ObjectiveTo know about equipment of pulmonary function tests (PFTs) in community health service centers and the knowledge of pulmonary function in general physicians.MethodsThis questionnaire survey was carried out sponsored by Shanghai Basic Alliance for Respiratory Diseases Prevention and Treatment from June to December in 2016. Most community health service centers in 16 districts of Shanghai participated the survey. The questionnaire included education background, professional qualification, PFTs equipment, and knowledge about PFTs.ResultsThere were 963 general physicians in 131 community health service centers completed the questionnaire. There were 27 (20.6%) community health service centers equipped with simplified pulmonary function test device and 910 (94.5%) physicians knowing PFTs. Out of these 910 physicians, 458 physicians (50.3%) gave the correct answer on question about the items of PFTs. The accuracy of question about the diagnosis of chronic obstructive pulmonary disease (COPD) was 24.0% (218/910).ConclusionsThe rate of community health service centers with equipment on PFTs is low and the knowledge on pulmonary function in general physicians is insufficentt in Shanghai. Training on pulmonary function is essential to adapt the stratified treatment of COPD.
Objective To provide evidence for the establishment of an essential medicines list, we investigated the institutional medicine supply in rural hospitals and community health service centers in Chengdu. Methods The trained investigators collected medicine sales records and information about the management of institutional pharmacies. Through in-depth interviews with the pharmaceutical personnel, we inquired into the drug supervision and supply networks in rural areas. Then we performed secondary research based on a comparative analysis of drug classification, administration and pharmacies in developed countries. Results Seven township hospitals/community health service centers had pharmacies, facilities, storage, and a clean environment. Three of them used electrical databases to manage medicine sales records. Five township hospitals and 5 village medical rooms purchased medicines from the drug supervision and supply networks every week. In this way, they ensured the quality and accessibility of drugs in rural areas. In the urban community health service centers, medicines were supplied based on the traditional commercial distribution system. Conclusion Rational allocation of health resources to set up institutional pharmacies and village medicine rooms is important. The supervision of village medical rooms must be stricter. We should expand the use of electrical databases and integrate the supervision and supply networks with the supply system of the essential medicines.
Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.
China is in the best period of development since modern times, and in the face of the “great changes” in the world, China’s medical and health field needs to reconstruct the medical service model actively. Under the guidance of the “Healthy China” strategy in the new era of socialism with Chinese characteristics, full life cycle health service emerged as the times require. The whole life cycle health service is based on the two focuses of the whole population and the whole life cycle, with the main characteristics of “system continuity” and “fair accessibility”, aiming to achieve the overall improvement of the health level of the whole people. This article reviews the concept, connotation and research progress of whole life cycle health service, aiming to implement the strategy of “Healthy China”, so as to provide reference for carrying out the whole life cycle health service with Chinese characteristics in the new era.
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 understand the status of needs, demands and utilization of health services of urban and rural residents in Chongqing, so as to provide references for the evaluation of health services status and policy making and regulating. Methods The data from family health questionnaire of health service survey in Western China in 2008 were descriptively analyzed. Results The two-week prevalence rate was 216.9‰ and the two-week hospital visit rate was 211.5‰. The sick people who did not seek medical care accounted for 56.2% among the sick population. The chronic disease prevalence rate was 226.4‰. The annual hospitalization rate was 77.1‰. Conclusion During the past five-year from 2003 to 2008, the needs of health services in Chongqing have had no big change, but the chronic disease prevalence rate has been in uptrend, and the utilization has obviously increased. And the economic factor is still the major cause for impeding residents to seek medical care. So it’s necessary to strengthen the construction of primary health care institutions, to improve the level of health insurance system, and to decrease the disparity in urban and rural areas.
Lung cancer is the malignant tumor with the highest incidence and mortality rate in China. Early diagnosis and treatment are key to improving the survival rate and reducing the mortality rate for lung cancer patients. This article introduces the integrated management model for patients with pulmonary nodules/lung cancer developed by West China Hospital of Sichuan University based on “internet plus” and health service team of treatment, nursing, and care. The Integrated Care Management Center has established a multidisciplinary team, using internet platforms and artificial intelligence tools to develop a whole life cycle health service system for patients with pulmonary nodules/lung cancer, which is from the screening of high-risk population for lung cancer, the intelligent risk stratification and follow-up management of pulmonary nodules, the subsequent standardized diagnosis and treatment of lung cancer and comorbidity management, until the patient’s demise. After the implementation of this model, the malignancy rate in surgically treated patients with pulmonary nodules reached 85.08%, and the patient satisfaction score was 95.76. This model provides a new idea and reference for the innovation of chronic disease service model and the management of pulmonary nodules and lung cancer.
ObjectiveTo investigate the demand of pediatric health service, the current situation of resource allocation and the equity of health service, so as to provide guidelines for optimizing the resource allocation of pediatric health service in Sichuan province.MethodsA questionnaire of all healthcare institutions with legal capability from a total of 183 prefectures in Sichuan province was performed in 2015. We described the demand of pediatric health service by two-week hospital visit rate, the proportion of no-visit rate within two-weeks, hospital admission rate, and the patient required hospitalization rate. We assessed current situation of resource allocation, equity and accessibility by analyzing Gini coefficient, Lorenz curve and thermodynamic diagram.ResultsThe demand of pediatric health service in Sichuan province was huge and the current resource allocation can be shown a " inverted triangle” form. According to population distribution, the Gini coefficients of physician, bed and equipment were 0.47, 0.40 and 0.49, respectively, which represented inequality in resource allocation. By location, the Gini coefficients of physician, bed and equipment were 0.82, 0.77 and 0.81, respectively, which indicated an absolutely unfair situation.ConclusionsThe health resources of pediatric in Sichuan province are limited, the distribution is unbalanced, and the supply of pediatric healthcare is not compatible with demand. The lack of resources and waste coexist simultaneously. Furthermore, the fairness of distribution in terms of geographical areas is far less than that in terms of population. The accessibility of superior health resources is low.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.
Objective To investigate the inpatient disease constitution of Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to learn about the local burden of diseases and to provide baseline data for further study. Methods Both questionnaire and focus interviews were applied to collect inpatients’ records in JCHSC between 2008 and 2010. Based on the primary diagnosis on hospital discharge record, the diseases were standardized and classified according to the International Classification of Disease, 10th Edition (ICD-10). Data including general information of the inpatients and discharge diagnosis were rearranged and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 4 804, 6 011 and 6 552 in 2008, 2009 and 2010, respectively, and males were less than famales (37.89% vs. 62.11%, 37.68% vs. 62.32%, 41.09% vs. 58.91%); b)The disease spectrum included 19 to 21 categories, accounting for 90.5% to 100% of ICD-10; c) The top 5 systematic diseases accounted for 78.91%-83.61%, including circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases; d) The top 15 single diseases were coronary heart disease, urinary calculi, cholecyslithiasis or accompanied with cholecystitis, chronic gastritis, hypertension, diabetes, chronic bronchitis, pulmonary infection and inguinal hernia; and e) In these 3 years, most of the inpatients suffered from chronic diseases rather than acute diseases, mostly over 35 years old; while the acute diseases were commonly seen in patients younger than 15 years old. Conclusion a) In recent 3 years, the major inpatient systematic diseases are circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases. The chronic diseases are more than the acute, and mainly focus on coronary heart disease, urinary calculi and chronic bronchitis; b) Nine common inpatient disease spectrum of the top 15 single diseases keep same in recent 3 years; and c) Further attention should be paid to the chronic patients over 35 years old and the acute patients less than 15 years old.