Value-based healthcare (VBHC) is an important guideline for current and future healthcare services. In practice, VBHC should be the best goal of public welfare of healthcare service. Meanwhile, VBHC and cost-effectiveness analysis together provide scientific evidence for healthcare decision-making. Pay by value is inevitable in the next stage of the reform of the payment system of medical insurance, and the health service system should be reconstructed based on VBHC. Finally, the challenges of VBHC implementation are discussed.
The increasing need for healthcare services in rural areas cannot be satisfied because of the lack of healthcare professionals, and poor medical education and training. These result in the low competency of rural healthcare workers. Therefore, the medical education system needs to be reformed in order to improve healthcare human resources in rural areas.
Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.
ObjectivesTo investigate the utilization of essential medicines and antibiotics in primary healthcare system of Xinjin county of Chengdu city from 2009 to 2011.
MethodsThe data of utilization of all the medicines, essential medicines and antibiotics was collected from 17 hospitals of Xinjin primary healthcare system. Microsoft Excel 2003 was used to analyze the data.
ResultsCompared with 2009, the total costs of medicines and essential medicines increased by 72.27% and 135.4% respectively in 2010. After the implementation of essential medicine policy in 2010, the proportion of essential medicines accounted for more than 90% in community healthcare centers (CHCs) and township hospitals (THs) and over 50% in county-level hospitals in 2011. In 2010, the average cost per prescription among outpatients increased by 3.51% in total, but deceased by 16.23% in CHCs/THs (RMB 15.09 yuan per prescription). In July of 2011, the policy to control the use of antibiotics was implemented in Xinjin county. The use of antibiotics decreased, but still accounted for over 30% in 9 out of 13 CHCs/THs. The use of bigeminy antibiotics and trigeminy antibiotics accounted for 0.42 to 5.56% and 0 to 0.44%, respectively.
ConclusionsThe use of essential medicines increases in Xinjin county and met the national requirements. The average cost per prescription among outpatient decreases in THs and CHCs. After controlling the use of antibiotics, the proportion and cost of antibiotics is still very high, and irrational use of antibiotics probably still exists. The training and guide for evidence-based rational use of medicine should be enhanced in future.
ObjectiveTo comprehensively evaluate the essential public health service in Xinjin county of Chengdu from 2009 to April 2011, so as to provide evidence for improving primary healthcare system reform in Chengdu city.
MethodsThe data was collected from the Xinjin county-wide health information system. The electronic health records, chronic disease management, childbirth management and mental health were quantitatively described and compared.
Resultsa) In 2010, 88 772 residents had the physical examination and health assessment, among which, 14 497 (16%) were detected with some health problems. The average cost per positive detection was RMB 122.5 yuan. b) Up to April 2011, 98.2% of people in Xinjin county have their health records but the proportions were ranged from 68.08% to 109.02% in different primary healthcare providers. The details of the most health records were incomplete. c) 7 318 patients with hypertension and 2 187 diabetes mellitus were detected, and among them, 90.1% of patients with hypertension and 95.1% of patients with diabetes had their health records for chronic diseases management. d) The rate of stillbirth or neonatal mortality was lower than 4‰. There was no maternal death in the 8 years. But the cesarean section rate was about 61%. e) 97.3% of the patients with mental disorders were supervised in 2010, which was reduced by 2.7% compared to 2009.
Conclusionsa) There is low proportion of all the residents in Xinjin having physical examination and health assessment and the rate of diseases detection is low as well. b) There is very wide coverage of health records for residents in Xinjin county, nearly universal coverage. c) The health records for the chronic disease patients were well-established, but the early detection rate of the chronic diseases is low. d) High proportion of the patients with mental disorders is supervised. e) The strategy that only county-level hospitals could provide obstetrical service instead of township hospitals is successful to reduce the neonatal mortality and maternal mortality. However, the cesarean section rate is high. f) It acts, to some extent, as a model to successfully improve the essential public health service and management based on the conuty-wide healthcare information system. However, the data quality, data mining and data utilization should be further improved
Objective To systematically review and conclude the healthcare reform policy in rural China throughout the past 62 years. Methods This study was applied with PICOS structure to formulate research issues. National/ministry policies and documents on healthcare reform in rural China were systematically collected. The primary healthcare issues and healthcare reform measures carried out at each stage were studied, and, the criteria as population healthcare indicators, indicators for healthcare workforce and infrastructure in rural areas, healthcare expenditure indicators, and the results of national surveys for healthcare service were used to evaluate the reform performance achieved at each stage. Results A total 396 national policies on healthcare reform in rural China were included through comprehensive search. In accordance with the results of quantitative analysis on literatures, characteristics of economy system reform at each stage as well as actual advancement on healthcare reform, the reform courses of healthcare system in rural China in this study were divided into six periods as follows: national economy recovery and adjustment period, cultural revolution period, early stage of economy system transition, initial stage of healthcare reform, middle stage of healthcare reform, and implement stage for new rural cooperative medical system (NRCMS). The average policies of each period increased year by year, which generally showed as features as laying more emphasis on medical services than medicine, and thinking little of medical insurance. The population health indicators, sickbeds per thousand rural population and medical practitioners kept improving gradually. Yet the import of market mechanism and influence of international economy condition led to the decline in public welfare of healthcare system, increase of personal expenditure proportion among general healthcare cost, and duplicate content among some polices.Conclusion Commonwealth orientation is the fundamental principal to fulfill healthcare service system, thus performance on policies should be concluded in combination with the present national conditions, future requirements as well as evidence-based policy-making, and additionally, such performance should be improved during implementation.
It is essential to improve the practice of community healthcare service for the resolution of the problem of inadequate and overly expensive medical services, to promote the harmonization of doctor-patient relationship. From the aspects of the introduction of community healthcare service and the necessity of its standard management, the civil legal relation of community healthcare and its major problems, as well as the rights and duties of community doctors, the authors discussed the importance and necessity of scientific management, right protection by law as well as sound and orderly development of community healthcare service.
Objective To evaluate the current status of human resources in healthcare-associated infection prevention and control (infection control) in Jiangxi Province, and explore the impact of emergency public health events on the human resources of infection control professionals in various levels and types of medical institutions. Methods From October 1st to 31st, 2023, questionnaire and on-site interviews were conducted to investigate the human resources situation of infection control professionals in various levels and types of medical institutions in Jiangxi Province. Three stages were selected for the investigation: before the outbreak of COVID-19 (before the event, December 2019), during the event (June 2022), and after the transition of COVID-19 (after the event, June 2023), focusing on the characteristics of human resources between before the event and after the event by the comparative analysis. Results Finally, 289 medical institutions were included. There was a statistically significant difference in the number of infection control professionals in medical institutions among 2019, 2022, and 2023 (χ2=189.677, P<0.001). The number of infection control professionals in 2019 was lower than that in 2022 (P<0.001) and 2023 (P<0.001), but there was no statistically significant difference between 2022 and 2023 (P=0.242). The number of infection control professionals per thousand beds in 2019, 2022, and 2023 was 4.40, 6.16, and 5.76, respectively. There was no statistically significant difference between 2019 and 2023 in terms of professional titles, gender, educational level, or professional background (P>0.05). Conclusion Emergency public health events have promoted the increase in the number of infection control professionals, but there is no statistical significance in the professional titles, educational level, or professional background of infection control professionals.
ObjectivesTo evaluate the reporting quality of clinical practice guidelines published in Chinese journals in 2017.MethodsCBM, CNKI and WanFang Data databases were searched for articles published in 2017. Two reviewers independently screened literature, extracted data, and evaluated the reporting quality of clinical practice guidelines using the Reporting Items for Practice Guidelines in Healthcare (RIGHT).ResultsOne hundred and seven clinical practice guidelines were included and a total reporting rate of 34.8%±0.1% in RIGHT. Among the seven domains of RIGHT, field on basic information had the highest reporting rate (56.8%) and fields on review and quality assurance had the lowest reporting rate (9.3%).The average reporting rate of RIGHT items of Chinese Science Citation Database (CSCD) articles was lower than non-CSCD [MD=?0.73, 95%CI (?0.78, ?0.68)] articles. The average reporting rates of RIGHT items differed between Chinese Medical Association (CMA) journal articles and non-CMA journal articles [MD=2.30, 95%CI (2.26, 2.34)]. The average reporting rates of RIGHT items was lower in guidelines established by associations or institutes [MD=?3.78, 95%CI (?3.83, ?3.73)], and was higher reported in Chinese medicine guidelines [MD=21.94, 95%CI (21.91, 21.97)].ConclusionsThe reporting quality of clinical practice guidelines published in journals of mainland China in 2017 is low in general, especially in fields such as review and quality assurance, funding and declaration and management of interests and other information. To improve this phenomena, it is suggested that guideline developers report the guidelines rigorously with international standard.
Since the concept of digital twin technology has been put forward, after decades of rapid development and wide application, it has not only made great achievements in many fields, but also brought broader prospects for the development of the medical field. As an important trend in the medical industry, digital twin hospitals play multiple roles by connecting physical hospitals and virtual hospitals and benefit the “patient-medical staff-hospital administrators”, highlighting the immeasurable promising application of digital twin technology in smart hospitals. This review takes digital twin technology as an entry point, briefly introduces the progress of its application in various fields, focuses on the characteristics of digital twin technology, practical application cases in hospitals and their limitations, and also looks forward to its future development prospects, aiming to provide certain useful insights and guidance for the future of digital twin hospitals, and also expecting it to play an important role in changing the future of healthcare to a certain extent.
