Integration of Medical Care and Endowment: A New Exploration of Endowment Mode in the Context of Population Aging

China's aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pressure is also constantly increasing. Traditional endowment mode is already incapable of satisfying current endowment demands. On the basis of the population aging,this paper came up with the new endowment mode " hospital + nursing home" and analyzed its feasibility. Finally,it reached the conclusion that this endowment mode is helpful for solving problems of endowment and medical care,and alleviating the problem of population aging.

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.

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.

Analysis of the Effect of Integrated Extended Care Model in Improving the Quality of Life of Elderly Patients with Type 2 Diabetes Mellitus

Objective: To analyze the impact of an integrated extended care model on improving the quality of life of elderly patients with Type 2 Diabetes Mellitus (T2DM). Methods: A total of 176 patients admitted to the hospital from March 2015 to February 2018 were selected and randomly assigned to an observation group and a control group, with 88 patients each. The control group implemented conventional nursing interventions, and the observation group carried out an integrated extended-care model. The level of glycemic control, quality of life, and daily medication adherence between both groups were compared. Results: The observation group showed significant improvement in the level of glycemic control, and their fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels were significantly lower as compared with those in the study group (P < 0.05). The quality of life of the patients in the observation group was higher than that of the control group (P < 0.05). The observation group had a higher compliance score (95.48 ± 7.45) than the control group (81.31 ± 8.72) (t = 8.909, P < 0.05). Conclusion: The integrated extended care model allows patients to receive comprehensive and individualized nursing services after discharge, which improves the effect of drug therapy and the quality of life of patients.

Health and Medical Care for the Elderly

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Implementation Strategy of“Eight in One”of Integrated Medical and Care Service System in China:A Case Study of Anshan City of Liaoning

With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.

Thoughts on the Innovative Design of the Integrated Service Mode of Pharmacies and Elderly Care Centers

Objective To evaluate the service model that integrates medical treatment and elderly care to provide a reference for the development of pharmacies and elderly care centers.Methods Through the literature investigation and case analysis,the domestic integrated medical treatment and elderly care service model was analyzed,and new ideas for the integration of pharmacies and elderly care centers were provided.Results and Conclusion The integrated service model of pharmacies and elderly care centers is designed and the integration mode of pharmacies,hospitals and elderly care centers is proposed by analyzing their advantages.The“pharmacy+elderly care”mode and the“pharmacy+medical treatment+elderly care”mode that integrates pharmacies,hospitals,and elderly care centers are put forward to predict its new development opportunities in the future.

Observation on the Effect of Integrated Medical and Nursing Care in Patients with Pulmonary Tuberculosis Combined with Lung Cancer

Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.

Outcomes of Integrated Community Care Interventions for Frail Elderly People: A Literature Review

This study aimed to summarize the outcome measures and the significant outcome of effective integrated community care for frail elderly people through a literature review. A literature search was conducted using the Cochrane Library and PubMed for articles published up to November 2016 with the following search terms: Integrated community care, primary care, community, frail elderly, and effectiveness. A total of 106 articles were identified, of which eight with an interventional research design the inclusion criteria. All outcome measures were classified into the three categories: Functional abilities, quality of life, and health. As the significant effect, the physical function was perceived in four references, the quality of life in one reference, and the mental health in one reference. The evidence of the effectiveness of integrated community care seemed to be lacking. More studies will need to be conducted.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Clinical Efficacy of the Integrated Medical Care Model Combined with Psychological Intervention in Tuberculosis Patients with Lung Cancer

Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.

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.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review

This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: “urban”, “rural”, “comparison of community”, “elderly health”, and “comparison of community health”. A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.

Integrating Psychiatric Services into Comprehensive Dementia Care in the Community

Purpose: This study was conducted to clarify the utility of patient-held records as an integrated care approach for patients with dementia in the community. Method: We analyzed the family-held/patient-held records of patients with dementia in the community. The inclusion criteria in the study were as follows: 1) patient-held/family member-held records of patients with dementia in the community;2) patient-held records designed to share information across different professionals, direct-care staff members, and local government staff;and 3) the continuous participation of psychiatrists in the development and use of the patient-held records. Results: We identified eight sets of family-held/patient-held records in Japanese communities of various sizes, all of which were aimed at integrating information from various services, including information provided by medical and psychiatric professionals to the family and patient. Innovative tools have been available in the areas of the hopes and preferences of the patient, medication and monitoring, sharing information, and the use of information technology. Conclusion and Discussion: Family-held/patient-held records have potential as a tool to enhance the integrated care of people with dementia in the community.

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.

基于Andersen行为模型的机构内老年人医养结合模式选择及其影响因素研究

目的了解老年人对医养结合机构服务模式选择意愿及其影响因素,为构建全方位、多层级、不同类型"医养结合"机构服务体系提供科学参考。方法基于Andersen行为模型,通过焦点访谈和问卷调查,采用多阶段分层抽样方法于2017年6月-2018年8月对青岛市7个区43家医养结合机构2040位入住老年人进行问卷调查,构建多分类logistic回归模型,分析机构老年人医养结合模式选择的影响因素。结果机构老年人当中选择养中有医模式最多(42.32%),医养并重的次之(37.55%),医中有养的最少(20.14%)。与医养并重模式相比,中低教育程度、健康状况好、半自理、无任何疾病、睡眠时间较短的老年人更愿意选择养中有医机构模式(P<0.05);教育程度低、与子女在同一市居住、无任何疾病、睡眠时间较短的老年人更愿意选择医中有养机构模式(P<0.05)。从Andersen模型各维度来看对医养结合机构模式选择影响最大的是促成性因素,其次分别是需求性因素、倾向性因素和健康行为因素。结论青岛市机构老年人医养结合模式选择以养中有医机构模式最多,机构老年人医养结合模式选择受社会人口学特征、居住安排、健康状况和日常生活状况等因素的影响,其中促成性因素影响最大。

县域医共体医防融合实现机制与典型路径

目的:构建县域医共体医防融合实现机制,总结医防融合的典型路径,为其他地区开展基层医防融合提供借鉴和参考。方法:基于扎根理论并借助Nvivo软件进行数据编码及定性分析。结果:确定县域医共体开展医防融合的7个核心维度为体系融、管理融、服务融、人员融、信息融、绩效融和资金融,在实践中仅有少数县域医共体实现了较多维度的融合。结论:将服务融、管理融、信息融放在开展医防融合的首要位置,注重体系融和资金融的均衡设置,参考县域医共体医防融合实践的典型路径,进一步推动医防融合的发展。

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。

居家社区医养结合服务利用及满意度现状研究

目的 了解居家社区医养结合服务的利用情况和满意度现状,提出促进医养结合发展的对策和建议。方法 通过目的抽样法于2023年5-7月在我国东、中、西部分别选取无锡市、长沙市、成都市对2 125名60岁及以上正在接受或曾接受过服务的老年人进行问卷调查。采用描述性分析、卡方检验、单因素方差分析、多元线性回归等统计学方法对有效问卷数据进行分析。结果 不同地区的就医习惯、服务方式、常用药的获取情况差异具有统计学意义(P<0.05)。服务总体满意度均值为(4.32±0.625)分,处于“满意”与“非常满意”之间。线性回归结果显示,失能程度、慢性病患病情况、地区差异、就医习惯、服务方式、常用药获取情况、地理可及性情况是服务满意度的影响因素(P<0.05)。结论 老年人所接受的居家社区医养结合服务对于基层医疗卫生机构利用情况较好,服务总体满意度较高,但存在地区之间发展不平衡的问题。应进一步以基层医疗卫生机构为重点发展居家社区医养结合服务,完善医保支付机制,加快建立健全长护险制度,不断提高居家社区老年人的满意度和居家社区医养结合服务质量。