Aiming at the shortcomings in the theory and practice of integrated elderly care and medical services in China, using the methods of literature analysis and comparative analysis, we summarize four typical models of integrated elderly care and medical services, namely, the American commercial pension model, the British national tax financing system pension model, the Japanese national security transformation, and the German long-term care insurance system, and compare the four models systematically from the aspects of system overview, service principle, operation mode, financing supervision, etc. The enlightenment for the policy and practice development of integrated elderly care and medical services in China is obtained: firstly, the service concept should be innovated; secondly, it is important to improve the relevant legal protection and supporting measures; thirdly, the refinement of the integrated elderly care and medical service projects are supposed to be promoted; fourthly, a multi-party linkage mechanism ought to be establishd; and fifthly, community endowment model should be advocated.
The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
Objective To analyze the impact of removing medicine makeups and two rounds of medical service price adjustment reform on inpatient expenses, and to provide reference for policy-making and adjustment of hospital management strategy. Methods Select the front page data of medical records of the case hospital medical record management system from 2016 to 2018. According to the time of cancellation of drug addition and two rounds of medical service price adjustment reform, the data on the first page of medical records in the hospital medical record management system are divided into two groups, including before the implementation of the policy (2016) and after the implementation of the policy (2017-2018). Interrupted time series (ITS) was used to analyze the changes of hospitalization expenses before and after the adjustment of the policy. Results Before the implementation of the policy, the average hospitalization expenses in 2016 was (17 863.35±334.73) yuan; After the implementation of the policy, the average hospitalization expenses in 2017 was (18 066.16±398.42) yuan, and the average hospitalization expenses in 2018 was (18 238.95±258.28) yuan. ITS analysis showed that before the implementation of the policy, the average hospitalization expenses of patients increased by 26.616 yuan per month, but there was no statistical significance (P=0.323). In the month when the policy was implemented (December 2016), the average hospitalization expenses of patients decreased by 141.212 yuan, but there was no statistical significance (P=0.547). After the implementation of the policy, the slope of average hospitalization expenses of patients 22.363, and the inpatient expenses showed an upward trend, but there was no statistical significance (P=0.881). In the past three years, the drug expenses has decreased by 13.64%, the material expenses has decreased by 3.69%, and the labor expenses has increased by 12.25%. Conclusions After the removing medicine makeups and two rounds of medical service price adjustment reform, the drug expenses and material expenses decreased during hospitalization, and the labor expenses increased, but no change in hospitalization expenses.
Objective To explore the influencing factors of subjective well-being of patients after the same-day surgery, and to provide evidence for optimizing the management mode of same-day surgery and improving the quality of life of patients after the operation. MethodsPatients who underwent same-day surgery at the Day Surgery Center, West China Tianfu Hospital of Sichuan University between June 2024 and May 2025 were retrospectively selected. The ordered Probit regression stratified model was adopted, with six dimensions variables were sequentially included: demographic characteristics, social support, community services, health status, lifestyle, and socioeconomic status, to analyze their impact on postoperative subjective well-being among patients undergoing same-day surgery. Results A total of 481 patients were included, with an average age of (54.58±15.69) years. The final model (Model 6) was statistically significant overall (LR χ2=172.840). The regression analysis results showed that there were statistically significant differences in the current physical condition-health, self-rated health status-poor (reversed scoring), and number of comorbidities-0 in the health status dimension (P<0.05). In the social support dimension, receiving comfort and care during emergencies was a strong positive predictive (P<0.05). In the community service dimension, there was no statistically significant difference in participation in follow-up management, community-provided examinations or guidance (P>0.05), but there was a statistically significant difference in the combined effect on subjective well-being (P<0.05). In the socioeconomic status dimension, “monthly income below 3 000 yuan”“postgraduate or higher education”“self-employment” were statistically significant (P<0.05). Conclusions Postoperative subjective well-being in patients undergoing same-day surgery mode is influenced by multiple factors, including social support, health status, and community services. Targeting these primary influencing factors with appropriate measures can enhance postoperative subjective well-being in same-day surgery mode patients.
摘要:目的: 探討基層醫院急診“120”院前救治水平的影響。 方法 :分析301例死因,年齡及百分比。 結果 :急診致死原因疾病病譜前9位分別是交通事故,猝死,溺水,意外傷害,自殺,電擊傷,刀傷,一氧化碳中毒及呼吸道梗塞,“無名氏”群體86例占285%,這部分給臨床和社會帶來了新問題,這仍有待今后繼續探討。 結論 :完善基層醫院“120”體系,提高救治水平。Abstract: Objective: To explore the factors relate to prehospital“120”Emergency Medical Services cases death. Methods : Analysis the cause for death, ages and percentage of the age in 301 cases. Results : Traffic accident, sudden death, drowns, accident, suicide, electric burn, knife trauma, anthracemia and respiratory tract obstruction were the leading cases in the diseases spectrum of the cause for death in emergency cases. 86 cases were anonym, which brought new problems to clinic treatment and provoked social issue, accounting for 285% in total cases. These remain us to study henceforth. Conclusion : Consummate the “120” Emergency MedicalServices system in grassroots hospital and enhance the level of cure.
With the aggravation of population aging, the medical and care needs of the elderly have increased significantly. Nowadays the integrated elderly care and medical services have been greatly promoted and various services modes have been developed in different regions. In order to promote the healthy development of integrated elderly care and medical services in China, we summarized the practical experience of integrated elderly care and medical services implemented in various parts of China, including six typical service modes such as elderly care in medical services, medical care in elderly care, cooperation between medical services and elderly care, community radiation, family doctor embedded and “Internet+”. Moreover, we compared their providers, service methods, construction specifications, service standards, regulatory agencies and payment methods. Finally, we analyzed the problems and their causes, and proposed corresponding improvements for outstanding problems in the practice of integrated elderly care and medical services in China.
Objective To explore the matching relationship between the supply and demand of different types of integrated elderly care and medical service for the elderly population in the region, and achieve the simulation purpose of coordinated allocation and balanced development of supply and demand of integrated elderly care and medical service. Methods Combining literature, interviews, and expert consultation to sort out the main factors and system element relationships between the supply and demand of integrated elderly care and medical service in the region, the Vensim software was used to clarify the relationships and operation mechanisms between the subsystems of supply and demand of integrated elderly care and medical service. The data of the construction base for the integrated elderly care and medical service project in Suzhou city, Jiangsu province from January 1, 2010 to December 31, 2022 were selected. Results Combined with the accessibility and completeness of data, the main variables and indicators of the five subsystems were screened, and the causality diagram and flow diagram of the system dynamics were drawn to clarify the main variables and flow direction of the subsystems, and the constructed model was more stable in simulation operation. The simulation model results showed that the supply-demand ratio of home-based elderly care and community elderly care decreased relatively before 2012, and the institutional elderly care model gradually emerged and developed from 2013 to 2018. From 2019 to 2022, the supply-demand ratio of medical care with elderly care and elderly care with medical care decreased. Conclusions Based on the theoretical foundation of system dynamics, the supply and demand the integrated elderly care and medical service in the region are regarded as a complex system. Through the analysis of the system elements among the subsystems and the sorting out of the mechanisms, it can provide certain theoretical support for constructing and improving the system dynamics model for matching the supply and demand of integrated elderly care and medical service in the region.
ObjectiveGiven the relatively limited resources available for tumor radiotherapy, the reengineering theory to the tumor radiotherapy process of a tertiary hospital is applied to improve the efficiency of medical service, shorten patient waiting time and improve patient satisfaction. MethodsThe tumor radiotherapy process of a tertiary hospital was studied from January 2017 to September 2018. The indicators such as efficiency and satisfaction were analyzed before reconstruction (from January to December 2017) and after reconstruction (from January to September 2018). ResultsAfter radiotherapy process reengineering, on the one hand, the medical efficiency was improved: the number of new patients for radiotherapy per month rose by 16.58% (P<0.05), and the number of daily radiotherapy increased by 5.80% (P<0.05). On the other hand, the patient treatment process became more concise: the preparation time was shortened from 2-3 days to 1 day, while the waiting time for radiotherapy was shortened by nearly 10 days, and the overall satisfaction of patients increased from 64.17% to 83.55%. ConclusionIt can improve the operation efficiency of tumor radiotherapy and improve patient satisfaction under the condition of relatively fixed resources through the reconstruction of the information-based tumor radiotherapy process.
This paper systematically compares the common integrated elderly care and medical services models and related elements in China, analyzes the six major elements of system dynamics order flow, capital flow, equipment flow, personnel flow, information flow and material flow under the health care integration service model, compares the current situation of the application of system dynamics in the operation mechanism of the integrated elderly care and medical services model, supporting policies, cooperation and collaboration model, effect evaluation and industrial prediction simulation of key elements, summarizes the shortcomings of the existing application research and proposes research outlook, and provides a theoretical basis for the optimization research of the integrated elderly care and medical services model.
This article takes the regional cooperative medical service practice provided by the West China Hospital of Sichuan University as example, analyzes several problems with regional medical service practice in western region based on the introduction of the general situation and system of regional cooperative medical service provided by the West China Hospital. The problems are:lack of motivation to promote regional collaborative medical care, serious lag of policies, and lack of stratified configuration of tests/exams quality standards and construction standards of medical information system platform. This article puts forward the key point to promote western regional medical collaboration:strengthening government dominance, and establishing suitable medical insurance system and regional laboratory examination centre.