Emergency response model of stroke in regional medical alliances: A case study of the Western Baiyun District Stroke Alliance in Guangzhou

Background: A hospital alliance has been established in the western part of Guangzhou, with the initial goal of optimizing the procedures of stroke care in the region and improving the efficiency of treatment services. Comparison of data reveals that the alliance proves to be effective, but there is still a gap between its performance and the objective. Methodology: Stakeholders in the stroke alliance are identified and classified through a comprehensive review of the stakeholder theory and the synergy theory. Structural equation modeling is used to quantify the synergy of healthcare alliances. A synergistic capacity model is developed to analyze the path relationships between the variables. Results: Several rounds of questionnaire survey reveal that there are 22 stakeholders in the Western Baiyun District Stroke Alliance, including six core stakeholders, eight latent stakeholders, and eight marginal stakeholders, and “hospitals at all levels” are the central members of the core stakeholders of the Western Baiyun District Stroke Alliance. Structural equation modeling has verified that the synergy of the Western Baiyun District Stroke Alliance is an organically integrated system comprised of three levels, namely, macro level synergy, meso level synergy, and micro level synergy, with a significant positive correlation between them. The macro level synergy includes cultural synergy and strategic synergy; the meso level synergy includes system synergy, innovation synergy, and information synergy; and the micro level synergy includes business synergy and process synergy. The score of synergy of the Alliance is 3.9646, still in a medium level. Conclusion: A regional stroke alliance is an organically integrated system of macro, meso and micro level synergy, with good macro synergistic capacity and average meso and micro synergistic capacity. Synergistic factors at all levels need to be taken into consideration so as to improve the overall synergy.Antecedentes: Estabelecimento de uma aliança dos hospitais ocidentais em Guangzhou, na China. A intenção da aliança é otimizar o processo de tratamento do AVC. De acordo com os dados existentes, embora a aliança tenha alcançado alguns resultados, ainda não conseguiu atingir todos os objetivos. Metodologia: Teoria dos stakeholders e teoria da sinergia, identificação e classificação dos stakeholders da aliança médica. Quantificação da sinergia na aliança médica através de um modelo de equações estruturais, estabelecimento do modelo de sinergia e análise das relações de dependência entre as variáveis. Resultados: Administração de questionários aos 22 stakeholders da aliança, incluindo os 6 stakeholders principais, 8 stakeholders potenciais e 8 stakeholders marginais. Usando o método de análise de centralidade, provou-se que o hospital é o elemento central dos stakeholders principais. Através da utilização de modelos de equações estruturais verificou-se que a capacidade colaborativa da aliança é um sistema de competências composto pelos níveis macro, meso e micro. O nível macro inclui as sinergias cultural e estratégica; O nível meso inclui a sinergia institucional, a sinergia de inovação e a sinergia de informação; O nível micro inclui a sinergia de negócios e a sinergia de processos. O resultado da capacidade colaborativa da aliança é de 3,9646, o que representa um nível médio de sinergia. Conclusões: A aliança é um sistema de capacitação composto por três níveis: nível macro, nível meso e nível micro. A capacidade de macro sinergia é muito boa, enquanto as capacidades de meso e de micro sinergia são medianas. É preciso levar em conta os fatores de sinergia em todos os níveis para melhorar de forma abrangente a capacidade geral de sinergia

Establishment of tiered diagnosis and treatment system based on the stakeholder theory and its strategies: a case study on Nanjing

Purpose: This dissertation's purpose is to discuss the tiered diagnosis and treatment system and its implementation strategies in China based on the stakeholder theory. Method: The thesis will take Nanjing as an example to compare the composition, management, and operation of the three major medical partnerships, namely, Jiangsu Province Hospital Group, Nanjing Drum Tower Hospital Group, and Zhongda Hospital Southeast University Group, based on the stakeholder theory and case analysis. Key stakeholders will be derived from the literature review, and the attribute of all stakeholders will be determined by Mitchell score-based approach. The thesis will also investigate cognition, recognition, interest demands and suggestions of core stakeholders concerning tiered diagnosis and treatment, and propose relevant suggestions to facilitate the implementation of tiered diagnosis and treatment. Results: The three major medical associations in Nanjing are mainly established according to the model of "government appointment plus voluntary association". Their operation model and effects are different. Core stakeholders of tiered diagnosis and treatment include: health administrative departments, medical insurance departments, medical staff working at superior medical institutions, the public (patients, dependents of patients and residents), medical staff working at primary medical institutions, and companies; marginal stakeholders include center for disease control and prevention, new media such as WeChat official accounts and Microblog, administration for industry and commerce, medical staff working at private medical institutions, commercial insurance institutions, traditional media such as newspapers and TV channels; and general stakeholders include departments of finance, price departments, National Development and Reform Commission, Food and Drug Administration, public security organs, procuratorates and people’s courts, and industrial associations. There are differences in the cognition, recognition, and interest demands among all key stakeholders. Conclusion: The effect of the implementation of tiered diagnosis and treatment is not satisfactory. To further develop tiered diagnosis and treatment, more measures should be taken, such as publicity and guidance, proper resource allocation, introducing commercial capital, strengthening independent practices of medical personnel, and establishing sharing medical platform.Propósito: O objetivo desta dissertação é discutir o sistema de diagnóstico e tratamento em níveis e as suas estratégias de implementação na China com base na teoria dos stakeholders (partes interessadas). Método: A tese tomará Nanjing como um exemplo para comparar a composição, gestão e operação das três principais parcerias médicas, ou seja, o Grupo Hospitalar da Província de Jiangsu, o Nanjing Drum Tower Hospital Group e o Zhongda Hospital Southeast University Group, com base na teoria dos stakeholders e na análise de caso. As principais partes interessadas serão identificados com base na revisão bibliográfica e o atributo de todas as partes interessadas será determinado pela abordagem baseada no escore de Mitchell. A tese também investigará a cognição, o reconhecimento, as exigências de interesses e as sugestões dos principais interessados no diagnóstico e tratamento escalonados, e proporá sugestões relevantes para facilitar a implementação do diagnóstico e tratamento escalonados. Resultados: As três principais associações médicas em Nanjing são estabelecidas principalmente de acordo com o modelo de "nomeação governamental mais associação voluntária". O seu modelo de operação e efeitos são diferentes. As principais partes interessadas do diagnóstico e tratamento escalonado incluem: departamentos administrativos de saúde, departamentos de seguros de saúde, equipe médica trabalhando em instituições médicas superiores, o público (pacientes, dependentes de pacientes e residentes), equipe médica trabalhando em instituições médicas primárias e empresas; partes interessadas marginais incluem o centro para controle e prevenção de doenças, novos meios de comunicação como contas oficiais do WeChat e Microblog, administração para indústria e comércio, pessoal médico trabalhando em instituições médicas privadas, instituições de seguros comerciais, meios de comunicação tradicional como jornais e canais de televisão; e as partes interessadas em geral incluem departamentos de finanças, departamentos de preços, Comissão Nacional de Desenvolvimento e Reforma, Administração de Alimentos e Medicamentos, órgãos de segurança pública, procuradorias e tribunais do povo e associações industriais. Existem diferenças nas exigências de cognição, reconhecimento e interesse entre todos os principais interessados. Conclusão: O efeito da implementação do diagnóstico e tratamento escalonado não é satisfatório. Para desenvolver ainda mais o diagnóstico e o tratamento escalonados, mais medidas devem ser tomadas, como publicidade e orientação, alocação adequada de recursos, introdução de capital comercial, fortalecimento das práticas independentes de pessoal médico e estabelecimento de plataformas de partilha médica

Inhalation therapy in the next decade : Determinants of adherence to treatment in asthma and COPD

Peer reviewedPublisher PD

Increasing Access To Interventional Pain Management Therapies For Palliative Care Patients With Cancer Through Referral System Improvement

Introduction: The need for palliative care increases as the number of patients continues to grow due to the aging population and rising cancer rates. Pain management is one of the essential components of palliative care. Anesthesia providers are well-positioned to become active members of palliative care teams and to provide pain management services, including regional and interventional therapies to patients in the acute care setting. Due to lack of awareness of the need, there have been few referrals for these services. Consequently, despite anesthesia providers’ knowledge of pain management and anesthesia care delivery, they have not been consistently involved in contributing to palliative care services. Purpose: The overall goal of this project was to improve the current referral system of patients to the Smilow Pain Clinic, and as a result to improve access to highly specialized pain management interventions. Methods: 1. Two-phase review of literature, pertaining to: a. palliative care, interventional pain management therapies, and involvement of anesthesia providers; b. protocols for referral of patients for interventional pain management therapies, general protocols for referral for treatment, components of a protocol, and protocol evaluation. 2. Assessment and evaluation of the current referral system to the Smilow Pain Clinic via the following methods: a. retrospective chart review of patients referred to the Smilow Pain Clinic; b. assessment of the frequency of use; c. interview of providers referring patients to the Smilow Pain Clinic and the receiving providers. 3. Dissemination of findings to appropriate stakeholders, strengthening of the current referral system through application of the assessment findings and evidence-based strategies. Results: Data revealed varying degrees of understanding of the referral process and its components among providers; consistent expression of the need for education about the referral process, patient selection, and interventions the clinic provides; and opportunities to incorporate data use to drive the referral process. Findings were consistent with the need for an educational intervention for providers pertaining to the referral process. Conclusion: Implementation of educational interventions (Fast Fact Sheet, educational course, data dashboard creation) has the potential to increase providers’ knowledge level about the referral process and interventional pain management therapies, and as a result increase referral rate to the clinic

Quality of care for older adults with chronic obstructive pulmonary disease and asthma based on comparisons to practice guidelines and smoking status

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to describe the prevalence of respiratory diseases in older adults and compare the demographic, health and smoking characteristics of those with and without these diseases. Furthermore, we evaluate the association between smoking status and patterns in health care and how concordant this care is with guidelines.</p> <p>Methods</p> <p>Using a nationally representative sample of 29,902 older adults who participated in the Medicare Current Beneficiary Survey (1992–2002), we compared guideline recommendations on the treatment and prevention of chronic obstructive pulmonary disease and asthma with survey utilization data, including the use of bronchodilators, spirometry and influenza vaccine.</p> <p>Results</p> <p>26% to 30% of older adults were diagnosed with or self-reported chronic respiratory diseases; however 69% received no pharmacological treatment and 30% of patients reporting use of pharmacological treatments did not receive short-acting bronchodilator inhalers. Current smokers appeared to receive significantly less care for respiratory diseases than non-smokers or former smokers.</p> <p>Conclusion</p> <p>Disparities between recommended and actual care for older adults with chronic lung disease require further research. The needs of older adults with co-morbidities and nicotine addiction deserve special attention in care as well as guideline development and implementation.</p

Consultation-liaison services in Aarhus: a service organization proposal

RESUMO: São diversos os programas e tipos de organização de serviço que podem ser encontrados no contexto da Psiquiatria de Ligação (PL) por todo o mundo. Na Dinamarca, a relação entre a psiquiatria e as outras especialidades está organizada de diferentes maneiras a nível nacional. Em Aarhus, estão disponíveis duas vezes por semana a consulta programada para os pacientes admitidos no hospital geral e esta consultas são fornecidos por 2 psiquiatras consultores que trabalham a tempo inteiro na urgência de psiquiatria. A urgência de psiquiatria faz parte do Departamento P - Departamento das Psicoses do Hospital Universitário Aarhus e fornece serviços não só para as referências externas agudas dos médicos de clínica geral, mas também para referências agudas de outras especialidades. Além disso, há uma Clínica de Investigação de Doenças Funcionais integrada no Departamento de Clínica Médica da Universidade de Aarhus, mas atualmente não há nenhum tipo de colaboração formal entre este Departamento de Investigação e os serviços de PL prestados pelos médicos de emergência. Esta dissertação tem como objetivo apresentar uma revisão da literatura sobre os diferentes modelos de serviços de PL existentes, seguido da descrição do contexto histórico, bem como os pontos fortes e fracos dos serviços de PL existentes em Aarhus. Além disso, o autor irá identificar as necessidades de serviço, as barreiras e os fatores facilitadores para uma eventual reorganização e, finalmente, propor uma solução nova, mais eficiente e integrada de serviços de PL em Aarhus.---------------------------------------- ABSTRACT: Several programs and services' organizations are to be found in the context of Consultation-Liaison (C-L) psychiatry around the world. In Denmark, the links between psychiatry and the other specialities are organized in different ways. In Aarhus, elective C-L services are available twice a week to patients admitted to the general hospital and these consultations are provided by 2 consultant psychiatrists who work daily in the emergency psychiatric department. This department is a part of Department P - Department for Psychosis of Aarhus University Hospital and it provides services not only to the acute external referrals from the general practitioners but also to acute referrals from other specialities. Moreover, there is a research Clinic for Functional Diseases under the Department for Clinical Medicine of Aarhus University but presently there is no formal collaboration between this research department and the C-L services provided by the emergency doctors. This dissertation aims to present a literature review about the different models of C-L services followed by the description of the historical background as well as by the highlighting of the strengths and weaknesses of the existing C-L services in Aarhus. Moreover, the author will identify the service needs, the barriers and facilitating factors to an eventual reorganization and finally propose a new, more efficient and integrated solution for C-L services in Aarhus

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication