papers. 69.0% authors worked in TCM hospitals; 55.8% (506/906) were co-author; 11.3% (102/906) were cited more than nine times; 9.1% (82/906) had fund support, and most of them were from Guangdong, Zhejiang, Jiangsu, and Guangxi. The acupoint sticking was mostly applied to asthma, postoperative care, and cancer therapy. Conclusions The acupoint sticking is mainly used in asthma, postoperative care, and cancer treatment. Despite an increasing amount of the literature, the published papers tend to have low impact factors, limited fund support, and insufficient cooperation. Key words: Bibliometrics; Acupoint sticking; Traditional Chinese medicine nursing technique

Outpatients′ compliance with Chinese medicine decoction and its influencing factors in TCM hospitals of Shanghai city

Objective To investigate patients′ compliance with Chinese medicine decoction, and analyze its influencing factors. Methods A survey was conducted in a sample of 406 patients in 3 TCM hospital in Shanghai. Data were collect by Information table of patients who receive Chinese medicine decoction and analyzed. Results The total score of patients′ compliance with Chinese medicine decoction was (11.0±2.2). Score of patients′ tisane compliance was (4.7±1.8), with 25.6% having good compliance; score of patients′ medication adherence was (6.3±1.1), with 57.4% having good compliance. Patients′ compliance with Chinese medicine decoction was affected by ages of the patients, family monthly income, patients′ physical status, and number of family members. Conclusions Patients′ medication compliance is unsatisfactory. With the influencing factors considered for management system and better social support, patients′ compliance will be improved. Key words: Chinese herbal; Decoction; Compliance; Influencing factor; Outpatient

Application of standardized training mode for junior nurses in TCM hospitals

Standardized training model for junior nurses with 1 to 3 years experience is used in traditional Chinese medicine hospital. A4358 management model is established, and humanistic culture is stressed. Junior nurses with job experience less than 3 years are divided into different grades, and are arranged to receive at least 3 years training in more than 5 major departments. They are evaluated from 8 aspects, including basic quality, job competence, basic skills, nursing documents writing, operation assessment, theory assessment, continuing education and nursing safety management. PDCA circulation method, SWOT method, and evaluation of performance appraisal are applied in the analysis of training management. Long-term training, humanities education, hierarchical management to junior nurses in traditional Chinese hospital could improve the nursing skills, ensure nursing safety, increase nurses′ professional identity. This study shows the practical significance of popularizing this model to other traditional Chinese medicine hospitals. Key words: Traditional Chinese medicine hospital; Nurse training; Management mode

Evaluation of medical efficiency before and after Sanming healthcare reform

Objective To evaluate the medical efficiency of sample hospitals in Sanming city before and after Sanming health care reform. Methods One tertiary hospital, two general county hospitals and two TCM county hospitals in Sanming were sampled for the study.Two dimensions(the intensity index of medical work and work efficiency index)were selected.In addition, six indexes were identified, namely the number of discharged patients, number of outpatients and emergency diagnostics, doctor′s daily workload per capita for inpatients, bed turnover times, bed utilization rate and average days of stay.Descriptive trend analysis and comprehensive index method were applied in turn to evaluate the longitudinal changes in medical efficiency at the sample hospitals before and after the medical reform. Results The five sample hospitals in Sanming were found with less days of stay in average, and three were found with year-by-year rise of medical efficiency index, with one of them rising from 1.57 to 2.42. Conclusions Sanming′s health care reform has effectively improved internal operational efficiency at the sample hospitals, and has well addressed the relationship of medical service efficiency and scale expansion.On the other hand, the relationship between work intensity and medical efficiency needs to be further balanced, resource allocation to be further optimized, and more priority to be put in the development of TCM hospitals. Key words: Sanming; Health care system reform; Medical efficiency; Comprehensive evaluation

Epidemiology of depression at Traditional Chinese Medicine Hospital in Shanghai, China

BackgroundThough Chinese Traditional Medicine (TCM) is one of the most important parts of health care system in China, studies on the epidemiology of depression in TCM are scarce and mental health issues in TCM have been neglected for longtime. MethodsThis was an interview-based survey. The prevalence of depression and suicidal risk in outpatients at a TCM hospital was identified by a one-stage diagnosing process using the Mini International Neuropsychiatric Interview. Associated risk factors, role impairment, and service utility were also assessed. ResultsA total of 2000 outpatients aged from 18 to 65years completed the survey with a response rate of 87.0%. The estimated prevalence of major depressive disorder was 13.2% for lifetime and 4.9% for current. No significant gender differences were found. Depression was more common in patients who lacked social support, experienced family economic burden and health burden, and underwent negative life events, poor self-rated health, or with moderate/severe sleep problem than in their correspondents; all with statistical significance (OR: 1.83–6.82). Patients with depression reported a mean of 82.7days and 99.3days of sick leave due to their physical and mental condition, respectively, which was much longer than those without depression (24.8days and 25.8days, respectively). Only 30.0% of patients with depression sought professional help from psychiatrists/psychologists or used antidepressants. LimitationsThe recall bias could not be ruled out in this study and could have led to an underestimation of true prevalence and the unmet need for treatment. Since this study was cross-sectional, the causal relationships between sociodemographic factors and depression cannot be determined. ConclusionsDepression is common at TCM hospitals. The impairments due to depression are striking, and unmet needs for treatment are pervasive. Consequently, mental health services in TCM should not be neglected any longer.

Empirical study on the relationship between hospital governance structure and social responsibility

This paper sampled 79 TCM hospitals above county level in Jiangsu Province for research.With hospital ownership, board governance and hospital directors as three dimension of internal governance structure, the multiple regression model was used to investigate the impact of such structure on its social responsibility performance.Education level, number of hospital directors, and their values are found to be significant factors on their social responsibility performance. Key words: TCM hospitals; Board of directors; Governance structure; Hospital social responsibility

Investigation and analysis of hand hygiene facilities at all levels of TCM hospitals in Guangxi

Objective Survey of Guangxi Traditional Chinese Medicine hospital hand hygiene facilities at all levels was made with improvement measures proposed. Methods Hand Hygiene Norms for Medical Workers questionnaires designed by the Ministry of Health was used in a field survey on hand hygiene facilities of 89 TCM hospitals in Guangxi. Results Facilities of the non-hand-touch taps, hand sanitizer and hand disinfectants were found satisfactory at key departments at all TCM hospitals in the region, yet poor performance with the hand drying facilities.Hospitals with such departments with non-hand-touch taps, hand sanitizer and hand disinfectants accounted for 93.3%, 100.0% and 100.0%.Only 41.6% of the hospitals were found to use dry hand towels as drying facilities.Significant difference was found at various levels of hospitals' hand hygiene facilities. Conclusion The hand hygiene facilities at such hospitals in Guangxi are receiving growing attention, yet further investment is still required for further improvement and compliance of the medical staff in hand hygiene. Key words: Traditional Chinese Medicine hospital; Hand hygiene facilities; Deployment; Investigation; Countermeasure

Mortality and recurrence of vascular disease among stroke patients treated with combined TCM therapy

ObjectiveTo confirm the long-term outcomes of stroke patients and determine predicting factors for death, recurrence of vascular events and poor outcome (either recurrence or death) after the use of combined TCM therapy. MethodsThis was a retrospective hospital-based cohort study and was performed in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine in Tianjin. All subjects with stroke consecutively admitted to an inpatient ward of the Acupuncture Department from January 1, 2008, to December 31, 2008 were retrospectively followed through one year. The main outcomes were either a recurrence of vascular events, mortality or both. Risk factors were recorded from medical records. Multivariate regression models were used to analyze predictors. The following independent variables were used: age, gender, hypertension, ischemic heart disease, atrial fibrillation, diabetes mellitus, carotid arterial lesions and history of stroke. ResultsFour-hundred and five patients were included. The 1-year mortality rate was 11.11%. 23.70% of the patients had a recurrent vascular event, and 30.86% suffered a poor outcome. Multiple logistic regression analysis found that previous stroke, and advanced age were predictors of death within one year, Recurrence of vascular events was associated with carotid arterial lesions, history of diabetes and previous stroke. Long-term poor outcome was predicted by advanced age, history of diabetes, and previous stroke. ConclusionAge, previous stroke, carotid arterial lesions and diabetes history seem to have different impacts on the three outcomes within one year. Our findings provide important data for planning future hospital register studies of stroke patients in TCM hospitals.

Clinical research of acupoint application for “treatment of winterdisease in summer” used to prevent and treat bronchial asthma inchildren

ObjectiveTo preliminarily analyze key factors influencing curative effect through clinical observations of acupoint application for “treatment of winter disease in summer” used to prevent and treat bronchial asthma in children. MethodsIn an observational study and prospective cohort study, we observed children in remission of asthma at three class III grade A TCM hospitals in Liaoning, Hubei, and Chengdu. ResultsA total of 609 children conformed to diagnostic and inclusive standards for remission of bronchial asthma. Through follow-up visits, we observed their skin reactions and the time and chance of treatment with different therapies in the three hospitals; we also compared and analyzed different drugs, acupoints, and preparations. We found that the key Chinese drugs were Bai Jie Zi (Semen Sinapis Albae) and Yian Hu Suo (Rhizoma Corydalis); the key acupoints were Feishu (BL 13), Gaohuang (BL 43), Dingchuan (EX-B1), Tiantu (CV 22), and Shanzhong (CV 17); and the best preparation was a mixture of drugs, ginger juice, and musk. Acupoint application was practiced on the hottest days of summer and the coldest days of winter for 0.5 to 2 h with the lowest rate of asthma relapse. ConclusionsThe present data analysis shows that the curative effect of acupoint application for “treatment of winter disease in summer” may be influenced by recipes of Chinese drugs, preparations, prescriptions of acupoints, chance, time, and skin reactions. A curative effect is the result of the comprehensive action of these factors.

Clinical Pathways Based on Integrative Medicine in Chinese Hospitals Improve Treatment Outcomes for Patients with Acute Myocardial Infarction: A Multicentre, Nonrandomized Historically Controlled Trial

Objective. To determine the impact of an integrative medicine clinical pathways (CPs) on the length of in-hospital stay and on outcomes for patients with acute myocardial infarction (AMI). Methods. A multicenter nonrandomized controlled trial enrolling 197 consecutive patients with AMI at eight urban TCM hospitals was conducted between 1 January 2010 and 31 October 2010. These patients were enrolled in the interventional group after the CPs had been implemented. The control group included 405 patients with AMI from eight hospitals; these patients were treated between 1 January 2008 and 31 December 2009, before the CPs were implemented. Outcome measures were the length of hospital stay costs of medical care, and major cardiovascular events (MACEs) during hospitalization. Results. Compared with the control group, the patients in intervention group had a shorter length of hospital stay (9.2 ± 4.2 days versus 12.7 ± 8.6 days, P < 0.05), and reduced healthcare costs in hospital (46365.7 ± 18266.9 versus 52866.0 ± 35404.4, P < 0.05). There were statistically significant differences in MACE between the two groups during the hospitalization period (2.5% versus 6.9%, P = 0.03). Conclusion. These data suggest that the development and implementation of the clinical pathways based in Integrative Medicine could further improve quality of care and outcome for patients with AMI.

Self-choice right among patients visiting psychology department of TCM hospital

Objective To study the self-choice right of the patients who visit psychology department in TCM hospitals and provide a reference for further TCM psychological treatment application.Methods Self-choice and visiting condition inquiry enacted by ourselves was used in the survey.It is an unregistered and on-sight investigation.The inquiries were distributed by doctor.Patients were instructed by their doctors in the process.Results 64.35％ of patients in psychology department of TCM hospitals select treatment methods by themselves.TCM is the first choice among 66.96％ of patients in psychology department of TCM hospitals.44.35％ of patients visiting psychology department refuse western medicine due to their side effects.6.09％ of patients in psychology department of TCM hospital know a little about psychological treatment; however,some of them believe in psychological treatment.Conclusion The research finds out the main methods of self-choice right among patients visiting psychology department of TCM hospital.It proposes that self-choice right should be respected,at the same time,doctors are responsible to guide patients to understand the etiology of diseases.These efforts will contribute to harmony relationship between doctors and patients and facilitate their recovery and rehabilitation. Key words: Psychology department; Self-choice right; Clinic-visiting attitude