ObjectiveTo analyze the application status and existing problems of value stream mapping (VSM) in improving medical services at home and abroad, so as to provide decision evidence for hospitals to apply VSM to improve medical services.MethodsUsing “value stream mapping” and “value stream” as search terms, we searched PubMed, Embase, China National Knowledge Infrastructure, CQVIP Journal Database and Wanfang Database (2009-2019), and collected relevant literature on the application of VSM to improve medical services at home and abroad. We conducted bibliometric analysis after confirming the literature according to the inclusion criteria. The standardization of application of VSM was also evaluated.ResultsOf the 299 articles retrieved, 13 studies fulfilled the inclusion criteria. The publication time of the literature was distributed between 2013 and 2019. Of the 8 foreign articles included, the regions to which the first author belonged were 4 in the United States, 1 in Ireland, Norway, Lebanon and Indonesia respectively. Of the 5 included domestic articles, the regions to which the first author belonged were 2 in Zhejiang and Shanghai respectively, and 1 in Guangdong. Of the foreign literature, 5 articles did not clearly state the sample size observed when drawing VSM, 5 articles incomplete drawing elements of VSM, and 3 articles did not show VSM. Of the domestic literature, 2 articles did not clearly state the sample size observed when drawing VSM, 3 articles had incomplete drawing elements of VSM, and 1 article did not show VSM.ConclusionsVSM is relatively more used in high-income and upper-middle income countries. The medical service improvement issues for which VSM is applied are relatively single. The standardization of the application of VSM in domestic and foreign literature needs to be improved overall.
In the context of actively coping with aging, China has introduced a series of health care integration policies. Using the advocacy coalition framework theory, this paper aims to analyze the process of health care integration policy changes in China from three dimensions: policy beliefs, external events and policy learning. The policy subsystem of health care integration in China includes two coalitions: top-down cascade promotion and bottom-up absorption and radiation. External events and policy learning triggered policy change, where policy learning included endogenous learning within the coalition and exogenous learning between the coalitions. A policy impasse occurs when the two advocacy coalitions are at odds, and policy brokers and professional forums can get rid of the policy impasse. In the process of policy change in China’s health care integration, the two major advocacy coalitions have reached a certain consensus. It is recommended to alleviate the problems in the integration of health care by strengthening the external factors in the change of health care policy, enhancing the policy learning in the change of health care policy, and making full use of the information resources in the change of health care policy, so as to promote the high-quality development of the integration of health care.
ObjectiveTo explore the comprehensive hospital administrative management system for urban and rural cooperation in the process of medical reform.
MethodsBy reviewing literature and interviewing directors of the administrative departments and hospital medical staff, we gradually established and improved the administrative management system for urban and rural hospital counterpart support.
ResultsBetween 2010 and 2013, 123 medical workers were dispatched to support eight county-level hospitals, after which the comprehensive capacity, and technology and quality control in those hospitals were largely improved. Till the end of 2013, two of those hospitals were promoted to be grade-three class-B comprehensive hospitals; two were promoted as grade-two class-A comprehensive hospitals; three passed the reassessment to be grade-two class-A comprehensive hospitals; and another three county-level medical centers were promoted to be city-level key disciplines.
ConclusionThe comprehensive administrative management system improves the management level of grass-roots hospitals at the county level; promotes the social public welfare of tertiary public hospital counterpart support; facilitates the process of medical system reform at the county level; establishes a series of administrative management modes such as unified support, personnel management, assessment standards and evaluation system; and promotes the sustainability of long-term counterpart support system.
This paper introduces the concept, characteristics, similar concepts, system of knowledge, theoretic model and typical example of improvement science in health care sector, and analyzes a project of quality improvement in order to demonstrate the practical implication. It attempts to provide evidence and reference for future relative studies.
Objective To systematically review the prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 pandemic. Methods The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect cross-sectional studies on the prevalence of depression and anxiety among health care workers from December 2019 to April 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 21 cross-sectional studies were included, involving 38 372 participants. Meta-analysis results showed that during the COVID-19 epidemic, the prevalence of depression and anxiety among health care workers in designated hospitals were 31.00% (95%CI 0.25 to 0.37) and 44.00% (95%CI 0.34 to 0.53). The results of subgroup analysis showed that individuals of female, married, bachelor degree or above, nurses, junior professional titles, and non-first-line medical staff had higher prevalence of depression and anxiety. Conclusions During the COVID-19 pandemic, the incidence of depression and anxiety among health care workers in designated hospitals remain high. Therefore, more attention should be paid to the mental health of health care workers in designated hospitals. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusions.
In Shaanxi, some medical institutions especially the primary medical institutions, have outstanding problems such as unbalanced and inadequate development of infection prevention and control efficiency. The concept, knowledge and attention of infection prevention and control of the medical institution managers need to be improved. With the strong support of the health administration department, the Infection Control Professional Committee of Shaanxi Provincial Preventive Medicine Association has given full play to its functions and explored innovative service models for infection prevention and control in recent years. This paper is written to share the measures and achievements for building a multi-dimensional leadership improvement platform to improve the infection prevention and control ability, aiming to offer a reference for other medical institution managers and infection prevention and control professionals.
Objective To investigate the depression status，score of asthma control test (ACT) and quality of life in asthma patients before and after health care education according to Global Initiative for Asthma guidelines.Methods 59 enrolled outpatients with asthma were asked to self-administer the CES-D (center for epidemiologic studies-depression) scale，ACT scale and the quality of life (QOL) questionnaire respectively.All the patients were educated and treated by health care professionals under the guidance of GINA 2004.After average of 2.5 months ± 15 days，they were asked to self-administer all the scales and questionnaire mentioned above once again on return visit.The data was collected and analyzed statistically based on whether or not the patient had depression according to the CES-D score and the data before and after the education was compared statistically.Results （A）40.7% (24/59) of the patients had depression emotion before guided treatment，and after that the percentage significantly decreased to 13.6% (8/59) (Plt;0.05).（B）Comparing the depressive and non-depressive groups，there was significant difference in 3 of 5 domains in QOL excluding limitation of activity and self concern about health (Plt;0.05) before guided treatment.While on return visit 3 domains in QOL excluding limitation of activity and psychologic status had shown a significant difference (Plt;0.05).There was no significant difference in ACT score before guided treatment，while wise versa after that (Plt;0.05).（C）Before guided treatment the depression status was inversely correlated with 3 in 5 domains of QOL (symptoms of asthma，psychologic status and response to irritant)，as well as QOL as a whole (Plt;0.05)，but not with the other two domains of QOL scale and ACT score.After guided treatment，the depression status had inverse correlation with QOL and 3 in 5 domains of QOL scale (excluding limitation of activity and psychologic status) (Plt;0.05)，as well as ACT score (Plt;0.05).Conclusions The symptoms of asthma and response to irritants are common factors that influence the depressive emotion in asthma population.While psychologic status and self concern about health are both important factors that can not be overlooked.Health care education is important for asthma patients in view of appropriate treatment，symptom control and relief of depression emotion.
ObjectivesTo evaluate the fairness of medical resource allocation in the five provinces in Northwest China from 2006 to 2017 so as to provide scientific basis for the optimal allocation of medical resources in Northwest China.MethodsThe Gini coefficient and Theil index were adopted to evaluate the fairness of medical resource allocation from the two dimensions of population and geography.ResultsThe Gini coefficient was above 0.4 in terms of population allocation and geographical distribution in the five provinces in Northwest China from 2006 to 2011, which indicated the medical resources were unbalanced in the five provinces. The Gini coefficient had gradually declined from 0.4 from 2012 to 2017, which indicated the equity of medical resource allocation in the five provinces in Northwest China had gradually become reasonable. The total Thiel index of medical resources in the five northwest provinces in Northwest China from 2006 to 2017 ranged from 0.0829 to 0.187 4. Equity of medical resource allocation: allocation by population was superior to that by geography.ConclusionsIt is necessary to optimize the structure of human medical resources in the five northwest provinces, promote the coordinated development of medical human resources allocation, and narrow the gap of medical resources among the five provinces in Northwest China.
Objective To explore the research progress of the multimodal clinical support system (CSS). Methods With recognized development and operation of the multi-model CSS, and compared to the traditional CSS, to explore the research progress of the multimodal CSS. Results Based on the realization of the concept, purpose and characteristics of the multimodal CSS, it has been known that the international research progress of the multimodal CSS. Conclusion The developing and evolving of the CSS model have offered a new assist to the multi-disciplinary treatment model, and have enhanced the improving system associated with the practice of evidence-based medicine. However, the application of clinical support system program (CSSP) in our country still needs more research.
