As an important component of the healthcare system reform, the regional rehabilitation medical alliance aims to integrate medical resources within the region, promote standardization, specialization, and accessibility of rehabilitation medical services, and achieve efficient collaboration and resource sharing among medical institutions at all levels. This article comprehensively and systematically reviews and analyzes the current situation of the construction of regional rehabilitation medical alliance in China. At the same time, combined with the construction practice of West China Airport Hospital of Sichuan University, it summarizes experience and puts forward suggestions, providing a reference for the development of regional rehabilitation medical alliance.
Objective To explore the clinical effect of multidisciplinary team (MDT) in elderly patients with hip fracture under the model of close-type medical alliance. Methods The elderly patients with hip fracture treated in the Department of Orthopedics of Deyang People’s Hospital between January 2015 and December 2020 were included retrospectively. According to different treatment modes, the patients were divided into traditional mode treatment group (traditional group) and MDT mode treatment group (MDT group). The waiting time for operation, hospitalization time after operation, total hospitalization time, total hospitalization cost, and death and loss of follow-up were analyzed. Results A total of 661 patients were enrolled, including 275 in the traditional group and 386 in the MDT group. There was no significant difference between the two groups in terms of gender, age, Charlson comorbidity index, types of fracture or surgical methods (P>0.05). The waiting time for operation [5.50 (3.50, 7.50) vs. 6.00 (4.00, 6.00) d; Z=?3.473, P=0.001], hospitalization time after operation [7.44 (6.27, 8.67) vs. 8.34 (6.72, 13.70) d; Z=?4.996, P<0.001] and total hospitalization time [12.95 (10.46, 16.30) vs. 15.49 (11.77, 19.91) d; Z=?5.718, P<0.001] in the MDT group were shorter than those in the traditional group. The total hospitalization cost of the MDT group was higher than that of the traditional group, but the difference was not statistically significant [39 300 (33 400, 46 400) vs. 38 000 (31 800, 44 000) Yuan; Z=1.524, P=0.128]. There was no significant difference in the lost follow-up rate between the traditional group and the MDT group (9.82% vs. 6.48%; χ2=2.474, P=0.116). Except in-hospital mortality and 30-day postoperative mortality (P>0.05), there was significant difference between the traditional group and the MDT group in 6-month (6.45% vs. 2.77%; χ2=4.875, P=0.027) and 1-year (11.29% vs. 6.37%; χ2=4.636, P=0.031) postoperative mortality. Conclusion Under the model of close-type medical alliance, MDT can reduce the waiting time for operation, hospitalization time after operation, total hospitalization time, as well as 6-month and 1-year postoperative mortality.
Objective To evaluate the impact of the trusteeship of Guang’an People’s Hospital by West China Hospital, Sichuan University on its operational efficiency and quality, so as to provide empirical evidence for the construction of trusteeship-style medical alliances. Methods Annual operational data of Guang’an People’s Hospital from 2013 to 2024 were collected. Taking the initiation of trusteeship in September 2015 as the intervention point (2013-2015 as the pre-trusteeship period and 2016-2024 as the post-trusteeship period), 15 evaluation indicators were selected across six dimensions: operational efficiency, economic performance, medical service quality, discipline development and research, workforce development, and patient satisfaction. Between-group comparisons were performed using the Welch t-test or Mann-Whitney U test. Interrupted time series analysis (ITSA) with segmented regression was conducted to assess level and trend changes of each indicator before and after the trusteeship, with the Newey-West method used to correct for autocorrelation and the Durbin-Watson statistic to test residual autocorrelation. Results Compared with the pre-trusteeship period, annual outpatient and emergency visits, annual discharges, total revenue, medical revenue, the proportion of level-Ⅲ and level-Ⅳ surgeries, total research funding, and the number of locally trained postgraduate staff increased significantly after trusteeship (P<0.05), while the drug revenue proportion and bed occupancy rate decreased significantly (P<0.05). ITSA results showed that after trusteeship, the growth trend of annual outpatient and emergency visits was significantly enhanced (β3=35941.23 visits/year, P<0.05); the average length of stay declined at an accelerated rate (β3=?0.17 days/year, P<0.05); the bed occupancy rate fell significantly (β3=?8.20 percentage points/year, P<0.05); the decline in drug revenue proportion further accelerated (β3=?1.05 percentage points/year, P<0.05), dropping from 41.8% to 19.6%; the growth trend of examination revenue proportion increased significantly (β3=0.61 percentage points/year, P<0.05); the proportion of level-Ⅲ and level-Ⅳ surgeries rose instantly by 6.89% (P<0.05); and the growth slope of locally trained postgraduate staff increased significantly (β3=7.97 persons/year, P<0.05). No statistically significant level or trend changes were observed for annual discharges, total revenue, or medical revenue (P>0.05); the number of research projects, total research funding, and publications showed no sustained improvement after trusteeship (all β3<0, P<0.05); and outpatient and inpatient satisfaction scores stayed high and stable at approximately 95 points. Conclusions The trusteeship-style medical alliance model of West China Hospital, Sichuan University has effectively and significantly strengthened the long-term growth trend of service volume in the trustee hospital, continuously improved its operational efficiency and revenue structure, markedly enhanced its capacity for the diagnosis and treatment of complex and severe diseases, and effectively promoted the development of local healthcare personnel. This model provides a replicable practical pathway for deepening the reform of the medical and health system and promoting the downward extension of high-quality medical resources.
