Objective To investigate the influencing factors in the service volume of primary health care institutions in Chengdu, and provide references for promoting the hierarchical diagnosis and treatment. Methods A self-administered questionnaire was used to investigate the service volume of a total of 390 primary health care institutions (including community health service centers and township hospitals) across 22 districts and counties of Chengdu from October to November 2016. Rank sum test, rank correlation analysis and multiple linear regression model were used to analyze the influencing factors of outpatient visits in the institutions. Results The median annual amount of outpatient visits was 60 493 in community health service centers and 31 374 in township hospitals. Between community health service centers and township hospitals, the difference in median daily visits per doctor was not significant (14.41 vs. 13.29), but the median daily visits per doctor in general practitioners (12.22 vs. 8.16), rehabilitation physicians (10.10 vs. 6.34) and traditional Chinese medical doctors (4.82 vs. 6.17) varied considerably. Multiple linear regression analysis showed that the amount of outpatient visits in community health service centers was related to the amount of intermediate physicians, while the amount of outpatient visits in township hospitals was related to the setup of dental clinics, the amount of primary physicians, the amount of beds and population to be served (P<0.05). Conclusions Differences exist in the service volume among primary health care institutions in Chengdu. It’s necessary to make proper plans for the management of administrative offices and the allocation of personnel, so as to improve medical services of primary health care institutions.
Under the vigorous promotion of national policies, by the end of 2018, the construction of the national medical consortium has been fully launched, and all public tertiary hospitals have actively participated in the construction of medical consortium. The practice of lead-type close medical consortium in West China Hospital of Sichuan University is an innovative exploration in the context of the new national medical reform. Combining the social responsibilities, location characteristics, functional orientation of West China Hospital of Sichuan University, and the remarkable results of the lead-type close medical consortium, this article elaborats three distinctive features of the lead-type close medical consortium, namely the cooperation between the government and the hospitals as the cornerstone, the hierarchical collaboration as the core, and the medical care and great health as the guiding principle, to provide a reference for the construction of a high-quality and efficient medical and health service system in China.
Day surgery is an important diagnosis and treatment modality to promote hierarchical diagnosis and treatment and form a “surgery in hospital, recovery in community” diagnosis and treatment mode. At the same time, the promotion and implementation of hierarchical diagnosis and treatment provides institutional support and promotion for the perfection of day surgery management. Based on the experience from the Day Surgery Centre of General Hospital of Eastern Theater Command, this paper investigates the role of “gate-keepers” and recovery guidance in community and secondary hospitals in the perfection of day surgery in tertiary hospitals. Taking orthopedic day surgery as an example, which accounts for the largest proportion in day surgery in General Hospital of Eastern Theater Command, this paper aims to explore a feasible model of hierarchical diagnosis and treatment of day surgery, which specifies the responsibilities and works of hospitals at all levels.
This article discusses the new needs and development direction of medical testing technology under the hierarchical diagnosis and treatment system in China, outlines the principles and advantages of new medical testing technology based on smartphones, and briefly describes the development status and research results of smartphone testing technology in specific medical testing directions such as immune analysis, nucleic acid analysis, biochemical analysis and cell morphology analysis. In addition, the article also discusses the current problems of smartphone medical testing technology, such as poor compatibility with different models of smartphones, few detection indicators, low automation, lack of clinical verification. Finally, a prospect is made for the possible future development direction of smartphone medical examination technology, aiming to provide a certain reference for the promotion and more reasonable application of smartphone medical examination technology.
This article conducts a mid-term evaluation of the implementation effect of the “West China-Chenghua Urban Area Medical Service Alliance” from 2016 to 2019 based on structure-process-outcome model. The structure of the alliance included five organizational sections, including the leadership group, West China departments, grassroots organizations, information platforms, and residents and health fan teams, aiming to provide integrated, homogeneous, and accessible medical services centered on residents’ health. The process of the alliance mainly included the joint reforms led by the “combination of government and hospital” and the management mechanism of “politics-people-medicine-network” four links. Alliance performance: in terms of grassroots services, the number of diagnoses and treatments increased, the number of diseases received increased, and the homogenization of test was initially achieved; in terms of grassroots training, several high-quality community doctors were trained, and the number of talents introduced increased; in terms of grassroots scientific research, 3 large-scale scientific research projects were undertaken and 4 articles were published in national-level publications; in terms of grass-roots awards, 5 honorary titles at national, provincial, and municipal levels were gained, and award-winning “zero” breakthrough in national skill competitions and academic conferences was achieved; in terms of alliance satisfaction, the employees in primary medical institutions and West China Hospital of Sichuan University and the residents in Chenghua District were all had high degree of satisfaction. The alliance has achieved innovation in management and services, and the employees and residents are highly satisfied, which is conducive to promoting the realization of the homogeneity of regional medical service capabilities. However, the salary system and capacity improvement of grassroots medical staff should be further explored.
Objective To analyze the characteristics of patients transferred by ambulances to emergency department before and after coronavirus disease 2019 epidemic, in order to improve the efficiency of emergency triage, optimize the utilization of emergency resources, and provide a reference for standardized tiered medical services in different situation. Methods The patients’ information collected through Wenjuanxing questionnaire was extracted, who were transferred by ambulances to the Emergency Department of West China Hospital of Sichuan University between December 27th, 2018 and April 28th, 2019 (before epidemic), or between December 27th, 2019 and April 28th, 2020 (during epidemic), or between December 27th, 2020 and April 28th, 2021 [in regular epidemic prevention and control period (REPCP)]. The general information, sources, reasons for referral, disease spectrum and triage levels of patients in the three periods were compared. Results There were 3993, 2252 and 1851 cases before epidemic, during epidemic, and in REPCP, respectively. The differences in gender and age among the three periods were not statistically significant (P>0.05). The percentage of referrals from tertiary hospitals in each period was 74.00%, 72.65%, and 76.12%, respectively, which was higher in REPCP than that during epidemic (P<0.05). The percentage of direct referrals from emergency department in each period was 41.00%, 42.14%, and 44.46%, respectively, which was higher in REPCP than that before epidemic (P<0.05). The percentage of two-way referrals in each period was 37.79%, 36.63%, and 34.36%, respectively, which was lower in REPCP than that before epidemic (P<0.05). During epidemic and in REPCP, the proportions of referrals due to “need for surgery” (24.72%, 27.84%, and 28.74%, respectively) and “request by family members” (49.64%, 53.33%, and 56.24%, respectively) increased compared with those before epidemic (P<0.05), while the proportion of referrals due to “critical illness” decreased compared with that before epidemic (40.20%, 35.21%, and 33.17%, respectively; P<0.05); the proportion of referrals due to “diagnosis unknown” decreased in REPCP compared with that before epidemic (15.50%, 13.90%, and 11.89%, respectively; P<0.05). The proportion of acute aortic syndromes in REPCP increased compared with that during epidemic (3.46%, 2.98%, and 4.65%, respectively; P<0.05), the proportion of trauma in REPCP increased compared with that before epidemic (13.72%, 15.76%, and 17.77%, respectively; P<0.05), and the proportion of pneumonia/acute exacerbation of chronic obstructive pulmonary disease during epidemic and in REPCP decreased compared with that before epidemic (8.44%, 3.73%, and 3.84%, respectively; P<0.05). The proportion of critically ill patients referred in each period was 72.88%, 75.58%, and 79.15%, respectively, which was the highest in REPCP (P<0.05). Conclusions The epidemic has a significant impact on emergency ambulance referrals, and emergency triage needs to be continuously optimised and improved in staff, facilities, processes and management. It is necessary to further improve the implementation of hierarchical diagnosis and treatment, strengthen information communication between referral and emergency departments of receiving hospitals, and improve referral efficiency.