The purpose of evidence-based healthcare management is to prevent the overuse, underuse or misuse of some management measures, and to eliminate the gap between research and practice or the difference between best practices and conventional practices. Evidence-based healthcare management is still in an early stage of development. It also faces many challenges, which have aroused some criticism and even suspicion. This is closely related to the complexity of the management field itself and the lack of empirical research in the field. Considering the scarcity of high-quality health and medical resources in China, in order to improve the scientificalness of healthcare decision-making, we strongly appeal that promoting evidence-based healthcare management requires government-led, universal education, intensified research, scientific evaluation, technological innovation and integration.
Compared with traditional medical devices, artificial intelligence medical devices face greater challenges in the process of clinical trials due to their related characteristics of artificial intelligence technology. This paper focused on the challenges and risks in each stage of clinical trials on artificial intelligence medical devices for assisted diagnosis, and put forward corresponding coping strategies, with the aim to provide references for the performance of high-quality clinical trials on artificial intelligence medical devices and shorten the research period in China.
With the development of society and the progress of technology, artificial intelligence (AI) and big data technology have penetrated into all walks of life in social production and promoted social production and lifestyle greatly. In the medical field, the applications of AI, such as AI-assisted diagnosis and treatment, robots, medical imaging and so on, have greatly promoted the development and transformation of the entire medical industry. At present, with the support of national policy, market, and technology, we should seize the opportunity of AI development, so as to build the first-mover advantage of AI development. Of course, the development and challenges are coexisted. In the future development process, we should objectively analyze the gap between our country and developed countries, think about the unfavorable factors such as AI chips and data problems, and extend the application and service of AI and big data to all links of medical industry, integrate with clinic fully, so as to better promote the further development of AI medicine treatment in China.
Objective To learn the current status, publication standards, formats, and contents of medical advertisements published in journals in China, and to discuss the possibility of evidence-based evaluation and standards for advertisement publication. Methods We handsearched Issue One, 2008 of 222 core medical journals indexed by A Guide to the Core Journals of China (2004 version) and the most important databases to index top 20% academic journals to identify basic journal information and the content of their advertisements. The general and trade name of the drugs, and the advertisements and production license number of the drugs and devices were collected. We used EXCEL software for data input and SPSS 13.0 for statistical analyses. Results Two-hundred and eighteen journals were handsearched and evaluated. The other 4 journals were excluded because the print version could not be found. A total of 1,201 advertisements were published in 159 (72.9%) of the journals, with the average of 5.5 (range of 1-37) for each journal. Of the advertisements, 910 (75.8%) were related to medical drugs or devices, including 598 (49.8%) drug and 312 (26.0%) medical device advertisements. Most of them were published in clinical and special medical journals. There were 518 (86.6%) drug advertisements which had both advertisement license and production license number, but only 116 (36.1%) medical device advertisements stated the advertisement license and production license number. Conclusion The medical drug advertisements published in core medical journals in China lack sufficient publication standards, and medical device advertisements are even worse. We cannot conclude the efficacy, safety, and cost-effectiveness of advertisement production according to the current limited, unclear, and highly-commercialized advertisements.
Objective To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes. Methods We searched The Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), PubMed (1951 to 2010), EMBASE (1966 to 2009), PsycINFO (1967 to 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies. Randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. The included strategies were increasing awareness of schemes, modifying enrolment, improving management and organization of insurance schemes, and mixed strategies. Two review authors independently screened literatures, extracted data and assessed the risk of bias. We narratively summarized the data. Results We included two studies, both from the United States. One randomized controlled trial study with a low risk of bias showed that community-based case managers who provided health insurance information, application support were effective in enrolling Latino American children into health insurance schemes (RR=1.68, 95%CI 1.44 to 1.96, n=257). The second quasi-randomized controlled trial, with an unclear risk of bias, indicated that handing out insurance application materials in hospital emergency departments can increase enrolment of children into health insurance (RR=1.50, 95% CI 1.03 to 2.18, n=223). Conclusion The two studies included in this review provide evidence that providing health insurance information and application assistance and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. But the application of the interventions to other countries beyond the US still depends on contextual factors of health medical systems. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.
ObjectiveTo investigate the medical quality of rehabilitation departments in medical institutions at all levels in Shenzhen and analyze the problems, so as to promote the continuous improvement of rehabilitation care quality in this city.MethodsFrom September to November 2019, a field investigation was carried out in 53 rehabilitation departments in Shenzhen. Five dimensions were scored by experts, including professional capacity, rules and regulations, knowledge and skills, supervision and feedback, and hospital infection control. Descriptive statistical analysis was used to characterize the data, and one-way analysis of variance was used to analyze the difference among different level hospitals.ResultsThe average score of rehabilitation medical care quality in Shenzhen was 83.98±8.28. The average score of tertiary, secondary, and primary hospitals were 85.61±7.02, 84.54±7.83, and 77.55±10.60, respectively, and the difference among different level hospitals was statistically significant (P<0.05). According to the standard score, the highest score was in the dimension of supervision feedback (95.75±6.50), and the lowest score was in the dimension of knowledge and skills (77.27±14.64).ConclusionThe overall quality of rehabilitation care in Shenzhen needs to be improved, and the management and professional training systems need to be established.
Since 2015, when the day surgery mode was officially reckoned and supported by the National Health Commission, the day surgery model has entered the new period of rapid development. But at the same time, challenges in the vacancy of the evaluation indexes of the medical quality and safety of day surgery still pose obstacles to its growth. At present, there is no nationally unified evaluating index or appraising system for the day surgery-related medical quality and safety. In this paper, based on structure-process-outcome theory, the day surgery practice and involved researching literature were retrieved, reviewed, and analyzed. Also, the practice model at West China Hospital of Sichuan University (a pioneer day surgery hospital in China) was comprehensively compared with the National Clinical Improvement System. From the aspect of day surgery medical quality and safety evaluation indicators, it is hoped to provide an evidence-based method and evaluation of day surgery, and a theoretical basis for establishing policies and data reference.
ObjectiveTo analyze the application status and existing problems of value stream mapping (VSM) in improving medical services at home and abroad, so as to provide decision evidence for hospitals to apply VSM to improve medical services.MethodsUsing “value stream mapping” and “value stream” as search terms, we searched PubMed, Embase, China National Knowledge Infrastructure, CQVIP Journal Database and Wanfang Database (2009-2019), and collected relevant literature on the application of VSM to improve medical services at home and abroad. We conducted bibliometric analysis after confirming the literature according to the inclusion criteria. The standardization of application of VSM was also evaluated.ResultsOf the 299 articles retrieved, 13 studies fulfilled the inclusion criteria. The publication time of the literature was distributed between 2013 and 2019. Of the 8 foreign articles included, the regions to which the first author belonged were 4 in the United States, 1 in Ireland, Norway, Lebanon and Indonesia respectively. Of the 5 included domestic articles, the regions to which the first author belonged were 2 in Zhejiang and Shanghai respectively, and 1 in Guangdong. Of the foreign literature, 5 articles did not clearly state the sample size observed when drawing VSM, 5 articles incomplete drawing elements of VSM, and 3 articles did not show VSM. Of the domestic literature, 2 articles did not clearly state the sample size observed when drawing VSM, 3 articles had incomplete drawing elements of VSM, and 1 article did not show VSM.ConclusionsVSM is relatively more used in high-income and upper-middle income countries. The medical service improvement issues for which VSM is applied are relatively single. The standardization of the application of VSM in domestic and foreign literature needs to be improved overall.