Objectives To construct patient trust evaluation index system based on the background of hierarchical medical system, and to provide reference for the evaluation of the degree of patient trust on medical institutions and offer guidence to the implementation and further improvement of the hierarchical medical policy in China. Methods Based on literature review, the modified Delphi method was used to carry out 2 rounds of expert consultations from 11 experts in different fields to determine the indicators of patient trust evaluation index system. Results Questionnaire recovery rates of 2 rounds were 100.00% and 90.91%, the expert authority coefficient was greater than 0.75, the coefficient of variation of each index was less than 0.25, and the coordination coefficient of experts in the total index were 0.236 and 0.424 (P<0.001). Patient trust evaluation index system was preliminary constructed including medical environment, service trust, technical skills, pharmaceutical and equipment, the overall trust 5 first-level indexes and 20 level two indexes. Conclusions The patient trust evaluation index system can be used to evaluate patients' trust in different levels of medical institutions under the hierarchical medical system.
Under the policy background of deepening the reform of the hierarchical diagnosis and treatment system in the country, large public hospitals, as centers for the diagnosis and treatment of difficult and severe diseases, face multiple challenges such as difficulty in patient appointment, difficulty in precise diagnosis and treatment, and difficulty in continuous medical care. To overcome this series of severe challenges, West China Hospital of Sichuan University has established a “panoramic” outpatient diagnosis and treatment service system for difficult and severe diseases based on the pain points of patients seeking medical treatment. This system optimizes the entire diagnosis and treatment process through innovative measures such as pre-diagnosis “three convergences”, during-diagnosis “three guarantees”, and post-diagnosis “three connections”. It not only significantly improves the efficiency and quality of diagnosis and treatment, but also provides patients with a high-quality and convenient medical service experience, offering a practical example for large public hospitals to address the diagnosis and treatment challenges of difficult and severe diseases.
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.
Patient priority evaluation has been studied and applied abroad for a long time, which is a mature theory and widely used in practice now. This article uses the priority, patients, waiting list and criteria as keywords to search Wiley Inter Science, Web of Science, Scopus Pub Med, The Cochrane Library, Science Direct, Springer, and Jstor database (searching time is up to December 2017), to collect relevant indicators for patient admission priority evaluation. In addition, relevant citations and grey literature were searched, and experts from relevant fields in China were consulted to obtain more comprehensive research literature. On this basis, this article describes the concept of patient admission priority evaluation, and describes the meanings of the indicators and the countries of application from the three dimensions of clinical indicators, expected results, and social factors. It is considered that the research and implementation of the evaluation of the priority of patient admission has been relatively many. However, there are only a few related researches in the country and without unity. There is no systematic patient-related priority evaluation. It is necessary to use foreign mature theory research to establish a hospital admission priority evaluation system suitable for China’s national conditions.
ObjectiveTo explore the possible factors which can influence the tiered medication situation in dog-bite clinic in comprehensive hospitals and village (community) health service centers, in order to provide references for the standardization of the diagnosis and treatment for dog-bite exposed patients. MethodsWe conducted a retrospective observational study, searched the database of Dujiangyan Center for Disease Control and Prevention, and collected all the information of dog-bite patients administrated by village (community) health service center or hospital from January 2012 to December 2015.Then we investigated the patients' satisfaction and clinical workers' familiarity of dog-bite injury treatment protocols by questionnaires in March 2016.The data were analyzed with statistical description and chi-square test, to explore the possible factors which might influence the tiered medication situation for patients exposed to dog bite in Dujiangyan city. ResultsThere was one comprehensive hospital and 27 township (community) health centers included in this study.During the study period, the total number and proportion of dog-bite injury patients admitted in the comprehensive hospital decreased year by year, especially for the number of grade-two dog-bite exposure patients.One the contrary, the total number and proportion of patients administrated by township (community) health service centers increased year by year, especially for the number (proportion) of grade-two and grade-three dog-bite exposure patients, which increased to 1 944(44.10%) and 1 248(28.31%), respectively.The results also showed that there were significant differences between the comprehensive hospital and township health centers in the satisfaction and familiarity investigation (P < 0.05). ConclusionsTownship and village (community) health service centers are treating many more patients than the comprehensive hospital, but with a lower satisfaction rate.The distribution of dog-bite exposure patients visiting different degrees of hospitals are generally consistent with tiered medication policy.However, township and village (community) health service centers are recommended to strengthen the staff training about how to deal with dog-bite injuries standardly in order to improve patients' satisfaction.
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.
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.
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.