Analysis of the Implementation of Integrated Healthcare Management in Preoperative Preparation

Objective:To strengthen preoperative preparation management and reduce preoperative preparation defects.Methods:We set up a special medical care management team to investigate the preoperative preparation in surgical departments,analyze the causes of the shortcomings in preoperative preparation,and propose countermeasures.The medical staff jointly formulated plans related to preoperative preparation management including clear outline of responsibilities,strengthening of training,integrated medical care,timely feedback,and continuous improvement.Besides,the preoperative preparation of patients before and after the improvement measures were compared using statistical analysis.Results:The rate of inadequate preoperative preparation was 11.14 per thousand before the integrated management model was implemented.After the implementation of the integrated management model,the rate of inadequate preoperative preparation decreased to 2.99 per thousand,and the difference was statistically(P<0.05).Conclusion:The integrated management of preoperative preparation can help reduce the rate of preoperative complications and ensure the safety of surgery.

Integrated Behavioral Healthcare in Thailand:A Case Study from Chiang Mai

Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.

Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access to digital imaging and communication in medicine persistent object protocol

AIM:To address issues in interoperability between different fundus image systems,we proposed a web eyepicture archiving and communication system(PACS)framework in conformance with digital imaging and communication in medicine(DICOM)and health level 7(HL7)protocol to realize fundus images and reports sharing and communication through internet.METHODS:Firstly,a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise(IHE)Eye Care technical framework.Then,a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object(WADO)protocol,which contains three tiers.RESULTS:In any client system installed with web browser,clinicians could log in the eye-PACS to observe fundus images and reports.Multipurpose internet mail extensions(MIME)type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians.Some functions provided by open-source Oviyam could be used to query,zoom,move,measure,view OICOM fundus images.CONCLUSION:Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports,therefore is of great significance for teleophthalmology.

Novel Block Chain Technique for Data Privacy and Access Anonymity in Smart Healthcare

The Internet of Things (IoT) and Cloud computing are gaining popularity due to their numerous advantages, including the efficient utilization of internetand computing resources. In recent years, many more IoT applications have beenextensively used. For instance, Healthcare applications execute computations utilizing the user’s private data stored on cloud servers. However, the main obstaclesfaced by the extensive acceptance and usage of these emerging technologies aresecurity and privacy. Moreover, many healthcare data management system applications have emerged, offering solutions for distinct circumstances. But still, theexisting system has issues with specific security issues, privacy-preserving rate,information loss, etc. Hence, the overall system performance is reduced significantly. A unique blockchain-based technique is proposed to improve anonymityin terms of data access and data privacy to overcome the above-mentioned issues.Initially, the registration phase is done for the device and the user. After that, theGeo-Location and IP Address values collected during registration are convertedinto Hash values using Adler 32 hashing algorithm, and the private and publickeys are generated using the key generation centre. Then the authentication is performed through login. The user then submits a request to the blockchain server,which redirects the request to the associated IoT device in order to obtain thesensed IoT data. The detected data is anonymized in the device and stored inthe cloud server using the Linear Scaling based Rider Optimization algorithmwith integrated KL Anonymity (LSR-KLA) approach. After that, the Time-stamp-based Public and Private Key Schnorr Signature (TSPP-SS) mechanismis used to permit the authorized user to access the data, and the blockchain servertracks the entire transaction. The experimental findings showed that the proposedLSR-KLA and TSPP-SS technique provides better performance in terms of higherprivacy-preserving rate, lower information loss, execution time, and Central Processing Unit (CPU) usage than the existing techniques. Thus, the proposed method allows for better data privacy in the smart healthcare network.

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.

On Monetizing Personal Wearable Devices Data:A Blockchain-based Marketplace for Data Crowdsourcing and Federated Machine Learning in Healthcare

Machine learning advancements in healthcare have made data collected through smartphones and wearable devices a vital source of public health and medical insights.While wearable device data help to monitor,detect,and predict diseases and health conditions,some data owners hesitate to share such sensitive data with companies or researchers due to privacy concerns.Moreover,wearable devices have been recently available as commercial products;thus large,diverse,and representative datasets are not available to most researchers.In this article,the authors propose an open marketplace where wearable device users securely monetize their wearable device records by sharing data with consumers(e.g.,researchers)to make wearable device data more available to healthcare researchers.To secure the data transactions in a privacy-preserving manner,the authors use a decentralized approach using Blockchain and Non-Fungible Tokens(NFTs).To ensure data originality and integrity with secure validation,the marketplace uses Trusted Execution Environments(TEE)in wearable devices to verify the correctness of health data.The marketplace also allows researchers to train models using Federated Learning with a TEE-backed secure aggregation of data users may not be willing to share.To ensure user participation,we model incentive mechanisms for the Federated Learning-based and anonymized data-sharing approaches using NFTs.The authors also propose using payment channels and batching to reduce smart contact gas fees and optimize user profits.If widely adopted,it’s believed that TEE and Blockchain-based incentives will promote the ethical use of machine learning with validated wearable device data in healthcare and improve user participation due to incentives.

“互联网+医养”综合管理系统设计与应用

目的:巩固宁夏回族自治区(以下简称宁夏)“互联网+医疗健康”示范区建设成果,提升医养结合服务能力。方法:结合宁夏本地医养服务现状,应用大数据和互联网技术,构建基于互联网医疗的医养综合服务信息化体系,搭建适用于不同层级医养结合机构的医养协同综合服务信息化平台。结果:面向医养结合机构、社会养老机构、社区居家养老人群提供多方位联合体机制,形成线上线下一体化的全流程医养服务及管理模式,可为老年人提供全方位多层次连续性的医疗、养老等服务。结论:“互联网+医养”综合管理系统实现了医养融合互联互通全流程管理,是“互联网+医养”融合服务模式的积极探索。

医联体数据集成与共享平台设计

目的:设计医联体数据集成与共享平台,以提升医联体同质化管理水平和区域整体医疗服务水平。方法:该平台采用基于Hadoop生态的云平台架构,使用Java作为主要开发语言,以Apache HDFS和Apache MapReduce为主要底层技术。整个平台包括数据集成与治理、数据资源仓储、数据服务支持和安全对接中心四大核心模块。结果:采用该平台可实现医联体数据资源的整合和治理,同时提供面向管理、临床、科研的应用服务,充分挖掘医联体数据的应用价值。结论:该平台可完成医联体机构数据资源的整合,实现医联体数据价值释放与信息共享互联。

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

整合型医疗卫生服务体系下社区健康服务机构次均门诊费用结构变动度研究

[目的]了解社区健康服务机构次均门诊费用结构及变化趋势,为优化门诊费用结构及有效控制就医成本提供参考。[方法]以深圳市2018-2021年481家社区健康服务机构次均门诊费用为例,采用结构变动度分析方法进行分析。[结果]2018-2021年社区健康服务机构次均门诊费用结构变动度为30.41%;计免疫苗费、中成药费、西药费、化验费、诊察费5项费用累计结构变动贡献率为94.15%,计免疫苗费、中草药费比重逐年增高,西药费、中成药费、诊察费比重逐年降低。[结论]整合型医疗服务体系对社区健康服务机构次均门诊费用结构优化具有推动作用。建议通过强化社区健康服务机构服务能力建设、加强对辅助检查项目监管、增强计免疫苗宣传力度、提高体现医务人员劳务价值费用占比等措施进一步加强门诊费用结构优化。

中国和欧洲精准医疗发展现状研究

随着精准医学相关技术不断成熟,精准医学体系逐渐成熟走向应用。全球精准医学处于高速发展阶段,其科学和社会价值日益凸显,但整体也面临多方面发展瓶颈,个体化诊疗体系尚未形成。本项目组采用科学文献检索、灰色文献搜索、咨询“地平线2020”国家咨询联络点、中国-欧盟精准医疗合作支持计划(IC2PerMed)专家调查等方法,系统梳理了中国、欧盟精准医疗有关的政策措施、规划方案和行动计划等资料和信息,对各种信息进行标准化、结构化处理并进行对比分析,形成本报告。报告内容涵盖:精准医疗概念演变过程;国际精准医疗联盟介绍;中欧精准医疗领域政策措施、规划方案和行动计划相关性的详细信息;中欧精准医疗模式下医疗健康研究的重点方向;全球精准医疗发展目标。本报告深入分析中欧精准医疗战略,找出双方战略、计划和行动的共同点、差异和差距;明确了各自的PM创新重点;指明了中欧医疗健康研究资助机制各自的优势与不足;探寻了未来全球卫生领域合作的热点。该报告一方面为IC2PerMed的专家小组在精准医疗国际标准、可转移性和扩大合作研究领域提供信息支撑,另一方面,也为促进欧盟和中国之间精准医疗领域合作指引方向,为促进中欧精准医疗合作奠定了坚实的基础。

南京医保大数据平台的构建与应用

为破解新医保部门赋予职责和传统管理手段的不匹配、医保基金监管高压和常态化监管手段的不匹配、医保精细化管理和改革落地保障手段的不匹配等问题,南京市医疗保障局建设全流程一站式的医保大数据平台,实现多源异构数据归集,对医保数据进行全面治理,提升数据质量,并基于业务应用需求进行数据加工和多跨协同共享,构建“一数一源”的中枢化数据资产体系和统一的数据分析指标体系,支撑医保数据分析应用和数据价值挖掘。南京医保大数据平台通过全领域数据汇聚、全方位分析展示、全流程监管服务,赋能集中采购、集中结算、医保支付方式改革、医保基金监管等业务,南京地区“群众享实惠、医保提效能、医院获发展、药企得成长”的多赢局面初步形成。

基于市域一体化卫生人才引进的实践探索

整合优质资源,加强市县联动,开展市域一体化卫生人才引进是卫生健康引才工作高质量发展的必然要求。文章阐明了苏州市对卫生人力资源的渴求和推进市域一体化引才的必要性,对苏州市卫生人才引进现状进行了分析,对标先进城市做法,从建立全域引才工作体系、搭设招才引智平台、营造人才发展环境等方面进行一系列的实践探索,逐步打造富有苏州卫生健康行业特色的引才品牌,取得了明显的引才聚才成效,并提出今后要进一步提高市域一体化引才参与度、品质度、精准度的发展思路。

“两院融合”视域下精神病院发展的策略分析

“两院融合”是进一步推动公共医疗机构发展的重要战略方针,也是提升医疗卫生服务水平的重要举措。随着医疗卫生领域改革与发展的进一步深入,部分医疗卫生机构在发展过程中开始面对不同程度的困境和瓶颈,为此调整发展战略,贯彻落实“两院融合”战略思想,整合医疗卫生资源,以共建共享提高管理效能和服务水平,追求更高的经济效益与社会效益。某地区两家精神病院为了进一步提高自身服务质量与经营效益,在政府主导下积极践行“两院融合”战略。文章简要阐述了“两院融合”推进精神病院发展相关背景,分析了“两院融合”视域下精神病院发展不足之处。之后根据精神病院发展需求提出“两院融合推进精神病院发展的基本思路”,并且分别从创新、融合、效益、和谐等角度提出相关发展建议,以期能够为推动精神病院高质量发展提供可靠借鉴。

医护一体工作模式在白内障患者护理中的应用研究

目的 观察医护一体工作模式在白内障患者护理中的应用价值。方法 选取2023年1月至2023年6月收治的80例白内障手术患者为研究对象,依照患者管理模式不同分为研究组和对照组,每组40例患者,其中,研究组患者实施医护一体工作模式护理,对照组实施常规护理模式,对比两组护理满意度、健康知识知晓率、心理状态、并发症发生率、眼压及视力情况。结果 研究组健康知识知晓率、满意度高于对照组(P<0.05),研究组并发症发生率低于对照组(P<0.05)。干预前,两组间心理状态对比差异无统计学意义(P>0.05);干预后,研究组心理状态评分低于对照组(P<0.05)。干预前,两组间眼压及视力对比差异无统计学意义(P>0.05);干预后,研究组眼压及视力水平高于对照组(P<0.05)。结论 白内障手术患者护理中给予患者医护一体工作模式护理,可提高患者护理质量,有助于患者护理工作开展。

体养融合视域下城市社区体育公共服务的供给困境与对策研究

在如今老龄化日益严重的社会发展背景下,体养融合对于提升老年人身体综合素养、避免老年人失能、预防老年慢性疾病发生等方面具有极为重要的现实意义。通过加强社区体育公共服务供给工作,不仅能够实现城市美好社区养老群体生活,满足社区老龄人的各项体育服务体验需求,切实提升他们的身体健康水平,还可以促进我国和谐社会建设稳定持续发展。该文将进一步对体养融合视角下城市社区体育公共服务的供给困境展开分析与探讨,旨在提出相关解决对策。

医护一体化护理干预在早期微创钻孔引流术治疗硬膜下血肿中的应用

目的探讨医护一体化护理干预对早期微创钻孔引流术治疗硬膜下血肿的意义。方法随机选取2020年6月—2023年6月于扬州大学医学院附属兴化市人民医院就诊的硬膜下血肿接受微创钻孔引流术治疗的患者60例,利用随机数表法分为对照组和观察组,每组30例。对照组采取常规护理干预,观察组采取医护一体化护理干预。对比两组患者负面情绪和护理满意率。结果护理后,两组患者负面情绪分数均降低,且观察组各项评分均低于对照组,差异有统计学意义(P<0.05)。护理后观察组患者满意率为96.67%,显著高于对照组的76.67%,差异有统计学意义(χ^(2)=5.192,P<0.05)。结论医护一体化护理干预对改善微创钻孔引流术治疗硬膜下血肿患者的负面情绪效果显著,可促进患者术后恢复,安全性更高。

四川省整合型医疗卫生服务体系评价指标体系构建

目的:建立整合型医疗卫生服务体系评价指标体系,以便从不同层面对整合医疗卫生服务体系现状进行评估。方法:运用文献综述、德尔菲专家咨询方法,以Donabedian卫生服务质量评价为理论框架,构建整合型医疗卫生服务体系评价框架。结果:从结构-过程-结果3个层次构建了包括12个二级指标和43个三级指标在内的整合型医疗卫生服务体系评价框架。指标选取突出体系质量提升,评价框架具有较高的合理性,可以真实全面评价整合型医疗卫生服务的绩效水平。结论:建议评价内容增加围绕老龄人口健康相关服务的整合,针对不同模式的整合体系增加特异性指标,选择适宜方法对每个指标赋权,将评价指标体系进行实证应用并动态调整。

国外医防融合全科人才培养对我国医学教育的启示

全科医生作为同时具备疾病诊疗和健康服务的提供者,在提供基层医疗卫生服务方面的重要性越来越强。目前全科医生培养模式的转变已成为医学教育的当务之急,文章通过文献研究分析国内医防融合全科人才培养实践和研究现状,针对国内全科医学学历教育存在医防割裂、缺乏全科医生医防融合岗位培训相关的政策、标准与策略研究的问题,结合美国、英国等国医防融合全科人才培养实践与研究经验,提出构建医防融合全科医生学历教育培养体系,完善配套法律法规与政策文件,以标准先行,细化医防融合全科医生培训管理和研究的建议。