目的:探讨根本原因分析法(root cause analysis, RCA) 在我国医疗安全质量管理中应用的研究现状、热点与前沿,为未来RCA 在医疗安全质量领域更广泛的应用提供参考.方法:检索2000-2022 年CNKI数据库收录的RCA 在医疗安全质量管理应用的相关文章,运用CiteSpace 6.1.R 2 对发文量、作者、发文机构、关键词等进行可视化分析.结果:共纳入文献507 篇,发文量可分为孕育期、发展期和平稳期3 个阶段.对文献进行作者及发文机构共线分析发现,作者和发文机构分散,无高产作者与机构.作者间和机构间合作少,未形成稳定的合作团体.对关键词进行共现、聚类和突现分析发现,研究热点聚焦在安全管理、护理、跌倒、原因分析、不良事件、手术室、依从性等方面,研究范围逐步扩大,内容由单一不良事件发展至类别事件分析.结论:RCA正在逐步应用于医疗安全质量管理领域,研究内容有待拓展,质量有待提高,未来应进一步加强应用范围的延伸,创造出更有价值的医疗安全质量管理理念与方法.
Objective:This study aims to conduct bibliometric and visual analyses on commercial health insurance research in China,understanding the current research landscape and shortcomings,providing insights for future development.Methods:CNKI was used as the literature data source to retrieve articles related to commercial health insurance from January 1,1998 to March 7,2023.CiteSpace 6.1.R4 software was applied for co-occurrence analyses of authors and institutions,and for keyword analysis.Results:The search yielded a total of 1373 articles,contributed by 306 authors across 261 research institutions.However,connec-tions among authors and institutions were observed to be sparse.The top ten keywords by frequency include"basic medical insur-ance(frequency 266),premium income(frequency 67),influencing factors(frequency 37),moral hazard(frequency 35),tax incentives(frequency 28),risk control(frequency 27),health management(frequency 25),Huimin Insurance(frequency 15),adverse selection(frequency 14),business model(frequency 8)".The emerging keyword of note was"Huimin Insurance"with a strength of 4.94.Conclusion:Articles on commercial health insurance in China have been increasing,but a core author group has not yet emerged,indicating a lack of collaboration among research institutions.Research focuses on the integration of basic and commercial health insurance,demand,business models,and supervision."Huimin Insurance"is emerging as a future research hotspot.
Objective:To comprehensively evaluate the law enforcement effectiveness of county-level health supervision insti-tutions in Henan province,to understand the current situation of law enforcement effectiveness,and propose corresponding improve-ment measures,so as to enhance the enforcement effectiveness of health supervision and promote the sustainable development of health supervision.Methods:Ten county-level health supervision institutions in Henan province were selected as the evaluation objects.The weighted sum comprehensive evaluation method,TOPSIS method,and RSR method were collectively used to compre-hensively evaluate and rank the law enforcement effectiveness of health supervision agencies in 2021 from four dimensions:supervi-sion capacity,supervision efficiency,supervision effect,and supervision benefit.Accordingly,the main factors affecting the law enforcement effectiveness were studied and explored.Results:Among the four dimensions,supervision efficiency had the highest score(0.80),followed by supervision capacity(0.56),and supervision effect had the lowest score(0.32).Among them,the scores for human resources,funding input,facilities and equipment,emergency response capability,law enforcement and case handling,departmental evaluation,health benefit and social benefit were relatively low.The TOPSIS evaluation results showed that among the ten county-level health supervision agencies,County A ranked first in the law enforcement effectiveness.Combined with the RSR method,the evaluation results were divided into three levels,with County A and County F rated as"excellent",County G rated as"poor",and the remaining seven counties rated as"average".Conclusion:There are significant differences in the law enforcement effectiveness of county-level health supervision institutions in Henan province,the effect and beneficial result of law enforcement should be improved,and more investment is needed to bolster weak spots.
Objective:To understand the turnover intention of TCM practitioners in grassroots medical institutions in Guangxi,and explore the influence of work pressure,personal development satisfaction and social support satisfaction on turnover intention,so as to provide basis for improving the stability of TCM practitioners in grassroots medical institutions in Guangxi.Methods:The turnover intention of 1959 TCM practitioners in grassroots medical institutions was investigated by multistage sampling method.This study analyzed the related factors of turnover intention by using binary logistic regression analysis method.Results:Among the 1959 TCM practitioners,570(accounting for 29.10%)had the turnover intention.Gender,spouse status,income level,education lev-el,professional title level,work pressure,welfare satisfaction,interpersonal satisfaction,job satisfaction,personal development satisfaction and social support satisfaction(P<0.01)had significant effects on turnover intention.Conclusion:The turnover inten-tion of men and unmarried people is stronger than that of women and married people.Education,professional title level and work pressure are positively correlated with turnover intention.Income level and related job satisfaction factors are negatively correlated with turnover intention.It is suggested to improve the management system of TCM practitioners in grassroots medical institutions,improve wages and benefits,and enhance the career development space,and reduce the turnover willingness of TCM practitioners in grassroots medical institutions.
Objective:To explore the influence of Internet game addiction on undergraduate and junior college students'sub-jective well-being in Hunan and Chongqing,so as to provide references for improving students'subjective well-being.Methods:The Internet game addiction scale,UCLA loneliness scale,sense of emptiness scale,index of well-being were used to study 768 undergraduate and junior college students in Hunan and Chongqing.Results:The subjective well-being score of students was 10.36±2.84.The subjective well-being of students was significantly negatively correlated with Internet game addiction,loneliness and emptiness.Internet game addiction significantly and negatively predicted subjective well-being(β=-0.156,P<0.001),lone-liness mediated the relationship between Internet game addiction and subjective well-being(effect value-0.091,95%CI:-0.113,-0.072),and emptiness mediated between Internet game addiction and subjective well-being(effect value-0.023,95%CI:-0.041,-0.004).Conclusion:Internet game addiction significantly affects undergraduate and junior college students'subjective well-being,and loneliness and emptiness play parallel mediating roles between Internet game addiction psychology and subjective well-being.
Objective:To analyze the current research status and hotspots about overdiagnosis in Chinese and English data-bases based on bibliometric methods,so as to provide references for subsequent research.Methods:Literature search was conduc-ted in the English database of Web of Science Core Collection(WOSCC)and the Chinese database of China National Knowledge Infrastructure(CNKI),from the establishment of the database to May 31,2023.The CiteSpace 6.2.R4 was used to visualize and interpret the included literature about overdiagnosis.Results:2513 English and 52 Chinese publications were included in this study.The annual publication volume of both Chinese and English literature had shown an increasing trend,and the publication volume of English research had increased significantly since 2010.The countries with the highest number of publications about overdiagnosis in English were all high-income developed countries with strong collaboration between countries,while the coopera-tion network in Chinese literature was untight.According to keyword clustering,it showed that the English research mainly focused on breast cancer,prostate cancer,thyroid cancer,lung cancer,cardiomyopathy and other diseases about overdiagnosis,while the Chinese literature had fewer and more fragmented clusters,which mainly focused on over-treatment,early diagnosis and treatment,and thyroid cancer,with an overall fragmentation of research content.Conclusion:The research topics of literature in Chinese about overdiagnosis lag significantly behind the research in English.It is suggested that more research about overdiagnosis should be actively promoted and conducted in China in the future.
Objective:To systematically review the qualitative research on the treatment decision-making of elderly cancer patients,so as to provide references for improving the quality of life of patients.Methods:This study searched nine literature data-bases,including PubMed,Web of Science,CNKI and so on from inception to December 31,2022 and collected qualitative studies with the theme of treatment decision-making of elderly cancer patients.The 2016 version of the Joanna Briggs Institute's critical ap-praisal tool for qualitative studies in Australia was used to evaluate the quality of the literature.Meta-synthesis was applied to in-tegrate research results.Results:A total of 13 articles were included and summarized into 3 integration results.The decision-mak-ing modes of elderly cancer patients'preferences included orientation of patients,doctors and nurses,family members and sharing of multiple subjects.The factors that affected the decision-making of elderly cancer patients mainly included patient characteristics,medical supply status and so on.There were individual differences in the attitude of elderly cancer patients towards information see-king,and they preferred to collect practical information,probability information and professional information of doctors through self-study or seeking help from others.Conclusion:The treatment decisions of elderly cancer patients arise from specific social and cultural backgrounds.Physical function and quality of life are the core treatment demands of patients.The quality of decision infor-mation directly affects the final decision.
Objective:To analyze the referral status and its influencing factors of patients in compact county medical commu-nity in Xinyi city of Jiangsu province,so as to provide suggestions for improving the referral system of medical community.Meth-ods:The stratified cluster sampling method was utilized to select 1068 patients from 20 grassroots medical institutions in Xinyi county medical community via the questionnaire survey.The random forest model and logistic regression were employed to analyze the influencing factors of referral behavior of patients in the medical community.Results:The referral rate of patients in the Xinyi county medical community was 12.6%.The results of random forest model showed that the out-of-bag estimation error rate reached the lowest when the number of variables was 11.The top 11 variables in order of ranking included medical expenses,the awareness about medical community,literacy,type of medical facility preferred for treating common illnesses,time taken to reach the nearest general hospital,age,time taken to reach the grassroots medical institutions,knowledge of the health insurance system,choice of medical facility for this visit,and impact of illness on life.The results of logistic regression analysis showed that the patients who had the average and more awareness level of the medical community(OR=2.235,OR=12.579),the 3001-5000 yuan and more than 5001 yuan of medical expenses(OR=2.371,OR=4.786),as well as the general and significant perceived impact level of ill-ness on daily life(OR=1.834,OR =3.043),made more use of referral services.Conclusion:The referral rate of patients within the Xinyi county medical community is not high,and the factors affecting patient referral include the awareness about medical com-munity,the medical expenses and the impact of illness on life.It is recommended to enhance the recognition of scientific referrals among patients through innovating the ways of policy advocacy and improving the awareness about medical communities.To achieve the orderly referral and scientific diversion of patients within the medical communities,it is suggested to establish the cooperative referral mechanism and to encourage the divisional collaboration of medical institutions.
Objective:To analyze the efficiency of health resource allocation and its influencing factors in Guangzhou from 2016 to 2021,so as to provide a basis for decision-making by relevant departments.Methods:Health technicians,the number of beds in medical institutions and total health costs were selected as input indicators,the total number of consultations and bed utili-zation rate were taken as output indicators,and the DEA-Malmquist index method was used to measure the efficiency of health re-source allocation.The gray correlation analysis was used to explore the influencing factors of efficiency in three dimensions of eco-nomic factors,demographic factors and social factors.Results:The average overall efficiency of Guangzhou in 2016 was 0.854,the average overall efficiency in 2021 was 0.766,and the average total factor productivity index of health resource allocation in 2016-2021 was 0.938.The correlations of factors influencing the efficiency of health resource allocation during 2016-2021 were,in or-der,urbanization ratio(0.811),the proportion of the total population aged 60 or above(0.792),GDP per capital(0.757),and total retail sales of social consumer goods(0.728).Conclusion:The overall trend of health resource allocation efficiency in Guang-zhou is decreasing,and the spatial heterogeneity of health resource allocation efficiency among all districts is obvious.The most in-fluential factor for health resource allocation efficiency is the demographic factor,followed by economic and social factors.The gov-ernment needs to increase the supply of health care resources,optimize the balanced layout of health care resources,and improve the efficiency of health resource utilization.
"Health care related"and"human related"are the two most essential characteristics of health data.Health data is a valuable resource with high commercial value and significant personal implications.The development and utilization of health data have yielded substantial data dividends but have also raised the risk of data breaches.All countries are committed to improve the health data governance framework to safely handle health data for the benefit of society.Countries worldwide are dedicated to enhan-cing the governance framework of health data to ensure its secure and beneficial utilization for society.However,three key challen-ges hinder the advancement of the health data governance system in China:unclear data rights ownership,inadequate regulatory o-versight,and restricted data circulation.Although health data primarily originates from individuals,attributing exclusive ownership rights to individuals is not appropriate.The health data governance framework should strike a balance between safeguarding public interests and protecting individual rights.It should be founded on a comprehensive regulatory system involving diverse experts and should aim to facilitate secure and organized health data sharing.This approach fosters transparency in data processing,enhances public trust in data utilization by the government,dismantles barriers to data sharing,and facilitates medical innovation and pro-gress.
Objective:Latent transition analysis was used to investigate the latent classes,latent transition characteristics and influencing factors of depressive symptoms in emerging adulthood group in China.Methods:Data from China family panel studies in 2018 and 2020,1906 valid cases were analyzed.Results:Three subgroups were identified:severe depressive symptoms(class 1),low positive emotion(class 2),and mild depressive symptoms(class 3).The probability of remaining in the original status of the class 1,class 2 and class 3 was 63.7%,37.7%and 30.3%.Emerging adulthood in severe depressive symptoms were highly stable,the group of low positive emotion had a 38%chance of transition to the group of severe depressive symptoms,participants in mild depressive symptoms were nearly 70%more likely transit to the other two groups.Further analysis showed that neuroticism and interpersonal trust played significant roles in the prediction of the transition mentioned above,but the effect of gender was not signif-icant.Conclusion:There are three classes of depressive symptoms in emerging adulthood,class transition in depressive symptoms are at higher risk and were influenced by neuroticism and interpersonal trust.
Objective:To evaluate the operational efficiency of Traditional Chinese Medicine(TCM)hospitals in Jilin Prov-ince and analyze the influencing factors,so as to provide references for improving the efficiency and optimizing the future develop-ment direction of these hospitals.Methods:Indicators for measuring hospital efficiency were obtained through literature research and cluster analysis.The Data Envelopment Analysis(DEA)method was used to calculate the operational efficiency of TCM hospi-tals,and a panel Tobit model was established to analyze factors influencing the operational efficiency of TCM hospitals.Results:The number of TCM hospitals that achieved optimal operational efficiency in 2018-2020 were 21,14,and 16 respectively.The av-erage comprehensive efficiency of TCM hospitals over the years was 0.912,0.874,and 0.877 respectively.The pure technical effi-ciency value decreased from 0.922 to 0.887.In 2020,factors influencing the operational efficiency of TCM hospitals mainly includ-ed the total number of employees,the actual number of open beds,the proportion of drug income to medical income,and popula-tion density.Conclusion:The healthcare service capacity of 49 TCM hospitals in Jilin Province has improved,but there is still room for enhancement.The operational efficiency of TCM hospitals in Jilin Province showed a slight decline from 2018 to 2020.The key to improving the overall operational efficiency of TCM hospitals at all levels lies in enhancing their pure technical efficiency.
Objective:To track and analyze the research hotspots of healthcare utilization among patients with chronic diseases in China,so as to provide references for further study in this field.Methods:Keyword cooccurrence,cluster,burst and timeline a-nalysis of the relevant literature included in China National Knowledge Infrastructure database from 2000-2022 were conducted by CiteSpace 5.8.R3.Results:A total of 748 papers were included.The annual number of publications of research on healthcare utili-zation among Chinese patients with chronic diseases was relatively low from 2000 to 2022,and the overall trend was precariously in-creasing.A total of 9 high-frequency keywords(influencing factors,elderly,health service,chronic disease,equity,utilization,health status,rural residents,hypertension),11 cluster labels(health service,influencing factors,diabetes,health education,health care insurance,health,utilization,elderly,middle-aged and elderly,evaluation,satisfaction)and 14 burst terms were pro-duced in the map."Influencing factor"was the most frequent keyword,and"utilization"was the most central one."Health serv-ice""influencing factor"and"diabetes"were the largest clusters.Conclusion:The research on healthcare utilization among Chi-nese patients with chronic diseases indicates an upward trend,and the research content continues to develop in depth.Hot topics of the research are health care demand and utilization(current situation,influencing factor,equity),health insurance,health educa-tion of chronic disease patients,and satisfaction of community health services.
The multi-level medical security system for rare diseases is an important livelihood project and social infrastructure in China,and an ideal governance tool to effectively alleviate the problems of delayed diagnosis,insufficient drug supply,and diffi-cult payment security for patients with rare diseases.Based on the structural theory perspective,this study examines the main prob-lems in the current practice of multi-level health care coverage for rare diseases in China,reconstructs the multi-level health care coverage system for rare diseases,analyzes the structural duality tensions implied within the system,and proposes suggestions to promote the development of the system in a virtuous cycle.Firstly,we should strengthen the policy of rare disease drug coverage,and establish multiple funding channels and multiple payment guarantee mechanisms.Secondly,we should stimulate the construc-tion of specialized teams,reposition the health care service system,and actively engage in actions to improve the quality of treat-ment and services.Thirdly,we should improve the organizational management system and articulation mechanism to activate the generation of resilience to deal with the disease.Fourthly,we should create a supportive environment,improve comprehensive serv-ices,and integrate the participation of multiple types of social forces.
Objective:To Analyze the literature research on the influencing factors of psychological help seeking status among health professionals,so as to provide references for government agencies,mental health service providers,medical institutions,and other entities to develop targeted intervention measures.Methods:The qualitative research on mental health help-seeking among health professionals was collected by searching Wan Fang Data、VIP、CNKI、Embase、CINAHL、PubMed、Web of Science databases.After the quality evaluation of the included literature,the thematic synthesis method was used to integrate the results.Results:A total of 2902 literature was retrieved,and after screening,12 were included.42 descriptive themes were extracted,10 analytical themes were summarized,and 4 key themes were identified.Mental health help-seeking among health professionals is influenced by four aspects:individual,interpersonal relationships,psychological service providers,and social environment,including cognitive factors,attitude factors,ability factors,family relationships,workplace relationships,professional abilities,privacy protection abil-ity,doctor-patient communication ability,cultural factors,and objective conditions.Conclusion:The mental health help-seeking among health professionals is affected by many factors.It is necessary to comprehensively evaluate the influencing factors and formu-late intervention measures around the obstacles that can be intervened.
Objective:To estimate the dependence of Chinese hospitals on imported anti-tumor drugs,so as to provide refer-ences for decreasing the supply risk of imported anti-tumor drugs.Methods:Descriptive statistical analysis method was used to conduct a quantitative study on the number of generic name,sales amount and DDDs of imported anti-tumor drugs in the Chinese medical economic information network from 2017 to 2021,and to sort out the basic utility of imported anti-tumor drugs in China and the import dependence of different countries and different manufacturers.Combined with the drug approval and marketing infor-mation in the Insight database,the dependence of imported drugs with unique generic name,unique dosage form,unique specifica-tion,unique indication and unique treatment target of imported drugs were sorted out.Results:From 2017 to 2021,the generic name number,sale amount and DDDs of imported anti-tumor drugs accounted for 42.87%,39.28%and 30.73%respectively in Chinese hospitals,and all showed a rising trend.The imported anti-tumor drugs included 42 unique generic names,47 unique dos-age forms and 79 unique specifications,with the sales amount accounting for 14.68%,16.32%and 16.78%respectively.3 unique indications and 16 unique targets.The most dependent countries in China were Germany,the United States,Switzerland and Aus-tralia.Conclusion:From the perspective of clinical dosage,Chinese hospitals still have a certain degree of dependence on imported anti-tumor drugs.From the perspective of unique specifications,the generic name number and usage proportion of imported unique generic name anti-tumor drugs are growing rapidly,and a few indications and drug targets still need to rely on imported anti-tumor drugs.
Objective:To explore the status of social participation and its relationship with cognitive impairment among Chi-nese elderly,so as to provide references for prevention and intervention of cognitive impairment of the elderly.Methods:Based on the China health and retirement longitudinal study in 2018,the status of social participation of the elderly aged≥60 years old in Chi-na was analyzed and the minimum mental state examination was used to measure the cognitive function.Logistic regression model was used for multivariate analysis.Results:A total of 3370 valid subjects were included after screening,and 589 had cognitive impairment(17.48%),and 1931 participated in a social activity at least(57.30%).The results of multivariate analysis showed that participating in social activities[AOR=0.699,95%CI was(0.552,0.886)],the number of activities[AOR=0.799,95%CI was(0.712,0.897)]and the number of types of activities participating in[AOR=0.742,95%CI was(0.634,0.868)],the overall level of social participa-tion[AOR=0.885,95%CI was(0.837,0.936)],the level of participating in activities of entertainment[AOR=0.898,95%CI was(0.838,0.962)]and the level of participating in activities of digital media[AOR=0.705,95%CI was(0.590,0.843)]were negatively associated with the risk of cognitive impairment among the elderly.Conclusion:The social participation level of the elderly in China is relatively low.The increase in the number,variety and frequency of social activities in the elderly will reduce the risk of cognitive impairment.The elderly should be encouraged to participate actively in various social activities,and improving the participation in so-cial activities of entertainment and digital media should be focused on to help prevent the elderly's occurrence of cognitive impairment.
Objective:To analyze the effect of incentive and restraint mechanism(IARM)in the drug volume-based procure-ment(VBP),that is,to prove the role of improving the enthusiasm of medical institutions and pharmaceutical companies to partici-pate the VBP,so as to provide references for improving the IARM in the VBP.Methods:A game matrix was established to analyze the behavioral preference of medical institutions and pharmaceutical companies.Evolutionary stabilization strategy(ESS)of the basic model and the influence of IARM on game results were available according to individual rationality,incentive compatibility and data simulation.Results:The analysis results of the behavior preference game model of medical institutions and pharmaceutical companies indicated that both medical institutions and pharmaceutical companies had low enthusiasm to be involved in the VBP.Balance retention for medical institutions could simultaneously improve the enthusiasm companies of both parties.The higher the proportion of balance retention,the more obvious this positive promoting effect was.While gradient price reduction based on phar-maceutical companies could reverse the behavior choice of pharmaceutical companies,with insignificant inducing effect on medical institutions.Even if the price of non-selected drugs was gradually reduced to the selected price,medical institutions still tended to use non-selected drugs in the remaining quantity.Conclusion:IARM can improve the enthusiasm of both parties to participate in the VBP.In the future,it is necessary to further improve the IARM by establishing new compensation mechanisms for medical insti-tutions and ensuring the competitive advantage of the selected drugs,which can improve the price reduction and implementation effects of the VBP.
Objective:To explore the influence of narrative disorder on the network moral misconduct behavior of medical students in a college in Zhengzhou City,so as to provide a theoretical basis for exploring the causes of network moral misconduct be-havior of medical students as well as its prevention and intervention.Methods:797 medical students from a university in Zhengzhou City were selected to complete the Toronto Alexithymia Scale(TAS),the College Students Network Moral Judgment Questionnaire,the Meaning in Life Questionnaire(MLQ)and Network Anomie Behavior Scale for College Students(NABSCS).Results:There were significant correlations among alexithymia,network moral judgment,sense of meaning in life significance and network moral anomie behavior.Alexithymia can significantly and positively predict network moral anomie behavior(β=0.17,t=5.98,P<0.001).Network moral judgment played a partial mediating role in the relationship between alexithymia and network moral anomie behavior(β=0.19,t=6.63,P<0.001;β=0.12,t=3.86,P<0.001).The sense of meaning in life regulates the direct effect of alexithymia on network moral anomie behavior(β=-0.06,t=-2.16,P<0.01).Conclusion:Alexithymia can not only directly affect network moral anomie behavior,but also indirectly affect network addiction through the network moral judgment.The sense of meaning in life can buffer the influence of alexithymia on network moral anomie behavior.Therefore,we should pay attention to the construction of the mental health education system of medical students and strengthen the life education of medical students.
The Civil Code adds a new reason for annulment of marriage"concealing a serious disease"in the system of annul-ment of marriage,but it is not clearly define the definition of"serious disease",which brings a difficult application problem to judi-cial practice.In order to solve the practical problems,this paper intends to define"serious diseases"from the perspective of legisla-tive value concept.In conclusion,through the analysis of the legislative reform,the article extracts the value concept contained in the cause of"concealing serious illness"marriage annulment,and proposes that behind the new addition of the cause,contains the value concept of individual freedom and the weak.Therefore,we should focus on understanding from the perspective of personal will,but also take into account the interests of the weak in marriage and family relations.This means that when determining a seri-ous disease,the court should not take the personal will of the concealed party as the sole basis,but should give due consideration to the interests of the weak in the marriage and family relationship,and determine whether the disease claimed by the concealed party is a serious disease.Below that,the category of critical diseases includes incurable diseases and curable diseases that seriously affect the rights and interests of the concealment party.If,however,the concealment party has been cured of his illness at the time of filing an action for annulment,the court shall not revoke the marriage.
