Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement

The purpose of this Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was to evaluate the impact of wellness and relaxation and group psycho-education on health out-comes in an integrated care setting. Individuals diagnosed with mental illness and a co-occurring chronic medical condition participated in the ICPCQI initiatives which were run by peer support and wellness experts in an integrated care setting over the one-year project implementation period. Evaluation of outcome measures revealed an overall decline of 8.3% (p < 0.0001) and 7.3% (p < 0.0001) in the average systolic and diastolic blood pressure respectively. There was a 12.3% (p = 0.02) reduction on the average PHQ-9 scores. GAD-7 (p = 0.9) scores had a mean reduction of 1.5%. These preliminary results suggest that the evidence-based ICPCQI initiatives positively impact health outcomes among individuals with mental illness and chronic medical conditions.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

Retrospective analysis of hepatitis C infected patients treated through an integrated care model

AIM To determine if our health system's integrated model reflects sustained virologic response(SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.METHODS Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat(ITT) analysis. Inclusion criteria consisted of both treatment na?ve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype(GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions.RESULTS At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir(SOF)/ledipasvir(LDV), 8 SOF/LDV and ribavirin(RBV), 7 SOFand Simeprevir(SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue(41.4%), headache(28.6%), nausea(18.1%), and diarrhea(8.3%). No serious adverse effects were reported.CONCLUSION Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus(HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.

An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.

Analysis of Professional Quality Cultivation Strategies for Infant and Child Care Service Talents from the Perspective of Collaboration of Medical Care,Parenting,and Education,and Integration of Industry and Education

The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements related to the infant care industry chain.This integration targets pediatrics talent training in nine infant care positions,including nursing,infant health care and management,and child rehabilitation,to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children.This article briefly explains the background of the“collaboration of medical care,parenting,and education,and integration of industry and education.”It analyzes the necessity of cultivating infant and child care service talents based on the perspective of“collaboration of medical care,parenting,and education,and integration of industry and education.”Based on this perspective,we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.

Challenges of the dialog between humanization of health and medicine for the assistance to woman health in the Brazilian scenario

The present article aims to present, by a bibliographic review, the current challenges of the dialog among fundamental issues referring to humanization as for current public policy in Brazilian scenario. The first one concerns with national health humanization policies and ultimately the humanization of the assistance to the woman’s health, especially at delivery and child birth. Using the hermeneutic dialectic as methodology, it’s understood that having these three facets, dialog consists not only of a great challenge but also of a condition on being put into practice, and expected issues become an effective reality.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

走向健康现代化的战略转型与实现路径:从“三医”联动到健康治理

健康现代化是社会主义现代化的重要内容。面对健康脆弱性,公共健康治理面临着治理界限交互扩大、治理内容更迭扩展、治理进程压缩叠加等诸多挑战。秉持人民中心、生命至上、系统整合、全民参与的公共健康治理理念,中国在提升健康公平性方面探索出一条医保、医疗与医药协同改革的发展之路。新时代进一步提升健康福祉,需要从“三医”联动到健康治理,通过互助共享的健康保障战略、医防融合的健康支持战略、均衡协同的健康服务战略和多元合作的健康促进战略,实现全人群、全周期、全方位为特征的全民健康福祉。基于此,走向健康现代化的具体路径包括,依托健康资源配置体制、健康制度协同机制、健康服务递送体系和健康行动协同网络,最终促进资源互通、结构改革、服务融合和治理提升。

基于DEA-Malmquist的天津市16家保健定点医院运营效率评价

目的分析干部保健定点医院运营效率,为进一步提升保健医院综合实力提供依据。方法采用数据包络分析(data envelopment analysis,DEA)方法和动态Malmquist指数模型,获取2017—2021年16家保健医院医疗指标,计算全要素生产率指数、生产技术变动指数和技术效率指数,研究医院运营管理效率。结果2017—2021年,只有3家保健医院的全要素生产率呈上升趋势,即第6、第10和第12家医院的均值>1.000,其余医院变化均值均<1.000。全要素生产率均值为0.977,生产技术变动指数为0.983,技术效率变动指数为0.994,运营效率仍有进一步提升空间。结论医院运营效率的下降与生产技术的关系密切,天津市保健医院在2017—2021年的全要素生产率呈下降趋势,这表明生产技术变动和技术效率变动是影响运营效率的主要因素。建议采取加强技术创新投入、人才培养与引进、优化资源配置等措施提高医院运营效率。保健行政部门应做好统筹规划,保证保健医院的有序投入。

中医药服务参与医养结合机构的困境与出路

随着中医药文化传播和健康老龄化观念普及,中医药逐渐开展医养结合发展模式研究。目前,中医药与养老产业融合尚不紧密,本文通过走访调查、政策分析、文献梳理等方法,揭示中医药参与医养行业实践现状及存在问题,探索具有中医药特色的医养结合模式。

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

Policies towards implementation of positive changes and the introduction of integrated health care for health systems

1 Introduction Quality of life is influenced by health, education, environment, fairness and respect of public benefits by main stake holders of each country. A pre-summit policy roundtable report of the European Congress for Integrative Medicine （ECIM） 2015 Global Summit on Integrative Medicine and Healthcare held on September 26-27, 2015 in Greater Copenhagen, declared a call for strategic policies in support of integrated health care that would include a vision for setting up ＂an integrative medicine （IM） department in at least one hospital in every European country.＂

MHC （Makkah Health City）： A Futuristic Approach

A Health City, to be known as Makkah Health City, is in the process of being established in Makkah, Saudi Arabia. It will be composed of a health promoting hospital, and a college of medicine and health sciences that would aim at training doctors and other members of the health team, whose practice of medicine would be holistic. Our ultimate goal is for MHC to be a model for other health institutions to emulate.

医护一体化模式对前庭外周性眩晕病人眩晕症状及负性情绪的影响

目的:探讨医护一体化模式对前庭外周性眩晕病人的眩晕症状、焦虑抑郁负性情绪的影响。方法:选取2022年10月—2023年3月某三级甲等医院耳鼻咽喉头颈外科行住院治疗的前庭外周性眩晕病人120例,随机分为对照组和试验组,每组60例。对照组实施常规诊疗护理工作模式,试验组实施医护一体化模式,干预2周后观察两组病人的眩晕、平衡状况和焦虑、抑郁负性情绪。结果:干预后两组病人眩晕、平衡状况较干预前均有所改善,两组病人眩晕障碍量表评分、Berg平衡量表评分比较差异均有统计学意义(P<0.05)。负性情绪方面,干预后两组病人较干预前均有所改善,试验组更早缓解了病人焦虑、抑郁情绪(P<0.05)。两组病人负性情绪干预2周后与1周后比较差异无统计学意义(P>0.05)。结论:将医护一体化模式应用于前庭外周性眩晕病人,能更早改善病人眩晕症状,缓解其负性情绪,加快病人康复。

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

某大型公立医院医养结合模式实践探索

随着人口老龄化程度的加深以及医疗需求的增加,家庭病房作为一种医养结合服务模式逐渐受到重视,成为一种对医疗资源紧缺的重要补充手段。广东省第二人民医院建设智慧家庭病房,探索实践医养结合“互联网+养老”新模式。本文以广东省第二人民医院建设智慧家庭病房的医养结合实践为对象,探索分析公立医院医养结合“互联网+养老”模式在应用中存在的问题,并提出相应的对策建议。

面向继续医学教育的多模态围产保健知识图谱构建研究

目的/意义将多模态知识图谱应用于围产保健继续医学教育,以提高医护人员围产保健服务质量。方法/过程结合北京协和医院围产保健继续教育项目学员需求和课程主要特点构建顶层本体,对本体类、关系和属性进行设计和定义,利用不同粒度教学资源表示教学内容,利用Protégé软件构建围产保健知识图谱概念层和实例层。基于团队自主研发的医学知识服务平台MedKaaS,实现多模态实体进一步交互式构建,以及围产保健课程知识的可视化、检索和问答。结果/结论该多模态知识图谱实现了围产保健课程内容的语义化整合,有助于学员直观和有针对性地学习围产保健知识。

基于文献和知识学习的重症医学大语言模型探索

目的:通过大语言模型技术学习重症医学专科的临床知识,理解和识别临床医疗需求和临床问题意图,并对临床用户提出的问题进行智能反馈。方法:在通用大语言模型的基础上,进行医疗大语言模型数据集的设计,并收集大量的医学知识数据进行多任务多阶段的大语言模型训练,实现对重症医学临床信息的智能分析。结果:实现对重症医学临床医疗信息的智能化理解及自动化问答。结论:应用医疗大语言模型技术,结合临床规则库、医学文献等外部知识体系,可构建重症临床信息大语言模型系统,为临床医疗提供科学、智能的信息理解和决策支持,为大语言模型技术在医疗领域的进一步研究和应用提供经验和参考。

以家庭为中心的赋能健康教育模式在剖宫产初产妇早期母乳喂养中的应用

目的探讨以家庭为中心的赋能健康教育模式在剖宫产初产妇早期母乳喂养中的应用效果。方法选取2021年11月-2022年1月在我院计划行剖宫产的初产妇及其照顾者93例作为对照组,采用常规健康教育宣教方法,宣教对象主要为初产妇本人;选取2022年3-7月在我院计划行剖宫产的初产妇及其照顾者98例作为观察组,在对照组基础上实施以家庭为中心的赋能健康教育模式。比较2组初产妇及其照顾者干预前后母乳喂养知识情况;干预前后初产妇婴儿喂养态度、母乳喂养家庭支持;干预后初产妇泌乳Ⅱ期启动时间和出院时纯母乳喂养率。结果干预前2组初产妇及照顾者各指标比较,差异均无统计学意义(P>0.05);干预后,观察组初产妇及其照顾者母乳喂养知识,以及初产妇婴儿喂养态度、母乳喂养家庭支持、泌乳Ⅱ期启动时间和出院时纯母乳喂养率方面均优于对照组(P<0.05)。结论以家庭为中心的赋能健康教育模式能提高产妇及照顾者的母乳喂养知识,提升婴儿喂养态度及母乳喂养家庭支持,缩短泌乳Ⅱ期启动时间,提高产妇出院时纯母乳喂养率。

健康老龄化视域下“医养结合嵌入式”养老服务的质量评价研究

健康老龄化视角下的嵌入式医养结合养老模式是未来老年人养老质量的保障,也体现了老年人对未来老年幸福美好生活的需求。但对该模式的研究多集中在理论研究层面,对实证的研究较为缺乏。本研究基于医养结合的嵌入式养老服务的评价方法和评价原则,对构建嵌入式医养结合养老模式的评价指标体系进行了较为详尽的阐释。发现目前嵌入式养老机构重在养老轻在医疗,医疗机构与养老机构之间存在着衔接不足的问题,具体表现在医护人员的服务主体不够专业、服务项目不够落实、医疗机构与养老机构的资源整合碎片化以及机构管理的多头监管等问题。研究针对相关问题提出了建议,对我国医养结合的嵌入式养老模式的进一步实施具有一定借鉴意义。